In 2002, Anda et al. described the childhood antecedents of depression and alcoholism in a large adult sample. They discovered an independent, graded association between the number of adverse childhood experiences (such as physical, sexual, or psychological abuse) reported and the risk of alcoholism and depression. In this study, we examined both childhood factors and current factors to provide a broader picture of the correlates of depression in homeless parolees.
Consistent with the literature, we revealed high level of depressive symptoms to be prevalent among homeless parolees. These participants suffered from depressive symptoms at a rate of 40%, roughly six times that of the general U.S. population (Kessler, Chiu, Demler, & Walters, 2005
; US Census Bureau, 2002
). Moreover, these parolees were also confronted by a host of socio-economic as well as physical adversities, such as poverty, serious illness (requiring hospitalization), fractured family relations, and abusive childhoods. As expected, substance abuse went hand in hand with depressive symptoms in this population. Serious drug use was pervasive and over half reported binge drinking.
Other factors strongly associated with depressive symptoms included violent behaviors, hallucinations, serious learning problems and cognitive difficulties. Many psychosocial factors measured in this group of homeless parolees were significantly related to their depressive symptoms - self-esteem, emotional support, positive interaction, and ineffective coping skills such as denial, blame, and disengagement. In this study, a lack of social support, along with a disengaged coping style, are associated with depressive symptoms in this study. Logistic regression analyses revealed predictors of depressive symptoms including childhood physical abuse, non-residential alcohol treatment, violent behaviors, low self-esteem and disengagement coping. However, being Mexican-American, Mexican, American, Indian, Asian and of another race ethnicity without cognitive problems was inversely related to depressive symptoms.
The high level of depressive symptoms among substance-abusing parolees is perhaps not surprising. Since the late 1950s, the deinstitutionalization movement in mental health services has shifted emphasis from state-funded mental institutions to community-based programs (Petersilia, 2003
). However, the movement, while more humane in some aspects than institutionalization, has also left many people with mental illnesses, without adequate treatment or proper supervision for medications and other services. As a result, prisons are now increasingly used as the default venue to warehouse persons with mental illnesses as many state-funded mental institutions were closed (Petersilia, 2003
All prison inmates, except for the few on death row and with life sentences, will eventually be paroled back into the community. The implications for correctional agencies are serious, as people with mental disorders are released into the community from a highly structured environment but expected to make independent decisions and adjust to a different life (Taxman, 2004
). According to Petersilia (2003)
, the majority of parole agencies in the country are not prepared to deal with large number of clients with mental disorders. Unless parolees exhibit explicit psychiatric symptoms or their offenses were determined to have been caused by mental illness, mental health problems among parolees are either ignored or underserved (Lurigio, 2001
Many parolees quickly revert back to old behaviors that lead to re-arrest, as their reentry process is complicated by numerous contextual and psychological stressors (Sung & Richter, 2006
). This is particularly notable in California. With a prison population of 164,000 and another 108,000 parolees in the community, the state of California spends more on its correctional system than any other state in the nation (CDCR, 2009a
). However, community reentry efforts in California have for decades seen little success. Roughly 40% of parolees are returned to prison within 12 months of release, and the rate of reincarceration increases to 70% within three years after release (Zhang, Roberts, & McCollister, 2009
; Zhang, Roberts, & Callanan, 2006
Unfortunately, as discussed earlier, little research has been done regarding mental illness on parole populations (Skeem & Louden, 2006
) or the prison population in general (Petersilia, 2003
: 37). Such lack of basic knowledge hinders clinical intervention in community corrections and other reentry efforts, because mental health problems, substance abuse, and criminal activities are well known to correlate strongly with one another (Forrester, Chiu, Dove, & Parrott, 2010
; Sacks et al., 2009
; Shinkfield, Graffam, & Meneilly, 2009
To make matter worse, the use of illicit drugs, such as those identified in this study, is also known to correlate significantly with violent behaviors and homelessness (Cartier, Farabee, & Prendergast, 2006
; Darke, Torok, Kaye, Ross, & McKetin, 2010
; Felson & Staff, 2010
). It is therefore important, from a policy-making perspective, to recognize the complexity and challenges confronting community reentry programs as parolees face multiple obstacles to recovery and reintegration. Proper assessment and identification of these clinical and social obstacles will enable health care and social service providers to explore and deploy effective interventions.
There are several limitations in this study that warrant cautions when interpreting the findings. First, the study sample is relatively small and based on convenience sampling, which limits the generalizability of the findings. Second, participants were recruited from a residential drug treatment facility, which may have magnified the prevalence and severity of depression and other psychosocial adversities. Although in concordance with existing literature, the findings of the high rates of depressive symptoms and other comorbidities perhaps were unique to this population and may reflect at best an exaggeration of the challenges facing certain segments of the correctional population in California. In other words, one would expect to find high rates of depressive symptoms and other mental health problems among homeless and substance abusing parolees.
In addition, the findings are based upon self-report data and two of the subscales of coping had relatively low reliability (Cronbach’s alpha = .61 for self-blame coping and .66 for denial coping). However, the disengagement coping style, which was in the final model for depression, was more reliable at .74 and therefore can be interpreted with greater confidence. Although these results demonstrate the correlates of depressive symptoms among men on parole, cross-sectional data cannot determine the causes of depression in this sample. Finally, we do not claim that all of those with depressive symptoms might necessarily meet criteria for a DSM-IV diagnosis of depression, although certainly it is known that depression remains under-diagnosed in the general population (Ani et al., 2008
Despite the limitations, findings in this study provide further evidence on two major challenges confronting correctional agencies across the nation in their reentry efforts: (a) proper assessment of mental health problems among prison inmates to be released into the community; and (b) provision of appropriate services. High level of depressive symptoms, as indicated in this study sample, may be common in the general parolee population. This leads to the question of how these ex-prison inmates, already facing insurmountable psychosocial and economic adversities, may cope with their mental health problems. Illicit drugs and alcohol are likely to become their obvious choice of “self-medication.” Thus, mental health implications are critical. The persistently high rates of recidivism in California suggest that extensive screening and treatment of parolees with mental illnesses should be an integral part of community reentry programs. This will ensure the mobilization of necessary health services to stabilize and treat a sizeable number of released inmates to decrease the risk of recidivism. It is also important for healthcare providers and other correctional service agencies to become aware of the widespread mental health challenges in the correctional population and devise interventions that target the underlying causes.
Understanding that fractured, dysfunctional families are an important component in the etiology of alcoholism, substance abuse, and depression could be critical to the diagnosis and treatment of depression in a homeless, parolee population. In addition, a better understanding of the factors that lead to high level of depressive symptoms can assist in primary prevention efforts. As children, the homeless parolees in this study often grew up in extremely dysfunctional family relationships. That, combined with cognitive problems, social isolation, and poor coping styles is correlated with the high level of depressive symptoms and substance abuse revealed in this sample. Clearly, our study findings support the need for a multifaceted system for primary prevention in childhood and intervention and provision of treatment for homeless parolees with comorbid psychiatric disorders.