Examining the Dose-Response Relationship Between Childhood Victimization, Depression, Psychosis, and Substance Misuse for Women Prisoners

Background and Purpose:  Experiences of childhood victimization are associated with mental health and substance misuse problems in adulthood. A dose-response model is suggested to interpret these relationships, which theorizes a positive relationship between the frequency of childhood physical abuse (CPA), frequency of childhood sexual abuse (CSA), multi-victimization (CPSA), and subsequent symptomatology. Hypotheses included positive relationships following a dose-response pattern between frequency of CPA, CSA, and CPSA and three discrete outcomes for women prisoners: depression, psychosis, and substance misuse. The purpose is to gain a deeper understanding of how frequency and multi-victimization contribute to mental health and substance misuse issues for women prisoners as a vehicle for the improvement, development, and implementation of targeted mental health and substance misuse interventions offered within the prison context.

Methods:  A random sample of 230 women prisoners was obtained from two state prisons. Participants completed the Childhood Trauma Questionnaire (CTQ), the Mini International Neuropsychiatric Interview (MINI), and the Substance Abuse Module-Revised (SAM). Binary logistic regression models assessed the relationship between frequency of victimization and multi-victimization on depression, psychosis, and substance misuse. For each model we examined the following: case-to-predictor variable ratio, multicollinearity, model fit, and relationships between predictor variables and the dependent variable. Depression, psychosis, and substance misuse, defined as meeting DSM-IV criteria for a substance use disorder, were operationalized as dichotomous variables in all models. 

Results:  Findings on the influence of frequency of victimization were mixed. Neither frequency variable significantly predicted depression and only frequency of CPA predicted substance misuse (OR = 1.125, 95% CI = 1.009-1.255). A one-unit increase in frequency of CPA was associated with being 12.5% more likely to have met criteria for a substance use disorder. However, both frequency of CPA (OR = 1.099, 95% CI = .999-1.208) and CSA (OR = 1.050, 95% CI = 1.003-1.100) were significant predictors of psychosis. A one-unit increase in CPA was associated with being 9.9% more likely to report current psychosis and a one-unit increase in CSA was associated with being 5% more likely to report current psychosis. All multi-victimization analyses were significant. Women prisoners who experienced CPSA were 5.7 times as likely to report depression (OR = 5.687, 95% CI = 2.216-14.597), 4.2 times as likely to report psychosis (OR = 4.210, 95% CI = 1.879-9.430), and 3.8 times as likely to meet criteria for a substance use disorder (OR = 3.830, 95% CI = 1.531-9.583). This finding conforms to our dose-response hypothesis – that CPSA would be a more powerful predictor of depression than either CPA only or CSA only.  

Conclusions and Implications:  The current study provides a deeper understanding of the specific victimization histories of women prisoners and the relationship of those experiences to depression, psychosis, and substance misuse. These findings support a call in the literature for the development of targeted and trauma-focused mental health and transition services offered to women prisoners. Our evaluation of the dose-response relationship of childhood victimization and subsequent depression, psychosis, and substance misuse support the provision of trauma-informed and gender-responsive interventions to women prisoners.