The relationship between childhood polyvictimization and subsequent mental health and substance misuse outcomes for incarcerated women.

摘要

Over the past four decades, the rate of incarcerated for US women has increased more than 700%. Although the rate of incarceration for US men has also increased dramatically, incarcerated women differ from their male counterparts in several key ways. Incarcerated women are more likely than incarcerated men to have less than a high school diploma (or equivalent), to be under- or unemployed, to have experienced homelessness, to be living in poverty at the time of their arrest, to have custody of minor children, and to come to prison with untreated physical and mental health issues (Bloom et al., 2004; DeHart, 2008). The largest disparities are reported on measures of drug use and drug crimes and experiences of interpersonal victimization (Belknap, 2007). The Gendered Pathways Perspective (GPP) identifies victimization as an important pathway to criminal behavior for women and girls, as approximately half of incarcerated women report being first arrested as juveniles, many of whom were running away to escape abuse. Incarcerated women and girls also indicate that they use drugs and alcohol, in some measure, to cope with their experience of violence (DeHart, 2009; Fuentes, 2014; Messina & Grella, 2006).;Incarcerated women report much higher rates of victimization than women in the community, with estimates suggesting that more than two-thirds of incarcerated women have experienced either physical or sexual abuse in childhood (e.g., Kennedy, Tripodi, et al., 2015). However, there is evidence that experiences of victimization are rarely mutually exclusive, but rather that victimization tends to cluster for some individuals and in some environments (Finkelhor et al., 2007b). Although robust relationships between childhood polyvictimization (defined as multiple, cumulative forms of direct and indirect interpersonal violence) and a variety of criminal offending, re-victimization, mental health, and substance misuse outcomes are reported using samples of youth (e.g., Cyr et al., 2012; Ford et al., 2010), our understanding of how polyvictimization relates to these outcomes for incarcerated adult women is less clear.;The current project examined polyvictimization and five interpersonal and behavioral health outcomes among a probability sample of 39 incarcerated women held in a state prison in Florida. The outcomes of interest were intimate partner violence victimization (IPVV), current incidence of dissociation, psychosis, and posttraumatic stress, and substance misuse in the year prior to incarceration. These outcomes were chosen because they are associated with women's crime, increase the risk for suicide attempts and interpersonal conflict during custody, and have been linked to recidivism after release (DeHart, 2008, 2009; Dowden & Brown, 2002; Lord, 2008; Salisbury & Van Voorhis, 2009; Wright et al., 2007; Zust, 2009). A cross-sectional survey design was used and all data was gathered via self-report during face-to-face interviews.;For women in the sample, an increase in the number of cumulative victimization domains experienced in childhood was statistically significantly associated with increased dissociation and meeting criteria for a substance use disorder in the year prior to incarceration. Further, sexual assault statistically significantly moderated the relationship between polyvictimization and both dissociation and substance misuse for women in the sample. A positive effect was noted when looking at IPVV, psychosis, and posttraumatic stress, although the relationships in the current sample were statistically non-significant. Although the data did not permit precise estimates of the effect, the confidence intervals suggested moderate to strong effects that indicated concern about the relationship between polyvictimization and subsequent challenges.;Understanding experiences of polyvictimization for incarcerated women, and how polyvictimization relates to subsequent IPVV, dissociation, psychosis, posttraumatic stress, and substance misuse, is of particular importance to the social work profession, as social workers provide the majority of behavioral health services in the US (Proctor, 2004). Social work is well positioned to lead community-based prevention efforts which address how experiences of violence and victimization can influence a woman's sense of herself in relationships and can serve to alienate her from family, school, and employment. If drugs and alcohol are used to cope with experiences of violence, social work prevention and intervention can highlight how substance misuse perpetuates experiences of victimization for at-risk women and girls, increasing risk for arrest and incarceration. Further, over the past decade, comprehensive mental health services have become increasingly available in women's prisons across the country (e.g., Daroowalla et al., 2005; Teplin et al., 1997; Wright et al., 2007). Social work professionals are well equipped to take a leadership role in therapeutic service delivery. More research is needed to examine polyvictimization among incarcerated adult women and evaluate the predictive utility of polyvictimization on negative outcomes among this population.