Additional Insight on the Confluence and Impact of Trauma, Mental Health, and Incarceration

Additional Insight on the Confluence and Impact of Trauma, Mental Health, and Incarceration

In this study of incarcerated women, childhood and adulthood abuse were associated with the presence of a range of mental health concerns, lending further support for the increased use of trauma-informed treatment approaches with this population. This is the bottom line of a recently published article in the International Journal of Forensic Mental Health. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | International Journal of Forensic Mental Health | 2020, Vol. 19 No. 3, 241-252

Mental Health Difficulties of Incarcerated Women: The Influence of Childhood and Adulthood Victimization


Rachel C. Casey, School of Social Work, University of Southern Maine
Kia J. Bentley, School of Social Work, Virginia Commonwealth University
Shelby E. McDonald, School of Social Work, Virginia Commonwealth University



With the aim of identifying avenues for targeted implementation of trauma informed care in correctional contexts, this study engaged in a secondary data analysis to examine comorbidity patterns in the mental health difficulties of incarcerated women. Latent class analysis was conducted using nine indicators of mental health, and indicated the sample (N = 2553) was best represented by four patterns of mental health functioning: serious mental illness (8.7%); mood and drug use disorders (30.3%); substance use only (11.7%); and no/low mental health concerns (49.4%). Multinomial logistic regression indicated that sexual and physical victimization in childhood were important in distinguishing between the classes. These findings support the increased use of trauma-informed approaches to mental health treatment for incarcerated women.


Incarcerated women; mental health; victimization

Summary of the Research

“Recent decades have seen dramatic increases in the incarceration of women and girls worldwide such that growth in female incarceration has consistently outpaced growth in male incarceration…As the number of women behind bars has increased, so too has awareness grown around the unique treatment needs of justice-involved women…research has consistently shown incarcerated women to be a population plagued by both trauma and related mental health difficulties…Many correctional jurisdictions have begun incorporating ‘trauma-informed’ approaches to their provision of mental health and rehabilitative services…However, mental health providers in correctional settings must also contend with resource limitations that create barriers to optimal care provision…With the hope of identifying fruitful avenues for targeting resources, the present study analyzed data from a nationwide sample of incarcerated women to examine both patterns of co-occurrence in their mental health difficulties and to elucidate the relationship between those difficulties and specific forms of trauma” (p.241).

“The findings indicate that there are indeed patterns of mental health difficulties among incarcerated women which have implications for our approach to care. Specifically, we identified four latent classes of incarcerated women according to patterns of mental health functioning, addressing the first aim of the study…the analysis identified a small proportion of women in the SMI [serious mental illness] group who demonstrated elevated probabilities of every mental health difficulty considered…and indicates that correctional systems must be prepared to offer intensive wrap-around services for at least some portion of their female population…” (p.247-248)

“Another notable pattern that emerged was the identification of a large subgroup of women with high probabilities of contending with both mood and drug use disorders specifically…The results also identified a significant proportion of the sample in the no/low mental health concerns subgroup. Notably, Black and Latina women were less likely to be in the mental health difficulties subgroups than the no/low mental health concerns subgroup. On the one hand, this reflects the findings from epidemiological studies that have consistently noted a lower prevalence of mental health difficulties among people of color…Alternatively, this finding may support prior work attributing lower rates of mental health difficulties to disparities in access to mental health treatment for women of color…” (p.248).

“The second aim of the study involved an examination of differences in childhood and adulthood victimization across subgroups of mental health functioning. The present study analyzed relationships between four specific types of victimization -childhood sexual abuse, childhood physical abuse, adulthood sexual abuse, and adult physical abuse – and patterns of co-occurrence of mental health difficulties. Specifically, this study demonstrated that both childhood and adulthood victimization may put women at higher risk for multiple serious mental illnesses… such as psychosis…and substance use…The examination of difference in perpetration of violence across subgroups of mental health functioning – the third and final aim of the study – did not indicate that women convicted of violent offenses were any more likely to present with specific patterns of mental health difficulties compared to their peers convicted of nonviolent offenses, when adjusting for victimization history and sociodemographic factors…” (p.248-249).

Translating Research into Practice

“…Because a large proportion of incarcerated women in this sample seem to struggle with substance use, substance abuse treatment services should be made even more widely available within correctional environments. Additionally, whenever possible substance abuse treatment services should be tailored to account for co-occurring disorders…Interventions should address both mental health difficulties and substance use issues in a coordinated, complementary fashion…” (p.248).

“…Supplementing formal mental health services with peer-led services might represent an opportunity to both leverage the strengths of women in the group with no/low mental health concerns, while also addressing disparities in service use among women of color…further research is needed to illuminate whether incarcerated women in the United States experience the offense-related mental health difficulties that have been identified in other samples…” (p.248-249).

Other Interesting Tidbits for Researchers and Clinicians

“While it is well-established that the experience of victimization can result in mental health difficulties, several studies have demonstrated the potentially traumatizing effects of violent perpetration as well, indicating the need for a fuller examination of the impact of violent offending on the mental health of perpetrators…researchers…identified rates of offense-related TPSD that ranged from 33%…to 58%…No prior studies have identified whether violent offending is associated with patterns of comorbid mental health difficulties among incarcerated women, or whether these associations persist when adjusting for the effects of other forms of trauma and sociodemographic factors…” (p.242).

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