Incarceration History and Women's Mental and Behavioral Health Problems: A Nationally Representative Study

Background and Purpose: Incarceration is increasingly prevalent among women in the U.S., particularly women from disadvantaged minority communities. In the past three decades, the number of women behind bars has increased by more than 700%. However, the impact of confinement experience as a social determinant on women’s mental health and substance abuse remains underinvestigated. Some studies have suggested that the poor outcomes of these women are attributable to the stress and stigma associated with the imprisonment history. Other studies have found that confinement experiences are inconsequential to women’s mental and behavioral health. Because this group of women is predominately marginalized minorities, their exposure to cumulative disadvantages before or after criminal justice involvement such as poverty and victimization are the main contributors. The conflicting findings on the effects of incarceration history might be attributable to sample differences across studies. This research was conducted with a nationally representative sample of women who have participated in the National Longitudinal Study of Adolescent to Adult Health (Add Health) to determine the associations between incarceration history and women’s mental health problems and substance abuse.

Methods: A sample of 15,701 adolescents enrolled in grades 7-12 were recruited for Add Health baseline data collection during the 1994-1995 academic year and had been followed through adolescence in 2001 and 2002 and early adulthood in 2007 and 2008. This research was conducted with women with (n = 231) and without incarceration histories (n = 2,530). Participants self-reported their sociodemographic characteristics (e.g., poverty), exposure to cumulative disadvantages (e.g., imprisonment history and victimization), mental health diagnoses (i.e., depressive disorder, PTSD, and anxiety disorder), and substance abuse (i.e., alcohol, cannabis, and illicit drugs). Chi-square tests and t-tests were employed to determine the health disparities between women with and without confinement experiences. Multiple logistic regressions were then conducted to examine the associations between imprisonment history and women’s mental health conditions and behavioral health.

Results: Findings suggest that women with incarceration histories have had significantly higher rates of depressive disorder, PTSD, anxiety disorder, alcohol abuse, cannabis abuse, and illicit drug abuse, compared to women without confinement experiences. Logistic regression analyses revealed that incarceration history was a significant predictor of women’s depressive disorder (OR = 1.81, 95% CI = 1.27-2.58), PTSD (OR = 3.20, 95% CI = 1.82-5.65), alcohol abuse (OR = 2.32, 95% CI = 1.40-3.85), cannabis abuse (OR = 3.34, 95% CI = 1.97-5.67), and illicit drug abuse (OR = 4.81, 95% CI = 2.94-7.87), after controlling for exposure to disadvantages aside from incarceration history. Further, racial and ethnic minority status (i.e., African American, Latino American, and Asian American) and lower socioeconomic status were significantly associated with women's mental and behavioral health.

Conclusions and Implications: Incarceration history is an essential social determinant on women’s mental health and substance abuse. Policy and legislation change that prevents or alleviates women's mass imprisonment might contribute to health equalities in the U.S. Further, social work interventions that recognize the effects of incarceration history and tackle economic and racial disparities are necessary to improve the health of American women.