Abstract
ObjectivesTo determine bidirectional relationships between incarceration and mental disorders. We hypothesized that (1) pre-existing mental disorders would be associated with increased incarceration risk, and (2) incarceration would be associated with increased incident mental disorder diagnosis risk in adolescents without prior psychiatric diagnosis.MethodThis retrospective cohort study included 1551 adolescents (aged 10-17 years) from four New South Wales (NSW) health surveys linked to justice and health records. Modified Poisson regression examined associations between pre-existing mental disorders and incarceration. Prentice-Williams-Peterson Total-Time models examined associations between time-varying incarceration exposure and incident mental disorder diagnoses among those without prior diagnosis.ResultsAmong 1551 adolescents (87.7% male; median age 15 years), pre-existing mental disorders were associated with an increased incarceration risk (adjusted Risk Ratio [RR]: 1.26, 95% Confidence Interval [CI]: 1.09-1.45), which was more pronounced among those with violent offences. Among 1424 adolescents without prior diagnosis, incarceration was associated with increased incident diagnosis risk (adjusted Hazard Ratio [aHR]: 1.22, 95% CI: 1.09-1.37), with stronger associations among adolescents residing in areas of higher socioeconomic disadvantage.ConclusionsFindings suggest incarceration may be associated with adverse mental health outcomes, with implications for diversionary pathways and custodial mental health care.