Association between mental health outcomes and lifetime criminal justice involvement in U.S. adults with diabetes

Background: Diabetes is a leading cause of death in the United States, and comorbid mental illness is associated with worse diabetes outcomes. Those with criminal justice involvement (CJI) have high rates of mental illness and diabetes prevalence. However, little is known about the relationship between CJI and mental illness among those with diabetes.

Methods: Using a nationally representative sample of U.S. adults with diabetes from the National Survey of Drug Use and Health (2015-2018), we investigated the relationship between CJI and mental health outcomes (depression, serious psychologic distress, serious mental illness, moderate mental illness, any mental illness, functional status). Multiple linear and logistic regression models were used to assess the relationship between CJI and each mental health outcome adjusting for multiple socio-demographic and comorbidity variables.

Results: Of 11,594 respondents, representing 25,834,422 adults with diabetes, 17.1% reported prior CJI. In fully adjusted models, CJI was independently associated with all mental health outcomes: depression (aOR 1.80, 95% CI: 1.41, 2.30), serious psychologic distress (aOR 1.53, 95% CI: 1.23, 1.90), serious mental illness (aOR 2.00, 95% CI: 1.58, 2.52), moderate mental illness (aOR 1.72, 95% CI 1.30, 2.26), any mental illness (aOR 1.92, 95% CI: 1.56, 2.35) and functional status (regression coefficient 3.6, 95% CI: 3.53, 3.79).

Conclusion: Those with diabetes and criminal justice involvement experience concentrated risk for poor mental health outcomes. Our findings suggest that mental health interventions may be imperative to achieving control of diabetes in the justice-involved population.