Childhood maltreatment and NSSI in prisoners: mediation through self-identity and moderation by sensation-seeking

Introduction

The prevalence of non-suicidal self-injury (NSSI) among prisoners is widely recognized. However, most research conducted in prisons setting has focused on lifetime engagement in NSSI, with limited knowledge about its correlates and risk factors during imprisonment.

Methods

Drawing on the integrated theoretical model of NSSI, this study aimed to examine the combined effects of childhood maltreatment (an environmental factor) and two intrapersonal factors, namely self-identity and sensation-seeking, on NSSI. 1042 Chinese male offenders participated in the current study, and regression analyses is used to examine the relationship among variables.

Results

The results revealed that self-identity mediated the association between childhood maltreatment and prisoners' NSSI. Sensation-seeking moderated the relationship between self-identity and NSSI, and this connection was only significant for offenders with high sensation-seeking.

Discussion

We discuss the results of the current research and possible practical implications.

Trauma, post-traumatic stress disorder and violence in the prison population: prospective cohort study of sentenced male prisoners in the UK

BACKGROUND

Violence is a common problem in prisons. Post-traumatic stress disorder (PTSD), a prevalent disorder in prison populations, has been identified as a risk factor for violent behaviour in community and military populations. Although cross-sectional associations between PTSD and prison violence have been documented, prospective cohort studies are required.

AIMS

To investigate whether PTSD is an independent risk factor for prison violence, and examine the potential role of PTSD symptoms and other trauma sequelae on the pathway from trauma exposure to violent behaviour in prison.

METHOD

A prospective cohort study was conducted in a large, medium security prison in London, UK. A random sample of sentenced prisoners arriving into custody (N = 223) took part in a clinical research interview, which assessed trauma histories, mental disorders including PTSD, and other potential sequelae of trauma (anger, emotion dysregulation). Incidents of violent behaviour were measured with prison records covering the 3 months after reception into custody. Stepped binary logistic regression and a series of binary mediation models were performed.

RESULTS

Prisoners who met current (past month) criteria for PTSD were more likely to engage in violent behaviour during the first 3 months of imprisonment, after adjusting for other independent risk factors. The relationship between lifetime exposure to interpersonal trauma and violent behaviour in custody was mediated by total PTSD symptom severity. Hyperarousal and negatively valenced cognitive and emotional appraisal symptoms were particularly implicated in this pathway.

CONCLUSIONS

The identification and treatment of PTSD has the potential to reduce violence in prison populations.

PTSD and complex PTSD in sentenced male prisoners in the UK: prevalence, trauma antecedents, and psychiatric comorbidities

BACKGROUND

Posttraumatic stress disorder (PTSD) is highly prevalent within prison settings, yet is often unidentified and undertreated. Complex PTSD (CPTSD) has been recently formally recognised in the International Classification of Diseases 11th revision (ICD-11) diagnostic framework but has never been explored in prison settings. We aimed to establish the prevalence of ICD-11 PTSD and CPTSD in a UK prison sample using a validated instrument (the International Trauma Questionnaire). We also explored the associations of these two diagnoses with their traumatic antecedents and psychiatric comorbidities.

METHOD

Randomly selected male, sentenced prisoners in a large medium-security prison in south London (N = 221) took part in a clinical interview which assessed PTSD, CPTSD, trauma histories, and comorbid disorders. Multinomial logistic regression was performed to examine differences between those with PTSD or CPTSD, and those without symptoms.

RESULTS

A total of 7.7% (95% CI 4.5-12) of the male sentenced prisoners met diagnostic criteria for ICD-11 PTSD and 16.7% (95% CI 12.1-22.3) for CPTSD. A diagnosis of PTSD was associated with more recent traumatic exposure, comorbid generalised anxiety disorder, alcohol dependence, and Cluster B personality disorder. A diagnosis of CPTSD was associated with complex trauma exposure antecedents (developmental, interpersonal, repeated, or multiple forms), and comorbid with anxiety, depression, substance misuse, psychosis, and ADHD.

CONCLUSIONS

This study confirms that CPTSD is a very common and comorbid condition in male prisoners. There is an urgent need to develop trauma-informed care in prisons.

Adverse childhood experiences and adult self-harm in a female forensic population

AIMS AND METHOD

This study aimed to investigate the prevalence of adverse childhood experiences (ACEs) among patients in a female forensic psychiatric in-patient medium-secure unit, and to analyse the link between ACEs, adulthood self-harm and associated comorbidities and risk factors. The study used a cross-sectional design, with data gathered from the anonymised electronic health records of patients.

RESULTS

It was found that there was a high prevalence of both ACEs and self-harm among this patient group, and that there was a relationship between the two; those with more ACEs were more likely to have self-harmed during adulthood. Of the individual ACE categories, it was also demonstrated that emotional abuse had a significant association with adulthood self-harm.

CLINICAL IMPLICATIONS

In medium-secure settings for women, implementation of trauma-informed care will be beneficial because of the high number of those with mental disorders who have experienced adversity during their childhood.

Trauma exposure and mental health of prisoners and ex-prisoners: A systematic review and meta-analysis

The present meta-analytic review examined the associations between different forms of trauma and mental disorders among prisoners and ex-prisoners. Studies published from 1998 to March 31 2021 were identified by searching PsycINFO, PubMed, Medline and Web of Science. Data were meta-analyzed using a random-effect model. Moderator and mediator analyses were conducted. The protocol was registered in PROSPERO (CRD42020181587). We identified 62 studies (50 non-duplicated samples) with 15,115 (97.86%) prisoners and 330 (2.14%) ex-prisoners in 16 countries. A multi-level meta-analysis found that overall trauma was positively associated with more diagnoses or symptoms of mental disorders (Zr = 0.198, 95% CI = [0.167, 0.229], p < 0.001). Stronger effect sizes were found between childhood trauma (Zr = 0.357, 95% CI = [0.147, 0.568], p < 0.01) and sexual trauma (Zr = 0.326, 95% CI = [0.216, 0.435], p < 0.001) and stress-related disorders. Multilevel moderator analysis showed that effect size was stronger in imprisonment trauma (β = 0.247, 95% CI = [0.177, 0.316], p < 0.01), mixed trauma (β = 0.234, 95% CI = [0.196, 0.272], p < 0.001), and stress-related disorders (β = 0.261, 95% CI = [0.214, 0.307], p < 0.01). Associations between trauma and mental disorders were mediated by social support but not coping. Our findings provide an evidence base for future research on the impact of trauma and inform assessments and interventions in correctional settings.

Posttraumatic stress symptomology and non-suicidal self-injury: The role of intrusion and arousal symptoms

BACKGROUND

Previous evidence has shown a strong relation between Posttraumatic Stress Disorder (PTSD) symptomology and Non-Suicidal Self-Injury (NSSI). The current study aimed to extend prior research by investigating the relationship between PTSD symptom clusters (arousal and intrusion) and NSSI, and putative moderators of this association within a large-scale adult sample in England.

METHOD

A subsample of participants with experiences of trauma in adulthood (n = 2,480) from the Adult Psychiatric Morbidity Survey 2007 (APMS 2007) was utilised to examine the relations among PTSD intrusion and arousal symptom clusters, childhood interpersonal trauma, perceived social support and lifetime NSSI.

RESULTS

Arousal symptoms were consistently associated with NSSI, even when adjusting for multiple covariates, and had a stronger relationship than intrusion symptoms. Childhood interpersonal trauma was independently and significantly associated with lifetime NSSI after adjusting for covariates. The moderating effects of childhood interpersonal trauma and perceived social support were not statistically significant.

LIMITATIONS

The study was cross-sectional and utilised self-report assessments to measure PTSD, NSSI, and childhood interpersonal trauma.

CONCLUSION

Findings support the role of PTSD arousal and childhood interpersonal trauma in relation to NSSI. The moderating role of childhood interpersonal trauma and perceived social support lacks supporting evidence. Findings highlight the need for NSSI screening as well as for specific interventions that target the complex needs of those who exhibit elevated PTSD arousal symptoms, especially those with a history of childhood interpersonal trauma.

PTSD in prison settings: A systematic review and meta-analysis of comorbid mental disorders and problematic behaviours

Purpose

Prevalence rates of PTSD are higher in the prison population than in the community. We sought to systematically review the extent to which this disorder is associated with other mental health disorders and problematic suicidal or aggressive behaviours in the prison population.

Methods

Studies reporting a relationship between PTSD and comorbid mental disorders and/or problematic behaviours in imprisoned adolescent and adult populations were identified from four bibliographic indexes. Primary studies involving clinical interviews, validated instruments leading to DSM or ICD diagnoses, or validated self-report questionnaires such as the PTSD checklist were included. Random-effects meta-analysis was conducted where possible. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results

This review identified 36 studies, with a combined sample of 9594 participants, (6478 male and 2847 female prisoners) from 11 countries. Thirty-four of the identified studies employed a cross-sectional design. We identified significant associations between PTSD and comorbid mental disorders including depression (OR = 3.4, 95% confidence interval (CI): 2.3–4.9), anxiety (OR = 2.9, 95% confidence interval (CI): 1.8–4.7) and substance use (OR = 1.9, 95% confidence interval (CI): 1.5–2.4). We also identified significant associations between PTSD and suicidality (OR = 3, 95% confidence interval (CI): 2.4–3.8) and aggressive behaviours (this latter finding was not subject to meta-analysis). Significant methodological heterogeneity was identified between studies.

Conclusions

High rates of psychiatric comorbidity among prisoners with PTSD, and links to suicidal behaviour, self-harm and aggressive behaviour, provide further support for the need for trauma-informed treatment approaches in prisons. However, significant gaps in the current evidence were apparent. In particular, a lack of large, longitudinal studies meant that the temporal relationships between PTSD and relevant outcomes cannot currently be determined.