How Is Trauma Exposure Measured in Populations Who Have Experienced Incarceration? a Systematic Scoping Review

Background

In the last 20 years, researchers have begun building a “public health criminology” aimed at understanding the far-reaching consequences of having the largest incarcerated population in the world. Of particular concern are the physical and mental health outcomes associated with the elevated levels of trauma exposure experienced by those who spend time in U.S. jails and prisons. A public health approach to both understanding and addressing the complex needs of this population requires, first, defining and measuring these needs. Because mass incarceration is a relatively new phenomenon, there is still no clear consensus on how to define or measure trauma exposure in this context, particularly for men, who make up the vast majority of the incarcerated population.

The current scoping review seeks to identify all research studies on incarcerated populations in the U.S. that included a measure of trauma exposures before, during, and after incarceration. We summarize the key characteristics of the most commonly used instruments and assess their strengths and limitations.

Methods

Ten library databases were searched using “trauma exposure” and “incarceration” as key terms, resulting in 7164 articles which were imported into Covidence for review. Two reviewers conducted separate title and abstract screenings, followed by full-text reviews of 440 articles. We identified 223 unique studies that included measures of trauma exposure. Of those, 105 used psychometrically validated instruments.

Results

The most frequently used instrument was the Adverse Childhood Experiences Survey (Felitti et al., 1998), which was used in a third of the studies (n=35). The next most common were the Trauma History Questionnaire (Hooper et al., 2011) and the Childhood Trauma Questionnaire (Bernstein, 1997), which were used in 20% (n=21) and 14% (n=15) of studies, respectively. We did not find any instruments designed for use with an incarcerated population and the majority of studies (n=84) either modified the instrument or used multiple trauma exposure instruments. Of note, 65% of the studies (n=68) used female-only samples while 90% of the U.S. incarcerated population is male. Only 3 studies captured trauma exposures occurring during incarceration, and only 2 studies assessed post-release trauma exposures. Also of note, over half (n=55) of the studies have been published in just the last 10 years.

Conclusion

Social work has called for research, policy, and practices to promote smart decarceration as one of our Grand Challenges for the 21^st century. Central to this effort is the need to assess and treat trauma, which is both a driver and consequence of incarceration and significantly shapes individuals’ capacity to reintegrate and thrive post-release. This scoping review identifies that for studies that measure trauma exposure in incarcerated populations, the majority have not used validated measures. For the ones that have, measures are significantly modified in an attempt to capture the unique experiences of this population. While studies have consistently shown markedly elevated levels of trauma exposure across the life course for this population, there is a lack of measurement consistency and precision. Gender-specific and psychometrically reliable and valid instruments are needed.