Center on Sentencing and Corrections

Shedding Light on “the Hole”: A Systematic Review and Meta-Analysis on Adverse Psychological Effects and Mortality Following Solitary Confinement in Correctional Settings

Shedding Light on “the Hole”: A Systematic Review and Meta-Analysis on Adverse Psychological Effects and Mortality Following Solitary Confinement in Correctional Settings

Luigi, Mimosa, Laura Dellazizzo, Charles-Édouard Giguère, Marie-Hélène Goulet, and Alexandre Dumais. “Shedding Light on ‘the Hole’: A Systematic Review and Meta-Analysis on Adverse Psychological Effects and Mortality Following Solitary Confinement in Correctional Settings.” Frontiers in Psychiatry 11 (2020), 840.

This article in Frontiers in Psychiatry provides a systematic review and meta-analysis of previous research exploring the psychological effects of segregation and the mortality rates of incarcerated people exposed to conditions in segregation. The analysis included 13 studies, including a total of 382,440 incarcerated people—of which 23 percent experienced segregation. To be included in the review, studies needed to include an analysis of segregation (measured as 22 to 24 hours per day in a cell) in a federal, state, provincial, or remand facility, a comparison group of incarcerated people from the general population, and measurements of psychological symptomatology, self-harm, or mortality effects after exposure to segregation. Studies also had to report symptoms on a scale to allow for calculations of rates.

Researchers found that “segregation was associated with an increase in adverse psychological effects, self-harm, and mortality, especially by suicide.” Additionally, studies included in the meta-analyses that examined mortality showed a trend for a “moderate effect for mortality by any or unnatural causes (i.e., suicide, homicide, overdose, and accidents).” The authors conclude that segregation is associated with psychological deterioration for incarcerated people, which is distinctly different from the effects of general incarceration or the presence of prior mental illness, and thus “may pose significant harm” to those subjected to it. They note further research is needed to pinpoint whether exposure to segregation can increase the risk of death post-release. The article also includes a discussion of some alternatives to segregation that may reduce psychological harm—including recommendations to partner correctional agencies from Vera’s Safe Alternatives to Segregation Initiative.

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Keywords: Canada, mentally ill, meta analysis, health, physical harm, psychosis, mood, hostility, symptoms, death.