History of Solitary Confinement Is Associated with Post-Traumatic Stress Disorder Symptoms among Individuals Recently Released from Prison


This study assessed the relationship between solitary confinement and post-traumatic stress disorder (PTSD) symptoms in a cohort of recently released former prisoners. The cross-sectional design utilized baseline data from the Transitions Clinic Network, a multi-site prospective longitudinal cohort study of post-incarceration medical care. Our main independent variable was self-reported solitary confinement during the participants’ most recent incarceration; the dependent variable was the presence of PTSD symptoms determined by primary care (PC)-PTSD screening when participants initiated primary care in the community. We used multivariable logistic regression to adjust for potential confounders, such as prior mental health conditions, age, and gender. Among 119 participants, 43% had a history of solitary confinement and 28% screened positive for PTSD symptoms. Those who reported a history of solitary confinement were more likely to report PTSD symptoms than those without solitary confinement (43 vs. 16%, p < 0.01). In multivariable logistic regression, a history of solitary confinement (OR = 3.93, 95% CI 1.57–9.83) and chronic mental health conditions (OR = 4.04, 95% CI 1.52–10.68) were significantly associated with a positive PTSD screen after adjustment for the potential confounders. Experiencing solitary confinement was significantly associated with PTSD symptoms among individuals accessing primary care following release from prison. Larger studies should confirm these findings.

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We thank all of the community health workers, clinical staff, and research staff who contributed to the Transitions Clinic Network study. We also thank our patients for their participation.

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

The project described was supported by Grant Numbers 1CMS331071-01-00 and 1C1CMS331300-01-00 from the Department of Health and Human Services, Centers for Medicare and Medicaid Services

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Correspondence to Brian O. Hagan or Aaron D. Fox.

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Hagan, B.O., Wang, E.A., Aminawung, J.A. et al. History of Solitary Confinement Is Associated with Post-Traumatic Stress Disorder Symptoms among Individuals Recently Released from Prison. J Urban Health 95, 141–148 (2018). https://doi.org/10.1007/s11524-017-0138-1

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  • Solitary confinement
  • Incarceration
  • Post-traumatic stress disorder
  • Post-traumatic stress disorder screening