Typologies of Child Abuse & Neglect As Determinants of Mental Health & Substance Use Disorders of People Incarcerated in US Prisons

Background & Purpose: Previous research documents how child abuse and other adverse experiences can impact the development of mental health and substance use disorders, in addition to contributing to crime and incarceration. Incarcerated people also have disproportionally high rates of exposure to adverse experiences and diagnoses for these disorders. This study identifies typologies of adverse experiences among people incarcerated in US prisons. Typologies of adversity are then used to predict mental health and substance use disorders. The impact of gender, race and ethnicity on adversity typology are also examined.

Methods: Data come from the 2004 Survey of Inmates in State and Federal Correctional Facilities (SI-SFCF). The SI-SFCF is a cross sectional survey of adults incarcerated in US prisons. The survey was administered via a computer assisted personal interview conducted by telephone. The response rate was 89.1% in state prisons and 84.6% in federal prisons (n=18,185). State and federal datasets were combined during analysis. Analysis was conducted in four steps. First, bivariate statistics (frequencies and t-tests) compared rates of adverse experiences, mental health and substance use disorders by gender, race and ethnicity. Next, latent class analysis was conducted using adverse experiences as indicators of latent classes of adversity. Then, multinomial regression was conducted, using gender, race and ethnicity to predict latent class membership. Finally, logistic regression was used to predict the development of mental health and substance use disorders based on the latent classes, using gender, race and ethnicity as covariates.

Results: Incarcerated people who identified as either a women or White, experienced higher rates of nearly all types of adverse experiences, as compared to people identifying as either a man or a Non-White race. Incarcerated people also experienced high rates of mental health and substance use disorders, with women having higher rates of mental health and substance use disorders and men having a higher rate of alcohol use disorder. Four typologies of adverse experiences were found: Class-1) Low exposure, Class-2) Moderate deprivation, high violence exposure, Class-3) High deprivation, low violence exposure, and Class-4) High exposure.

People at highest relative risk for the Low exposure typology included men and people identifying as Hispanic. Regarding the Moderate deprivation, high violence exposure class, people with higher relative risk were those who identified as either White, Native American or “Other race.”  However, people who identified as Native American also had elevated relative risk for the High deprivation, low violence exposure, and High exposure classes. People who identified as Asian had a lower relative risk of belonging to the High deprivation, low violence exposure as compared to the Low exposure class. While people identifying as Black had a higher relative risk of belonging to the High deprivation, low violence exposure class.

As compared to the low exposure group, all other typologies significantly predicted mental health and substance use disorders.

Conclusions & Implications: Given that incarcerated people experience high rates of adverse experiences, mental health and substance use disorders, additional attention should be paid to differential typologies of adverse experiences to tailor services to specific populations.