Sociodemographic Information,Aversive and Traumatic Events,Offence-Related Characteristics,and Mental Health of Delinquent Women in Forensic-Psychiatric Care in Switzerland

Abstract

The present study describes a much understudied group—namely, female prisoners under forensic-psychiatric care in the German-speaking part of Switzerland—to improve understanding of their risks and their needs. Data were derived from internal databases of a Forensic-Psychiatric Service. Data were collected in the form of their sociodemographic characteristics, prevalence of aversive and traumatic events, type of offence committed, and mental health conditions. Based on a full-sample approach, a total of 1,571 files were analysed. Results reveal that two thirds of the participants were not in a stable relationship, more than half did not complete a school degree, and three quarters were without stable employment prior to their incarceration. Two thirds were mothers and about one third did not grow up with their parents. Almost half grew up with an alcohol abusing parent, about half experienced violence and/or neglect in childhood, and about a quarter of the cases sexual abuse. About 95% had a mental health diagnosis according to International Classification of Diseases–Version 10 (ICD-10), and the most prevalent mental and behavioural disorder was due to psychoactive substance abuse. The most frequent offence type was drug-related crimes. Women convicted for drug-related crimes were more likely to have an ICD-10 F1 disorder compared with those convicted for other crimes. Conversely, women with violent offences were less likely to suffer from ICD-10 F1 disorder than those who had committed nonviolent offences. Findings have implications for practitioners and policy makers, and contribute to the cycle of violence theory discussion. In conclusion, future research areas are suggested.

Keywords

delinquent women aversive and traumatic events mental health legal characteristics comorbidity

Background

Switzerland reports a rather low incarceration rate with about 84 prisoners per 100,000 inhabitants.¹ In September 2015, there were a total of 6,884 prisoners, of which 5.5% were female.² Although the female incarceration rate remained rather stable between 1999 and 2015, there is a general underlying trend indicating a small annual increase. There were 348 female prisoners in 1999, yet by 2015 the population had increased to 375. Still, these numbers indicate that incarcerated women represent a minority group in Switzerland, similar to reports from many other countries. Across the world, about half a million girls and women are incarcerated (Walmsley, 2006), and about 100,000 women in Europe on any given day (MacDonald, 2013).

Due to the low incarceration rate, research into female prisoners has been neglected for a long time (Van Voorhis, 2012). More attention regarding this understudied group has been recommended by the United Nations (Atabay, 2008) and the World Health Organization (WHO; 2007). Hollin and Palmer (2006) have argued that gender-specific research of the prison populations should be undertaken for two reasons: First, research is needed to inform services, so an adequate level of intervention may occur; and second, to inform risk- assessment to avoid over- or underestimation of actual risks.

Recent studies show higher levels of stress among imprisoned women compared with nonimprisoned women, caused by mental and physical health problems as well as social and interpersonal problems. For example, delinquent women are more likely to report a lower level of education attainment than women from the general population (Hollin & Palmer, 2006). Compared with male incarcerated groups, female prisoners have a less extensive and shorter criminal history (Hollin & Palmer, 2006), and tend to commit less violent crimes (Carson & Sabol, 2013). Furthermore, imprisoned women report more aversive and potentially traumatic experiences both during child- and adulthood compared with the general population, as well as with the male population in prison (McCabe, Lansing, Garland, & Hough, 2002; Messina, Burdon, & Prendergast, 2003). They also present higher rates of mental health problems such as depression, psychotic illnesses, posttraumatic stress disorder (PTSD), borderline personality disorder (Coolidge, Marle, Van Horn, & Segal, 2011; Fazel & Baillargeon, 2011; Fazel & Seewald, 2012; Moloney, van den Bergh, & Moller, 2009), and attention deficit hyperactivity disorder (Coolidge et al., 2011), but lower rates of psychopathy compared with incarcerated men (Salekin, Rogers, Ustad, & Sewell, 1998). All this means that this subgroup has special needs that might not be currently provided by a penitentiary service that is tailored for the male population.

Whilst, gender-specific data among prison population from different countries around the world have been reported, information about female delinquents in Switzerland is significantly scarce. The literature review revealed only six studies of this specific prison group. Rossegger and colleagues (2009) investigated 16 women convicted for violent crimes in the German-speaking part of Switzerland in a retrospective study. The participants reported more aversive childhood experiences, lower education attainment, different offence-related characteristics, as well as a higher likelihood for having been in psychiatric treatment prior to offending compared with matched men. Three retrospective studies (conducted in the French-speaking part of Switzerland) revealed several gender differences regarding mental and physical health. In a review of 1,510 files from remand prisoners, the female cases (76) presented slightly more psychological symptoms or complaints than the male sample, including anxiety and depressive disorders, except substance abuse (Eytan et al., 2011). Wolff et al. (2011) studied 2,195 remand prisoners, of whom 108 were female, and found similar gender differences regarding psychiatric problems (except for substance abuse) but no differences regarding somatic health problems. Research conducted by Moschetti et al. (2015) on 1,664 prisoners, of whom 140 were female, revealed that the imprisoned females were more prone to mental health problems, including drug abuse and infectious diseases. Krammer, Linder, Peper, Covington, and Klecha (2015) investigated 20 imprisoned women under forensic-psychiatric care in the German-speaking part of Switzerland, and found that all participants experienced at least one traumatic event. The prevalence of PTSD was 29%. Finally, Handtke, Bretschneider, Elger, and Wangmo (2015) assessed the needs of 13 older female prisoners in comparison with 13 younger ones, and found that elder female prisoners reported poor quality of life, difficulties regarding the provision of health care and the maintenance of social relations. Thus, the existing literature describing female prisoners relies on small samples, and shows inconsistent findings regarding their health conditions.

Therefore, drawing from the research gaps identified, the aim of this study is twofold: first, to provide a detailed description of the female prison population in forensic-psychiatric care in the German-speaking part of Switzerland by analysing (a) sociodemographic data (e.g., age, education, employment status, civil status, motherhood, nationality), (b) offence-related characteristics (such as index offence or duration of imprisonment), (c) the prevalence of aversive and traumatic events (e.g., sexual abuse), and (d) mental health conditions; and second, to test for statistical significant differences regarding mental health and aversive or traumatic childhood events between population subgroups: convicted violent offenders compared with convicted nonviolent offenders, and female offenders for drug-related crimes compared with those with other offences.

Method

Design, Setting, and Procedure

The present study reviewed and statistically analysed data collected by the Forensic-Psychiatric Services (FPD) of the University of Bern in Switzerland. The FPD is responsible for the treatment of female detainees in remand and prisons of the German-speaking part of the canton Bern (Bern, Thun, Biel, Burgdorf), and the largest women-only prison facility (Hindelbank) in Switzerland, with a capacity of 107 places. Furthermore, the FPD provides treatment in an outpatient unit.

The study takes on a full-sample approach, reviewing all files of female clients since the foundation of the FPD in 1996 until 2014. The study population includes all the women who got in touch with the FPD at least once either (a) for the purpose of receiving psychotherapy or (b) for assessment for an expert witness report by the courts. Therefore, the sample covered female offenders who were either in forensic-psychiatric care or suspected to have mental health problems. The duration of the involvement with the FPD varied from one consultation to years. In cases where women got in touch with the FPD several times, data from the first contact were used. Extracted information included sociodemographic characteristics, aversive or traumatic experiences, offence-related characteristics, and mental problems based on the International Classification of Diseases–Version 10 (ICD-10; WHO, 1992).

The forensic-psychiatric files contained different documentary sources: Some included verdicts, some expert witness reports (the latter were exclusively written by forensic psychiatrists). Due to this variety, all variables had a relatively high number of missing values. However, it was decided that all cases would be retained leading to varying sample sizes for each variable. Each sample size is reported, alongside the frequency per variable item, in each table.

All information was available from FPD database of its clients for internal use and other records. No other records were included in the study.

Statistical Analysis

Analyses were done using IBM-SPSS Statistics Version 23 and included descriptive statistics as well as χ²- and F tests. No imputation of missing values occurred.

Two subgroup analyses were performed. First, mental health conditions and experiences of aversive and traumatic events were compared between women with violent offences and those with nonviolent offences. Information was aggregated following the Swiss criminal act that defines violent offences as violations that include manslaughter, murder, homicide, bodily assault, risking life, robbery, threat, kidnapping, and arson. The second analysis compared women with drug-related offences versus women convicted for other reasons. Individuals were coded as part of the drug-related group if they were convicted for at least one drug-related crime.

Mental disorder information was only extracted from expert witness statements. Such statements are generated if mental health problems are suspected to have had an impact on committing the crime. Thus, information on mental health will only be provided for the subgroup with an expert witness statement on files.

Ethical Considerations

The study was completed in accordance with the Declaration of Helsinki. The study was file-based, data were irreversibly anonymized to ascertain data protection, and only aggregated data were used. No informed consent was required.

Results

A total of 1,598 delinquent women were in contact with the Forensic-Psychiatric Services (FPD) since its establishment. Twenty-two files (1.4%) were excluded from analysis because they referred to minors (aged 13-17 years; M = 16.09, SD = 1.34), and five files (0.3%) due to missing information regarding the offender’s age. Hence, the final sample contained 1,571 case files corresponding to 1,571 females.

Datasets included verdict files in 155 cases, and in 239 cases there was an expert witness statement available. The majority, namely, n = 1,043 (97.9%), was incarcerated at least once, while n = 22 (2.1%) have never been incarcerated and were forensic outpatients within the forensic outpatient unit of the FPD. The setting status was unknown for n = 506 (32.2% of the full sample) due to missing data.

Sociodemographic Information

The subjects had an average age of 32.54 years (SD = 9.46), ranging from 18 to 69 years (see Table 1, where the corresponding sample size is presented), with the following distribution: 431 (27.4%) were 18 to 24 years old, while 618 (39.3%) aged 25 to 34 years, 357 (22.7%) aged 35 to 44 years, 134 (8.5%) aged 45 to 54 years, 29 (1.8%) aged 55 to 64 years, and 2 (0.1%) aged 65 years or more. About half were of Swiss nationality (50.8%). Statistics on the civil status reveals that a third of the women were single (36.1%), a third separated or widowed (32.8%), and a third was in a close relationship or married (31.1%).

Table 1.

Sociodemographic Information of Full Sample.

Information	Sample size	M (SD) / n (%)
Age	1,571	32.54 (9.46)
Swiss	1,498	761 (50.8)
Civil status	1,212
Single		437 (36.1)
Separated		236 (19.5)
Widowed		56 (4.6)
Married but separated		106 (8.7)
Marriage-like relationship		128 (10.6)
Married		249 (20.5)
Religion	288
No religion		72 (25.0)
Christian		183 (63.5)
Far eastern religion		7 (2.4)
Islam		26 (9.0)
Education in years	785	10.11 (2.95)
Educational status	1,057
Less than 9 years of school		186 (17.6)
Required schooling		409 (38.7)
Vocational training		354 (33.5)
High school degree		48 (4.5)
College without graduation		32 (3.0)
College degree		26 (2.5)
Continued training		2 (0.2)
Employment situation	872
Retired or similar		295 (33.8)
Benefits		90 (10.3)
Minimum wage job		5 (0.6)
Training		18 (2.1)
Partially employed		238 (27.3)
Part-time job		64 (7.3)
Full-time job		162 (18.6)

On average, these women had 10.11 years of education (SD = 2.95), with a range from 0 to 19 years (n = 785). More than half did not complete any schooling degree (56.3%). Prior to their incarceration, approximately one quarter was working part- or full-time (25.9%), whereas three quarters were without continuous employment.

Data on motherhood were found for a total of 1,251 women. Analysis revealed that approximately two thirds were mothers of at least one child (63.5%). About 27.8% had one child, 20.2% had two, 7.7% had three, and 7.9% had more than four children with a maximum of 11, while 36.5% had no children. In total, 1,624 children were concerned, and each woman had an average of 1.3 children. These numbers include children who passed away due to infanticides (see below).

The mean IQ was 95.88 (SD = 17.22; n = 52), ranging from 47 to 125. About one third were below 90, about half between 90 and 109, and about a fifth had an IQ of 110 or higher.

Aversive or Traumatic Events

Most female offenders (61.7%) grew up with one or both parents. The others reported having grown up in the following settings: 31.1% in changing situations (see Table 2; information on sample size is provided), 3.4% with relatives, 2% in a children’s home, and 1.8% with foster parents (see Table 2; information on sample size is provided). A quarter (25.4%) had lost one or both parents during childhood. Alcohol abuse by a family member was reported in 47.3% of the cases. Around half of the women reported being a victim of violence committed by a close person (48.8%) or neglect (52.4%). There was sexual abuse of a kind in 24% of the study population. In 18.1%, threats, assaults, injuries, or torturing were reported. While 23% were diagnosed with a life-threatening illness, 11.5% had a severe accident, 3.7% experienced war, 2.9% were held captive, and 0.8% experienced a natural disaster. Finally, 40.4% of imprisoned women reported attempting suicide at least once.

Table 2.

Anamnestic Information of Full Sample.

Information	Sample size	n (%)
Growing up situation	919
Children’s home		18 (2.0)
Changing situations		286 (31.1)
With foster parents		17 (1.8)
With relatives		31 (3.4)
With one parent		131 (14.3)
With both parents		436 (47.4)
Death of a parent	858	218 (25.4)
Alcohol abuse by a parent	460	222 (48.3)
Violence during childhood	506	242 (47.8)
Neglect during childhood	432	261 (52.4)
Sexual abuse	432	104 (24.0)
Serious harassment, violent assault, or attack	585	106 (18.1)
Diagnosis of a life-threatening disease	723	166 (23.0)
Severe accident	646	74 (11.5)
War, confinement	877	26 (3.7)
Taken hostage or kidnapped	651	19 (2.9)
Victim of a natural disaster	652	5 (0.8)
Suicide attempt	731	295 (40.4)

Offence-Related Characteristics

More than two thirds were finally convicted by the time of data assessment (n = 892 of a total of 1,307; 68.2%), the remaining were on remand. The average sentence was 2½ years, while seven of 1,307 (0.5%) women in prison were sentenced to “indefinite incarceration” in accordance with Swiss Criminal Law. Drug-related offences constituted the highest proportion of convictions, with 899 cases of 1,409 (63.8%), followed by theft (17.7%), fraud (6.7%), and robbery (5.2%). A small minority were convicted of assault-related crimes (3.6%), while a similar proportion accounted for offences against the road traffic act (3.15%). Sixty-three female prisoners were sentenced for other offences (see Table 3).

Table 3.

Offence-Related Characteristics of Full Sample.

Characteristics	Sample size	M (SD) / n (%)
SCL offence
Deliberate manslaughter	1,401	45 (3.2)
Murder	1,401	30 (2.1)
Homicide	1,402	5 (0.4)
Manslaughter	1,408	2 (0.1)
Aggravated assault	1,406	25 (1.8)
Simple assault	1,405	20 (1.4)
Assault	1,408	3 (0.2)
Risking lives	1,408	3 (0.2)
Theft	1,396	247 (17.7)
Robbery	1,404	73 (5.2)
Fraud	1,397	93 (6.7)
Blackmailing	1,409	6 (0.4)
Threat	1,410	17 (1.2)
Nesting	1,410	8 (0.6)
Kidnapping	1,410	8 (0.6)
Hostage taking	1,409	2 (0.1)
Arson	1,410	22 (1.6)
Dangerous treat	1,409	8 (0.6)
Drug offence	1,409	899 (63.8)
Road traffic act	1,409	44 (3.1)
Sentence in months	884	32.67 (35.0)

Note. SCL = Swiss Criminal Law.

Females convicted of deliberate manslaughter, murder, homicide, and manslaughter constituted 82 detainees (5.8%). Twelve women committed infanticide, with a breakdown of 11 cases involving the death of one child, while one case reported the death of three children. The victim’s age spanned from 0.25 to 11 years of age. Slightly more than half of these female offenders (seven of 12) committed the crime without an accomplice.

Mental Health

As mentioned before, only cases that included an expert witness statement were analysed for mental health disorders; hence, the sample size was 239. The participants presented an extensive range of mental health problems (see Table 4). The majority (94.7%) suffered from at least one diagnosis according to ICD-10: 34.7% fulfilled the criteria for one, 38.7% for two, 16.7% for three, 3.3% for four, and 1.3% for five disorders. Among the study group, the most prevalent mental health condition was mental and behavioural disorder due to psychoactive substance use (F1: 64.7%) with 150 cases of 232, followed by personality disorders (F6: 59.5%), mood disorders (F3: 29.2%), neurotic, stress-related, and somatoform disorders (F4: 28.9%), schizophrenia, schizotypal, and delusional disorders (F2: 11.9%), behavioural syndromes associated with physiological disturbances and physical factors (F5: 9.6%), and organic, including symptomatic, mental disorders (F0: 3.4%). On average, 1.40 (SD = 0.94) ICD-10 diagnoses were reported.

Table 4.

Mental Health (n = 239).

Mental health disorder	Sample size	n (%)
F0: Organic, including symptomatic, mental disorders	208	7 (3.4)
F02: Dementia in other diseases classified elsewhere	200	1 (0.5)
F06: Other mental disorders due to brain damage/dysfunction	201	4 (2.0)
F07: Personality and behavioural disorder due to brain disease/dysfunction	200	1 (0.5)
F1: Mental and behavioural disorders due to psychoactive substance use	232	150 (64.7)
F10: Alcohol	186	38 (20.4)
F11: Opioids	197	65 (33.0)
F12: Cannabinoids	173	19 (11.0)
F13: Sedatives or hypnotics	182	34 (18.7)
F14: Cocaine	190	39 (20.5)
F15: Stimulants	165	5 (3.0)
F16: Hallucinogens	164	1 (0.6)
F19: Multiple drug use	205	85 (41.5)
F2: Schizophrenia, schizotypal, and delusional disorders	202	24 (11.9)
F20: Schizophrenia	194	18 (9.3)
F22: Persistent delusional disorders	191	1 (0.5)
F23: Acute and transient psychotic disorders	191	5 (2.6)
F25: Schizoaffective disorders	190	3 (1.6)
F3: Mood disorders	192	56 (29.2)
F30: Manic episode	184	1 (0.5)
F31: Bipolar affective disorder	184	5 (2.7)
F32: Depressive episode	184	31 (16.8)
F33: Recurrent depressive disorder	184	17 (9.2)
F34: Persistent mood disorders	184	5 (2.1)
F4: Neurotic, stress-related, and somatoform disorders	187	54 (28.9)
F40: Phobic anxiety disorders	173	4 (2.3)
F41: Other anxiety disorders	175	5 (2.9)
F42: Obsessive-compulsive disorder	172	3 (1.7)
F43: Reaction to severe stress and adjustment disorders	180	40 (22.2)
F44: Dissociative disorders	172	6 (3.5)
F45: Somatoform disorders	173	3 (1.7)
F48: Other neurotic disorders	172	1 (0.6)
F5: Behavioural syndromes associated with physiological disturbances	188	18 (9.6)
F50: Eating disorders	182	16 (8.8)
F6: Disorders of adult personality and behaviour	200	119 (59.5)
F60: Specific personality disorders	188	83 (44.1)
F61: Mixed and other personality disorders	180	29 (16.1)
F63: Habit and impulse disorders	175	4 (2.3)
F7: Mental retardation	218	13 (6.0)

Regarding specific personality disorders, emotionally unstable personality disorder borderline type was most often reported (n = 27, 15.3%), followed by dependent (n = 11, 6.3%), dissocial and emotionally unstable impulsive type (each n = 8, 4.6%), other specific (n = 7, 4.0%), histrionic (n = 4, 2.3%), anxious avoidant (n = 3, 1.7%), and paranoid (n = 2, 1.2%).

Comorbidity analysis revealed that 36.0% (n = 72) of those diagnosed with an F1 diagnosis were also diagnosed with an F6 diagnosis, in 18.6% (n = 33) of the cases an F5 diagnosis was comorbid with an F6 diagnosis, in 16.1% (n = 30) F1 with F4, in 15.6% (n = 28) F3 with F6, in 14.7% (n = 28) F1 with F3, and in 10.8% (n = 19) of the cases, an F3 was comorbid with an F4 diagnosis. Further comorbidity rates are presented in Table 5.

Table 5.

Comorbidity Rates (n = 239).

Comorbidity diagnoses	Sample size	n (%)
F0 and F1	206	4 (1.9)
F0 and F2	193	1 (0.5)
F0 and F3	183	3 (1.6)
F0 and F4	180	3 (1.7)
F0 and F5		0
F0 and F6	189	3 (1.6)
F0 and F7		0
F1 and F2	201	13 (6.5)
F1 and F3	190	28 (14.7)
F1 and F4	186	30 (16.1)
F1 and F5	187	15 (8.0)
F1 and F6	200	72 (36.0)
F1 and F7	215	5 (2.3)
F2 and F3	181	5 (2.8)
F2 and F4	178	2 (1.1)
F2 and F5	180	4 (2.2)
F2 and F6	185	8 (4.3)
F2 and F7	192	3 (1.6)
F3 and F4	176	19 (10.8)
F3 and F5	173	6 (3.5)
F3 and F6	179	28 (15.6)
F3 and F7	186	4 (2.2)
F4 and F5	172	3 (1.7)
F4 and F6	177	33 (18.6)
F4 and F7	180	0
F5 and F6	173	13 (7.5)
F5 and F7	180	1 (0.6)
F6 and F7	195	10 (5.1)

On average, the psychopathy score (measured with the revised Psychopathy Checklist (PCL-R) — Hare, 2003 — and extracted from files) was 16.75 (SD = 10.81; n = 12), ranging from 2 to 38. One woman exceeded a score of 30, whereas three women exceeded 25.

Women With Violent Offences

Statistical bivariate analysis revealed that mental health conditions among women with violent offences did vary compared with women who had committed nonviolent crimes. The first group were less likely to suffer from an F1 (24.6% vs. 39.9%, χ² = 17.07, p < .001) and F5 (2.7% vs. 7.0%, χ² = 4.04, p < .05) diagnosis. Statistical analysis into differences among both groups of offenders regarding aversive or traumatic events revealed no statistically significant differences.

Women With Drug-Related Offences

Bivariate analysis indicated that women convicted for drug-related offences were more likely to have an F1 diagnosis (37.3% vs. 27.2%, p < .001), and less likely an F6 (19.3% vs. 40.6%, p < .05) or F7 diagnosis (0.5% vs. 5.1%, p < .05) compared with women without a drug-related offence. None of the childhood variables tested differed between women with or without such an offence.

Discussion

This study provides a full sample, composed of 1,571 case files of adult delinquent women in forensic-psychiatric care in the German-speaking part of Switzerland, including all women who ever came in contact with the FPD. Findings indicate that about nine out of 10 of these women are younger than 45 years, tend to have a low educational level and disadvantageous employment situation before imprisonment, difficulties in social relationships, are mothers, and have a high rate of aversive and traumatic childhood events, and a high rate of mental health disorders. Subgroup comparative analysis indicated that there are only few differences between women with and without violent offences, and women with and without drug-related offences regarding their mental health conditions, and no differences regarding childhood variables tested.

In line with other studies on delinquent women, the average of 10 years of education demonstrates a low-level educational attainment of the study population. Most women had not completed basic school education (56%) according to Swiss standards. Nearly three quarters (74%) were without a steady employment prior to their offence. In contrast, 86% of the female general population (aged between 25 and 54 years) are estimated to be employed in Switzerland.³ Consequently, educational programs during imprisonment and support regarding career entry upon release would be highly relevant.

Our sample also showed a poor or unstable relationship status. Compared with the Swiss general population (43%, see Note 3), the rate of stable relationships was lower (31%). Furthermore, the divorces and the widowhood rate is almost twice as high for these delinquent women than for the Swiss general population (24% vs. 13%). This indicates suboptimal relationships and vulnerable family situations among delinquent women in Switzerland. Probably, these women would benefit from intramural programs that address interpersonal difficulties and influence social competence.

Most of the women (90%) were aged between 18 and 44 years. This is not in line with current discussions about an increasingly old prison population (e.g., Handtke et al., 2015; Maschi, Viola, & Sun, 2013), and may represent either a selection effect or a specificity regarding women in the Swiss criminal justice system.

About half of the delinquent women were Swiss Nationals (51%) compared with 23% of the general female population.⁴ It is important to clarify that Switzerland’s immigration policy is heavily regulated, especially in relation to individuals from non-EU member states, and relies on a system of quotas and permits, and may prevent naturalization for several generations. (In Switzerland, nationality is granted on the basis of jus sanguinis [“right of blood”], as compared with countries granting it on the grounds of jus soli [“right of soil”], such as Canada or the United States.) Therefore, the present calculations might under represent Swiss females, by categorizing women as non-Swiss who were actually born and raised in Switzerland (Fischer, Nicolet, & Sciarini, 2002).

A high proportion of women were mothers of at least one child (64%). No data were collected about the well-being of these children or about the imprisonment rate of the women’s parents. Currently, in Switzerland, little is known about intergenerational effects of imprisonment and the long-term adjustment of these children, whereas there is evidence for an increased risk regarding later behavioural difficulties in children from delinquent parents from abroad (e.g., Murray, Farrington, & Sekol, 2012; Wildeman & Turney, 2014). Future studies should focus on the offspring of delinquent women in Switzerland.

In accordance with other studies, high rates of aversive and potentially traumatic events during childhood were found. About one third of the women did not grow up with their parents (38%). Alcohol abuse by a parent (48%), neglect during childhood (52%), violent experiences (49%), and sexual abuse (24%) were frequent in these women’s lives. It is a repeatedly confirmed finding that exposure to negative childhood events increases the risk for a series of mental disorders, poor psychosocial functioning, and further victimization over the life course (e.g., Krammer, Simmen-Janevska, & Maercker, 2013; Repetti, Taylor, & Seeman, 2002). The pathway to crime theory (Covington & Bloom, 2006) explains the link between negative childhood events and later delinquency. According to this theory, such events increase a person’s risk to become involved in illegal activities. Interestingly, the prevalence of negative childhood events in the current sample did not differ between women with or without violent offences, or between women with or without drug-related offences. More specifically, the rate of women involved in violent crime who had experienced violence in their childhood did not differ from the rate of women convicted for violent crimes without such experiences. Although this might seem to contradict the cycle of violence theory (Widom, 1989), in fact, this was an expected finding. Previous studies have already indicated that the cycle of violence theory does, up to a certain extent, explain violent acts committed by men who had experienced violence themselves. However, it does not explain violent acts by women with violent childhood experiences. There is evidence to suggest that aversive events somewhat reliably predict general delinquency of women offenders but not violent crimes (Widom, 1989). Hence, it could be argued that childhood traumatic events lead to a general increased vulnerability for criminal behaviour among the female population. Future studies should statistically compare with a matched general population sample.

Violent offences were reported in 15% of the cases. The present study did not test for the influence of mental health on the rate of these offences. Further research should focus on this to further knowledge on risk factors within the female population.

The current full-sample approach also revealed a prevalence of 1% for infanticide, which is rare also compared with international reports (Devakumar & Osrin, 2016). According to previous research, mostly young, poor, unmarried women with no prenatal care (Friedman, Horowitz, & Resnick, 2005) and mentally ill women (Liem & Koenraadt, 2008) commit infanticides. Although these risk factors apply to the current sample, the infanticide rate was low.

According to federal statistics of Switzerland, offences against the road traffic act are the ones committed most often by women, namely, in 54% of all verdicts.⁵ However, in the present study, only 3% were convicted for that type of offence. Most likely, these women participated in different, so-called “alternative” forms of their execution of their prison sentence. Furthermore, they may not have reported mental health problems, which prevented them from being in touch with the FPD, where the current sample was drawn from.

Mental health disorders were highly prevalent in our sample: 95% were diagnosed with at least one disorder. This high prevalence was expected, as the data were provided from the FPD, who are responsible for the forensic-psychiatric care of detainees. Not surprisingly then, the prevalence is much higher compared with that in the Swiss general population, where 18% report psychological problems.⁶ The prevalence did not amount to 100%, because some suspected mental health issues did not proof sufficient for meeting ICD-10 diagnoses criteria. A high proportion of mental health problems among imprisoned women is consistent with statistics across Europe and samples from other studies. Salize and Dressing (2008) found a prevalence of mental health rates between 21% and 88% among female prisoners, whereas Von Schönfeld et al. (2006) reported a 92% prevalence rate for at least one mental health disorder among incarcerated women in Germany. In the present study, the highest rate was found for drug-related disorders, namely, 65%. Among European prisoners, the prevalence data ranged between 1% and 80% (Salize & Dressing, 2008), while in Germany a similar rate (71%) was found in a sample of incarcerated women (Von Schönfeld et al., 2006). The second highest rate in the present study was found to be 60% for personality disorder. This is much higher than that found in the Swiss general population, where the prevalence amounts to about 1%,⁷ and, interestingly, is still higher compared with European prisoners (4%-53%; Salize & Dressing, 2008). However, it fits the prevalence rate of 65% found by Von Schönfeld et al. in a German sample of imprisoned.

Interestingly, the prevalence rates of mental health conditions found in the current sample differ, in some respect, from those reported by the other three studies from Switzerland, which compared both female and male prisoner rates. For example, mental health rates presented by Moschetti et al. (2015) were lower compared with those from the present study group. To illustrate this, drug-related disorders were found in 33% and personality disorders in 28%, in both cases about half as high as this research result. There are similar differences referring to the study of Eytan et al. (2011) and Wolff et al. (2011). Most likely, these differences are due to a selection effect. The aforementioned studies included remand and regular prisoners, while the present study only included mental health data of prisoners with an expert witness statement. Thereby, as mentioned previously, high rates of mental health disorders were to be expected.

Regarding comorbidity rates, most often, F1 was found to be comorbid with F6 (36%). Post hoc analysis revealed that this mostly applied to emotional unstable personality disorder borderline type (comorbidity rate: 11%). Previous studies have suggested that the majority of those diagnosed with borderline report childhood traumatic events (Golier et al., 2003). There is also research evidence that suggests how self-medication might explain the high comorbid rates between F1 and trauma-related diagnoses (Khantzian, 1997). Thus, speculating, the high comorbidity rate found between F1 and borderline might be a result of self-medicating trauma-related symptoms—Future studies should clarify this possible mechanism.

From a differential diagnostic point of view, the high rate of borderline personality disorder as well as childhood traumatic events highlights whether these women should be more adequately diagnosed with complex PTSD (Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014). This diagnostic concept will most probably be added to the forthcoming 11th edition of the ICD (Maercker et al., 2013). A previous study from the United States had found that incarcerated women present high rates of symptoms of this conceptual disorder (Guyton, 2011). If so, psychotherapy care and services delivered to these women should follow guidelines developed for this condition (Cloitre et al., 2011).

Suicide attempts were found to be 4 times more frequent among female offenders (40%) compared with the Swiss general population.⁸ It was not assessed whether these attempts had occurred prior to prison entry or in the course of incarceration, which would be a crucial research area. However, this adds to the previous findings that the sample studied is highly burdened and at risk not only for other-harm but also for self-harm.

Altogether, a picture emerges showing that these delinquent and mostly incarcerated women in forensic-psychiatric care in the German-speaking part of Switzerland are burdened by a wide range of problems. In general, this is in line with previous studies from Switzerland (Eytan et al., 2011; Handtke et al., 2015; Krammer et al., 2015; Moschetti et al., 2015; Rossegger et al., 2009; Wolff et al., 2011) and with studies from abroad (e.g., Hollin & Palmer, 2006). Despite the fact that women prisoners represent a minority group and that there is a strong discourse on gender-specific risks, needs, and programming (e.g., Kruttschnitt, 2016), this study’s results might tentatively be interpreted as adding further weight to a gender-specific theory of female criminal behaviour. Such a theory might guide more adequate primary prevention, intramural interventions, and postrelease services (e.g., Freudenberg, Wilets, Greene, & Richie, 1998), thereby reducing suffering of these women, promoting their quality of life and possibly improving legal prognosis, which in turn reduces burden on society. However, caution must be exercised to the fact that the present study rather points to risk factors for initial crime rather than for recidivism. Variables increasing recidivism risks could still differ from those leading to crime in the first place.

Increasing the knowledge of female pathways into criminal behaviour is critical, so preventive strategies are put in place by practitioners and designed by policy makers. This way, tailored community-based services might be built up, and authorities could be informed about early on risk factors that are worth monitoring once detected. For example, if traumatized women self-medicate by drug abuse, leading to delinquent behaviour, the latter could be prevented if we ensure, at an early stage, care and support provision for traumatized girls and young women; enabling them to deal with their traumatic experiences, and educating them about the negative consequences of self-medicating. In addition, Greenfield and colleagues (2007) identified pregnancy, lack of services for pregnant women, fear of losing custody for a new born, or fear of prosecution, coupled with lack of child care outside of treatment, to be gender-specific barriers keeping women from entering treatment for substance use disorders (Ashley, Marsden, & Brady, 2003; Schober & Annis, 1996). Furthermore, women have repeatedly been reported to experience greater social stigma and discrimination than males, when entering treatment programs for substance abuse (Kline, 1996; Liebrenz, Stohler, & Nordt, 2014). Such barriers must be addressed by crime reduction policies and strategies.

The current study has several limitations, which should be addressed in future research. First, the data source contains mostly interpretations from forensic professionals, likely to have not captured the situation of the imprisoned women as seen by them. Moreover, their accounts may differ from the contents in the files. In addition, due to the study being file-based, the data are retrospective in nature and limited by file content. A mixed-methods research would address these failings. Furthermore, some limitations are defined by the sample. The sample per variable varied due to significant number of missing values across the different subsets. Moreover, the study only included the female offender population; therefore, inferences regarding gender-specific characteristics are weak. However, the comparison of research results with the literature and national statistics does tentatively address this limitation. A comparative gender study would allow stronger inferences regarding women-specific characteristics.

Despite the limitations, this study is the most extensive and descriptive analysis of the female population under forensic-psychiatric care for the German-speaking part of Switzerland undertaken to this date. By including several datasets, one of the largest female detainees’ samples (in Switzerland) was obtained. The findings reveal that the average female offender under psychiatric care is relatively young, in an unstable relationship, a mother, with low education attainment and not in full employment prior to arrest, having a traumatic background, and at least one mental health diagnosis according to ICD-10. We also found a high number of women inflicted in drug-related crimes in comparison with the general population. Findings contribute to furthering deeper understanding of the female criminal behaviour and theoretical discussions on violence crime theory. Implications for psychiatric care include awareness that posttraumatic stress might be underdiagnosed among this population and psychiatric treatment is hence required. Finally, this remains a fertile field of research, and our future research will focus on identifying gender-specific characteristics through a comparative sample method, and understanding the relationship between female detainees’ backgrounds and/or their mental health conditions and their criminal behaviour.

Footnotes

Acknowledgements

The authors would like to thank Friederike Biegel, David Hügli, Sophie Köhler, Yves Linder, Livia Peterhans, Maria Rothen, Alesia Schwenzel, and Priska Zuber for data collection.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

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