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

描述（由申请人提供）：被监禁的妇女是一个易受伤害的群体，同时出现精神健康和物质使用障碍（COD）的比例很高（约50%）。先前的研究，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性、竞争性需求和权衡，特别是对于有COD的女性。面对贫困、精神疾病、成瘾、身体健康状况不佳、职业技能差、缺乏教育和环境中的暴力，重新进入的吸毒妇女需要找到并维持安全、无物质的住房、交通、合法就业以及心理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，并进一步努力与孩子团聚。他们经常面临巨大而重要的权衡：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中对类似情况（稀缺、权衡、反复挑战自我控制）的研究表明，这些情况消耗了认知处理资源，导致（可逆的）流体智力和抑制冲动的能力下降，导致随后的决定倾向于冲动、直觉和往往令人遗憾的选择。如果这些影响也适用于即将离开监狱的妇女，那么就意味着，未能将足够的资源用于出院规划和重返监狱服务，可能会导致一些妇女不仅面临实际挑战，而且认知能力受损，几乎没有认知能力用于寻找治疗或记住药物，除了损害其身心健康的熟悉行为之外，几乎无法做任何事情。本研究的目的是研究再入环境如何影响104名COD女性的认知加工和随后的健康决策。因变量包括流体智力和认知控制（RDoC结构），在释放后的精神健康和药物使用治疗中定位和坚持的能力，以及对药物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解不充分的再入服务对释放后精神困扰、物质使用复发、危险性行为、接受治疗、药物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，将实验室发现扩展到高风险临床人群，检查已知的监狱再入健康失败发生的一种新的重要机制（即，情境驱动的认知功能下降），并为干预开辟新的途径。以前被认为是静态的个体差异变量的重新入狱囚犯的特征（流体智力、自我控制、毅力）深刻影响健康行为，可能受到环境因素的影响，因此比以前认为的更容易得到补救。

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.