A Mixed Methods Investigation of Incarcerated Women's Experiences with Psychotropic Medication

Background:

Incarcerated women disproportionately experience mental health challenges (James & Glaze, 2006) and use psychotropic medications (Langner, Barton, McDonagh, Noel, & Bouchard, 2002; Beck & Maruschak, 2001).  Regrettably, current research on psychotropic medication use with this populations focuses on adherence issues, leaving major gaps in our understanding of women’s perceptions of medication’s effects, their perceptions of personal agency, and their experiences of stigma, for example. The hope is that expanding our knowledge base regarding incarcerated women’s experiences with psychotropic medication will have important implications for creating a more effective and compassionate social work response.

Methods:

The researchers conducted a mixed methods investigation using data from a 35-item cross-sectional survey (N=274) and in-depth semi-structured interviews (N=25) with women incarcerated in a medium-security state correctional center in a mid-Atlantic state. SPSS 23 was used to conduct univariate and bivariate analyses, an exploratory factor analysis, ANCOVA, and linear regression analyses. A content analysis was conducted on response to a single open-ended question.  The interviewees were randomly selected from a subsample of survey respondents who volunteered to be interviewed. Thematic analysis of the narrative data was carried out using nVivo software. Data were subjected to simultaneous processes of deductive coding, applying codes derived from existing literature and research questions, and inductive coding, applying codes as relevant ideas emerged from the data (Harding, 2013). Codes were then grouped into categories and subcategories, and themes were identified.

Results:

Over three quarters of the women who participated in the survey reported they were currently taking psychotropic medication (77%, N=213) with 93% of those taking antidepressants. Results indicate positive effects with medication were the norm with this group of women, and perceptions of strong personal agency and choice were predominant. Regression analyses revealed those with higher external locus of control are more likely to perceive medication as a means of control [B = .33, t(267) = 3.72, p < .001] and experience stigma related to their medications [B = .36, t(267) = 3.09, p < .01].  Content analysis of the open question suggested these women fiercely want others to know how much they need medication to function well. 

Findings from the qualitative data highlighted the lengthy process of trial and error involved in determining the optimal medications and dosage. This process was particularly fraught for these women because of formulary restrictions within the institution and limited access to mental health professionals, particularly prescribers. Participants emphasized the myriad ways in which the prison environment impacts their mental health, often inhibiting the achievement of optimal effects of psychotropic medication.

Conclusions:

The research findings highlight the major role of psychotropic medication in mental health care for incarcerated women. Although these women emphasized positive experiences with medication effects, they also reported significant obstacles to obtaining optimal treatment, many of which require further investigation. Given the restrictive nature of carceral environments, particular attention must be devoted to creating opportunities for maximizing women’s role in decision-making around mental health treatment and offering more tailored interventions to women according to their experiences and preferences.