Associations between Solitary Confinement and Psychosis Symptoms in a Post-Release Community Setting

Background and Purpose: Evidence suggests that the practice of solitary confinement in incarceration settings is linked to adverse psychological symptoms. Adverse psychological symptoms associated with solitary confinement persist for incarcerated adults transitioning into the community; however, prior research has not yet examined associations between experiences of solitary confinement and psychotic experiences in community settings. Diathesis-stress and social deafferentation models of psychosis suggest that solitary confinement may be a highly relevant exposure for the development of psychotic symptoms, due to both the trauma and social isolation intrinsic to this exposure. To address this gap, we conducted a cross-sectional survey of 201 formerly incarcerated women and men in the United States. We hypothesized that prior solitary confinement would be associated with greater frequency of recent (past 2-weeks) psychotic experiences when controlling for time incarcerated, interpersonal violence histories, and sociodemographic characteristics.

Methods: An online, cross-sectional survey was administered to formerly incarcerated women and men (> 2 weeks prior incarceration) in the U.S. recruited through Qualtrics Panels, an online general population sampling and survey-administration service. Psychosis symptoms were measured using The Community Assessment of Psychosis Experiences (CAPE-15). The CAPE-15 is a 15-item measure that assesses the frequencies and levels of distress associated with experiences that are consistent with psychosis symptomology. Solitary confinement history was measured dichotomously with an item that asked respondents if they had been held in solitary confinement while incarcerated. Linear regression was used to assess the relationship between solitary confinement and psychosis symptoms, controlling for time incarcerated, interpersonal violence histories, and sociodemographic characteristics.

Results: A total of 43% of study participants reported being placed in solitary confinement while incarcerated. Linear regression results indicated that solitary confinement was significantly associated with higher levels of current psychosis symptoms after controlling for time incarcerated, interpersonal violence histories, and sociodemographic characteristics. For respondents who reported being placed in solitary confinement while in prison, psychotic experience frequency scores increased by 4.80 units (B= 4.80, p<.001, 95% CI = 2.54, 7.05) when adjusting for the effects of covariates.

Conclusions and Implications: Study results indicate a statistically and clinically significant association between prior solitary confinement and recent psychosis symptoms in the community. These findings highlight the need for short-term and long-term community-based mental health interventions and prevention efforts in the post-release community setting. Practitioners in community mental health settings should be cognizant of patients’ histories with solitary confinement and consider how these experiences may present risks to current mental health symptoms (i.e., early on-set psychosis). Given that this was a cross-sectional study, longitudinal data are needed to determine the extent to which people with psychosis are disproportionally placed into solitary confinement versus the effect of solitary confinement on the development of psychosis-like symptoms. Future studies are also needed on protective mechanisms that may buffer the effects of solitary confinement on psychosis-risk, or ideally, policy-level interventions to reduce the usage of solitary confinement and other social isolation methods in the prison system.