Psychological Distress in Solitary Confinement: Symptoms, Severity, and Prevalence in the United States, 2017-2018.
Level 4 - case-series / case-control
Uncontrolled prospective longitudinal cohort / case-series design without a concurrent control group
PubMed 31967876 · doi:10.2105/AJPH.2019.305375
What was done
Researchers evaluated 106 randomly selected incarcerated individuals in long-term solitary confinement within the Washington State Department of Corrections in 2017. Data were collected using semistructured qualitative interviews, Brief Psychiatric Rating Scale (BPRS) assessments, and systematic audits of medical and disciplinary records. Follow-up BPRS assessments and interviews were conducted 1 year later with 80 of the participants, followed by descriptive statistical and qualitative content analysis.
What was found
BPRS assessments identified clinically significant symptoms of depression, anxiety, or guilt in half of the cohort. Review of administrative records showed disproportionately high rates of serious mental illness and self-harming behavior compared to general prison populations, though specific numerical rates and effect sizes were not reported in the abstract. Qualitative analysis documented symptoms of social isolation, loss of identity, and sensory hypersensitivity.
Why it matters
These findings provide systematic empirical evidence of high psychiatric symptom severity among people held in long-term solitary confinement, informing correctional health standards and post-release transition planning.
Limits
The study evaluated a single state prison system, limiting generalizability to other jurisdictions. The sample size was modest (n = 106 baseline, n = 80 follow-up) with 25% attrition over 1 year. The study lacked an internal concurrent non-isolated comparison cohort, making it impossible to isolate the causal effect of confinement from pre-existing psychiatric morbidity, and the abstract omits specific numeric frequencies for administrative findings.
Cited by
- supports Solitary confinement in prisoners impairs mental health and disrupts their sense of self.