Mental Health Difficulties and Service Use of Incarcerated Women: The Influence of Violence Perpetration and Victimization

Background and Purpose

Incarcerated women experience mental health difficulties at alarmingly disproportionate rates (James & Glaze, 2006), and these difficulties are likely influenced by the experiences they have both as victims and as perpetrators of violence. Estimated rates of victimization among this population range from 25% to a shocking 72% (Cook et al., 2005; McDaniels-Wilson & Belknap, 2008), and 36% of women are incarcerated for perpetrating violent offenses (Carson & Anderson, 2016). The present study sought to expand the knowledge base regarding the association between women’s specific experiences with violence and their mental health difficulties and use of correctional mental health services.

Methods

To achieve the study aims, a secondary data analysis was performed using data from the Bureau of Justice Statistics Survey of Inmates in State Correctional Facilities. The final sample comprised 2553 women from state correctional facilities throughout the United States. Six research questions pertaining to two broad types of women’s experiences with violence (victimization and perpetration) and their mental health and service use guided the inquiry, which involved univariate, bivariate, and multivariate statistical analyses. Specifically, logistic regression procedures were conducted to examine associations between the independent variables of childhood sexual victimization, childhood physical victimization, adulthood sexual victimization, adulthood physical victimization, and violent offending and the dependent variables of mental health difficulties, the use of psychotropic medication, mental health counseling, and substance abuse treatment during incarceration.

Results

Results showed that women who had experienced childhood sexual victimization or adulthood sexual victimization were more likely to be categorized as having a serious mental illness (OR=3.59, p<.001; OR=2.00, p<.001), and more likely to use psychotropic medication (OR=1.77, p<.001; OR=1.43, p=.001) and substance abuse treatment (OR=1.52, p<.001; OR=1.29, p=.020). Similarly, childhood physical victimization and adulthood physical victimization were associated with an increased risk of serious mental illness (OR=3.30, p<.001; OR=2.49, p<.001) and use of both psychotropic medication (OR=1.87, p<.001; OR=1.29, p=.007) and substance abuse treatment (OR=1.35, p=.004; OR=1.41, p=.001). Interestingly, women who were incarcerated for committing a violent offense were also more likely to be categorized as having a serious mental illness (OR=1.59, p=.002), and more likely to use both psychotropic medication (OR=1.78, p<.001) and mental health counseling (OR=2.03, p<.001). Overall, incarcerated women’s experiences with violence—as both victims and perpetrators—seem to be associated with an increased need for mental health services.

Conclusions and Implications

These results speak loudly to the urgency with which social workers in both community and correctional contexts should treat and prevent trauma stemming from violence. In the community, possible programmatic responses include mobilization around bystander intervention and implementation of educational initiatives targeted at future perpetrators of violence against women. In correctional contexts, mental health providers should make concerted efforts to address trauma stemming from both victimization and perpetration of violence. Future quantitative research should use longitudinal data to establish time order of variables related to violent perpetration and mental health difficulties. Future qualitative inquiries might strive to uncover women’s own perspectives on the mechanisms by which their experiences with violence uniquely impact their mental health.