Gender Differences in Factors Associated with PTSD Among the Incarcerated: Victimization, Social Support, and Prison Climate

Background: Post-Traumatic Stress Disorder (PTSD) is often a predictor of serious mental illness (SMI) and is frequently comorbid with major depressive disorders (MDD). Despite a disproportionally high prevalence among inmates (from 10-36%), compared to community samples (3-6%), PTSD is often overlooked among a highly victimized incarcerated population Incarcerated individuals are likely to experience traumatic events before, during, and after incarceration, but there is little understanding of how these events effect the incarceration and re-entry experience or how events may differ by gender. Although women comprise smaller proportions of those confined, they are more likely to suffer from current PTSD (up to 43%) than their male counterparts (up to 31%). Understanding what factors influence PTSD among prisoners – and how those factors differ by gender – may provide information for practitioners and administrators to create a more ‘trauma-informed’ environment. The main research question of this paper is “Do factors associated with PTSD differ among males and female inmates?  

Method: This study uses data collected from 117 male and 66 female (n=183) prisoners enrolled in a clinical trial for treatment of MDD. Eligibility included incarcerated for a minimum of 4 weeks, a positive screen for MDD, and lack of substance abuse disorder. The DV was measured by PTSD Checklist-Civilian Version (46% males; 46% females). IV included sexual, physical and psychological victimization (Lifetime Trauma History Questionnaire; Conflict Tactics Scale 2), prison climate (Life Events Questionnaire-LEQ-adapted for prisons) and social support (Multidimensional Scale of Perceived Social Support). Following a bivariate analysis, stepwise multivariate linear regressions were used to answer the main research question.

Results: Similar proportions of men and women experienced physical/psychological victimization per the CTS (35% and 40% respectively), but severity was greater for women (15 v. 32; t=1.43**). Half of men (50%) and 71% of women experienced sexual victimization. The model with the most explanatory power for men suggested that psychological (β = .297, p < .01) and sexual victimization (β = .217, p < .05), low levels of social support (β = .288, p < .05), and total time incarcerated (β = -.188, p < .05), were associated with PTSD symptoms. All four IV have a significant combined effect on PTSD severity (F =8.72; p < .001), explaining 29% of the variance. In the model for females, only one item from the LEQ, indicating that women were insulted or made fun of in prison, was associated with PTSD (β = .449, p < .05); a determinant that was not found significant in the male model. The one-item model for females explained 25% of variance in PTSD symptoms, which was statistically significant

Conclusion and implications: The somewhat surprising findings should be replicated in future studies. However, it is clear that incarcerated males also experience interpersonal trauma and that there is a need for trauma-informed and gender-responsive interventions that accommodate BOTH male and female needs within prison. Prison climate may be particularly triggering for women with PTSD suggesting the need for organizational interventions along with clinical treatment need.