LeMasters Katherine, Delamater Paul, Brinkley-Rubinstein Lauren, Edwards Jesse K, Robinson Whitney R, Pence Brian
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States.
Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, United States.
SSM Ment Health. 2023 Dec;3. doi: 10.1016/j.ssmmh.2023.100189. Epub 2023 Jan 20.
High community incarceration rates are associated with worse community mental health. However, it remains unknown whether higher rates of probation, a form of criminal legal community supervision, are similarly associated with worse community mental health. Our objective was to evaluate temporal and geographic correlations of county-level probation and mental health rates separately and to assess the association between county-level probation and mental health rates, measured by self-inflicted injury and suicide. We performed ecological analyses using North Carolina administrative data (2009-2019) and used repeated cross-section, multivariable spatial error models. From 2009 to 2019, probation rates trended downward while self-inflicted injury and suicide remained stable. We found positive spatial autocorrelation suggesting that there are spatial determinants of probation and self-harm, though less so for suicide. Hot spot analyses showed local variation with high self-harm and suicide rates being clustered in rural Western North Carolina and high probation rates being clustered in rural Eastern North Carolina. Probation was positively associated with self-inflicted injury and suicide. For example, in 2018, a 1 percentage point increase in probation was associated with a 0.05 percentage point increase in self-harm in 2019 (95% CI: 0.03, 0.06), meaning that in a county of 100,000 people, an increase in 1000 county residents being on probation would be associated with an increase in 50 self-harm injuries. High county-level probation rates may exert collateral damage on the mental health of those living in areas with much of the population under state control. These findings emphasize that the criminal legal system is not separate from communities and that future public health research and advocacy must consider these collateral consequences of probation on communities.
较高的社区监禁率与较差的社区心理健康状况相关。然而，作为刑事法律社区监督形式的缓刑率较高是否同样与较差的社区心理健康状况相关，目前尚不清楚。我们的目标是分别评估县级缓刑率与心理健康率的时间和地理相关性，并评估以自残和自杀衡量的县级缓刑率与心理健康率之间的关联。我们使用北卡罗来纳州的行政数据（2009 - 2019年）进行了生态分析，并使用了重复横截面多变量空间误差模型。从2009年到2019年，缓刑率呈下降趋势，而自残和自杀率保持稳定。我们发现存在正空间自相关性，这表明缓刑和自残存在空间决定因素，不过自杀的空间决定因素较弱。热点分析显示存在局部差异，高自残和自杀率集中在北卡罗来纳州西部农村地区，高缓刑率集中在北卡罗来纳州东部农村地区。缓刑与自残和自杀呈正相关。例如，在2018年，缓刑率每增加1个百分点，2019年的自残率就会增加0.05个百分点（95%置信区间：0.03，0.06），这意味着在一个有10万人的县，缓刑的县居民增加1000人将导致自残伤害增加50起。县级高缓刑率可能会对那些生活在大量人口受国家管控地区的人的心理健康造成附带损害。这些发现强调刑事法律系统与社区并非相互独立，未来的公共卫生研究和宣传必须考虑缓刑对社区的这些附带后果。
