Epidemiological analysis of schizophrenia and incarceration: A multi-center exploration of the criminalization of mental illness in the United States.

OBJECTIVE

This study investigates the diagnostic relationship between schizophrenia and incarceration and elucidates a temporal relationship between these conditions.

METHODS

This analysis utilized TriNetX (December 2024), querying 60+ U.S. Healthcare Organizations using ICD-10-CM codes to compare the prevalence ratio (PR) of schizophrenia in patients with and without electronic health record (EHR) documented incarceration, and conversely, to compare the PR of incarceration in patients with and without schizophrenia. An additional cumulative incidence ratio (CIR) analysis was performed to compare cumulative incidence of incarceration after schizophrenia diagnosis to that of incarceration before diagnosis.

RESULTS

Of 80,224 patients with incarceration history, 7.35 % had schizophrenia, compared to 0.36 % among those without incarceration (PR: 20.3, 95 % C.I. 19.8-20.8). Of 423,270 people with schizophrenia, 1.4 % had incarceration history compared to 0.06 % among people without schizophrenia (PR: 21.6, 95 % C.I. 21.0-22.1). Schizophrenia followed incarceration in 1.5 % of cases, while incarceration followed schizophrenia in 0.93 % (CIR: 0.62 %, 95 % C.I. 0.53-0.71 %).

CONCLUSIONS

Schizophrenia is overrepresented in incarcerated populations, and incarceration may be a risk factor for schizophrenia presentation. Adopting a medicalized approach to criminal justice may help alleviate the U.S.'s mass incarceration crisis.