Discussion
psychiatric illness, psychiatric, OUD, anxiety/depression
DISORDER, CHRONIC PAIN, APPENDIX, COMPLICATIONS
Increased psychiatric complications, as measured by the ASI, were strongly associated with reduced HRQoL scores over the period immediately following incarceration, in all domains explored (mobility, anxiety/depression, pain/discomfort), as well as a relatively large decrease in overall utility. Although the ASI does not diagnose psychiatric illness, it does target problematic mental health areas in individuals with substance use disorder. Other studies have found a similar association between HRQoL and mental health among individuals with SUD, including OUD, [Increased severity of one’s medical condition was associated with a significant reduction in their HRQoL within the pain/discomfort domain, and was negatively correlated with their overall utility, but just outside of the traditional 5% threshold at p = 0.06. Given the high prevalence of chronic conditions among persons with OUD, particularly among those who are incarcerated, the results are not necessarily surprising. This is representative of previous literature which has shown that OUD is often associated with comorbid medical conditions, including chronic pain [Additionally, individuals with health insurance were more likely to have worse HRQoL in the pain/discomfort domain. As this result was not expected, further bivariate analyses were conducted to explore the potential causal mechanisms (Appendix Table Although not significantly associated with any of the individual HRQoL domains, family/social relationship issues were associated with slightly higher utility. This finding is in contrast to previous studies examining family/social relationships and HRQoL, which indicated that as family/social relationships improve, HRQoL improves as well, including among individuals undergoing treatment for OUD/SUD [The primary strengths of this study were the longitudinal and detailed nature of the data, which allowed us to analyze determinants of HRQoL at different time points surrounding an individual’s release from incarceration. Limitations of this study included the small sample size (n = 86), and the extent of missing data for the 12-week follow-up period. As discussed in the methods section and supplementary appendix, MICE was used to minimize potential bias arising from the missing data, and sensitivity analyses were conducted to evaluate alternative imputation methods. Furthermore, the racial/ethnic make-up of the study population was 62% Non-Hispanic White/Caucasian, 20% Non-Hispanic Black/African American, and 16% Hispanic-Puerto Rican, whereas according to the August 2022 Philadelphia Prison Population Report, the racial/ethnic make-up was 72.4% Black, 17% Latinx, and 9.3% White. This discrepancy likely limits the generalizability of our findings both within and outside of the Philadelphia Department of Prisons; however, there is little-to-no information regarding the racial/ethnic makeup of the incarcerated population with OUD.