A Call for Help: Women Offenders' Reflections on Trauma Care

Female prisoners have extensive trauma histories and complex treatment needs that contribute to their criminality, yet trauma screening and treatment is not widespread in prisons. This article examines qualitative data gathered from face-to-face interviews with 31 female offenders in Canadian prisons. Using a grounded theory approach we demonstrate an unmet need for trauma-specific services for female offenders. These services go beyond trauma-informed practice and treat the psychological and behavioral sequelae of trauma exposure (e.g., mental illness and addictions) to facilitate recovery. The findings suggest that women in prison want and need specific treatment for trauma exposure. Integrating trauma-specific services involves a cultural shift within the prison environment that might be achieved by positioning trauma within the risk–need–responsivity model as an additional risk factor for criminality. Although counter to the public health perspective that trauma is a health concern, it is a way to ensure that trauma becomes part of the battery of care in corrections so that the needs of traumatized women are addressed while they are in custody. This was a unique opportunity to learn about what women would like to help deal with their experiences of trauma.     

An Analysis of Advertisements: A Lens for Viewing the Social Exclusion of Women in Police Imagery

This study examines whether there are differential relationships among trauma exposure, familial risk and protective factors, substance abuse, and posttraumatic stress disorder (PTSD) among incarcerated and non-incarcerated women. A case-control method was used to match 100 incarcerated women with 100 women in the general population. Incarcerated women had a significantly higher risk of trauma exposure as compared with controls, with odds ranging from 1.7 to 3.7. When group was controlled, exposure to sexual or physical trauma significantly increased the odds of PTSD (odds ratio = 5.0; p < .05), as did substance use in response to traumatic distress (odds ratio = 8.9; p < .001). Family-related characteristics did not appear to moderate this relationship. The findings suggest that incarcerated women are at high risk for PTSD given their high rates of trauma exposure and apparent lack of appropriate coping mechanisms; the results support the use of trauma-specific interventions for this population.     

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 Predictors of Depression Among Older Incarcerated Women

For older women in prison, adjustments to prison life are often affected by a variety of mental and physical health symptoms. Many come to prison with specific histories of traumatic life experiences that place them at risk for high levels of depression. Using data gathered from 327 older women (mean age = 56.5), we examined the relationship between a variety of preprison conditions and prison deprivation factors as possible predictors of depression. Stepwise regression results indicated that depression was greater for those with prior abuse histories, functional health problems along with poorer perceptions of mental and physical health, safety and other prison environment concerns. Although race was not a significant predictor in the regression model, a t-test did find that whites were more depressed than African Americans in our sample. Other correlates of depression are also identified that lend insights into the high rates of depression found among elderly women in prison. With such high rates of psychiatric disorders among women offenders, more treatment interventions are needed to adequately serve this population.     

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.     

Assessing the Needs of Women Recently Released From Prison

The growing number of females incarcerated in the United States suggests that greater importance needs to be placed on preparing practitioners and communities for their eventual release from prison. Female offenders present a unique set of needs, including greater mental health, substance abuse, and medical health problems than their male counterparts. Furthermore, women may possess unique needs at various points of their involvement with the criminal justice system (i.e., before, during, and following a period of incarceration). The current study examines the needs of female offenders while they are reentering the community from the perspective of community service providers who work directly with recently incarcerated women. Survey results reveal that community service providers identify needs in 7 domains. Prevalence and urgency measures provide unique profiles of the needs of female offenders, and respondent reports of the effectiveness of the existing community-based service sector lead to numerous implications and suggestions for future research.     

Trauma and Posttraumatic Stress Disorder Among Substance-Using Women Entering Cook County Jail

In the United States, the number of incarcerated women continues to rise each year, with African American women having the highest incarceration rates. Many women enter prisons and jails with an extensive trauma history, though little is known about the percentage of these individuals suffering from posttraumatic stress disorder (PTSD) and specific trauma exposures they have had based on factors such as homelessness, degree of substance problems, and race. The present study examines a largely African American substance-using population of incarcerated women to determine the impact of various factors on specific traumas reported. We found that individuals reporting symptoms meeting criteria for PTSD had experienced the highest average number of traumas, and those who had ever been homeless also experienced many and varied trauma exposures compared with those who had never been homeless. Higher substance problems were also associated with more trauma exposure. Fewer than 10 percent of the sample met full criteria for PTSD, though those reporting having ever been homeless and those with higher substance problems were significantly more likely to meet all criteria. Results indicate a need to assess previous homelessness as a method for identifying additional trauma exposures and guiding treatment to women's specific needs and trauma profiles.     

Systemic Self-Regulation: A Framework for Trauma-Informed Services in Residential Juvenile Justice Programs

Most youth detained in juvenile justice facilities have extensive histories of exposure to psychological trauma. Traumatic stress plays a key role in their mental health and behavioral problems and needs, and in their safety and rehabilitation and the security and effectiveness of detention facilities. We provide an overview of the barriers to successful provision of mental health services for youths in juvenile justice facilities, including those involving youth, parents, and juvenile justice residential facility staff and administrators. Next, we discuss the relevance and potential utility of approaching mental health needs using posttraumatic stress disorder (PTSD), and more broadly posttraumatic dysregulation, as an organizing framework. Examples of how a posttraumatic dysregulation perspective can enhance juvenile justice residential facility milieus and services are presented, with an overview of traumatic stress intervention models that have shown promise, or potentially could be deployed, in developing and sustaining trauma-informed juvenile justice facilities.     

It's a Family Affair

Abstract

In the United States, incarceration rates are increasing at an alarming rate. In particular, the incarceration of women is increasing. Oklahoma has the highest rate of female incarceration in the nation, and drug offenders comprise a significant proportion of these female inmates. Placing large numbers of women in prison may have serious implications not only for the women but also for their families, particularly their children. We surveyed 144 incarcerated female drug offenders in Oklahoma, 96 of whom reported dependent children living with them prior to incarceration. The data included the women's perceptions of the effect of their incarceration on their families as well as an examination of the potential for serious problems due to placement of the children. The study indicates that many children are placed with families that have a history of abuse, which suggests that failure to consider the implications of incarcerating large numbers of women likely contributes to serious abuse risks for their children.     

Issues in Female Inmate Health: Results From a Southeastern State

The current study examines health care services and perceptions of those services by former inmates of a women's prison in 1 southeastern state. The results indicate that many women enter prison with health issues, including hypertension, HIV/AIDS, depression, anxiety, and drug addictions, and use health services while incarcerated. Women in this study expressed overall dissatisfaction with those health services and did not perceive that their health improved while incarcerated or that they received better health care in prison than on the outside. This exploratory study points to the need for further empirical investigation into the issue of health care for the incarcerated female. The generalizability of the study's findings is possibly limited by the fact that respondents were former female inmates. Also, results from 1 southeastern state may not be generalizable to other geographic locations.     

The mental health needs of incarcerated youth in British Columbia, Canada

The purpose of the study was to identify the current prevalence of mental disorders and mental health needs among incarcerated male and female youths in Canada, and to present these data in the context of rates found in other jurisdictions. One hundred forty male and 65 female incarcerated young offenders in British Columbia were screened with the Massachusetts Youth Screening Instrument Version 2 (MAYSI-2); provisional psychiatric diagnoses were assessed with the Diagnostic Interview Schedule for Children Version IV (DISC-IV); abuse history and aggressive symptoms of Conduct Disorder (CD) were coded from file information. Nearly all youths (91.9% of males and 100% of females) met the criteria for at least one mental disorder. Substance abuse and dependence disorders were highly prevalent (85.5% of males and 100% of females). Aggressive forms of CD were common (72.9% of males and 84.3% of females), as were exposure to physical abuse (60.8% of males and 54.3% of females) and sexual abuse (21.2% of males and 42.4% of females). Female youths had significantly higher odds of presenting with: (1) substance abuse/dependence disorders; (2) current suicide ideation; (3) sexual abuse; (4) PTSD; (5) symptoms of depression and anxiety; (6) Oppositional Defiant Disorder; and (7) multiple mental disorder diagnoses. Male youths had significantly higher odds of presenting with aggressive symptoms of CD. Overall, rates of mental disorder among this sample of serious and violent young offenders were higher than rates previously reported for incarcerated youths — both in Canada and in other jurisdictions.     

Bruised Inside Out: The Adverse and Abusive Life Histories of Incarcerated Women as Pathways to PTSD and Illicit Drug Use

The majority of incarcerated women who suffer from diverse traumatic life histories including abusive home lives and intimate partner violence (IPV), develop post-traumatic stress disorder (PTSD) and struggle with heavy illicit drug use. While many have offered examinations of these relationships, the current study is among the first to utilize an integrated feminist pathways and general strain theory (GST) approach to explain them. Using data from a stratified random sample of all incarcerated women in Oklahoma (N = 334), we explore the links between, adverse childhood experiences, including physical, sexual, emotional, and childhood neglect, IPV, PTSD, and heavy illicit drug use. Our findings indicate that the effects of IPV on heavy illicit drug use are mediated by PTSD symptoms suggesting that PTSD plays a significant role in the pathway to illicit drug use among Oklahoma women prisoners. Implications for the importance of utilizing an integrated feminist pathways and GST approach in future research are offered.     

Postshelter adjustment of children from violent families

Few studies have examined the adjustment of battered women and their children after exiting domestic violence shelters. Participants were 62 women who had endured severe partner abuse, completed a shelter program with their children, and resided in the community for at least 6 months. Field interviews concerned mothers' and children's abuse histories and included measures of maternal depression, maternal trauma, and child behavior problems. Nearly all women had lived violence free since shelter exit. Child internalizing behaviors were associated with direct abuse, maternal depression, and shelter program. Externalizing behaviors were related to maternal depression and shelter program. Neither severity of interparental violence nor maternal trauma symptoms was related to child behavior problems. Mothers' family of-origin abuse predicted current satisfaction with child functioning, beyond the effects of maternal depression and child behavioral problems. Findings suggest a need for postshelter therapeutic services and further research addressing the adjustment of such families.     

Relationship between type of trauma exposure and posttraumatic stress disorder among urban children and adolescents

This study examines the association between trauma exposure and posttraumatic stress disorder (PTSD) among 157 help-seeking children (aged 8-17). Structured clinical interviews are carried out, and linear and logistic regression analyses are conducted to examine the relationship between PTSD and type of trauma exposure controlling for age, gender, and ethnicity. Confrontation with traumatic news, witnessing domestic violence, physical abuse, and sexual abuse are each significantly associated with PTSD. Witnessing a crime, being the victim of a crime, and exposure to accidents, fire, or disaster are not associated with PTSD. These findings underscore the association between interpersonal violence and childhood PTSD.     

Making a case for personal safety: perceptions of vulnerability and desire for self-defense training among female veterans

We assessed perceptions of vulnerability and the desire for personal safety/self-defense (PS/SD) training among 67 female veterans receiving outpatient mental health treatment, primarily for post-traumatic stress disorder (PTSD) from sexual and/or physical trauma. Consistent with the literature on the impact of such training on nonclinical populations and on individuals with visual impairments, the results of this study indicate that traumatized female veterans believe that PS/SD training would be an effective and powerful addition to more traditional treatments for PTSD. Study participants indicated they believe such training would positively affect their sense of personal safety; promote increased competence in thwarting future assaults; improve their self-esteem, confidence, and assertiveness; and reduce avoidant and agoraphobic behaviors. These pilot results support the development of an adjunct intervention to augment current PTSD treatments for women veterans with histories of sexual and physical trauma.     

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.     

Attachment as a Moderator Between Intimate Partner Violence and PTSD Symptoms

Post-traumatic stress disorder (PTSD) symptoms have been linked to traumatic experiences, including intimate partner violence. However, not all battered women develop PTSD symptoms. The current study tests attachment style as a moderator in the abuse–trauma link among a community sample women in violent and non-violent relationships. Both attachment anxiety and dependency were found to moderate the relation between intimate partner violence and PTSD symptoms. However, attachment closeness did not function as a moderator. Differences in attachment may help to explain why certain victims of domestic abuse may be more susceptible to experiencing PTSD symptoms. Clinically, these findings may aid in the prediction and prevention of PTSD symptoms in women victimized by intimate partner abuse.     

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.     

Multiple traumatic experiences and the development of posttraumatic stress disorder

This study assesses the differential and combined impacts of multiple lifetime stressors in the development and severity of posttraumatic stress disorder (PTSD) symptoms. One hundred and four clinical and 64 nonclinical participants were assessed for their exposure to four types of interpersonal trauma: physical and sexual abuse in childhood, lifetime community violence, and domestic violence in adulthood. PTSD symptomatology was assessed using the Los Angeles Symptom Checklist (LASC). Results indicated that exposure to lifetime multiple traumatic experiences was positively correlated with severity of PTSD symptoms. Clinical participants had experienced significantly more multiple traumas and had a higher rate of PTSD than the nonclinical participants. Results also suggested that adults who had experienced childhood sexual abuse were at higher risk for the development of PTSD related to interpersonal violence than adults who were not sexually abused as children.     

The social,relational and mental health characteristics of justice-involved men in the south-west England

The aim of this article is to describe the social, relational and mental health characteristics of a sample of offenders serving prison or community sentences in the south-west England. About 100 adult male offenders were screened for anxiety and depressive disorders, post-traumatic stress disorder (PTSD), drug and alcohol dependence, and likely personality disorder using validated instruments. Fifty-eight per cent of the sample reported at least one common mental health problem, of these only 26% reported receiving treatment. Participants exposed to traumatic events and/or participants with past mental health problems were more likely to score positive for current common mental health problems. Our study identified factors that may increase the risk of a first episode or recurrent anxiety and/or depression for offenders. Health and criminal justice services should create partnerships and develop interventions that address the risk factors which lead and/or contribute to offenders' mental health difficulties.