Childhood Trauma and Risk for Past and Future Suicide Attempts among Women in Prison
Introduction
Incarceration rates in the United States continue to rise and have surpassed rates in other industrialized countries (Sabol, Minton, & Harrison, 2007). Although men constitute the largest proportion of incarcerated adults, the number of women in prison has increased at a much faster rate than men over the past 2 decades (Greenfield and Snell, 2000, Sabol et al., 2007). For example, in 2006 the female prison population increased 4.5%, whereas the male population only increased 2.7% (Sabol et al., 2007). Female prisoners face complex physical and mental health challenges (Arriola, 2008, Covington, 2007, Freudenberg, 2002), and many are at risk for suicide. Recent studies with women in prison have documented rates of attempted suicide that range from 28% to 42% (Chapman et al., 2005, De Ravello et al., 2008, Messina and Grella, 2006) and during the first few weeks after release, the risk of suicide among former inmates is extremely high (Binswanger et al.,, Pratt et al., 2006).
Several recent studies suggest that disproportionately high rates of childhood trauma, such as abuse and neglect (Harlow, 1999, Messina and Grella, 2006, Raj et al., 2008), may contribute to suicidal behavior among women in prison. Verona, Hicks, and Patrick (2005) interviewed 226 female prisoners in Florida and found that sexual abuse, but not physical abuse, accounted for unique variance in suicide attempts. Interestingly, Chapman et al. (2005) found that a combined category of childhood physical and emotional abuse was significantly associated with attempted suicide among 105 women in prison; however, child sexual abuse and neglect were not. Another study with 500 drug-dependent women incarcerated in California prisons found a strong dose–response relationship between the cumulative number of childhood traumatic events (events involving abuse, neglect, and household dysfunction) and lifetime suicide attempts (Messina & Grella, 2006). Similar findings were reported in a recent study with 36 American Indian/Alaskan Native women who were incarcerated in the New Mexico prison system (De Ravello et al., 2008).
Although these studies demonstrate that childhood trauma is associated with attempted suicide among women in prison, the nature of this association is unclear. Exposure to child maltreatment contributes to adult psychological disorders such as such as depression and anxiety (MacMillan et al.,, McHolm et al., 2003, Mullen et al., 1993, Weiss et al., 1999), illicit drug use (Dube et al., 2003, Heffernan et al., 2000, Kendler et al., 2000), and incarceration frequency and duration (Curtis, Leung, Sullivan, Eschbach & Stinson, 2001). However, previous studies with incarcerated women have not controlled for the potentially confounding effects of these risk factors when evaluating the effects of childhood trauma on suicidal behavior. Furthermore, past research has only assessed the prevalence of lifetime suicide attempts and has not investigated whether childhood trauma is a persistent risk factor for suicidal behavior during adulthood.
To clarify the relationship between childhood trauma and suicide risk among women in prison, we controlled for sociodemographic variables, psychological distress, illicit drug use, and incarceration duration and evaluated the independent influence of child maltreatment on past suicide attempts and future likelihood of attempts in a random sample of 247 female prisoners in Las Vegas, Nevada.
Section snippets
Participants and recruitment
On June 21, 2004, the warden of the Southern Nevada Women's Correctional Facility gave study investigators a census list of all female prisoners (N = 457). From this census list, investigators randomly selected 336 women (73.5% of the female inmate population). Between June 28 and August 17, 2004, study investigators set up private meetings with randomly selected women to describe the study, determine eligibility, obtain written informed consent, and complete the interview. Appointments were
Results
As shown in Table 1, the study sample was racially/ethnically diverse with almost half self-identifying as African-American, Latina, Native American/Alaskan Native, or Asian or Pacific Islander. The median age of participants was 34 years and 17% were currently married. Forty-one percent of the sample reported that they did not have any type of legal employment during the 6 months preceding their current incarceration and 28% did not have a high school diploma or General Equivalency Degree.
Discussion
We found that female inmates with higher childhood trauma scores were at increased risk for past suicide attempts as well as future likelihood of attempts. Importantly, the confounding effects of psychological distress, illicit drug use, or incarceration duration could not fully explain the observed relationship between cumulative childhood trauma and suicide risk. Our findings add to a growing body of literature with nonincarcerated women demonstrating that childhood trauma is a persistent and
Kristen Clements-Nolle, PhD, MPH, is Assistant Professor of Epidemiology at the University of Nevada, Reno School of Community Health Sciences. Dr. Clements-Nolle's research focuses on HIV/AIDS, suicidal behaviors, and interpersonal violence among underserved populations.
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Kristen Clements-Nolle, PhD, MPH, is Assistant Professor of Epidemiology at the University of Nevada, Reno School of Community Health Sciences. Dr. Clements-Nolle's research focuses on HIV/AIDS, suicidal behaviors, and interpersonal violence among underserved populations.
Matthew Wolden, MPH, was a graduate student at the University of Nevada, Reno at the time of this study. Currently, Matthew is quality and patient safety manager at New York Presbyterian, the University Hospital of Columbia and Cornell.
Jessey Bargmann-Losche, MPH, was a graduate student at the University of Nevada, Reno at the time of this study. Currently she is the patient experience analyst for Renown Health in Reno, Nevada.
Funded by a Junior Faculty Research Grant from the University of Nevada, Reno College of Health and Human Sciences.