Chronic Medical Conditions Among Jail Detainees in Residential Psychiatric Treatment: A Latent Class Analysis

Purpose: A robust finding of the National Comorbidity Survey replication (NCS-R) is that a large number of co-occurring psychiatric and substance use disorders (CODs) are concentrated in a small but significant number of individuals. Other studies have found that such individuals have higher rates of medical problems such as asthma, endocarditis, and infectious diseases such as HIV/AIDS. This study explored the pattern of chronic medical conditions in a sample of adult jail detainees in psychiatric treatment to determine if clinically meaningful subgroups could be identified. The relationship between the derived subgroups, CODs, and functional impairment were further explored to develop a clinical profile encompassing the full range of disorders experienced by incarcerated individuals with CODs.

Methods: A total of 305 male and 154 female jail detainees were sampled with certainty from recent admissions to a residential psychiatric treatment program (recruitment rate = 67%). Interviews were done using the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI), which assessed psychiatric and substance use disorders per DSM-IV criteria and 15 chronic medical conditions. Latent class analysis was conducted using the medical conditions as class indicators. Multinomial regression of the derived latent classes on demographics, and substance were done to determine their relationship to class membership. Post-hoc analyses compared the latent classes for CODs and functional disability as assessed by the WHO-Disability Assessment Schedule (WHO-DAS).

Results: Commonly used statistics (e.g., Akaike Information Criterion) indicated the best fitting model had 3 classes, composed of those with: a high probability of multiple medical conditions (HMC; 13% of the sample); an intermediate probability of a smaller number of medical conditions (IMC; 52%); and no or few medical conditions (NMC; 35%). Those in the HMC class were most likely to report respiratory problems, severe headaches, musculoskeletal pain, and arthritis. Multinomial regression revealed being older (50+ years), female, having an alcohol use disorder, and PTSD were associated with higher odds of being in the HMC or IMC classes relative to the NMC class (all OR, p <.05). Medical problems were also significantly associated with co-occurring psychiatric diagnoses. Those in the HMC class met DSM-IV criteria for 4.0 lifetime disorders compared with 3.2 lifetime disorders for the IMC class and 2.4 disorders for the NMC class (F(3,427)=17.0, p < .001). MANOVA results indicated functional disability across the spectrum of areas assessed by the WHO-DAS was significantly different across groups (F(16,824)= 5.5, p < .001) and in the predicted direction (HMC > IMC > NMC).

Implications: Among individuals with SMI in the criminal justice system, more than 50% have one or more chronic medical conditions with over 10% having a high degree of multi-morbidity, medical complexity, and functional impairment. For forensic social workers, this population reflects the need for training and attention to practice skills and knowledge related specifically to coordinating medical and psychiatric care across treatment settings as well as across institutional (i.e., jail and prison) and community boundaries. These findings are especially relevant for those working with incarcerated women and forensic geriatric populations.