Intellectual disability and patient activation after release from prison: a prospective cohort study

Area of Science:

• Health Services Research
• Disability Studies
• Criminology

Background:

• Intellectual disability (ID) and patient activation are critical factors influencing health service access and outcomes for individuals transitioning from prison.
• Inequities in healthcare access and outcomes persist for individuals with ID post-release.
• The role of prior identification of ID before prison release on post-release outcomes requires further investigation.

Purpose of the Study:

• To assess the association between intellectual disability (ID) and patient activation among individuals after prison release.
• To examine if the association between ID and patient activation differs based on prior identification of ID before release.
• To identify the impact of incarceration as an opportunity for ID identification and linkage to community services.

Main Methods:

• Screened 936 prisoners for intellectual disability (ID) using the Hayes Ability Screening Index.
• Administered the Patient Activation Measure (PAM) at baseline and at 1, 3, and 6 months post-release.
• Employed multilevel linear models and propensity score matching to analyze the association between ID status, prior identification, and PAM scores.

Main Results:

• Ex-prisoners screening positive for ID exhibited significantly decreased mean PAM scores over 6 months, regardless of prior identification.
• Individuals identified with ID prior to release showed a significant increase in PAM scores at the 6-month follow-up.
• Untreated ID in ex-prisoners is associated with substantially lower patient activation levels.

Conclusions:

• Ex-prisoners with intellectual disability (ID) experience reduced patient activation for at least 6 months post-release.
• Individuals with unidentified ID appear particularly vulnerable, underscoring the need for identification during incarceration.
• Prison release presents a critical window for identifying ID and initiating connections to essential health and community support services.