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A Systematic Review of Mental Health Outcomes, Challenges, and
Resilience Among Sexual and Gender Minority Individuals Who Are
Currently and Formerly Incarcerated
Shichao Qiu
Universiti Putra Malaysia, Malaysia
DOI: https://dx.doi.org/10.51244/IJRSI.2025.1215PH000188
Received: 12 October 2024; Accepted: 20 October 2024; Published: 14 November 2025
ABSTRACT
Background: Although the elevated attention has been drawn to sexual and gender minority (SGM) people and
their mental health, those who are currently and formerly incarcerated remain largely overlooked. To understand
both their psychological well-being during and after incarceration and their re-entry challenges is critical for
health equity and inclusion.
Methods: A systematic review was conducted following the PRISMA guidelines to identify peer-reviewed
articles published between 2000 and 2025 from Scopus and Pubmed, with additional relevant records retrieved
from EBSCO. Studies conducted outside the United States were excluded to ensure consistency in legal and
correctional contexts. Eligible studies were analyzed to offer key themes by using thematic analysis approach.
Results: Of the 42 studies identified in this research, 15 articles were included in the final review. Ten out of
fifteen studies examined mental health issues, such as depressive symptom, anxiety and psychological distress.
Six studies highlighted that the need for policy reform and inclusive training for healthcare professionals and
staff is necessary. Disrupted social support and intersectional discrimination were observed among incarcerated
SGM individuals. Four themes were synthesized: (1) Intersected stigma (2) Institutional harm and mental health
consequences (3) Post-release challenges (4) Coping and reintergration strategies.
Conclusions:The findings suggest that community, peer and social support network resources are critical for
fostering resilience and optimizing mental health outcomes for this SGM group during community re-entry.
Policy reform, inclusive training for correctional healthcare professionals, and enhanced community-based
re-entry program are essential to alleviate institutional harm and promote mental health improvement for this
vulnerable population.
Keywords: Sexual and gender minority; incarceration; mental health; discrimination; challenge; resilience
INTRODUCTION
Globally, the United States has the highest incarceration rate, a phenomenon that public health scholars have
described as an “epidemic of incarceration” (Dumout et al., 2013; Baćak et al., 2018). Although the general
incarceration rate in the United States has decreased slightly in recent years (Ghandnoosh, 2020; Bureau of
Justice Statistics, 2023), sexual and gender minority (SGM) people (those who seld-identify as lesbian, gay, or
bisexual or other non-heterosexual sexual orientation) were disproportionately incarcerated: 9.3% of men in men
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in prison, 6.2% of men in jail, 42.1% of women in prison, and 35.7% of women in jail were sexual minorities
(Meyer et al., 2017; Vogler, 2025). Most strikingly, the incarceration rate of self-identified homosexual and
bisexual persons was 1882 per 100000 (Meyer et al., 2017), more than 3 times that of the heterosexual and
cisgender US adult population. Additionally, 12% sexual minorities report being victimized by another inmate,
and 5% report being victimized by staff, compared with 1% and 2% of straight inmates, respectively (Wilson et
al., 2017).
Unsurprisingly, SGM individuals are more likely to experience solitary confinement and other sanctions while
incarcerated, and more likely to report current psychological distress in comparison to the general incarcerated
heterosexual inmates (Beck, 2015; James et al., 2016; Meyer et al., 2017). Together, there is a mounting body of
research indicates incarceration as a powerful social determinant of health (Wildeman & Wang, 2017). Notably,
incarceration may reinforces the existing mental health disparities among SGM individuals. For example, prior
research has shown that the mental illnesses are prevalent in prison populations and are more frequent than in
people of a similar age living in the community (Emilian et al., 2025). Additionally, previous research has also
indicated that SGM people who are incarcerated who have untreated mental health disorders are at elevated risks
of self-harm and suicide attempts (Carter et al., 2022), PTSD (Scanlon et al., 2024), and mortality and recidivism
(Chang et al., 2016), compared to straight inmates. For example, suicide is the second leading cause of death
among U.S. youth, and inadequate mental health screening and treatment in detention facilities further
exacerbates suicide risk (O'Rourke et al., 2023).
However, the long-term mental health impacts of incarceration extend beyond prison walls. Apart from their
sexual orientation, due to the incarcerated background, they will face several barriers to reintegration, including
family disconnection, housing discrimination and employment bias, which further isolate them from healthcare
systems and may ultimately cause recidivism. This highlights the urgency of recognizing incarceration as a
significant health determinant within the SGM individuals and underscores the need to explore effective
strategies to improve quality of post-release life through essential health-related processes. While extensive
research has examined the effects of incarceration on SGM populations, less attention has been paid to its
influence on SGM individuals’ mental health and quality of post-release life. Furthermore, there is a lack of
systematic research on incarceration within the complex digital media environment and how it affects the
community re-entry process for these individuals. Therefore, this study aims to address these research gaps by
systematically reviewing existing literature on the mental health outcomes, challenges, and resilience of SGM
individuals who are currently and formerly incarcerated.
Conceptualization of Incarceration
Incarceration, as a severe phenomenon in the United States, is a powerful social determinant of health (Dumont
et al., 2012). Moreover, sufficient literature has established incarceration as a critical element of health for SGM
individuals (Wilson et al., 2017; Meyer et al., 2017; Baćak et al., 2018; English et al., 2020). In correctional
facilities, rates of infectious diseases, especially HIV, hepatitis, and tuberculosis, and non-communicable disease,
such as cardiovascular problems, are much grater than in the general population (Dumont et al., 2012).
Regarding psychological health, a wealth of evidence shows that people who have experienced incarceration
have disproportionately high levels of psychological difficulties, even after controlling for psychological health
at time of imprisonment (Wildeman & Wang, 2017). Moreover, during the post-release life, the incarcerated
experience exerts profound and multifaceted impacts on mental health among SGM people, significantly
influencing their successful reintegration into society and resulting in what can be termed “secondary
punishment”. Thus, scholars identified the need for “studies of interventions that meet the distinct re-entry needs
of SGM inmates, at high risk for trauma before and after incarceration (Freudenberg & Heller, 2016). Critically,
the most important period during re-entry is immediately following release from confinement, when the risk of
mortality is extremely high (Binswanger et al., 2007). Undoubtedly, incarceration can be an extremely stressful
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challenge for SGM people whose social supports were disconnected during re-entry period.
The Rationale of the Study
Extensive research has been conducted in SGM groups and their mental health outcomes. However, limited
attention has been given to how incarcerated experience affects the psychological well-being of SGM
individuals and how they cope with these challenges. According to the empirical findings, black, gay, bisexual,
and other sexual minority men (SMM) are among the SGM groups facing the highest rates of incarceration in the
U.S. (English et al., 2017; Baćak et al., 2018). Incarceration has both direct effects, and indirect effects through
discrimination, on psychological and HIV-related outcomes among Black SMM. For example, public health data
indicate that HIV seroconversion is more likely among individuals who have been incarcerated, with the highest
risk among Black men (Goff et al., 2012). Indeed, recent incarceration and longer incarceration history has been
linked to post-release HIV risk among SMM (Scheidell et al., 2021), a risk which may be even higher among
Black SMM than their White SMM peers as a result of racial inequities in policing and arrests (Lim et al., 2021).
In general, despite the limited available data on incarceration at the intersection of racial and sexual minority
status, recent estimates from Meyer and his colleagues (2017) indicate that the percentage of Black SMM
incarcerated is at least 15 times greater than the percentage of theses men in the general U.S. population
(Foundation for AIDS Research, 2015). Notably, this is likely an underestimate, as these figures do not include
men who conceal their identity as SMM due to the potential and unsafe environment in prison (Herek, 2009;
Meyer et al., 2017) where anti-SMM violence is commonplace (Baćak et al., 2018). In addition, the prevalence
of heterosexism, as a core component of the institutional oppression faced by SGM people, has been extensively
documented in research. All people are presumed to be heterosexual, and heterosexual behavior and
different-sex relationship are considered normal, natural, and unproblematic (Herek, 2009). This assumption
makes gay, lesbian, and bisexual people invisible in most social situations.
Thus, it is imperative to investigate and comprehend the incarceration impact on mental health and disease
among SGM people. Given the existing gap in the incarceration regarding SGM people, this study aims to offer
a comprehensive examination drawn from diverse community contexts. The intended outcome is to furnish
insights that facilitate enhanced understanding and support from family and social circles for SGM individuals
with historical incarceration experience. Furthermore, the coping strategies will be provided to guide these types
of people to re-entry society reducing recidivism. With that, the two research questions were proposed: (1) to
synthesize evidence on how the experience of incarceration impacts the mental health of SGM individuals in the
United States; (2) to explore the individual coping mechanisms employed by SGM individuals with a history of
incarceration and to examine the role of external support systems (e.g., healthcare, community services) in their
post-release reintegration.
METHODS
This study employed a systematic review methodology to identify, evaluate, and synthesize the existing
evidence on mental health challenges and coping strategies among sexual and gender minority individuals who
are currently or formerly incarcerated in the United States. To ensure transparency and comprehensiveness, this
review process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
Framework (Moher et al., 2009). This framework has shown several benefits. Firstly, the framework allows for a
clear definition of research questions (Page et al., 2021). Secondly, it offers accurate screening metrics that
specify the criteria for inclusion and exclusion (Page & Moher, 2017). Thirdly, it also provides clear and reliable
conclusions to convey vast amounts of information and work to minimize the introduction of bias (Sohrabi et al.,
2021). Fourthly, it can examines large scientific literature databases within a specific time frame (Sierra-Correa
& Kintz, 2015). Figure 1 shows the completed retrieval process. Four basic steps were applied in this systematic
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reviewing process: identification, screening, eligibility, and inclusion.
Figure 1. PRISMA Flow Diagram Outlining the Process of Study Selection
Search Strategy
Firstly, researcher conducted a thorough literature search using two electronic databases (Scopus and Pubmed).
The search strategy used Boolean logic and combined relevant search terms such as “incarceration” and
“post-release” and search strings to identify relevant articles for this study (Table 1). Although Scopus requires a
subscription, it covers numerous journals and subject areas. On the other hand, as a free, searchable
bibliographic database, Pubmed was established and supported by National Library of Medicine. It covers a vast
collection in public health area. Moreover, an extra manual searches were employed using EBSCO database.
This approach is important to ensure that journal articles are not missed during the primary search (Chapman,
2012). The searches spanned from 2000 to 2025. Furthermore, to maximize the scope of the literature search, the
strategy incorporated numerous synonymous keywords, including but not limited to “incarceration”, “prison”,
“detention”, “juvenile”, and “correctional system”.
Table 1 Search strings to identify relevant articles in this study
Databases
Search strings
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Scopus
TITLE-ABS-KEY ( lgbt OR "sexual minority" OR "gender minority" OR transgender ) AND
TITLE-ABS-KEY ( incarceration OR prison OR jail ) AND TITLE-ABS-KEY ( "mental health"
OR depression OR anxiety ) AND TITLE-ABS-KEY ( "post-release" OR re-entry OR "social
support" )
Pubmed
(("Sexual and Gender Minorities"[Mesh] OR transgender persons[Mesh] OR LGBT*[tiab] OR
transgender[tiab]) AND ("Mental Health"[Mesh] OR "Depression"[Mesh] OR
"Anxiety"[Mesh] OR mental health[tiab] OR depression[tiab] OR anxiety[tiab]) AND
(Prisoners[Mesh] OR Prisons[Mesh] OR incarceration[tiab] OR prison[tiab] OR jail[tiab] OR
parole[tiab]) )AND "United States"[Mesh]
Screening and Eligibility
In this stage, all papers meeting the following criteria were eligible for inclusion. Firstly, the timeline was set
from 2000 to 2025. Secondly, only full journal articles were selected. Thirdly, only English was chosen to avoid
the language barrier and reduce the misunderstanding caused by translation. Fourthly, the scope of the search
mainly covers social sciences, psychology, arts and humanities, and communication science since researcher
aims to understand SGM individuals’ mental health with experience of incarceration and their post-release
quality of life from a communication perspective, rather than a purely medical one. Excluding articles during the
systematic review screening is also a crucial step guided by PRISMA principles. Following these guidelines
ensure rigor, transparency, and the integrity of this review. As a result, Table 2 displays inclusion and exclusion
criteria. Finally, 15 studies were included for coding and analyses after screening and eligibility.
Table 2 Inclusion and exclusion criteria
Criterion
Included
Timeline
Literature type
2000-2025
Journals (research articles)
Language
Subject area
English
Social sciences, Psychology,
Arts & Humanities, and Communication.
Data Extraction and Quality Assurance
The researcher carefully extracted the data that answers the research questions (Shaffril et al., 2021). Following
the guidance of Whittemore & Knafl (2005), this process involve three key stages to ensure rigor. Firstly, key
findings and contextual data related to mental health challenges and coping strategies were meticulously
extracted from the full text of each included article. Secondly, the extracted data were categorized and
reorganized into preliminary themes. Third, to ensure the accuracy and consistency of extraction, the extracted
data for a randomly selected 20% of the studies were cross-checked, verifying the accuracy and reducing the risk
of bias or oversight. Notably, this study followed an integrative review approach, incorporating qualitative and
quantitative research methods (Okoli, 2015). Furthermore, mounting studies shown that a mixed research design
is increasingly recognized as crucial for gaining a comprehensive understanding of complex issues from
diverse perspectives (Whittemore & Knafl, 2005; Dixon-Woods et al., 2005; Hopia et al., 2016). As for quality
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appraisal, all eligible articles must be appraised to ensure quality. The researcher qualitatively assessed the
articles by three categories: low, moderate, and high. Only those articles that have fulfilled the inclusion criteria
are considered moderate and high in the category Petticrew and Roberts (2008). Articles that failed to meet these
criteria were excluded. After reviewing the articles, all 15 articles qualified to rank between moderate and high in
categories. Thus, these articles are ready to be reviewed (see Appendix 1).
Data Analysis Approach
In this study, thematic analysis was utilized. Researcher analyzed the data using the qualitative synthesis
approach, guided by the research questions. After data extraction, the raw data was coded and converted into
meaningful data by identifying codes, categories, subthemes, and themes. Similar patterns or disparities and
recurring themes in a table that were related to incarcerated experience and coping strategies among SGM
groups.
RESULTS
This search across the two professionally electronic databases and one manually additional database identified
an initial set of 42 studies, all published between 2000 and 2025. After eliminating duplicate entries, a refined
total of 41 studies remained for a more thorough analysis. Consequently, 22 articles underwent a comprehensive
full-text review. Among these, 7 studies were excluded. A total of 15 studies fulfilled the inclusion criteria and
were therefore included in the final analysis. This review aims to answer two research questions: (1) How does
incarceration affect the mental health of SGM individuals? (2) What individual coping strategies do SGM people
with a history of incarceration utilize, and what support is available to them from external systems (e.g.,
healthcare, community organizations) during post-release reintegration?
Theme Overview Paragraph
Through thematic synthesis, four themes were identified from the reviewed studies. The first theme, intersected
stigma: dual mental burden of SGM identity and incarcerated record, highlights the compounded effects of SGM
stigma and criminal record, which jointly extends psychological distress and social marginalization. However,
the second theme, institutional harm and mental health consequences during incarceration, reveals the structural
and interpersonal violence that SGM inmates face, including lack of policy, solitary segregation, and sexual
victimization, leading to severe mental health issues. However, the third theme emphasizes on post-release
challenges: stigma, recidivism, and reintegration, explores how dual stigmatization extends beyond
incarceration, causing unemployment, homelessness, community rejection, and increased risk of substance use
and recidivism. Finally, the fourth theme, coping and reintegration strategies: from survival to belonging,
focuses on adaptive and institutional coping mechanisms such as selective disclosure, peer support, inclusive
training, and community-based employment and healthcare programs, which foster resilience and social
reintegration.
Intersected Stigma: Dual Mental Burden of SGM Identity and Incarcerated Record
The synthesized evidence consistently indicates that SGM individuals with incarceration histories face a
uniquely compounded form of stigma due to their marginalized sexual identity and orientation and criminal
record. These two types of stigmas are not separated, but they are a synergistic source of psychological distress
that profoundly impacts mental health outcomes. On the one hand, in many cases, carceral environment often
places SGM people in chronically stressful scenarios in which they must actively conceal their sexual identity to
ensure safety. For example, several participants from a qualitative expressed anxiety about performing basic
daily activities such as showering, due to fear of being identified and subsequently harassment by other inmates
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and officers (Harvey et al., 2021). On the other hand, criminal background, as an added stigma, has also caused
numerous troubles during their re-entry period. For example, feelings of isolation and hopelessness were
commonly manifested through self-blame, shame, and social exclusion, which were exacerbated by intersected
stigma. For example, homelessness and unemployment were prevalent among this group, as their frequently
experienced discrimination from both employers and landlords due to their sexual identity and criminal records.
Institutional Harm and Mental Health Consequences during Incarceration
Across multiple studies, incarcerated SGM individuals are at high risk for experiencing verbal, physical, and
sexual assault at the hands of other imprisoned people and/or jail and prison staff (Brown et al., 2015). Moreover,
incarcerated gay and lesbian persons were more frequently exposed to sexual victimization and solitary
segregation than were inmates who identified as straight (Baćak et al., 2018). Furthermore, SGM youth in
juvenile correctional facilities show poorer mental health indicators, as well as higher rates of suicidal ideation,
suicide attempt and self-harm behavior compared with non-SGM counterparts (Clark et al., 2022). Moreover,
victimization plays a crucial role in influencing SGM individuals’ general health outcomes. The correlation
between multiple victimization experiences (e.g., bullying, sexual and physical abuse as a child and as an adult)
and incarceration risk was linked by Hughto er al. (2022), suggesting that physical and sexual assault is
associated with the increased odds of incarceration in one’s life time. Moreover, incarceration has been found to
negatively impact overall health among older SGM people of color, with lifetime incarceration significantly and
positively associated with past 12-month polysubstance use and living with HIV. Additionally, a notable
example of institutionalized harm and stigma is the sex-segregateed housing policy, which allocate residential
spaces based on transgender individuals’ genitalia rather than their gender identity (Hughto et al., 2022). For
example, transgender women are typically incarcerated in men’s prisons, and their feminine appearance or
expression is often mocked and abused by other inmates, correctional healthcare providers and officers (Hughto
et al., 2018). Furthermore, among SGM inmates, the increased likelihood of consensual sex with other
imprisoned persons places them at disproportionate risk for punitive sanctions, which in turn significantly
exacerbate their psychological distress (Meyer et al., 2017). Such repeated exposure to an environment with
discrimination and violence leads to elevated levels of anxiety, depression, and trauma symptoms, highlighting
the dual burden of non-heterosexual identity and carceral oppression. Furthermore, institutional harms not only
emerge during incarceration but often have deep roots in earlier life experiences. Meyer et al. (2017) found that
imprisoned lesbian and gay people had substantially higher odds of sexual victimized in childhood than their
heterosexual peers. These findings suggest that victimization and trauma are part of a broader continuum of
structural vulnerability that begins to form long before incarceration.
Post-release Challenges: Stigma, Recidivism, and Reintegration
The effect of intersected stigma persist well beyond incarceration, continuing to influence the psychological and
social well-being of SGM people (Harvey et al., 2021). Also, these individuals frequently encounter social
exclusion and prejudice from other community members, which critically prevents their reintegration. Selected
research demonstrates that incarceration history is positively associated with severely numerous post-release
challenges, including increasing rates of drug use, unemployment and homelessness, particularly among young
transgender women. Undoubtedly, many return to substance use during re-entry phase as a method of escape for
discrimination, poverty, and social isolation. Moreover, due to the consistent substance use, it associated with
severely unhealthy behaviors, such as, condomless sex and marijuana use. A semi-structured interview revealed
that some individuals were also rejected by the broader LGBT community because of their incarceration history
(Harvey et al., 2021). For example, a lack of support from both family and sexual minority community further
undermines their healthy reentry into society. However, the added stigma of having a criminal record, further
marginalizes these individuals and restricts access to employment, housing, and social support networks.
Interestingly, although illicit drug use tends to increase following release, binge drinking has not been found to
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be significantly associated with incarceration history, suggesting that substance use behaviors may vary by type
and underlying motivation. Beyond healthy behavior, recidivism rates remain disproportionately high among
formerly incarcerated SGM individuals, which is often closely linked to unmet health needs and community
rejection. For example, exposure to community violence and criminal justice involvement have been proved to
be positively associated with psychological distress (Hotton et al., 2019). Consequently, the intersection of
criminal and sexual related stigma creates a cycle of psychological distress, socioeconomic instability, and
recidivism, thereby amplifying the impact of dual stigmatization on re-entry adjustment.
Coping and Reintegration Strategies during Detention and Re-entry
In this review paper, the research has identified two themes in answering research question 2: (1) Strategies for
survival and resistance. (2) Bridge to belonging.
Strategies for Survival and Resistance: Coping Mechanisms in the Face of Adversity
Based on the reviewed researches, several mechanisms were provided to deal with adversity.From the individual
perspective, many SGM inmates disclose their sexual orientation and identity selectively, based on their
assessment of safety and potential risks and benefits in this high-pressure environment of incarceration (Harvey
et al., 2021). For example, Black MSM are less likely to identify as gay or to disclose their sexual identity to
other White MSM (Baćak et al., 2018), due to compound discrimination from their race, sexual orientation and
criminal background. Although this selective disclosure serves as a protective coping mechanism that helps them
avoid temporarily potential risks from sexual harassment, violence and abuse from both inmates and staff, it may
simultaneously reduce opportunities for emotional and social support, after that reinforcing a long-term cycle of
minority stress. Therefore, supportive interventions to alleviate exposure to minority stressors (e.g., verbal and
physical harassment, internalized stigma, social isolation and fear of disclosure) are necessary.
During detention, there are numerous institutional regulations should be strengthened to protect the well-being
of incarcerated SGM individuals. Among these, sensitivity trainings for healthcare providers and staff within
correctional system and community settings plays a crucial role (Jaffer et al., 2016). These people who receive
training on diversity, equity and inclusion, particularly including SGM identities and the experiences of formerly
incarcerated individuals, are more likely to offer respectful and appropriate healthcare. The inclusive practices
help alleviate workplace discrimination and hostile attitudes (e.g., staff homophobia) against SGM individuals,
and also contribute to building a trusting relationship between patients and healthcare providers (Harvey et al.,
2021). Interventions aimed at improving healthcare providers’ knowledge of the unique needs of transgender
individuals within correctional settings have been shown to be efficacious (Jaffer et al., 2016; Hughto et al.,
2017), suggesting that similar interventions targeting all correctional staff could be beneficial for addressing the
diverse needs of SGM inmates. In addition, relevant policy establish a regulatory environment to against sexual
victimization and harassment. For example, the implementation of Prison Rape Elimination Act (PREA) in the
United States has encouraged correctional institutions to adopt more sensitive and gender affirming policies.
These government, educational, and community-led programs have been proved to reach the most vulnerable
trans young adults, enhancing their structural needs and mental health outcomes (King et al., 2023). Compared to
rational rules and regulations, SGM peer support should not be ignored, as it serves as a bridge between formerly
incarcerated SGM individuals and society. For example, a study suggest that a peer health navigator program
plays an important role in supporting Young Black Gay Men (YBGM), a vulnerable group with one of the
highest rates of HIV and incarceration (Donald et al., 2022).
Bridges to Belonging: Community Reconnection as a Pathway to Resilience
According to the reviewed studies, several forms of support and structural intervention have demonstrated
potential to enhance resilience and promote future reintegration among SGM individuals who are currently or
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formerly incarcerated. Peer health navigation programs were highlighted by Gerke er al. (2022), which provide a
personalized assistance to SGM individuals. Normally, social support from peers with same lived experiences
helps participants to receive HIV care, mental health counseling, and social services, after that, medical mistrust
and treatment adherence would be improved. Equally important is the role of employment assistance programs
during re-entry period, which are led by government or community organizations, and were proposed by Jaffer et
al. (2016) as a key strategy to prevent engagement in street economies, such as sex work for economic survival
(Hughto et al., 2022). By helping formerly incarcerated SGM individuals secure stable, long-term employment,
such programs not only provide financial stability but also enhance a sense of self-worth and belonging within
community. Furthermore, support from LGBT-specific organizations should not be ignored, as it plays a key role
in their community re-entry (Harvey et al., 2021). Because, these organizations often serve as safe spaces for
emotional healing and identity affirmation, helping individuals re-build trust in relationship with healthcare
providers, after incarceration. Despite the particularly stressful re-entry process for SGM individuals, many have
demonstrated remarkable resilience in coping with those pitfalls.
DISCUSSION
After reviewing 15 journals articles, it was found that 10 articles followed a quantitative approach while the one
article used a qualitative approach, one adopted mixed-method design, one was a conceptual review, and one was
a data-based review. Notably, the selected studies were not suitable for conducting a meta-analysis due to the
substantial heterogeneity in research designs, measurement instruments, and reported outcomes. Regarding the
origin of the papers,all papers were produced in the United States. Out of the 15 reviewed articles, 10 primarily
focused mental health issues, while the remaining 5 additionally examined health inequalities in carceral settings,
policy reform, and inclusive training for healthcare professionals and staff. Across these studies, many themes
emerged such as psychological consequence of incarceration, structural discrimination within carceral systems,
and the need for inclusive health policies. More than two-thirds (10 out of 15) of reviewed studies adopted
quantitative approaches, offering data-based support for understanding the correlations between incarceration,
stigma, discrimination and mental health outcomes. However, although there was only one purely qualitative
research employed in-depth interviews with 20 gay and bisexual men, the findings provided deeper valuable
insights into their experiences of stigma and isolation. Two review papers indicated that disproportionate
incarceration of SGM individuals and methodological limitations remain unresolved. Additionally, several
studies found that community reconnection program plays a pivotal role in the societal reintegration of SGM
people with incarceration experiences. Support from SGM peers, for example, is significantly crucial for helping
reconnection between formerly incarcerated SGM people and society. Also, a study suggest that a peer health
navigator program plays an important role in supporting Young Black Gay Men (YBGM), a vulnerable group
with one of the highest rates of HIV and incarceration (Donald et al., 2022).
Practical Implications
This research highlights the mental health outcomes, challenges and resilience among SGM individuals during
and after incarceration, offering healthcare professionals valuable insights to better support these SGM people
who are formerly or currently incarcerated. It underscores the unique medical and psychological needs of this
population. The necessity of inclusive, trauma-informed, and identity-affirming approaches in correctional and
community healthcare systems. Moreover, sensitivity training for staff and healthcare professionals is essential
to reduce institutional stigma and improve medical service delivery to SGM inmates. Post-release period should
not be overlooked or treated as separate from incarceration, but rather as a continuous process, during which
psychological distress and structural barriers often remain unresolved. Existing targeted interventions play a
vital role in promoting reintegration and reducing recidivism, such as peer health navigation programs,
employment assistance and community-based counselling. Policymakers and practitioners in hygiene industry
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must collaborate to establish nationally intersectional and sustainable support systems.
LIMITATIONS AND RECOMMENDATIONS
Seveal limitations of this study should be noted. Firstly, this analysis was restricted to studies published in
English and conducted in the United States, which may limit the generalizability of findings to SGM individuals
in other culture or legal contexts. Second, the majority included studies were cross-sectional quantitative
research relied self-reported data, which may cause potential biases and inaccuracy between incarceration
experiences and mental health outcomes. Third, due to the unclear self-disclosure, the representation of
transgender and other non-heterosexual individuals was relatively limited. Fourth, this review did not include
grey literature, government report and unpublished reports, which may have excluded potentially relevant
information. Fifth, only three electronic databases were searched, which may have introduced potential selection
biases. Moreover, the number of selected paper was limited (n = 15), as a result, some relevant contexts may
have been overlooked. Finally, the various definitions of SGM identity provided challenges in synthesizing
consistent findings.
In future research, scholars should use more longitudinal mixed-method designs to capture the dynamic process
of psychological change and resilience among SGM people during and after incarceration. Scholars are also
encouraged to investigate the interdisciplinary of race, gender and sexual orientation within carceral
environment. Meanwhile, future studies are encouraged to employ more diverse and inclusive measures of
sexual identity and attraction to better capture the experiences and participation of SGM individuals. Moreover,
special attention should be paid to underrepresented groups such as transgender women of color and other
non-heterosexual individuals. Furthermore, future reviews should broaden the search strategy to include
specialized healthcare and psychology databases such as PsycINFO, CINAHL and Web of Science. Additionally,
future studies also need to evaluate the effectiveness of intervention programs. Policymakers and practitioners
should also collaborate to develop more inclusive medical service in correctional systems and post-release
communities.
CONCLUSION
Incarceration is a detriment to SGM individuals’ mental health. It often exacerbates pre-existing psychological
vulnerabilities as well as exposes them to additional stressors such as isolation, violence and discrimination. The
cumulative effects of these experiences can lead to long-term mental health challenges that persist even after
release. Furthermore, institutional victimization and lack of gender-affirming support during incarceration also
continue to affect their well-being after release. However, resilience is evident through peer networks and
community-based initiatives. Moreover, this study calls on the U.S. justice system to implement relevant
measures to improve the situation of SGM people in detention centers. Furthermore, health promotion and
mental recovery requires more inclusive, trauma-informed and sustained interventions that bridge incarceration
and post-release support.
Author Contributions
Shichao Qiu solely contributed to the conception, literature search, analysis, and writing of this review.
FUNDING
This research received no external funding.
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI | Volume XII Issue XV October 2025 | Special Issue on Public Health
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Page 2520
Data Availability Statement
All data used to prepare this paper are available from the cited sources.
Conflicts of Interest
Author has no conflicts of interest to declare.
Informed Consent Statement
No applicable.
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APPENDIX 1
No
Year
Authors
Title
Methods
Key Findings
Theme
1
2015
Brown et
al.
Health
correlates of
criminal
justice
involvement
in 4,793
transgender
veterans
Quantitative
research
1. Higher incarceration
risk among transgender
veterans
2. Transgender
justice-involved (JI)
veterans experienced
higher prevalence of
depression, PTSD,
obesity, serious mental
illness, and suicidal
ideation.
1. Health disparities among
transgender justice-involved
populations
2. Need for specialized care
3. Intersection of gender
identity, incarceration, and
mental health
2
2016
Jaffer et
al.
Improving
transgender
healthcare in
the New York
City
correctional
system
Mixed-meth
od
1. After LGBT-focused
staff training across 12
jails clinics, patient
complaints decreased by
over 50%.
2. Following the
implementation of a
revised transgender
healthcare policy,
complaints dropped to
zero within six months.
1. Healthcare inequality
2. Impact of training and
policy reform
3
2016
Meyer et
al.
Incarceration
Rates and
Traits of
Sexual
Minorities in
the United
States:
National
Inmate
Survey,
2011–2012
Quantitative
cross-sectio
nal analysis
by using
National
Inmate
Survey
(2011-2012)
.
1. SGM people
experience higher rates
of sexual victimization
both before and during
incarceration.
2. SGM inmates are
more likely to
experience solitary
confinement and
psychological distress
3. Incarceration rate of
SGM individuals is over
three times higher than
that of general
population.
1. Structural violence and
victimization.
2. Mental health vulnerability
and institutional harm
4. Inclusive policy
interventions
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4
2018
Baćak et
al.
Incarceration
as a health
determinant
for sexual
orientation
and gender
minority
persons
Conceptual
review
based on
existing
public
health data
1. Higher incarceration
rates among SGM
populations
2. Incarceration leads to
severe health risks
3. Health outcomes
within the SGM
population exhibit
heterogeneity.
1.Disproportionate
incarceration of SGM
individuals.
2.Health risks and inequalities
in carceral settings.
3.Healthcare access during
and after incarceration.
4.Methodological and
measurement challenges.
5
2018
Hughto
et al.
A multisite,
longitudinal
study of risk
factors for
incarceration
and impact on
mental health
and substance
use among
young
transgender
women in the
USA
Quantitative
longitudinal
research
1. Recent incarceration
experience amplify
substance use.
2. Incarceration rate is
high in young
transgender women.
3. Both structural and
individual risk factors
predict incarceration
and poor health.
1. Structural and individual
risk factors
2. Need for multilevel
interventions
6
2019
Hotton et
al.
Exposure to
community
violence and
substance use
among Black
men who
have sex with
men:
examining
the role of
psychological
distress and
criminal
justice
involvement
Quantitative
research
1. Over 90% of young
Black MSM reported
lifetime exposure to
community violence,
and 41% had
experienced criminal
justice involvement.
2. Exposure to
community violence
was positively with both
psychological distress
and problematic
substance use.
1. Impact of structural
violence
2. Interconnection between
mental health and criminal
justice
7
2020
English
et al.
Intersectional
social
control: The
roles of
Quantitative
research by
using
Understandi
1. Both incarceration
and police
discrimination were
independently
1. Structural and institutional
oppression.
2. Mental health and
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incarceration
and police
discriminatio
n in
psychological
and
HIV-related
outcomes for
Black sexual
minority men
ng New
Infections
through
Targeted
Epidemiolo
gy study
(UNITE)
associated with higher
levels of psychological
distress and greater
HIV-related risk
behaviors.
2. Intersectional
discrimination (race,
sexuality and criminal
justice)
psychological distress
3. Behaviors related to HIV
and other infectious diseases.
8
2020
Scheidell
et al.
Incarceration,
social support
networks, and
health among
black sexual
minority men
and
transgender
women:
evidence
from the
HPTN 061
Study.
Quantitative
research by
using
secondary
data
analysis of
HPTN 061
Study.
1. Recent incarceration
significantly reduced
both medical and
financial social support
networks
2. Smaller support
networks were linked to
greater depressive
symptoms and increased
sexual risk behaviors.
3. Participants with
larger social networks
showed better health
engagement.
4. The study revealed
incarceration as a
structural barrier to
maintaining supportive
relationships and
accessing care among
Black SGM and
transgender women.
1. Disrupted social support
2. Mental health burden
3. Structural inequality and
marginalization
9
2021
Harvey
et al.
Minority
stress,
psychosocial
health, and
survival
among gay
and bisexual
men before,
during, and
after
incarceration
Qualitative
study by
using
semi-structu
red,
in-depth
interviews
with 20
formerly
incarcerated
gay and
bisexual
men in New
1. Gay and bisexual
men are incarcerated at
nearly twice the rate of
the general male
population.
2. Minority stress plays
a central role in
increasing incarceration
risk and shaping
psychosocial challenges
during and after
1. Post-release stigma and
challenges to social
reintegration.
2. Policy and public health
implications for supporting
gay and bisexual men.
3. Minority stressors as
catalysts for incarceration and
psychosocial harm.
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York City
incarceration.
3. Identity management
both protected against
and exposed them to
further stress and
stigma.
4. The study calls for
public health
interventions addressing
minority stress at all
incarceration stages.
10
2022
Clark et
al.
Mental
Health
Among
Sexual and
Gender
Minority
Youth
Incarcerated
in Juvenile
Corrections
Quantitative
cross-sectio
nal study by
using
Minnesota
Student
Survey data
1. Higher proportion of
incarcerated youth
identified as SGM
individuals compared to
public school youth.
2. Incarcerated SGM
youth reported
significantly higher
rates of suicidal
ideation, suicidal
attempt, and self-harm.
3. Depressive
symptoms were
elevated among SGM
youth regardless of
incarceration status.
1. Mental health disparities.
2. Intersectional vulnerability
and compound disadvantage.
3. Importance of institutional
support for SGM youths in
correctional systems
11
2022
Harvey
et al
Availability
of Accessible
Representativ
e Health Data
to Examine
Sexual and
Gender
Minority
Disparities in
Incarceration
and Its Health
Implications
in the United
States,
Data-based
review and
secondary
analysis
(Interview,
secondary
data
analysis and
systematic
review)
1. Life time
incarceration rates
among SGM
populations were
significantly higher than
heterosexual
populations
2. To highlight key data
gaps in public health
research on
incarceration and health
disparities among
marginalized minority
1. Disproportionate
incarceration of SGM
individuals.
2. Data limitation in studying
SGM individuals.
3. Lack of nationally
representative data.
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2010–2020
groups.
3. To indicate lack of
standardized,
representative data on
incarceration among
gender minorities
12
2022
Gerke et
al.
Help is
available:
supporting
mental
wellness
through peer
health
navigation
with young
Black men
who have sex
with men
with HIV
Longitudina
l
mixed-meth
ods,
non-experi
mental
study
(Quantitativ
e survey and
qualitative
interviews)
1. There is no
statistically significant
improvement in mental
health symptoms with
higher intervention
engagement, though
those with more
depressive symptoms
attended fewer sessions.
2. Qualitative data
showed positive
perceived effects,
participants valued peer
support and emotional
connection.
3. Over 25% of
participants had
clinically significant
depression, anxiety, and
nearly half reported
moderate or higher
PTSD symptoms.
1. Peer-based mental health
support
2. Barriers to care
engagement
3. Psychosocial resilience
and trust
4. Training needs for peer
health navigators
13
2022
King et
al.
Structural
needs,
substance use
and mental
health among
transgender
and
nonbinary
young adults
in the San
Francisco
Bay area:
findings from
the Phoenix
Longitudina
l
quantitative
study
1. Incarceration history
is one of structural
needs.
2. Greater structural
needs were associated
daily marijuna use and
suicidal ideation.
3. Unmet structural
needs were associated
with depressive
symptoms.
1. Structural vulnerability
2. Mental health and
substance use
3. Need for multisector
support
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Study
14
2022
Hughto
et al.
Victimization
within and
beyond the
prison walls:
a latent
profile
analysis of
transgender
and gender
diverse adults
Quantitative
study
(Online
survey)
1. High victimization
significantly increased
the likelihood of
lifetime incarceration.
2. Transgender women
are more likely to have
been incarcerated.
3. HIV-positive and
visibly gender
non-conforming
individuals experienced
higher victimization
levels in prison.
1. Structural inequality
2. Cycle of victimization
3. Need for inclusive
intervention
15
2024
Feelemy
er et al.
Impact of
decarceration
plus alcohol,
substance
use, and
mental health
screening on
life
expectancies
of Black
sexual
minority men
and Black
transgender
women
(BSMM/BT
W) living
with HIV in
the United
States: A
simulation
study based
on HPTN 061
Quantitative
study by
using
secondary
data
analysis
1. Baseline life
expectancy (LE) for
BSMM/BTW with HIV
was 61.3 years, notably
lower than the general
positive population.
2. Reducing
incarceration by
25%-100% could
increase LE by
0.29-1.08 years.
3. To combine
comprehensive
screening and treatment
will extend LE by 1.52
years.
1. Structural inequality and
incarceration
2. Mental health and
substance use burden