Prevalence and patterns of sexual assault across the life span among incarcerated women

Childhood Victimization and Adult Incarceration: A Review of the Literature

A growing body of work estimates the prevalence of childhood victimization among incarcerated people. The present study seeks to descriptively and quantitatively summarize this abundant literature by reviewing studies that report childhood victimization prevalence among people incarcerated in the United States. The review includes any study of childhood victimization that uses a sample of incarcerated adults (age eighteen or older) and that reports the proportion of the sample that experienced child abuse and/or neglect. Sixty-seven studies met these criteria and were analyzed, encompassing 1,187,044 incarcerated individuals. The studies vary in sample characteristics, methodological features, and employ an exceedingly wide range of victimization measures. Meta-analyses for pooled prevalence rates revealed that the inter-study heterogeneity was too great to draw conclusive summary estimates of childhood victimization from this literature, even when disaggregating by victimization type. Exploratory t-tests and correlation analyses suggest that a study's sample size, racial, ethnic, and gender composition, and variation in victimization measurement can influence reported child abuse and neglect, but more research is needed to fully assess how study characteristics influence reported victimization prevalence. Understanding the extensiveness of childhood victimization histories among incarcerated people emphasizes the need for robust screening and treatment for people within correctional facilities, as well as improved community prevention and intervention efforts.

Sexual Trauma Informed Understanding of Longitudinal Depression among Repeat Juvenile Offenders

Childhood sexual assault (CSA) victimization and depression are global public health concerns that disproportionately affect youths involved in the juvenile justice system. Little research has examined the influence of CSA on the stability of depressive symptoms among repeat juvenile offenders. The present study tested a gendered model of the association between lifetime CSA victimization and depression for three time points: baseline juvenile assessment entry; second reentry; and third reentry. Further, covariate analyses were conducted to explore the impact of socio-demographics on CSA victimization and depression. Results indicate that CSA victimization was associated directly with baseline depression and indirectly with depression at second reentry for both male and female justice-involved youths. For white, male youth, there were significantly higher rates of depression over time, than other males. However, age, African American or Hispanic race/ethnicity, living situation, and urbanity were not significantly associated with CSA victimization at baseline or depression over time. These findings underscore the need for juvenile justice services that address exposure to childhood trauma and mental illness more effectively.

Characteristics Associated with a History of Physical and Sexual Abuse in a Community Corrections Sample

Background: Most predictors of future criminal justice involvement are gender neutral. However, recent research has stressed the importance of physical and sexual abuse as a precursor of incarceration for women. Purpose: The aim of the present study was to assess the influence of a history of physical and sexual abuse on mental health, substance use, and criminal justice history for men and women under community corrections supervision. Methods: A sample of 613 (203 women and 410 men) participants completed structured clinical interviews and questionnaires assessing demographics, mental health and abuse history (physical vs. sexual), substance use, and criminal justice involvement. Results: Results of multivariate analyses indicated that for men, physical abuse was linked to White race, a higher number of arrests, history of a person offense, family problems, and suicidality; while sexual abuse was linked to White race, family problems, suicidality, and antisocial personality disorder. For women, physical abuse was only associated with meeting criteria for an anxiety or depressive disorder; while sexual abuse was linked to reporting a history of a substance offense, meeting criteria for an anxiety or depressive disorder, and increased suicidality. Substance use was not associated with any form of abuse in either gender. Conclusions: In general, abuse was associated with worse mental health and more severe criminal justice involvement. Women reported much greater rates of abuse and our results provide some support for the idea that a history of abuse may be an important precursor to criminal justice involvement for individuals under community corrections supervision.

Childhood Abuse, Nonsuicidal Self-Injury, and Suicide Attempts: An Exploration of Gender Differences in Incarcerated Adults

The relationship between types of childhood abuse, suicide attempts, and nonsuicidal self-injury (NSSI) was examined in a sample of 415 incarcerated adults (268 men, 147 women). Men and women were equally likely to experience childhood abuse, although women were more likely to report sexual abuse and men were more likely to report emotional neglect. Sexual abuse was the only type of abuse found to predict NSSI and suicide attempts in women. For men, physical abuse and physical neglect were significant predictors of NSSI and suicide attempts, respectively. Gender differences exist and should be examined in future research in this area.

Violent Victimization and Substance Dependency: Comparing Rural Incarcerated Heterosexual and Sexual Minority Women

This exploratory study examines the relationship between sexual identity and violent victimization experiences as predictors of differences in illicit substance and alcohol use and substance use problems among a sample of incarcerated women in rural Appalachia (N = 400). Results indicated that, compared to heterosexual women, sexual minority women were more likely to have a lifetime history of weapon, physical, and sexual assault, and were younger at the time of their first violent victimization. Sexual minority women were younger than heterosexual women at the age of onset for intravenous drug use and at the time they first got drunk, and were more likely to report having overdosed. Multivariate analysis found violent victimization to be the strongest predictor of a history of overdose and substance use problems.

Childhood adversity and adult depression among the incarcerated: differential exposure and vulnerability by race/ethnicity and gender

The relationship between childhood adversity and adult depression is well-established but less is known about the association between childhood adversity and adult depression among the incarcerated. In this paper, we examine differential exposure and vulnerability to childhood adversity by race/ethnicity and gender on adult depression among the incarcerated in the United States. We address three research questions: does exposure to childhood adverse experiences vary by race/ethnicity and gender? Is there an association between these childhood adverse events and depression and does the strength of the association vary by the specific adverse experiences? And does vulnerability to childhood adversity vary by gender and race/ethnicity? Using the 2004 Survey of Inmates in State and Federal Correctional Facilities (SI-SFCF), we measure four key childhood adverse events - parental/caretaker substance abuse, physical assault, having been placed in foster care, and sexual assault. We use ordinary least squares regression and a series of interaction effect analyses to examine differential exposure and vulnerability to the four childhood adverse experiences by race/ethnicity and gender. Incarcerated women are more likely to report parental substance abuse, but all inmates/prisoners are similarly vulnerable to this experience. For the other three adverse experiences measured, we find that there are important racial/ethnic and gender differences in both exposure and vulnerability. African American men and women are more vulnerable to the effects of physical and sexual victimization than White and Hispanic men and women. Women are much more likely to be exposed to sexual victimization, but men who report this experience are significantly more depressed. Hispanic women and White men and women are more likely to report foster care, but all inmates/prisoners who report foster care experiences are significantly more depressed than other inmates/prisoners, with the exception of white men. The findings indicate that there are significant differences in exposure and vulnerability to childhood adversity by race/ethnicity and gender. We conclude that in order to effectively design and implement programs to decrease the probability that childhood adversity is a risk factor for adult depression interventions must be targeted toward specific, vulnerable groups according to race/ethnicity and gender.

Perceived stress, external locus of control, and social support as predictors of psychological adjustment among female inmates with or without a history of sexual abuse

Given the growing number of women who are incarcerated across the United States, the current study investigated the relationships among female inmates' perceptions of their own stress, external locus of control (LOC), social support adequacy, and various aspects of psychological functioning. Generally, female inmates with a self-reported history of childhood sexual abuse did not differ from their nonabused counterparts on the variables of interest. Results suggested that female inmates' perceptions of higher stress, a higher degree of external LOC, and inadequate social support correlated with greater symptoms of depression and hopelessness as well as lower self-esteem. In regression analyses, stress and social support were significant predictors for depression and anxiety. In contrast, stress was the only significant predictor of hopelessness and self-esteem. Finally, none of the predictors examined here was significant in the prediction of traumatic stress. Overall, findings suggested the importance of stress and social support in the prediction of female inmates' adjustment, specifically their symptoms of depression and anxiety.

Emotional dysregulation and risky sex among incarcerated women with a history of interpersonal violence

Incarcerated women, in comparison to nonincarcerated women, are at high risk for sexually transmitted infections (STIs) and many have experienced interpersonal violence. The psychological construct of emotional dysregulation-which includes heightened intensity of emotions, poor understanding of emotions, negative reactivity to emotion state, inability to control behaviors when experiencing emotional distress, and maladaptive emotion management responses-is a possible pathway to explain the link between interpersonal violence exposure and STI risk. The present study examined maladaptive emotion management responses for emotional dysregulation (i.e., avoidance and numbing, and dissociation) occurring in the context of risky sexual behavior. We collected qualitative data from 4 focus groups with a sample of n = 21 incarcerated women (aged 18+ years) from urban facilities in New England. Qualitative data were analyzed using a thematic analysis approach. Findings indicated that incarcerated women reported engaging in a variety of maladaptive responses for emotion management during sexual encounters. These maladaptive responses for emotion management appear to increase sexual risk behaviors and alter women's ability to implement STI protective behaviors, such as sexual negotiation and condom use. Preventive interventions to reduce sexual risk behaviors should incorporate strategies to promote emotional regulation among incarcerated women with histories of interpersonal violence.

Incarceration during pregnancy: implications for women, newborns and health care providers

Women are now the fastest growing group among incarcerated persons in the United States. With approximately 6 percent to 10 percent of incarcerated women pregnant, the intersection of pregnancy and incarceration is an important issue. Incarcerated women are more likely to experience illness and serious diseases, and pregnant incarcerated women are particularly vulnerable, reporting late or less than optimal prenatal care. Nurses working in labor and delivery, postpartum units and correctional facilities are at the forefront of assessment, education and advocacy for pregnant women who are incarcerated. This column takes a second look at two recent studies in which researchers examined the health of pregnant incarcerated women (and their newborns) and discusses the importance of advocacy for this at-risk population.

Differences among incarcerated women with assaultive offenses: isolated versus patterned use of violence

A majority of the existing research on women's use of violence focuses on intimate partner violence, often excluding other types of violence for which women may be incarcerated. The current study expands this area of research by assessing between and within-group differences among a randomly selected group of incarcerated women (n = 543). Comparisons between violent and nonviolent offense types among women found few differences, but significant differences among women with an assaultive offense, based on the presence or absence of a self-reported uncaught violence, were found. Differences in women with isolated (i.e., single incident of violence perpetration through a review of formal and self-report data) and patterned uses of violence were present in relation to issues of mental health, substance abuse, criminogenic risk, and expressions of anger and personality factors. These findings have important implications for intervention as well as future research.

Correctional facilities as partners in reducing HIV disparities

The United States now has the highest incarceration rate in the world. The majority of prison and jail inmates come from predominantly nonwhite and medically underserved communities. Although incarceration has adverse effects on both individual and community health, prisons and jails have also been used successfully as venues to provide health services to people with HIV who frequently lack stable health care. We review demographic trends shaping the difficulties in providing care to incarcerated people with HIV and recommend the Centers for AIDS Research Collaboration on HIV in Corrections as a model of interdisciplinary collaboration in addressing those difficulties.

A syndemic model of women incarcerated in community jails

OBJECTIVE

The purpose of this study was to test whether variations in substance abuse, mental health diagnoses, individual experiences of violence, community experiences of violence, and incarceration history may be reduced to a single underlying syndemic factor for a sample of women incarcerated in three Midwestern U.S. jails.

DESIGN AND SAMPLE

Secondary data analysis of a cross-sectional study of a medical utilization survey; initial confirmatory factor analysis tested fit of model; modification indexes provided confirmatory fit. 290 women incarcerated in three urban Midwestern U.S. jails.

MEASURES

Demographics and variables associated with women's criminal justice experience and sexual health risk were assessed. The analysis included women's mental health, drug dependence, childhood sexual and physical abuse, and partner violence.

RESULTS

The final model had four variables with significant pathways: childhood sexual abuse, childhood physical abuse, domestic violence, and mental health diagnoses. The fit of this model was very good (χ(2) (1) = 0.6; CFI = 1.00; standardized RMR = 0.0147), strongly suggesting the intertwined nature of the variables.

CONCLUSION

Clarification of the specific components in a syndemic model for this population will allow for the implementation of interventions with the appropriate inclusion of content. In interventions and clinical practice, public health nurses should consider these interrelationships.

Pain characteristics and pain catastrophizing in incarcerated women with chronic pain

Chronic pain in incarcerated women is understudied and poorly described. Study objectives were to describe pain characteristics, correlates, and predictors in a convenience sample of incarcerated women with chronic pain. A survey packet that included the Brief Pain Inventory Short Form (BPI-SF) and the Pain Catastrophizing Scale (PCS) was distributed to all inmates at a state prison for women. Those who self-identified as having chronic pain ≥4 on a 0-10 numeric rating scale were invited to complete the survey. Demographics and medical and psychiatric diagnoses were abstracted by chart review. Participants (N=159) rated their current and average pain intensity as severe. Pain catastrophizing was found to predict average pain intensity and level of pain-related interference in functioning. Pain catastrophizing is treatable with behavioral intervention in the general population. Findings suggest that pain catastrophizing may be an important target for research and treatment in incarcerated women with chronic pain.

Substance use coping as a mediator of the relationship between trauma symptoms and substance use consequences among incarcerated females with childhood sexual abuse histories

Rates of substance use and maltreatment are alarmingly high among incarcerated women. Although the direct link between trauma and substance use has been established, less is known about potential mediators. Thus, we examined substance use coping as a mediator between trauma symptoms and substance use consequences among a sample of incarcerated females (N = 111) who were survivors of childhood sexual abuse. Trauma symptoms predicted the severity of substance use consequences, with this relationship being mediated fully by avoidance coping (e.g., using substances to cope). Overall, trauma histories are important in predicting outcomes but must be examined in the context of current coping behaviors and substance use. Findings (data collected in 2007/2008) may help promote interventions that target patterns of coping and/or emotional avoidance among trauma survivors with substance use problems in incarcerated populations. The study's limitations are noted.

Creating trauma-informed correctional care: a balance of goals and environment

BACKGROUND

Rates of posttraumatic stress disorder and exposure to violence among incarcerated males and females in the US are exponentially higher than rates among the general population; yet, abrupt detoxification from substances, the pervasive authoritative presence and sensory and environmental trauma triggers can pose a threat to individual and institutional stability during incarceration.

OBJECTIVE

The authors explore the unique challenges and promises of trauma-informed correctional care and suggest strategies for administrative support, staff development, programming, and relevant clinical approaches.

METHOD

A review of literature includes a comparison of gendered responses, implications for men's facilities, and the compatibility of trauma recovery goals and forensic programming goals.

RESULTS

Trauma-informed care demonstrates promise in increasing offender responsivity to evidence-based cognitive behavioral programming that reduces criminal risk factors and in supporting integrated programming for offenders with substance abuse and co-occurring disorders.

CONCLUSIONS

Incorporating trauma recovery principles into correctional environments requires an understanding of criminal justice priorities, workforce development, and specific approaches to screening, assessment, and programming that unify the goals of clinical and security staff.

Navigating the challenges of prison research with women

Despite the healthcare needs of an increasing number of incarcerated women in the United States, few researchers access this underserved population. The authors provide practical information to help novice researchers navigate potential institutional challenges including obtaining institutional review board approval, gaining entry, complying with rules and regulations, recruiting and retaining participants, and collecting data.

Childhood trauma and risk for past and future suicide attempts among women in prison

PURPOSE

We sought to determine whether childhood trauma is an independent risk factor for past suicide attempts and the future likelihood of attempts among women in prison.

METHODS

A random sample of 247 women incarcerated in a state prison in Las Vegas, Nevada, completed a confidential interview that included the Childhood Trauma Questionnaire, the 18-item Brief Symptom Inventory, standard measures of illicit drug use, and the revised Suicidal Behaviors Questionnaire. Multiple logistic regression models were developed to evaluate the independent influence of cumulative childhood trauma on past suicide attempts with intent to die and the future likelihood of suicide attempts.

RESULTS

Childhood trauma was frequently reported by female prisoners: emotional abuse (58%), physical abuse (54%), sexual abuse (51%), emotional neglect (53%), and physical neglect (41%). Factors independently associated with past suicide attempts included having a higher childhood trauma score (p < .001), a higher psychological distress score (p=.005), and longer duration of current incarceration (> or =5 years; p=.003). Childhood trauma (p=.05), psychological distress (p < .001), and lack of legal employment before incarceration (p=.05) were independent risk factors for future likelihood of attempting suicide.

CONCLUSIONS

Childhood trauma is an independent risk factor for attempted suicide among women in prison that persists into adulthood and cannot fully be attributed to psychological distress, illicit drug use, or incarceration duration. Addressing the emotional impact of childhood trauma among female prisoners may increase the effectiveness of correctional suicide prevention efforts.