BACKGROUND: The COVID-19 pandemic in Ireland resulted in a nationwide quarantine on March 27th , 2020 This study represents the first assessment of rates of anxiety and depression in the general population of Ireland during the pandemic AIMS: Our first aim was to estimate the probable prevalence rates of generalized anxiety disorder (GAD) and depression, and to identify sociodemographic risk factors associated with screening positive for GAD or depression Our second aim was to determine if COVID-19 related anxiety was highest amongst those in society at greatest risk of morality from COVID-19 METHOD: Self-report data was collected from a nationally representative Irish sample (N = 1,041) online between March 31st and April 5th ;the first week of the nationwide quarantine measures Recognised cut-off scores on the GAD-7 and PHQ-9 were used to estimate rates of GAD and depression Correlates of screening positive for GAD or depression were assessed using logistic regression analysis RESULTS: GAD (20 0%), depression (22 8%), and GAD or depression (27 7%) were common Screening positive for GAD or depression was associated with younger age, female sex, loss of income due to COVID-19, COVID-19 infection, and higher perceived risk of COVID-19 infection Citizens aged 65 and older had significantly higher levels of COVID-19 related anxiety than adults aged 18-34 CONCLUSIONS: Initial results from this multi-wave study monitoring changes in population anxiety and depression throughout the pandemic indicate that GAD and depression were common experiences in the population during the initial phase of the COVID-19 pandemic

https://onlinelibrary.wiley.com/doi/pdf/10.1111/acps.13219

Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic

Suicide in prisons: an international study of prevalence and contributory factors.

Severe mental illness and substance use disorders in prisoners in low-income and middle-income countries: a systematic review and meta-analysis of prevalence studies.

Post-release opioid-related overdose mortality is the leading cause of death among people released from jails or prisons (PRJP). Informed by the proximate determinants framework, this paper presents the Post-Release Opioid-Related Overdose Risk Model. It explores the underlying, intermediate, proximate and biological determinants which contribute to risk of post-release opioid-related overdose mortality. PRJP share the underlying exposure of incarceration and the increased prevalence of several moderators (chronic pain, HIV infection, trauma, race, and suicidality) of the risk of opioid-related overdose. Intermediate determinants following release from the criminal justice system include disruption of social networks, interruptions in medical care, poverty, and stigma which exacerbate underlying, and highly prevalent, substance use and mental health disorders. Subsequent proximate determinants include interruptions in substance use treatment, including access to medications for opioid use disorder, polypharmacy, polydrug use, insufficient naloxone access, and a return to solitary opioid use. This leads to the final biological determinant of reduced respiratory tolerance and finally opioid-related overdose mortality. Mitigating the risk of opioid-related overdose mortality among PRJP will require improved coordination across criminal justice, health, and community organizations to reduce barriers to social services, ensure access to health insurance, and reduce interruptions in care continuity and reduce stigma. Healthcare services and harm reduction strategies, such as safe injection sites, should be tailored to the needs of PRJP. Expanding access to opioid agonist therapy and naloxone around the post-release period could reduce overdose deaths. Programs are also needed to divert individuals with substance use disorder away from the criminal justice system and into treatment and social services, preventing incarceration exposure.

/pdf/a-conceptual-model-for-understanding-post-release-opioid-1thghwy9eh.pdf

A conceptual model for understanding post-release opioid-related overdose risk

Background Worldwide opioid-related overdose has become a major public health crisis. People with opioid use disorder (OUD) are overrepresented in the criminal justice system and at higher risk for opioid-related mortality. However, correctional facilities frequently adopt an abstinence-only approach, seldom offering the gold standard opioid agonist treatment (OAT) to incarcerated persons with OUD. In an attempt to inform adequate management of OUD among incarcerated persons, we conducted a systematic review of opioid-related interventions delivered before, during, and after incarceration. Methods and findings We systematically reviewed 8 electronic databases for original, peer-reviewed literature published between January 2008 and October 2019. Our review included studies conducted among adult participants with OUD who were incarcerated or recently released into the community (≤90 days post-incarceration). The search identified 2,356 articles, 46 of which met the inclusion criteria based on assessments by 2 independent reviewers. Thirty studies were conducted in North America, 9 in Europe, and 7 in Asia/Oceania. The systematic review included 22 randomized control trials (RCTs), 3 non-randomized clinical trials, and 21 observational studies. Eight observational studies utilized administrative data and included large sample sizes (median of 10,419 [range 2273–131,472] participants), and 13 observational studies utilized primary data, with a median of 140 (range 27–960) participants. RCTs and non-randomized clinical trials included a median of 198 (range 15–1,557) and 44 (range 27–382) participants, respectively. Twelve studies included only men, 1 study included only women, and in the remaining 33 studies, the percentage of women was below 30%. The majority of study participants were middle-aged adults (36–55 years). Participants treated at a correctional facility with methadone maintenance treatment (MMT) or buprenorphine (BPN)/naloxone (NLX) had lower rates of illicit opioid use, had higher adherence to OUD treatment, were less likely to be re-incarcerated, and were more likely to be working 1 year post-incarceration. Participants who received MMT or BPN/NLX while incarcerated had fewer nonfatal overdoses and lower mortality. The main limitation of our systematic review is the high heterogeneity of studies (different designs, settings, populations, treatments, and outcomes), precluding a meta-analysis. Other study limitations include the insufficient data about incarcerated women with OUD, and the lack of information about incarcerated populations with OUD who are not included in published research. Conclusions In this carefully conducted systematic review, we found that correctional facilities should scale up OAT among incarcerated persons with OUD. The strategy is likely to decrease opioid-related overdose and mortality, reduce opioid use and other risky behaviors during and after incarceration, and improve retention in addiction treatment after prison release. Immediate OAT after prison release and additional preventive strategies such as the distribution of NLX kits to at-risk individuals upon release greatly decrease the occurrence of opioid-related overdose and mortality. In an effort to mitigate the impact of the opioid-related overdose crisis, it is crucial to scale up OAT and opioid-related overdose prevention strategies (e.g., NLX) within a continuum of treatment before, during, and after incarceration.

/pdf/opioid-related-treatment-interventions-and-outcomes-among-xflcle8yu1.pdf

Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review

https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(16)30142-0.pdf

Katrina Bartellas

Papers

Mental health of prisoners: prevalence, adverse outcomes, and interventions