Associations between significant head injury and persisting disability and violent crime in women in prison in Scotland, UK: a cross-sectional study

Abstract

Background The prevalence of head injury is estimated to be as high as 55% in women in prison and might be a risk factor for violent offending, but evidence is equivocal. The extent of persisting disability is unknown, making decisions about service needs difficult. The UN recognises vulnerabilities in women in prison, but does not include head injury. This study aimed to investigate relationships among head injury, comorbidities, disability, and offending in women in prison. MethodsIn this cross-sectional study, women were recruited between Feb 2, 2018, and Sept 30, 2019, from four prisons across Scotland, UK: Her Majesty's Prison (HMP) Cornton Vale, Her Majesty's Young Offenders Institute Polmont, HMP Edinburgh, and HMP Greenock (detaining approximately 355 individuals at the time of recruitment). Women were included if they were aged older than 16 years, fluent in English, able to participate in face-to-face assessment and provide informed consent, and did not have a severe acute disorder of cognition or communication. Head injury, cognition, disability, mental health, and history of abuse and problematic substance use were assessed by interview. History of head injury was assessed with the Ohio State University Traumatic Brain Injury Identification method and disability was assessed with the Glasgow Outcome at Discharge Scale. Comparisons were made between women with and without a history of significant head injury. Findings We recruited 109 (31%) of the 355 women in these prisons. The sample was demographically representative of the approximately 400 individuals in women's prisons in Scotland. Significant head injury (SHI) was found in 85 (78%) of 109 women, of whom 34 (40%) had associated disability. Repeat head injury was reported in 71 (84%) of the 85 women with SHI and, in most cases, this resulted from domestic abuse that had occurred over many years. Women with a history of SHI were significantly more likely to have a history of violent offences than those without a history of SHI (66 [79%] of 85 women in the SHI group vs 13 [54%] of 24 women in the no-SHI group had committed a violent offence; odds ratio [OR] 3•1, 95% CI 1•2-8•1). This effect remained significant after adjusting for current factors (3•1, 1•1-9•0), including comorbidities associated with post-traumatic stress disorder, and was no longer statistically significant after adjusting for historical factors (3•3, 1•0-10•9), such as abuse as a child or adult. Women with SHI had spent longer in prison than women without SHI after adjustment for current (rate ratio 3•4, 1•3-8•4) or historical (3•5, 1•3-9•2) risk factors.Interpretation It is recognised that women in prison are vulnerable because of histories of abuse and problematic substance use; however, history of SHI needs to be included when developing criminal justice policy, interventions to reduce mental health morbidity, and assessment and management of risk of violent offending.Funding The Scottish Government.

Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective

“…Few studies have assessed whether the relationship between TBI and ADRD risk differs by sex, 160 and the evidence has been mixed 161–166 . This may be because adverse health and psychosocial factors throughout the lifespan moderate the risk of ADRD following TBI 167–172 . For example, greater exposure to adverse childhood experiences earlier in life has been observed as a risk factor for both TBI and other poor health behaviors and outcomes that interact throughout life to increase ADRD risk 170,173 .…”

“… 161 , 162 , 163 , 164 , 165 , 166 This may be because adverse health and psychosocial factors throughout the lifespan moderate the risk of ADRD following TBI. 167 , 168 , 169 , 170 , 171 , 172 For example, greater exposure to adverse childhood experiences earlier in life has been observed as a risk factor for both TBI and other poor health behaviors and outcomes that interact throughout life to increase ADRD risk. 170 , 173 Many of the overlapping adverse psychosocial risk factors for TBI disproportionally affect women, whereas sports and occupations, two of the biggest risks for TBI, differentially impact men.…”

Prevalence and characteristics of mental and physical disorders among female prisoners: a mixed-methods systematic review

“…Gender differences in severity of traumatic brain injury were not observed. The prevalence of significant head injury in (McMillan et al , 2021) all-female sample was 78%, of which a majority of the injuries had occurred during extended time periods, most likely caused by exposure to domestic violence. Ribeiro de Menezes and coworkers (2021) found the prevalence of lower urinary tract symptoms (LUTS) to be 36.5%.…”

Pathways From Recent Incarceration to Antiretroviral Therapy Adherence: Opportunities for Interventions to Support Women Living With HIV Post Release From Correctional Facilities

“…However, evidence suggests that transitional housing in Canada remains limited and unsafe for women (National Inquiry into Missing and Murdered Indigenous Women and Girls, 2019a), and our findings elucidate an urgent need for resources dedicated to increased gender-specific housing options upon release from correctional settings. Given the high rates of gender-based violence among marginalized women who experience incarceration (Erickson, Pick, Ranville, Martin et al, 2020; McMillan et al, 2021), along with research highlighting the relationship between gender-based violence and housing precarity among women living with HIV specifically (Zhao, 2021), there is an ongoing need for gender-specific approaches to housing stability (Desai, 2012; Fotheringham et al, 2014). Housing options could include self-contained units in women-only buildings (Currie, 2004; Desai, 2012), along with communal areas that foster social support surrounding community reintegration, and supports for women who have children (Desai, 2012; Ghose et al, 2019).…”

“…Gendered power dynamics and violence are linked to suboptimal HIV outcomes for women, including through reduced uptake of and retention in HIV treatment (Donastorg et al, 2014; Duff et al, 2016; Espino et al, 2015; Hatcher et al, 2015; Lichtenstein, 2006; Machtinger, Haberer et al, 2012). Experiences of gender-based violence perpetuated against women involved in the criminal justice system are extremely high (McMillan et al, 2021), and studies show that women living with HIV specifically experience high rates of violence and trauma (Erickson, Pick, Ranville, Martin et al, 2020; Lichtenstein, 2006; Orza et al, 2015), including relative to the general population of women (Machtinger, Wilson et al, 2012). Qualitative research indicates several ways by which intimate partner violence can affect ART adherence among women, including through increased stress leading to medication forgetfulness, having to leave home without medications, and partners throwing away medications (Roberts et al, 2016).…”