Elsevier

Women's Health Issues

Volume 19, Issue 3, May–June 2009, Pages 185-192
Women's Health Issues

Childhood Trauma and Risk for Past and Future Suicide Attempts among Women in Prison

https://doi.org/10.1016/j.whi.2009.02.002Get rights and content

Purpose

We sought to determine whether childhood trauma is an independent risk factor for past suicide attempts and the future likelihood of attempts among women in prison.

Methods

A random sample of 247 women incarcerated in a state prison in Las Vegas, Nevada, completed a confidential interview that included the Childhood Trauma Questionnaire, the 18-item Brief Symptom Inventory, standard measures of illicit drug use, and the revised Suicidal Behaviors Questionnaire. Multiple logistic regression models were developed to evaluate the independent influence of cumulative childhood trauma on past suicide attempts with intent to die and the future likelihood of suicide attempts.

Results

Childhood trauma was frequently reported by female prisoners: emotional abuse (58%), physical abuse (54%), sexual abuse (51%), emotional neglect (53%), and physical neglect (41%). Factors independently associated with past suicide attempts included having a higher childhood trauma score (p < .001), a higher psychological distress score (p = .005), and longer duration of current incarceration (≥5 years; p = .003). Childhood trauma (p = .05), psychological distress (p < .001), and lack of legal employment before incarceration (p = .05) were independent risk factors for future likelihood of attempting suicide.

Conclusions

Childhood trauma is an independent risk factor for attempted suicide among women in prison that persists into adulthood and cannot fully be attributed to psychological distress, illicit drug use, or incarceration duration. Addressing the emotional impact of childhood trauma among female prisoners may increase the effectiveness of correctional suicide prevention efforts.

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.

References (46)

  • K.L. Cole et al.

    Developing and assessing effectiveness of a time-limited therapy group for incarcerated women survivors of childhood sexual abuse

    Journal of Trauma Dissociation

    (2007)
  • A.E. Daniel

    Preventing suicide in prison: a collaborative responsibility of administrative, custodial, and clinical staff

    Journal of the American Academy of Psychiatry and the Law

    (2006)
  • L. De Ravello et al.

    Breaking the cycle/mending the hoop: Adverse childhood experiences among incarcerated American Indian/Alaska Native women in New Mexico

    Health Care for Women International

    (2008)
  • L.R. Derogatis

    The Brief Symptom Inventory 18: administration, scoring, and procedures manual

    (2001)
  • S.R. Dube et al.

    Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span

    Journal of the American Medical Association

    (2001)
  • S.R. Dube et al.

    Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study

    Pediatrics

    (2003)
  • M.W. Enns et al.

    Childhood adversities and risk for suicidal ideation and attempts: a longitudinal population–based study

    Psychological Medicine

    (2006)
  • N. Freudenberg

    Adverse effects of U.S. jail and prison policies on the health and well-being of women of color

    American Journal of Public Health

    (2002)
  • N. Freudenberg et al.

    Coming home from jail: The social and health consequences of community reentry for women, male adolescents, and their families and communities

    American Journal of Public Health

    (2005)
  • L.A. Greenfield et al.

    Women offenders

    (2000)
  • C.W. Harlow

    Prior abuse reported by inmates and probationers

    (1999)
  • D.W. Hosmer et al.

    Applied logistic regression

    (1989)
  • T. Hughes et al.

    Reentry trends in the United States

    (2003)
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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.

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