Testing a New Intervention with Incarcerated Women with Life Sentences: Assessing Short-Term Outcomes

Background and Purpose: Incarcerated women serving a life sentence comprise a growing subpopulation in prisons. They report multiple physical and mental health needs upon entry and during their stays in prison. These concerns include suicide ideation and depression, with some indication of escalated needs at the beginning of the sentence. However, there is no intervention designed for, tested with, or tailored for this population. Research has shown efficacy for a gender-responsive, trauma-informed intervention (Beyond Violence) with incarcerated women that focuses on improving women’s mental health and experiences of anger. This study implemented Beyond Violence (BV) exclusively with incarcerated women with life sentences. The research questions were: 1) Do symptoms of anxiety, depression, PTSD, and serious mental illness improve for incarcerated women with life sentences after participating in BV?; 2) Do forms of anger and anger expression change?. 3) Are there differences in outcomes for women based on the length of time served?

Method: This study was quasi-experimental with a pretest-posttest design. A random sample of 68 women with life sentences in a state prison was utilized to obtain a final sample of 26 women who were divided into two treatment groups. A survey was administered prior to treatment, end of treatment, and three months following treatment. Mental health measures examined symptoms of depression, anxiety, PTSD, and serious mental illness. Anger-focused measures included trait and state anger, anger expression in/out, and anger control in/out. The analysis was multilevel modeling to assess outcomes for all women and compare outcomes for women based on their length of time served.

Results: While the averages of the mental health outcome scores decreased over time, none of these changes were significant when examining all the women.  Sub-group analyses displayed specific dynamics based on time served. Women who had served less than 10 years had significantly higher scores of anxiety (4.08, SE=1.82, p=0.03), with scores that approached significant difference for depression (3.87, SE=2.05, p=0.07) and PTSD (3.37, SE=1.85, p=0.08). The rate of change was significant for depression (average decrease of 0.58 points per month, SE=0.24, p=0.02), anxiety (0.47 points per month, SE= 0.21, p=0.03), and PTSD (0.48 points per month, SE=0.21, p=0.03) for women who had served less than 10 years. Significant interactions of time and length of time incarcerated were found for anxiety (B=0.76, SE=0.27, p=0.008). For trait anger, the slope coefficients significantly decreased over time for all women. Women who had served less than 10 years had higher scores on all anger measures,  with a significant rate of change for trait anger (0.50 points per month, SE=0.18, p=0.009) and anger expression out (0.26 points per month, SE=0.12, p=0.03). Significant interactions were found for anger control out (B=0.66, SE=0.33, p=0.05).                

Implications: While this study had a small sample, it offers preliminary indications of intervention efficacy with this underserved population. Also, this study provides insight into social work practice, policy, and research. Specifically, there is an overarching need for social work policy advocacy to improve prison policies and the treatment of incarcerated women with life sentences.