The State of the Data: Mental Health Among Sexual Minority Persons in the United States Federal and State Prisons

Background and Purpose: Sexual minority adults consistently report greater mental health symptoms, including depression, anxiety and post-traumatic stress disorder (PTSD) compared to their heterosexual peers. In addition, evidence suggests that all persons who are incarcerated endure worse mental health than those who are not. While much is known regarding the relationship between incarceration and mental health, broadly, less is known regarding the association between incarceration and mental health among sexual minority adults, specifically. This paper aims to expand existing evidence regarding relationships between sexual orientation and mental health indicators among adults incarcerated in U.S. prisons, especially the differences within the sexual minority group (i.e., lesbian or gay, bisexual, another orientation).

Methods: Using secondary data from the Bureau of Justice Statistics (2016 Survey of Prison Inmates; N = 24,848), a series of multivariate logistic regression models were run to examine the association between sexual orientation and mental health indicators including illness (depression, anxiety, PTSD, and manic disorder) and mental health care (prior mental health hospitalization; taking prescription medicines at time of arrest; taking prescription medicines since the time of arrest; and professional help since arrest). All models controlled for age, assigned sex at birth, sexual orientation, race and ethnicity, education, and homelessness status.

Results: In the sample, 7.4% of the participants identified as sexual minority (4.8% as bisexual, 2.3% as lesbian or gay, and 0.3% with another orientation). For the models examining the association between sexual orientation and mental illness, identifying as lesbian or gay, and identifying as bisexual compared to straight was associated with significantly higher odds of reporting depressive disorder, anxiety, PTSD and manic disorder. Identifying with another sexual orientation compared to straight was associated with higher odds of reporting PTSD and manic disorder. Similarly, for the models examining association between sexual orientation and mental health care variables, identifying as bisexual compared to straight was associated with significantly higher odds of reporting prior mental health hospitalization, taking prescription medicines at the time of arrest and since arrest, and using professional mental health help since arrest. Identifying as lesbian or gay, or identifying with another sexual orientation compared to straight was associated with significantly higher odds of reporting prior mental health hospitalization, taking prescription medicines and professional mental health help since arrest.

Conclusion: The results add to the limited knowledge regarding sexual orientation and mental health among persons who are incarcerated. In addition, our results indicate diversity in mental illness as well as mental health care (pre and during incarceration) within the sexual minority group (gay or lesbian, bisexual, and another orientation). Practice implications are numerous including the critical need for targeted, supportive programming to improve mental health outcomes during incarceration and in preparation for reentry, reduce disparities, and reduce reincarceration. Further, efforts to improve the continuity of care for sexual minority adults are needed; and researchers, too, are encouraged to collect data surrounding sexual orientation and gender identity as available datasets truncate the lived experiences of these and related groups.