Race Differences in Symptoms of Mental Illness Among Jail

Inmates

Kerstin Youman, Christine Zepka, Jeffrey Stuewig, June Tangney

George Mason University

Overview

Background Differential rates of incarceration Crime and mental illness Previous studies

Methods Results Conclusions Future Directions

Differential Incarceration Rates

0102030405060708090

100

A-A white

Total Population

IncarceratedPopulation

Per

cent

age

Lifetime Chance of Being Incarcerated

32% of black men will likely be incarcerated in state or federal prisons at some point in their lifetime.

5.9% of white males will likely be incarcerated in state or federal prisons at some point in their lifetime.

(Bureau of Justice Statistics, 2004).

Mental Illness and Crime

Belief that deinstitutionalization has resulted in criminalization of the mentally ill (Teplin, 1984; Torrey,

1995)

Rates of mental illness much higher in incarcerated samples, thought to be a risk factor (Jordan, Schlenger, Fairbank, & Caddell, 1996; Teplin, 1990, 1994; Teplin, Abram & McClelland 1996; Veysey & Bichler-Robertson,

1999)

Questions

Are there race differences in mental illness that could, in part, explain overrepresentation?

Do incarcerated African-Americans have higher rates of mental illness than incarcerated whites?

Previous Studies of Mental Illness in

Jail Inmates Teplin studies only to report prevalence by race Males (Teplin, 1994) data collected 1983-1984 Females (Teplin, Abram & McClelland, 1996) data 1991-1993 A-A lower current prev than W for MDD, Drug

abuse/depend, Alcohol abuse/depend, APD, p<.01 Limited number of diagnoses Mixed diagnoses Did not control for income, education, or IQ DSM III based clinician rated assessment (NIMH-DIS:

Robins, Helzer, Croughan, & Ratcliffe, 1981)

Clinician Bias in Diagnosing A-As Well established pattern of differential diagnosis for

African-Americans compared to Whites (Adebimpe, 1981; Jones and Gray, 1986; Strakowski, Shelton and Kolbrener, 1993) Analog studies - identical data ascribed to diff races

(Loring & Powell, 1988). Self-report vs. clinician diagnosis – no diffs in self-

report but differences in diagnosis (Minsky, Vega, Miskimen,

Gara & Escobar, 2003; Neighbors, Trierweiler, Ford & Muroff, J.R., 2003) In general, AAs have been under-diagnosed with

affective disorders and over-diagnosed with schizophrenic disorders

Unknown how understanding of race differences has been impacted

Current Study

Research Questions:

Are there racial differences in self-report symptoms of a broad variety of mental illnesses in a jail sample?

Are there racial differences in self-report symptoms of mental illness in the clinically significant range in a jail sample?

Methods Subjects N = 323 jail inmates of both genders at

the Fairfax County Adult Detention Center. 185 African-American 138 White

Assessed at intake shortly after entry in general population

Measures The Personality Assessment Inventory (PAI: Morey,

1991). Self-report Measure of Psychopathology Symptoms

Control variables Highest level of education attained Income in past year The Wonderlic Personnel Test (WPT; Wonderlic,

Inc.1999) IQ

Results

Mean T scores Prevalence in the clinically significant range

(T>70)

Mean T Scores on PAI Clinical ScalesA-A W t .

Somatic 51.19 52.74 -1.28 Anxiety 53.22 55.44 -1.77OCD 58.76 55.78 2.45*Phobias 49.41 47.67 1.51Traumatic Stress 63.31 61.75 0.91Depression 54.54 59.30 -3.59***Mania 61.86 55.41 5.10***Paranoid 61.55 56.38 4.38***Schizophrenia 55.50 54.20 0.94 Borderline Features 62.11 64.54 -1.68Antisocial Features 64.30 65.23 -0.69Alcohol Problems 58.34 62.18 -1.91 Drug Problems 70.04 76.77 -2.84** *p<.05, **p<.01, ***p<.001

Differences in Self-Report Rates of Mental Illness Symptomotology in Jail

05

10152025303540

Dep*** Anx** Mania**

African-AmericanWhite

*p<.05, **p<.01,***p<.001

Differences in Self-Report Rates of Mental Illness Symptomotology in Jail

0

10

20

30

40

50

60

APD Drug* Bord*

African-AmericanWhite

*p<.05, **p<.01, ***p<.001

Percentage with Clinically Significant Symptoms

A-A (%) W (%) Chi-Square

Somatic 5.9 10.1 1.95 Anxiety 3.8 12.3 8.37**OCD 11.4 8.0 1.01Phobias 4.9 2.9 0.79Traumatic Stress 33.0 29.7 0.39Depression 8.6 22.5 12.13***Mania 27.6 13.8 8.87**Paranoid 20.5 14.5 1.96Schizophrenia 10.8 10.9 0.00Borderline Features 25.4 38.4 6.25*Antisocial Features 30.8 36.2 1.05Alcohol Problems 21.1 31.6 4.56* Drug Problems 45.9 57.7 4.32* *p<.05, **p<.01, ***p<.001

Race Differences in Clinically Significant Symptoms by Subscale

A-A (%) W (%) Chi-Square Depression 8.6 22.5 12.13***

Cognitive 8.1 16.5 5.54*Affective 6.5 20.9 14.99**Physiological 6.5 10.1 1.42

Mania 27.6 13.8 8.87**Grandiosity 42.2 11.6 35.8***Activity 16.2 16.7 0.01Irritability14.6 8.7 2.59

Schizophrenia 10.8 10.9 0.00 Psychotic 9.7 5.8 1.65

Social Detach 7.0 8.7 0.31Thought Disorder 14.6 15.2 0.02 .

*p<.05, **p<.01, ***p<.001

Items of the Grandiosity subscale

I have many brilliant ideas. I have some very special talents that few others have. My plans will make me famous some day. I have accomplished some remarkable things. I think I have answers to some very important questions. I think I would be a good comedian. Lately I feel so confident that I think I can accomplish anything.

Mean Scores Clinically Sig. Symptoms

higher t higher chi-square . SomaticAnxiety W**

OCD AA*PhobiasTraumatic Stress

Depression W*** W***Mania AA*** AA**

Grandiosity AA*** AA**ActivityIrritability AA*

Paranoid AA***Schizophrenia

Psychotic AA*Social Detachment Thought Disorder

Borderline Features W*Antisocial FeaturesAlcohol Problems W*Drug Problems W** W* .*p<.05, **p<.01, ***p<.001

Possible Explanations/ControlsSES

No mean diffs in total annual income AA = $22, 535 W = $26,420 t = .95

No mean diffs in years of school completed AA = 11.73 W = 11.82 t = .39

IQControlling for IQ results in no change in racial differences in the prevalence of Clinically Significant Mental Illness symptoms

Social Desirability/ Malingering No mean diffs PIM T value

AA = 44.47 W = 44.28 t = -0.14 No mean diffs NIM T value

AA = 56.04 W = 56.6 t = .43

Summary Compared to Ws, A-A jail inmates report a lower prevalence of:

Anxiety, Depression, Borderline Personality, Alcohol Problems and Drug Problems

Consistent with Teplin’s for Depression, Alcohol, Drug Compared to Ws, A-A jail inmates report a higher prevalence of :

Mania driven by Grandiosity- (a subscale of mania)Previously untested, no differences in manic episodes from Teplin

There are no race differences in the self-report prevalence of clinically sig. symptoms of mental illness for :Somatization, OCD, Phobia, Traumatic Stress, Schizophrenia, AntisocialInconsistent with Teplin for Antisocial, others previously untested

These race differences are robust and not explained by Education, Income, IQ, Pos Imp Management, or Neg Imp ManagementPreviously untested

Conclusions

Counterintuitive Findings Supported and Expanded Rates of incarceration much higher for A-As than whites Criminalization of the mentally ill/ mental illness suspected

as risk factor for incarceration A smaller percentage of A-As in jail have clinically sig self-

report symptoms of mental illness relative to whites Differential expression of symptoms at subtest level Something is Going on

In the community there are much smaller or insignificant race differences for mental illness prevalence compared to in jail

Future Directions If higher rates of mental illness are not implicated in

disproportionate incarceration for A-As what does explain this phenomenon?

Why are there such discrepant rates of mental illness in jail vs. the community?

Examine Racial Differences Moral Emotions (Shame, Guilt, Empathy) Moral Cognitions (Criminogenic beliefs that perpetuate

criminal behavior) Self-esteem Self-control Criminal behavior Perceived Innocence/Wrongful Incarceration