Lifetimes of Adversity: A Review of the Trauma Literature on Men Who Experience Incarceration

Background/Purpose:

In the United States, an estimated 2.2 million or 1 in 100 adults are incarcerated. Over 90% are men and 60% are men of color. While studies indicate that this population has unusually high rates of trauma exposure and PTSD across the life course, the specific nature of trauma experiences are not clear, with the majority of trauma research focusing only on women. To address this gap, we conducted three systematic reviews. Studies indicate that trauma is experienced in unique ways before, during, and after incarceration. Therefore, three separate searches were conducted to capture the full scope of literature for this population. Our aim was to summarize and examine the current research knowledge on trauma for incarcerated men in hopes of informing future research, policies, and intervention design.

Methods:

Three searches were conducted, each with distinct search terms and inclusion/exclusion criteria specific to time period. Search criteria was developed to capture research on trauma exposures, symptoms, and interventions. Following the Cochrane Collaboration guidelines, two independent researchers conducted each step of the review process. A total of 3,809 articles were retrieved and 2,198 title/abstracts were reviewed after removing duplicates. Of these, 176 were designated for full-text screening and 27 were included in this review.

Results:

Before: We identified 8 studies that asked incarcerated men about prior trauma exposures. Prevalence rates for at least one type of trauma exposure during childhood ranged from 34-45%. Mean number of prior trauma exposures was 6.3 (compared to a mean of 2.2 in community samples of men). Five additional studies reported lifetime trauma exposure rates of 61-96%, with assaultive violence and witnessing someone injured or killed as the most common types of exposures.

During: Only 1 study explored trauma exposure during incarceration, finding that 26% experienced physical victimization and 8% experienced sexual victimization. We also found 10 studies that captured current and lifetime PTSD prevalence rates for incarcerated men. As is common in trauma research, findings ranged broadly, from 20-60% lifetime and 4.6-48% current (compared with 0.5-12% lifetime and 0.4-1.8% current in community samples of men).

We found only 3 studies on trauma interventions during incarceration that included men. Two tested the use of meditation to reduce trauma symptoms and one tested the use of CBT. While each study found improvement in symptoms, effect sizes were small.

After: We found no studies on trauma exposures, symptoms, or interventions post-release. This is a serious gap in the literature. Sociological studies exploring the experiences of men following prison indicate ongoing high risk for repeated violence exposure.

Conclusions and Implications:

Incarcerated men have high risk for trauma exposure and symptoms across the life course. However, research investigating the specific nature of trauma experiences is limited, with research on the post-release period being non-existent. Given the serious threat trauma exposures and symptoms pose to the lives of those leaving and trying to remain out of prisons and jails, research in this area is essential for informing policy and practice aimed at reducing over-incarceration.