Effects of prisoner re-entry context on cognitive ability to manage mental health at re-entry

描述(由申请人提供)：被监禁妇女是一个弱势群体，精神健康和药物使用障碍(COD)的共生率很高(约50%)。之前的研究，包括我们的研究，已经确定从监狱重新进入社区的特点是稀缺、竞争的需求和权衡，特别是对患有死因死亡的女性。面对贫穷、精神疾病、成瘾、身体健康差、职业技能差、缺乏教育以及环境中的暴力，重新进入社区的妇女需要找到并维持安全、无物质的住房、交通、合法就业以及精神健康和药物使用治疗。他们必须做到这一切，同时避免精神健康和药物使用复发，并进一步努力与儿童重新团聚。他们经常面临巨大的和相应的权衡：满足一个领域的需求可能会极大地损害另一个领域的需求。行为经济学和认知心理学在实验室对类似情况(稀缺性、权衡、对自我控制的反复挑战)进行的研究表明，这些情况消耗了认知处理资源，导致液态智力和抑制冲动的能力(可逆)下降，使随后的决定倾向于冲动、直觉，而且往往是令人遗憾的选择。如果这些影响对离开监狱的女性适用，这意味着，未能投入足够的资源用于出院计划和重新入狱服务，可能会导致一些女性不仅面临实际挑战，而且认知受损，几乎没有认知能力致力于寻找治疗或记忆药物，除了损害其身心健康的常见行为外，几乎无法做任何事情。这项研究的目的是考察重返大气层的背景如何影响104名患有COD的女性的认知过程和随后的健康决策。因变量包括液体智力和认知控制(RDoC的一个结构)，找到并坚持释放后心理健康和物质使用治疗的能力，以及对物质使用和危险性行为的渴望和抵抗能力。我们还假设，认知功能受损将调节不充分的再入服务对出院后精神困扰、药物使用复发、危险性行为、接受治疗、服药依从性和功能的影响。这项R21概念验证研究将提供可操作的知识，将实验室研究结果扩展到高危临床人群，检查一种新的、重要的机制(即，背景驱动的认知功能减退)，通过该机制发生已知的监狱重新进入健康失败，并开辟新的干预途径。以前被认为是静态的个体不同变量对健康行为(液态智力、自控力、坚持性)有深刻影响的再入狱犯的特征可能会受到背景因素的影响，因此比以前认为的更容易采取补救措施。

DESCRIPTION (provided by applicant): Incarcerated women are a vulnerable population with high rates (~50%) of co-occurring mental health and substance use disorders (COD). Previous research, including ours, has established that re-entry into the community from prison is characterized by scarcity, competing demands, and tradeoffs, especially for women with COD. Faced with poverty, mental illness, addiction, poor physical health, poor vocational skills, lack o education, and violence in their environments, re-entering women with COD need to find and maintain safe, substance-free housing, transportation, legal employment, and mental health and substance use treatment. They must do all of this while avoiding mental health and substance use relapse and furthering efforts to re- unite with children. They are often faced with large and consequential trade-offs: meeting a need in one area may dramatically compromise another. Behavioral economics and cognitive psychology studies of similar circumstances (scarcity, trade-offs, repeated challenges to self-control) in the laboratory suggest that these circumstances consume cognitive processing resources, produce (reversible) decrements in fluid intelligence and ability to inhibit impulses, rendering subsequent decisions prone to favoring impulsive, intuitive, and often regrettable options. If these effects hold true for women leaving prison, the implication would be that the failure to devote adequate resources to discharge planning and re-entry services may contribute to some women having not only practical challenges, but being cognitively impaired, with little cognitive capacity to devote to finding treatment or remembering medications, and able to do little besides the familiar behaviors that compromise their mental and physical health. The purpose of this study is to examine how the re-entry context affects the cognitive processing and subsequent health decisions of 104 women with COD. Dependent variables include fluid intelligence and cognitive control (an RDoC construct), ability to locate and persist in post-release mental health and substance use treatment, and craving for and ability to resist substance use and risky sex. We also hypothesize that impaired cognitive functioning will mediate the effects of inadequate re-entry services on post-release psychiatric distress, substance use relapse, risky sex, receipt of treatment, medication adherence, and functioning. This R21 proof-of-concept study will provide actionable knowledge by extending laboratory findings to a high-risk clinical population, examining a novel, important mechanism (i.e., contextually-driven decrements in cognitive functioning) by which known prison re-entry health failures occur and opening new avenues for intervention. Characteristics of re-entering prisoners that profoundly affect health behaviors (fluid intelligence, self-control, persistence) previously thought to be static individual differene variables may be influenced by contextual factors and thus more open to remedies than previously believed.