Mental health issues and associated factors amongst healthcare workers in US forensic-correctional settings: a systematic review of literature since the COVID-19 pandemic.
Healthcare professionals provide essential services to populations in the criminal justice system, often at the expense of their own well-being. This review synthesized literature findings on mental health challenges faced by healthcare professionals working in the US forensic-correctional settings since the COVID-19 pandemic. We investigated the prevalence of mental health conditions, their risk-protective factors, the impacts of these mental health issues on workplace retention, and highlighted relevant recommendations.
This study followed PRISMA guidelines. A comprehensive search of major databases (PubMed/MEDLINE, PsycINFO, Web of Science, CINAHL, and Embase) was conducted and supplemented with citation chaining to identify eligible reports spanning January 1st 2020 up to March 18th, 2025. Article screening, full-text review, and data extraction were completed by two independent investigators. Study quality was assessed using the NIH tool for quantitative studies and the Critical Appraisal Skills Program (CASP) framework for qualitative studies.
A total of 10,005 identified reports were screened, with seven fair-to-good eligible studies included in the final review. Both quantitative (n = 4) and qualitative (n = 3) studies were included, and spanned multiple states, with most studies (n = 3, 42.9%) conducted in California. Healthcare workers reported various mental health conditions such as depression (48%), anxiety (18.8-51.1%), sleep disorders (17.4%), burnout (47.2%) and PTSD (49.3%), albeit significant heterogeneity constrains comparative analysis. Qualitatively, workers experienced considerable isolation, personality shifts, and cognitive dissonance. Risk factors predictive of mental health conditions included increased workload (β = 0.18, p < 0.001), workplace conflict (β = 0.15, p < 0.001), female sex (β = 0.10, p = 0.04), younger age, chronic medical conditions (β = 0.09, p = 0.03), fears around COVID-19 (β = 0.14, p < 0.001), and a lack of pandemic safety training (p = 0.033). Protective factors included resilience, administrator and peer support, access to needed resources, and a sense of fulfilment and purpose from working with populations in forensic-correctional settings.
Systemic reforms including decreased mandatory overtime, staffing, workload distribution, organizational support, training, improved communication, access to adequate resources and psychosocial interventions may help promote wellness and optimize the ability of healthcare workers to provide care in forensic-correctional settings. However, the preliminary nature of the study findings suggests caution in their interpretations. Further high-quality research is needed to support evidence-informed decision-making and translation.
This study followed PRISMA guidelines. A comprehensive search of major databases (PubMed/MEDLINE, PsycINFO, Web of Science, CINAHL, and Embase) was conducted and supplemented with citation chaining to identify eligible reports spanning January 1st 2020 up to March 18th, 2025. Article screening, full-text review, and data extraction were completed by two independent investigators. Study quality was assessed using the NIH tool for quantitative studies and the Critical Appraisal Skills Program (CASP) framework for qualitative studies.
A total of 10,005 identified reports were screened, with seven fair-to-good eligible studies included in the final review. Both quantitative (n = 4) and qualitative (n = 3) studies were included, and spanned multiple states, with most studies (n = 3, 42.9%) conducted in California. Healthcare workers reported various mental health conditions such as depression (48%), anxiety (18.8-51.1%), sleep disorders (17.4%), burnout (47.2%) and PTSD (49.3%), albeit significant heterogeneity constrains comparative analysis. Qualitatively, workers experienced considerable isolation, personality shifts, and cognitive dissonance. Risk factors predictive of mental health conditions included increased workload (β = 0.18, p < 0.001), workplace conflict (β = 0.15, p < 0.001), female sex (β = 0.10, p = 0.04), younger age, chronic medical conditions (β = 0.09, p = 0.03), fears around COVID-19 (β = 0.14, p < 0.001), and a lack of pandemic safety training (p = 0.033). Protective factors included resilience, administrator and peer support, access to needed resources, and a sense of fulfilment and purpose from working with populations in forensic-correctional settings.
Systemic reforms including decreased mandatory overtime, staffing, workload distribution, organizational support, training, improved communication, access to adequate resources and psychosocial interventions may help promote wellness and optimize the ability of healthcare workers to provide care in forensic-correctional settings. However, the preliminary nature of the study findings suggests caution in their interpretations. Further high-quality research is needed to support evidence-informed decision-making and translation.
Authors
Yu Yu, Wang Wang, Berdugo Berdugo, Towheed Towheed, Yang Yang, Moosavi Moosavi, Lalji-Mawji Lalji-Mawji, Czapla Czapla, Ostermeyer Ostermeyer, Olagunju Olagunju
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