Substance use disorder, psychiatric illness, and suicide risk among hospitalized incarcerated adults: A retrospective study using National Inpatient Sample (NIS) database
Karun Shrestha, Prakriti Subedi, Manoj Ghimire, Roshan Thapa, Nicolette Khalifian, Sanjay Bhandari, Pinky JhaAbstract
Background and Objectives
Hospitalization offers a limited but important opportunity to address medical and psychiatric needs among incarcerated adults, who have high burdens of substance use disorder (SUD), mental illness, and suicide‐related risk. National comparative data by SUD status remain sparse.
Methods
We conducted a retrospective study using the National Inpatient Sample (2016–2021) of hospitalized adults with ICD‐10 codes indicating incarceration to evaluate the association between SUD and psychiatric comorbidity, suicidality, and hospitalization outcomes in the United States.
Results
Among 92,715 ( N ) hospitalized incarcerated adults, 40.4% had SUD. Patients with SUD were younger (40.7 ± 11.4 vs. 48.4 ± 13.9 years) and more frequently female (22.2% vs. 12.6%). SUD was strongly associated with suicidal ideation (75.4% vs. 38.6%; adjusted odds ratio [aOR] 3.73; p < .001). Multivariable analyses demonstrated higher odds of major depressive disorder (aOR 1.43), schizophrenia‐spectrum disorders (aOR 1.61), bipolar disorder (aOR 1.66), anxiety disorders (aOR 2.07), trauma‐related disorders (aOR 1.90), and personality disorders (aOR 1.63) (all p < .001). Despite this, SUD was associated with lower in‐hospital mortality and total charges, with no significant difference in length of stay.
Discussion and Conclusions
SUD is highly prevalent and independently associated with increased psychiatric burden and suicide‐related risk in hospitalized incarcerated adults. These findings support prioritizing integrated inpatient approaches to address co‐occurring addiction and mental health conditions in this vulnerable population.
Scientific Significance
These findings identify SUD as a significant factor associated with psychiatric morbidity and suicidality among incarcerated patients, highlighting hospitalization as an important opportunity for integrated screening, assessment, and care delivery.