Physical victimization in prison: the role of mental illness

This study compares prison physical victimization rates (inmate-on-inmate and staff-on-inmate) for people with mental disorder to those without mental disorder in a state prison system. Inmate subjects were drawn from 14 adult prisons operated by a single mid-Atlantic State. A sample of 7,528 subjects aged 18 or older (7,221 men and 564 women) completed an audio-computer administered survey instrument. Mental disorder was based on self-reported mental health treatment ever for particular mental disorders. Approximately one-quarter of the sample reported some prior treatment for schizophrenia, bipolar disorder, depression, PTSD, or anxiety disorder. Rates of physical victimization for males with any mental disorder were 1.6 times (inmate-on-inmate) and 1.2 times (staff-on-inmate) higher than that of males with no mental disorder. Female inmates with mental disorder were 1.7 times more likely to report being physically victimized by another inmate than did their counterparts with no mental disorder. Overall, both males and females with mental disorder are disproportionately represented among victims of physical violence inside prison.     

Mental Health Among Incarcerated Women: An Examination of Factors Impacting Depression and PTSD Symptomology

Female offenders experience mental health symptoms at a higher rate than male offenders and females in the community. The current study investigated individual characteristics and experiences that may impact symptoms of depressive disorders and posttraumatic stress disorder (PTSD) among a sample of female inmates in a large Southern prison system. Results showed high rates of reported childhood and adult victimization experiences among the sample. Factors such as seeking mental health treatment prior to incarceration significantly impacted the reporting of depressive and PTSD symptoms, as did victimization histories. Findings suggest that women would benefit from screening to identify mental health needs at the onset of incarceration as well as gender responsive needs assessment and programming to address histories of victimization and current mental health symptomatology.     

Traumatic Event Exposure and Behavioral Health Disorders among Incarcerated Females Self-Referred to Treatment

At least half of the women inside prison have mental health problems, have experienced physical, sexual, or emotional abuse during their formative years and often in adulthood, and have addiction problems. Only a minority of these women receive treatment for their behavioral health problems associated with trauma while incarcerated, even though these problems are risk factors for returning to prison after release. This study focuses on the traumatic experiences and behavioral health problems of a group of female inmates who volunteered in August 2009, to be screened for admission into an integrated trauma-reentry program implemented at an adult female correctional facility. Of the 278 women who self-referred for screening, 196 preliminarily met the time eligibility criterion of residing at the prison for eight to 24 more months. Half of these women (n?=?97) were actually time-eligible for screening and agreed to be screened. Of this sample of treatment-seeking soon-to-be-released female prisoners, the vast majority (93%) reported significant and complex histories of traumatic event exposure and high rates of either posttraumatic stress disorder (PTSD) or sub-threshold PTSD, past alcohol and other substance abuse or dependence, other axis I psychiatric disorders, and subjective distress. Identifying trauma exposure histories and associated behavioral health problems within this population and providing effective interventions holds potential promise for preparing incarcerated women to manage their post-release lives in ways that will keep them safe, healthy, and in the community.     

Pregnancy in prison,mental health and admission to prison mother and baby units

Little is known about the mental health of pregnant women in prison in England or the factors which impact admissions to prison mother and baby units (MBUs). Research from the UK suggests women with more ‘stable’ backgrounds and lower prevalence of mental disorder are more likely to be admitted to prison MBUs. Eighty-five pregnant women were interviewed in eight different prisons. Schedules for the Clinical Assessment of Neuropsychiatry (SCAN) and Edinburgh Postnatal Depression Scale (EPDS) were used to assess mental health; Severity of Dependence Questionnaire (SOD-Q) for drug misuse; Alcohol Use Identification Test (AUDIT) for hazardous drinking; and the Structured Clinical Interview for DSM-IV (SCID-II) to identify personality disorder. Fifty-one per cent of participants had depression and 57% had anxiety. Those who were working prior to imprisonment were more likely to be admitted to MBUs, and those with a prior social services involvement, diagnosis of personality disorder or history of suicidality were less likely to be admitted. The high levels of depression and anxiety can have negative impacts on both the mother and her unborn child. Factors which influence MBU admission suggest those who might benefit most from MBU placement are least likely to be admitted.     

Social support among releasing men prisoners with lifetime trauma experiences

High rates of lifetime trauma experiences exist among men incarcerated in US state and federal prisons. Because lifetime trauma experiences have been linked to problematic behavioral and psychiatric outcomes for incarcerated populations, trauma-informed interventions could improve post-release well-being of releasing men prisoners with trauma histories. Social support has consistently been found to have a positive impact on trauma-related outcomes in non-incarcerated populations. Therefore, it is reasonable to hypothesize that social support may be an important intervention component for releasing men prisoners with trauma experiences; yet, the relationship between trauma experiences, psychiatric and behavioral factors, and social support has received almost no attention in research with men prisoners. Using a probability sample of 165 soon-to-be-released men, the present study examined differences in certain demographic, criminal justice history, mental health, substance abuse, and social support (type, quality, amount, and source) variables between releasing men prisoners with and without lifetime trauma experiences. Results indicate that men with trauma histories had more negative social support experiences and fewer positive social support resources before prison than their counterparts. Men with trauma histories also had more lifetime experiences with mental health and substance use problems. On further investigation of the subsample of men with trauma histories, those who were older, had substance use disorders, and histories of mental health problems anticipated fewer post-release social support resources. Study findings underscore the nuances of social support for men prisoners with trauma experiences and point to implications for future directions in targeted trauma-informed intervention development for releasing men prisoners.     

Examining the Traumatic Effects of Sexual Victimization on the Health of Incarcerated Women

Data from the 2004 Survey of Inmates in State Correctional Facilities were used to examine the effects of sexual abuse on the physical and mental health of incarcerated women. This nationally representative sample consisted of a cross-section of 2,885 female inmates ranging in age from 16 to 74. Using bivariate analysis, we made comparisons between sexually abused (n = 1,205) and non–sexually abused (n = 1,680) inmates. Abused women were more likely to report increases in health problems and mental health diagnoses, as well as other self-reported mental health conditions, such as paranoia, depressive symptoms, anger, and lifestyle changes. Respondents with extensive sexual abuse histories (multiple and across the life cycle) were also more likely to suffer higher levels of paranoia, depression, chronic health problems, and attempted suicide.     

An integrated exploration of factors associated with psychological distress among older prisoners

This paper compares the contributions of socio-demographic, health, mental health, social and environmental factors in explaining variations in psychological distress among older prisoners in two Australian states. One hundred and seventy-three prisoners (aged 50+ ) from 8 Australian prisons were interviewed using the Kessler Psychological Distress (K10) Scale. Three regression analyses were conducted to compare different models of 14 variables significantly associated with psychological distress. Independent variables most prominently associated with variations in psychological distress among older inmates were self-reported levels of social support, self-reported safety and ease of health care access. Difficulties in the built environment and mental health history were significantly explanatory of variations in older prisoner distress in two of the three models. The findings suggest that modifiable situational factors evident in current prison contexts are reasonably explanatory of variations in prisoner distress among older inmates.     

Current psychopathology in previously assaulted older adults

Older adult women age 55+ years (N = 549) were interviewed as part of a population-based epidemiological research study of lifetime experiences with physical and sexual assault and current mental health problems. Although overall rates of psychopathology were low, producing very small cells for comparison, women who reported experiencing physical assault an average of 28 years previously were more likely to present with past year substance abuse, depression, and avoidance and reexperiencing symptoms of posttraumatic stress disorder (PTSD) than those with no previous physical or sexual assault. Women who reported experiencing sexual assault an average of 50 years previously were more likely to present with autonomic arousal and avoidance symptoms of PTSD than those with no prior sexual assault. The aforementioned findings should be considered with caution, however, as sample cell sizes were minimal for all but the PTSD symptom subtypes. Mental health service implications for older adults are discussed.     

Substance use,health, and mental health: problems and service utilization among incarcerated women

This article profiles self-reported substance use, health, and mental health problems among a sample of incarcerated women in Kentucky as well as lifetime service utilization. Findings indicate that a high percentage of women reported use of alcohol, cocaine, and multiple substances during the month before incarceration. In addition, participants reported common health problems such as dental, female reproductive, physical injuries, and mental health problems including depression and anxiety. Participants reported moderate use of emergency room and mental health treatment but limited substance abuse treatment utilization. Implications for criminal justice programs and linkages with community-based aftercare services for women are recommended based on findings that health and mental health problems are associated with service utilization before incarceration.     

Pregnancy in prison,Mother and Baby Unit admission and impacts on perinatal depression and ‘quality of life’

Limited research exists on the impact of prison mother and baby unit (MBU) residence. Research in the UK suggests women in MBUs have lower prevalence of mental disorder. Higher rates of mother-child attachment for women in prison nurseries in the US have been reported. Eighty-five pregnant women were interviewed at baseline and 62 followed up in nine different prisons. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure perinatal depression; the World Health Organisation Quality of Life (WHOQOL – BREF), for quality of life; and the Mother-to-Infant Bonding Scale (MIBS) for mother-child bonding. EPDS scores were higher at baseline than follow-up. Women admitted to MBUs had lower EPDS scores at baseline and follow-up, and this reduction was greater than for women not admitted to MBUs. WHO-QOL scores were higher at follow-up than baseline on all domains, except the social domain for those not admitted to MBUs. Findings suggest women with perinatal depression are less likely to be admitted to MBUs, and MBU placement may contribute to a reduction in perinatal depression. Increased QOL-BREF scores at follow-up suggest improved quality of life for all participants. Reduced support post-separation may contribute to lower social domain scores for women not admitted to MBUs.     

Evaluation of the improving access to psychological therapies for offenders programme at HMP Lincoln: a three year prospective cohort study

The mental health needs of prisoners are significant with a high incidence of common mental health problems including anxiety and depression. Extending national initiatives such as the National Health Service Improving Access of Psychological Therapies programme to people in prison offers a valuable opportunity to address these mental health problems and improve continuity of care from prison to the community. This study adopts an observational, prospective cohort design and evaluates an IAPT for offenders service over the first three years of operation within a male Category B prison holding remand/convicted prisoners. The evaluation found large effect sizes for changes in anxiety and depression with clinical recovery being achieved in 55% of depression and 52% of anxiety cases. On average, prisoners were treated in less than five sessions employing a low-intensity cognitive-behavioural approach. The lack of established formal diagnoses and a control group limits the findings.     

Self-report rates of physical and sexual violence among Spanish inmates by mental illness and gender

High rates of mental illnesses and victimization have been reported for prison populations. This study estimates physical and sexual victimization rates (inmate-on-inmate and staff-on-inmate) for people with and without mental illnesses residing in Spanish prisons. A random sample of 2484 male and 225 female inmates was drawn from eight prisons in Spain. Self-report data were collected on victimization, mental illness and sociodemographic characteristics. Prevalence rates of physical and sexual victimization during the past six months in prison among men with mental illnesses were higher than for men without reported mental illnesses (39.1% vs. 16.4% and 8.6% vs. 3.3%, respectively). Similar comparative results were found for women with and without mental illnesses (29.7% vs. 17.5% and 13.3% vs. 10.3%, respectively). A positive association was found between mental illnesses and victimization. This evidence suggests the need for integrated trauma treatment and proactive steps to protect incarcerated persons from violence during incarceration.     

Perceptions of control,depressive symptomatology,and self-esteem of women in transition from abusive relationships

The relation between women’s histories of experiencing violence and current psychological health were examined. Locus of control, feelings of personal power, depressive symptomatology, self-esteem, and judgments of control over a contingently responsive computer display were investigated in groups of 21 abused women and 18 comparison women. Within the sample of abused women, relationships between severity of abuse and the psychological variables were also examined. The group of abused women had lower beliefs in self-efficacy, were more depressed, and had lower self-esteem than the comparison women. There were no differences found, however, between the two groups in perceptions of control on the computer task. Severity of physical abuse among the abused women was positively correlated with depression scores. Verbal abuse was found to contribute significantly to many of the between-group differences. Empirical evidence of the positive impact of transition house residence on the abused women’s mental health was also presented. The importance of future research into both the differential effects of verbal and physical abuse on women and the role of the transition house in empowering abused women were discussed.     

The mental health and substance misuse needs of male ex-armed forces personnel in prison

Ex-armed forces personnel constitute the largest known occupational group in prison but there is little evidence regarding their mental health, or substance misuse, needs. A total of 105 participants were interviewed and measures assessing symptoms of common mental health (CMH) problems and substance misuse were completed along with a review of their health care records. Forty (38%) participants screened for current CMH problems (CCMH) and high levels of dual symptomology and alcohol misuse were assessed. Thirty-nine (37%) had a mental health diagnosis recorded, most commonly for post-traumatic stress disorder (PTSD), depression and personality disorder. Those who screened for a CCMH problem were more likely to have pre-service vulnerability to negative health outcomes and those with dual symptomology were more likely to have experienced deployment during their service. Findings suggest the mental health needs of this group are similar to the general prison population. Potentially higher prevalences of PTSD and alcohol misuse may direct service provision.     

Revictimized Adult Women: Perceptions of Mental Health Functioning and Associated Services

In this study, using a sample of adult women (N = 418) from various environments, mental health outcomes and perceptions about different types of support following childhood and adulthood sexual and physical violence were assessed. The respondents were from three locations: general community, state prison, and sexual assault and domestic violence service providers. A cluster analysis based on victimization experiences was conducted; subsequent analyses showed that women who endured more types of abuse had more self-reported mental health difficulties. Somewhat paradoxically, women who utilized more therapeutic services held more negative perceptions of their mental health functioning, while use of tangible services had no significant association. Those who found therapeutic services helpful had significantly higher self-reported concurrent mental health functioning.     

Restrained Voices

Abstract

This research presents the voices of women inmates on health care services in prisons. Foucault's discourse analysis as a means of bringing to the surface restrained voices provides the theoretical basis for this study. The research is based on face-to-face interviews of fifty-six women inmates to understand better the role gender plays in prison health care delivery. The results show that women are willing to discuss only physical ailments and are reluctant to speak about mental health care or HIV. While women benefit from health care services in prison, they still feel that a female-oriented approach to health care in general will improve the services tremendously. This approach is not dictated by the “difference” in the ailments between men and women, but by the “difference” in the way men and women encounter health care providers and illnesses.     

The prevalence of violence and relation to depression and illicit drug use among incarcerated women in Recife, Brazil

PurposeTo assess the prevalence and different types of violence experienced by women prisoners in Brazil and the effects of violence on women's depression and illicit drug use.MethodsParticipants (N = 377) were incarcerated women from a state prison in a northeastern city of Brazil. Multivariate logistic regression models (adjusted for age, education, partner status, prison history, drug related offense, and sentencing status) were used to assess associations between each type of violence (physical abuse, sexual abuse, and life threats) and each outcome variable: recent depression and illicit drug use.ResultsThe majority of participants (87%) reported experiencing some type of violence in their lifetime, including physical violence (83%), sexual victimization (36%), and threats on their life (29%.) Sexual violence was significantly related to both recent depression (Odds Ratio (OR) = 2.8; 95% Confidence Interval (CI) = 1.4–5.3) and recent substance use (OR = 2.7; 95% CI = 1.6–4.4) in adjusted models. Experiences of life threats were also significantly associated with illicit drug use (OR = 2.2; 95% CI: 1.3–3.7), as was physical violence (OR = 2.4; 95% CI: 1.2–4.9); however, neither of these latter two violence variables were significantly associated with depression.ConclusionReports of lifetime violence victimization among this incarcerated sample of women were extremely prevalent and relevant to women's depression and illicit drug use. Prison efforts to address women's depression and illicit drug use may be most effective by incorporating aspects related to women's history of victimization, especially given the high rates of violence experienced by women in this sample.     

Early detection and early intervention in prison: improving outcomes and reducing prison returns

Our aim was to investigate whether early detection was feasible in prison and whether it could improve mental health outcomes in young prisoners. A secondary aim was to explore whether it can reduce returns to prison. Between 2011 and 2014, a total of 2115 young prisoners were screened, 94 (4.4%) met criteria for ultra-high risk for psychosis and were offered an intervention, 52 actually received it. Return to prison data were sought on the 52 participants, receiving a formal intervention. Of the 52 prisoners who received an intervention, 30.8% returned to custody compared to national average reconviction rates of between 45.4 and 66.5%. Our results suggest that early detection is a feasible option in a prison setting, improving mental health outcomes and reducing returns to prison. Mental health outcomes were recorded for a sub-sample of those receiving the intervention. The results indicated statistically significant improvements on measures of depression, anxiety and psychological distress.     

Gray Matters: Gender Differences in the Physical and Mental Health of Older Inmates

Although there has been a substantial increase in the number of older female inmates incarcerated in the United States, there has been little scholarly attention paid to this population. The purpose of this study is to extend the current understanding of older inmates by examining gender differences in their physical and mental health. Bivariate analyses of one of the largest known samples of older female inmates (n = 142) revealed significant gender differences. Older female inmates reported a greater number of physical health conditions and mental health disorders in all three time periods: in their lifetimes, since admission to prison, and in the previous year. This research informs the need for gender-specific health programming for older female inmates.