Michael S. Martin

Social capital, health and life satisfaction in 50 countries.

We explored links between social capital and self-rated health and life satisfaction in a diverse sample of rich and developing countries. A four-factor measure of social capital was developed using data on 69,725 adults in 50 countries that were collected in the World Values Survey. Multilevel analyses showed links between country social capital and health and life satisfaction. However, cross-level interactions indicated that the benefits of social capital were greater in women than men, in older adults and in more trusting, affiliated individuals. Social inequalities in the contributions of social capital to population health are worthy of further study.

Mental health screening tools in correctional institutions: a systematic review

BackgroundPast studies have identified poor rates of detection of mental illness among inmates. Consequently, mental health screening is a common feature to various correctional mental health strategies and best practice guidelines. However, there is little guidance to support the selection of an appropriate tool. This systematic review compared the sensitivity and specificity of mental health screening tools among adult jail or prison populations.MethodsA systematic review of MEDLINE and PsycINFO up to 2011, with additional studies identified from a search of reference lists. Only studies involving adult jail or prison populations, with an independent measure of mental illness, were included. Studies in forensic settings to determine fitness to stand trial or criminal responsibility were excluded. Twenty-four studies met all inclusion and exclusion criteria for the review. All articles were coded by two independent authors. Study quality was coded by the lead author.ResultsTwenty-two screening tools were identified. Only six tools have replication studies: the Brief Jail Mental Health Screen (BJMHS), the Correctional Mental Health Screen for Men (CMHS-M), the Correctional Mental Health Screen for Women (CMHS-W), the England Mental Health Screen (EMHS), the Jail Screening Assessment Tool (JSAT), and the Referral Decision Scale (RDS). A descriptive summary is provided in lieu of use of meta-analytic techniques due to the lack of replication studies and methodological variations across studies.ConclusionsThe BJMHS, CMHS-M, CMHS-W, EMHS and JSAT appear to be the most promising tools. Future research should consider important contextual factors in the implementation of a screening tool that have received little attention. Randomized or quasi-randomized trials are recommended to evaluate the effectiveness of screening to improve the detection of mental illness compared to standard practices.

The Incidence and Prediction of Self-Injury among Sentenced Prisoners

Objective: Prevention of self-injurious behaviour is an important priority in correctional settings given higher rates among inmates. Our study estimated the reported incidence of self-injury during the first 180 days in prison and tested potential risk and protective factors using official prison records. Methods: We conducted a retrospective cohort study using secondary data for 5154 admissions to the Correctional Service of Canada during 2011. Relative risks were estimated with Poisson regression. Recursive partitioning was used to create a parsimonious model of characteristics of offenders who engage in self-injury. Results: Thirty-six of 5154 (0.7%) offenders engaged in 1 or more incidents of self-injury during their first 180 days of incarceration. Educational and occupational achievement, family history, demographic factors, mental health service use, and results of mental health screening at intake were predictive of self-injury. Recursive partitioning models identified about 23% of inmates who presented with multiple risk factors, and had increased incidence of self-injury. A comparison of a model using information at intake to a model also incorporating events in prison suggested that events in prison added little to the detection of self-injury. Conclusions: Given high rates of most risk factors, screening for self-injury during early incarceration will be overinclusive. However, it may identify a group of inmates with complex needs for whom interdisciplinary responses are needed to address wide-ranging social, family, behavioural, and mental health deficits.

Risk of violence by inmates with childhood trauma and mental health needs

Inmates who experienced childhood trauma have higher rates of institutional violence. However, the potential intermediate roles of co-occurring mental health and substance use needs and early justice involvement have not previously been considered. The current study examined the relationships between trauma, mental health, substance abuse, youth criminal charges, and institutional violence during the first 180 days of incarceration. As secondary aims, we explored whether these associations differed by sex or differed for inmates of Aboriginal ethnicity. Secondary data from prison records for all 5,154 inmates admitted to a federal prison during 2011 were collected. Path analysis was used to estimate the direct and indirect associations between trauma and institutional violence. Approximately 45% of inmates reported childhood trauma, which was associated with a higher prevalence of co-occurring mental health and substance abuse needs, and youth criminal charges. Although mental health, substance abuse, and youth criminal charges interacted with one another in predicting violence, their associations were similar for those with and without histories of trauma. A direct association between trauma and institutional incidents remained (Relative Risk [RR] = 1.38, 95% CI [1.07, 1.78]) after accounting for indirect associations through these co-occurring risk factors. There was insufficient evidence to suggest that these associations differed between men and women or between Aboriginal and non-Aboriginal inmates. Given the high co-occurrence of multiple health and behavioral risk factors for inmates with traumatic histories, clarifying which factors are causally associated and reversible is needed to inform effective trauma informed care.

Yield and Efficiency of Mental Health Screening: A Comparison of Screening Protocols at Intake to Prison

Background The value of screening for mental illness has increasingly been questioned in low prevalence settings due to high false positive rates. However, since false positive rates are related to prevalence, screening may be more effective in higher prevalence settings, including correctional institutions. We compared the yield (i.e. newly detected cases) and efficiency (i.e. false positives) of five screening protocols to detect mental illness in prisons against the use of mental health history taking (the prior approach to detecting mental illness). Methods and Findings We estimated the accuracy of the six approaches to detect an Axis I disorder among a sample of 467 newly admitted male inmates (83.1% participation rate). Mental health history taking identified only 41.0% (95% CI 32.1, 50.6) of all inmates with mental illness. Screening protocols identified between 61.9 and 85.7% of all cases, but referred between 2 and 3 additional individuals who did not have a mental illness for every additional case detected compared to the mental health history taking approach. In low prevalence settings (i.e. 10% or less) the screening protocols would have had between 4.6 and 16.2 false positives per true positive. Conclusions While screening may not be practical in low prevalence settings, it may be beneficial in jails and prisons where the prevalence of mental illness is higher. Further consideration of the context in which screening is being implemented, and of the impacts of policies and clinical practices on the benefits and harms of screening is needed to determine the effectiveness of screening in these settings.

Diagnostic Error in Correctional Mental Health: Prevalence, Causes, and Consequences.

While they have important implications for inmates and resourcing of correctional institutions, diagnostic errors are rarely discussed in correctional mental health research. This review seeks to estimate the prevalence of diagnostic errors in prisons and jails and explores potential causes and consequences. Diagnostic errors are defined as discrepancies in an inmate’s diagnostic status depending on who is responsible for conducting the assessment and/or the methods used. It is estimated that at least 10% to 15% of all inmates may be incorrectly classified in terms of the presence or absence of a mental illness. Inmate characteristics, relationships with staff, and cognitive errors stemming from the use of heuristics when faced with time constraints are discussed as possible sources of error. A policy example of screening for mental illness at intake to prison is used to illustrate when the risk of diagnostic error might be increased and to explore strategies to mitigate this risk.

Food insecurity, diet quality, and mental health in culturally diverse adolescents

Purpose – The purpose of this paper is to increase the understanding of adolescents’ perceptions of food insecurity and diet quality, and the impact that these factors have on mental health. Design/methodology/approach – This study used a community-based research approach. It gathered qualitative data from 11 in-depth interviews conducted with adolescents aged 13-19. Participants were recruited through various programmes they attended at a community organization in Toronto. Findings – Overall, results indicate that respondents clearly identified a linkage between food insecurity and mental health. They also identified several effects of poor diet quality on mental health. Respondents understood food insecurity and poor diet quality to exist on a continuum. However, they also identified other reasons for making poor dietary choices such as peer pressure. Mental health effects of food insecurity and poor diet quality included sadness, stress, worry, anger, shame, impaired concentration, and fatigue. Practic...

Mental health treatment patterns following screening at intake to prison.

Objective: While there is general consensus about the need to increase access to mental health treatment, it is debated whether screening is an effective solution. We examined treatment use by inmates in a prison system that offers universal mental health screening. Method: We conducted an observational study of 7,965 consecutive admissions to Canadian prisons. We described patterns of mental health treatment from admission until first release, death, or March, 2015 (median 14-month follow-up). We explored the association between screening results and time of first treatment contact duration of first treatment episode, and total number of treatment episodes. Results: Forty-three percent of inmates received at least some treatment, although this was often of short duration; 8% received treatment for at least half of their incarceration. Screening results were predictive of initiation of treatment and recurrent episodes, with stronger associations among those who did not report a history prior to incarceration. Half of all inmates with a known mental health need prior to incarceration had at least 1 interruption in care, and only 46% of inmates with a diagnosable mental illness received treatment for more than 10% of their incarceration. Conclusion: Screening results were associated with treatment use during incarceration. However, mental health screening may have diverted resources from the already known highest need cases toward newly identified cases who often received brief treatment suggestive of lower needs. Further work is needed to determine the most cost-effective responses to positive screens, or alternatives to screening that increase uptake of services.

CARTOONS KILL: casualties in animated recreational theater in an objective observational new study of kids' introduction to loss of life.

Objectives To assess the risk of on-screen death of important characters in children’s animated films versus dramatic films for adults. Design Kaplan-Meier survival analysis with Cox regression comparing time to first on-screen death. Setting Authors’ television screens, with and without popcorn. Participants Important characters in 45 top grossing children’s animated films and a comparison group of 90 top grossing dramatic films for adults. Main outcome measures Time to first on-screen death. Results Important characters in children’s animated films were at an increased risk of death compared with characters in dramatic films for adults (hazard ratio 2.52, 95% confidence interval 1.30 to 4.90). Risk of on-screen murder of important characters was higher in children’s animated films than in comparison films (2.78, 1.02 to 7.58). Conclusions Rather than being the innocuous form of entertainment they are assumed to be, children’s animated films are rife with on-screen death and murder.

Mental Health Screening and Differences in Access to Care among Prisoners

Objective: Disparities in mental health care exist between regional and demographic groups. While screening is recommended as part of a correctional mental health strategy, little work has been done to explore whether it can narrow regional and demographic disparities in access to care. We compared treatment access rates by sex, race, age, and region in relation to screening results. Methods: We conducted a retrospective cohort study using administrative data. All 7965 admissions to the prison system were followed for a median of 14 months. Results: Males and non-Indigenous minority racial groups had lower rates of treatment regardless of screening results; they were less likely both to self-report needs and to receive treatment if these needs were reported. Regional differences revealed higher treatment rates in Atlantic Canada and Ontario, as well as higher rates of inmates self-reporting needs on screening who did not receive treatment in the Atlantic, Québec, and Pacific regions. There were minimal differences between inmates of different age groups. Conclusions: Findings suggest potential resource gaps and/or differences in the performance of screening to detect mental health needs across demographic and regional groups. Screening did not narrow, and may have widened, differences between groups.