Associations Between Interpersonal Violence,Psychological Distress,and Suicidal Ideation Among Formerly Incarcerated Men and Women

Abstract

Survivors of interpersonal violence are at increased risk of negative mental health outcomes; however, scant research has explored the relationship between violence exposure and mental health symptoms among formerly incarcerated individuals. This cross-sectional survey study investigates the demographic characteristics and mental health symptoms (i.e., psychological distress and suicidal ideation) associated with interpersonal violence exposure, including physical and sexual intimate partner violence, non-partner sexual violence, and sexual violence perpetrated by prison employees in a sample of formerly incarcerated men and women, with the aim that the findings both deepen the understanding of the effects of sexual violence exposure and help inform prison and jail policies. Surveys were administered to English-speaking adults ages 18 and older to recruit a sample of adults who were formerly incarcerated (N = 201). Questions on the survey included questions regarding demographic details, sexual violence exposure, mental health symptoms, and time incarcerated. Findings show that higher levels of sexual violence exposure were significantly associated with higher levels of psychological distress and reporting of suicidal ideation. Results also suggest that higher levels of income and education and younger age were significantly associated with sexual violence perpetrated by prison employees. In addition, most forms of interpersonal violence were independently associated with psychological distress and suicidal ideation in this population. The findings make recommendations for prison and jail policies to include targeted treatment for individuals with sexual victimization histories, to mitigate the risk of revictimization and appropriately treat adverse mental health outcomes from sexual victimization within and outside the confines of incarceration.

Keywords

violence exposure revictimization sexual assault mental health and violence adult victims

Introduction

Intimate partner physical and sexual violence and non-partner sexual violence are pervasive public health issues affecting millions of men and women in the United States (Black et al., 2011; Cronholm et al., 2011). Furthermore, rates of intimate partner violence (IPV) and sexual violence among incarcerated individuals far exceed that of the general population (Bloom et al., 2003; Browne et al., 1999; DeHart, 2008; Radatz & Wright, 2017). Between 60% and 94% of incarcerated women have a history of physical or sexual abuse compared with one in three women in the general population (Smith et al., 2017; Messina & Grella, 2006). However, limited research has assessed experiences of and mental health outcomes from IPV and sexual violence among both men and women with incarceration histories.

In addition to IPV and non-partner sexual violence experienced outside of prison, data suggest that men and women experience sexual violence within the confines of prison as well, frequently perpetrated by jail/prison employees (Beck et al., 2014). Sexual victimization within the confines of prison is distinct from non-partner sexual violence; non-partner sexual violence is defined as sexual violence perpetrated by a stranger, acquaintance, peer, friend, colleague, teacher, family member, or neighbor (Abraham et al., 2014), whereas sexual victimization in correctional facilities comprised a range of acts including unwanted sexual contact (e.g., groping/touching of sexual body parts), sexual coercion, and forcible rape, either by a fellow inmate or prison personnel, within the confines of prison (Wolff et al., 2007a). Estimates of sexual victimization in prison vary considerably due to varying definitions, measures, and methodologies used across studies. Although data from the National Inmate Survey 2011-2012 (Meyer et al., 2017) estimate that 4% of federal prison inmates and 3.2% of jail inmates experience sexual victimization while incarcerated by either fellow inmates or by prison/jail personnel (Beck et al., 2014) other studies have found that up to 41% of incarcerated persons experience sexual assault or rape by other inmates or by prison/jail personnel while incarcerated (Wolff et al., 2007a).

The number of substantiated allegations of sexual victimization within correctional facilities have risen from 902 in 2011 to 1,473 in 2015, where more than half (58%) of these incidents were perpetrated by prison/jail personnel (Rantala, 2018). Although improved response efforts established through the Prison Rape Elimination Act (PREA) of 2003 have likely led to this increase through increased reportings, sexual victimization in correctional facilities remains vastly underreported by victims and prisoners, and they may later recant their report, often due to fear of retaliation (Alarid, 2000; Islam-Zwart & Vik, 2004).

Research suggests that rates of sexual victimization in correctional facilities are higher among women, younger individuals, White non-Hispanic individuals, and individuals with higher levels of education than their counterparts (Wolff et al., 2006; Beck et al., 2014; Wolff et al., 2007b). Research on prison employee–perpetrated sexual violence reveal that prior histories of physical and sexual abuse may leave individuals vulnerable to revictimization while in prison (Swavola et al., 2016; Wolff et al., 2009). Indeed, IPV and sexual violence is associated with increased risk for revictimization and the development of negative mental health symptoms in the general population, including psychological distress, depression, anxiety, posttraumatic stress disorder (PTSD), and suicidality following their experiences of violence (Cronholm et al., 2011; Yuan et al., 2016; Leiner et al., 2008; Oshodi et al., 2016; Shah et al., 2018). Yet, existing research has not fully explored the relationship between the histories of these common forms of violence (i.e., IPV, non-partner sexual violence) in addition to experiences of sexual victimization while in prison and their effects on mental health symptoms among individuals with incarceration histories. Furthermore, little effort has been made to determine the extent to which these relationships vary among individuals based on salient demographic factors.

As a substantial population of formally incarcerated and currently incarcerated persons have been victimized by sexual violence in their lifetime, the current study is needed to further enhance the understanding of mental health outcomes of persons with both sexual violence and incarceration histories. This deeper understanding can aid the development of evidenced-based policies that target the effective treatment of adverse mental health outcomes from trauma of those currently incarcerated with such histories. Without adequate and appropriate treatment of trauma, the psychological impact from trauma is unlikely to disappear on its own, and further develop into other adverse mental health and physical outcomes (American Psychological Association, 2004). Although the current study was unable to collect substantial data from minority groups, it should be noted that disproportionately higher rates of IPV and sexual violence have been documented among racial, ethnic, sexual, and gender minority subgroups in the general population. It is suggested that this difference may likely be attributed to disparities in socioeconomic status between groups versus race/ethnicity differences. (Black et al., 2011; Brown & Herman, 2015; Walters et al., 2013). To date, scant data are available on experiences of interpersonal violence among incarcerated individuals from communities of color and lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Such data are also needed to further guide interventions that address inmates’ IPV and sexual violence histories, including subgroups who may be disproportionately affected by these pervasive forms of violence.

Current Study

The purpose of this study is to examine the relationship between IPV, non-partner sexual violence, and prison employee–perpetrated sexual violence and mental health symptoms (i.e., psychological distress, suicidal ideation) in a sample of formerly incarcerated men and women (N = 201). Specifically, this study aims to address two primary research questions: (a) What demographic differences exist in exposures to IPV, non-partner sexual violence, and prison employee–perpetrated sexual violence among formerly incarcerated individuals? (b) How are IPV, non-partner sexual violence, and prison employee–perpetrated sexual violence related to psychological distress and suicidal ideation among men and women, controlling for other demographic variables? We hypothesized that rates of IPV, non-partner sexual violence, and prison employee–perpetrated sexual violence would be significantly higher among women, younger individuals, racial/ethnic minority individuals, and sexual minority individuals. We also hypothesized that exposure to IPV, non-partner sexual violence, and prison employee–perpetrated sexual violence would all be significantly associated with increased psychological distress and suicidal ideation across all groups compared with individuals without such violence histories.

Method

Sampling and Study Procedures

A cross-sectional online survey was administered to English-speaking adults ages 18 and older using Qualtrics Panels to recruit a sample of adults who were formerly incarcerated. Qualtrics Panels is an online sampling service that retains panels of several million U.S. residents who consent to participate in periodic survey research and uses a quota sampling methodology to recruit demographically matched samples (i.e., ±10% of 2010 U.S. census distributions for age, sex, and race/ethnicity) based on geographic household data. Participants were provided with information on the purpose of the study and informed consent was obtained by agreeing to complete the survey. The following eligibility screening question was administered to participants: “Have you ever been at any time incarcerated (spent any amount of time in a county, state, or federal custodial facility) for 2 weeks or longer? Note: providing your incarceration experience will allow us to ensure your eligibility for the survey. No information will be used in any way to identify you.” Participants answering “yes” to this screening question were elected for the survey. Monetary incentives were provided to participants who completed the survey at rates determined by Qualtrics. Incentives were less than US$10 and determined by the difficulty in acquiring the targeted quota population such that participants from some harder-to-reach demographic groups were offered larger incentives to fill quotas based on age, sex, and race/ethnicity. Institutional Review Board (IRB) approval was obtained from the sponsoring university, and an IRB waiver for written consent was granted.

Measures

Demographics

Demographic variables included age, gender identity, race/ethnicity, sexual orientation, income, education level, and total years spent incarcerated. Gender identity was recoded as a dichotomous variable (male = 0; female = 1), as no participants identified as transgender or nonbinary. Participant race/ethnicity (Black or African American, White non-Latino, Asian or Pacific Islander, American Indian/Alaska Native, or Other) was recoded as a dichotomous variable (White non-Hispanic = 0; racial/ethnic minority = 1) given very small sample sizes within racial and ethnic minority groups. Sexual orientation was measured with a single item and coded as heterosexual (0) or lesbian/gay/bisexual (1). Annual household income (measured in US$20,000 increments, up to US$100,000+) and education level (high school, high school diploma or GED, some college or technical school, college graduate, graduate or professional degree) were treated as ordinal variables.

Intimate partner violence

Lifetime exposure to IPV was assessed using modified measures from the National Intimate Partner and Sexual Violence Survey (Centers for Disease Control and Prevention, 2016). Intimate partner physical and sexual violence was assessed with the following dichotomous (yes/no) items: (a) “Has a romantic or sexual partner ever made threats to physically harm you?” (b) “Has a romantic or sexual partner ever shot at, stabbed, struck, kicked, beaten, punched, slapped, or otherwise physically harmed you?” (c) “Has a romantic or sexual partner ever forced or pressured you to engage in unwanted sexual activity that you did not want to do? Unwanted sexual activity includes vaginal, oral, or anal intercourse or inserting an object or fingers into your anus or vagina.” Indicators were combined to indicate any IPV (physical and/or sexual), given that these forms of violence often co-occur (Bagwell-Gray et al., 2015).

Non-partner sexual violence

Non-partner sexual violence was measured using a modified item from the National Intimate Partner and Sexual Violence Survey (Centers for Disease Control and Prevention, 2016): “Has anyone else, other than a romantic or sexual partner such as a family member, acquaintance, or stranger) ever forced or pressured you to engage in unwanted sexual activity that you did not want to do? Unwanted sexual activity includes vaginal, oral, or anal intercourse or inserting an object or fingers into your anus or vagina” (no = 0; yes = 1).

Prison employee–perpetrated sexual violence

Lifetime sexual violence experienced in prison by an employee was measured with a dichotomous item adapted from the National Intimate Partner and Sexual Violence Survey (Centers for Disease Control and Prevention, 2016): “While you were in prison, did a staff member or employee of the prison ever force or pressure you to engage in unwanted sexual activity? Unwanted sexual activity includes touching of genitals or vaginal, oral, or anal intercourse” (no = 0; yes = 1). Participants who positively endorsed this item were then asked if they ever reported the incident(s) to prison authorities (no = 0; yes = 1).

Psychological distress

Psychological distress symptoms were assessed using the K-6 scale, which measures clinically significant levels of nonspecific clinical distress in the past 4 weeks (Kessler et al., 2003). The K-6 scale measures symptoms of psychological distress, such as, nervousness, hopelessness, restlessness, depression, worthlessness, and that if everything felt like an effort (Kessler et al., 2002). The K-6 scale uses a 5-point Likert-type scale (1 = all of the time, 2 = most of the time, 3 = some of the time, 4 = a little of the time, and 5 = none of the time), which were reversed coded and summed (ranging from 0 to 24, where higher scores indicate greater levels of distress; Cronbach’s α = .91).

Suicidal ideation

Past-year suicidal ideation was measured using an indicator from the National Survey on Drug Use and Health (Miller et al., 2015: “In the past 12 months, have you ever seriously thought about committing suicide?” Response options included yes, no, or unsure, and were recoded into a dichotomous variable (no = 0; yes = 1). Responses of “unsure” were recoded as “yes” to account for underreporting of suicidal ideation (Klonksy et al., 2016; Prinstein, 2008).

Data Analyses

All analyses were conducted using SPSS (Version 25.0) and were tested at a significance level of .05 (α = .05, two-tailed). Pearson’s chi-square tests and independent samples t-tests were used to examine bivariate associations between demographic factors, each form of violence (i.e., IPV, non-partner sexual violence, prison sexual violence) and mental health symptoms (i.e., psychological distress and suicidal ideation). Multivariate linear and binary logistic regression analyses were conducted to assess the relationship between each form of violence (IPV, non-partner sexual violence, and prison sexual violence), psychological distress, and suicidal ideation, controlling for participant demographics (i.e., age, gender, race/ethnicity, sexual orientation, income, education, total years incarcerated). Interaction terms were created to assess potential differences by gender in the relationship between each form of violence, psychological distress, and suicidal ideation. No missing cases were found due to the use of forced choice responding during the survey’s administration.

Results

Sample Description

Sample descriptives are presented in Table 1. Survey respondents were on average 38.6 years of age (N = 201). The majority of the sample was White (75.1%), 52.2% were female, and 47.8% were male. A total of 82% of participants identified as heterosexual whereas 18% identified as sexual minority (lesbian, gay, bisexual, or other sexual orientation). Household income was evenly distributed with 25.4% of respondents’ annual income US$20,000 or less, 27.4% between US$20,000 and US$39,999, 20.8% between US$40,000 and US$59,999, and the remaining 26.4% of respondents’ annual household income exceeded US$60,000. A total of 3.5% of those surveyed had not completed high school, 23.9% had completed high school, 43.2% had some college education, 23.4% had a college degree, and 6.0% had a graduate or professional degree. Nearly half (49.9%) of respondents’ total time incarcerated was between 1 month and 1 year, with the remaining sample having spent less than 1 month (14.9%), between 1 and 2 years (14.9%), between 2 and 5 years (14.4%), and more than 5 years (6.5%).

Table 1.

Sample Demographics (N = 201).

Demographics	n	%
Median current age (SD)	M = 38.6 (SD = 14.79)
25 or younger	34	16.9
26–40	97	48.3
41–55	41	20.4
56–70	24	11.9
71 and older	5	2.5
Race/ethnicity
White	151	75.1
Racial/ethnic minority	50	24.9
Gender
Female	105	52.2
Male	96	47.8
Sexual orientation
Heterosexual	165	82.0
Lesbian/gay/bisexual	36	18.0
Income
<US$20,000	51	25.4
US$20,000–US$39,999	55	27.4
US$40,000–US$59,999	42	20.8
US$60,000–US$79,999	27	13.4
US$80,000–US$99,999	19	9.5
>US$100,000	7	3.5
Education
Did not complete high school	7	3.5
High school or equivalent	48	23.9
Some college or technical	87	43.2
College graduate	47	23.4
Graduate or professional	12	6.0
Total time incarcerated
<1 month	33	14.9
1 month to 1 year	99	49.9
1–2 years	30	14.9
2–5 years	29	14.4
>5 years	13	6.5
Violence exposure
Intimate partner violence	118	58.7
Non-partner sexual violence	76	37.8
Prison employee sexual violence	34	16.9
Polyvictimization
No victimization reported	71	35.3
One type of victimization reported	54	26.9
Two types of victimization reported	54	26.9
Three types of victimization reported	22	10.9
Mental health symptoms
Past-year suicidal ideation	65	32.3
Psychological Distress (K6; M, SD)	M = 11.05 (SD = 6.41)

With regard to mental health symptoms, a total of 32.3% of respondents reported suicidal ideation in the past year. The overall mean score of participants on the psychological distress (K6) scale (range = 0–24) was 11.05, representing moderate levels of psychological distress (Kessler et al., 2003). With regard to lifetime violence exposure, 58.7% experienced IPV, 37.8% experienced non-partner sexual violence, and 16.9% experienced sexual violence from prison personnel, 35.3% of whom did not report the incident(s) to authorities. Results also indicate overlap between forms of exposure, with 35.3% reporting no exposure to any form, 26.9% reporting exposure to one form, 26.9% to two forms, and 10.9% to all three forms.

Bivariate Associations Between Main Study Variables

Demographic differences in violence exposure

Younger current age was significantly associated with greater likelihood of reporting prison sexual violence (t = .17; p < .05). Higher levels of household income (χ² = 28.57; p <.01) and education (χ² = 24.57; p < .01) were significantly associated with prison employee–perpetrated sexual violence; however, there were no significant group differences based on income and education for IPV and non-partner sexual violence exposure. Gender was significantly associated with IPV (χ² = 14.68; p < .01) and non-partner sexual violence (χ² = 8.99; p < .01), with women experiencing both IPV and non-partner sexual violence at higher rates than men. However, there was no statistical association between gender and prison employee–perpetrated sexual violence, with both men and woman having experienced similar rates of exposure to such violence. Finally, there were no significant differences by race and sexual orientation in exposure to IPV, non-partner sexual violence or prison employee–perpetrated sexual violence (see Table 2).

Table 2.

Demographic and Mental Health Correlates of Intimate Partner Violence (IPV), Non-Partner Violence (NPV), and Prison Sexual Violence (PSV).

Demographic Catagories	IPV (n = 118)		NPV (n = 76)		PSV (n = 34)
Demographic Catagories	n	%	n	%	n	%
Age	t = 0.21(1, 201)	p = .83	t = 1.11 (1, 201)	p = .27	t = 0.17(3, 201)	p < .05*
M (SD)	38.6	15.2	37.3	15.48	38.4	22.05
Race	χ² = 0.6 (1, 201)	p = .44	χ² = 0.41 (1,201)	p = .52	χ² = 2.38 (1,201)	p = .12
White non-Hispanic	91	77.1	59	77.6	22	64.7
Racial/ethnic minority	27	22.9	17	22.4	12	35.3
Gender	χ² = 14.68 (1, 201)	p <.01*	χ² = 8.99 (1, 201)	p < .01*	χ² = 2.01(1, 201)	p = .16
Male	43	36.4	26	34.2	20	58.8
Female	75	63.6	50	65.8	14	41.2
Sexual orientation	χ² = 1.15(1, 201)	p = .28	χ² = 5.87(1, 201)	p < .05*	χ² = 0.20(1, 201)	p = .66
Heterosexual	94	79.7	56	73.7	27	79.4
Lesbian/gay/bisexual	24	20.3	20	26.3	7	20.6
Income	χ² = 8.61(5, 201)	p = .13	χ² = 4.65(5, 201)	p = .46	χ² = 28.57(5, 201)	p < .01*
<US$20,000	32	27.1	19	25.0	1	2.9
US$20,000–US$39,999	39	33.1	23	30.3	5	14.7
US$40,000–US$59,999	18	15.3	11	14.5	9	26.5
US$60,000–US$79,999	14	11.9	10	13.2	7	20.6
US$80,000–US$99,999	11	9.3	9	11.8	9	26.5
>US$100,000	4	3.4	4	5.3	3	8.8
Education	χ² = 2.90(4, 201)	p = .58	χ² = 3.82(4, 201)	p = .43	χ² = 24.57(4, 201)	p < .01*
Did not complete high school	3	2.5	2	2.6	2	5.9
High school diploma or general educational development	31	26.3	21	27.6	9	26.5
Some college	52	44.1	30	39.5	5	14.7
College graduate	24	20.3	16	21.1	11	32.4
Graduate or professional	8	6.8	7	9.2	7	20.6
Suicidal ideation	χ² = 23.54(1, 201)	p < .01*	χ² = 23.00(1, 201)	p < .01*	χ² = 19.6(1, 201)	p < .01*
Yes	54	54.2	40	52.6	22	64.7
No	64	45.8	36	47.4	12	35.3

Significant at p < .05.

Violence exposure and mental health symptoms

Experiences of IPV (χ² = 23.54; p < .01), non-partner sexual violence (χ² = 23.00; p < .01), and prison sexual violence (χ² = 19.59; p < .01) were each significantly associated with past-year suicidal ideation; that is, significantly higher proportions of suicidal ideation were documented among individuals with any of the three forms of violence compared with individuals without such violence histories. Results revealed significant differences in psychological distress scores between individuals who experienced IPV, non-partner sexual violence, and prison employee–perpetrated sexual violence. The mean psychological distress score among those exposed to IPV was 12.67 (t = −4.45; SD = 6.22) compared with 8.76 (SD =5.99) among those without IPV exposure. The mean psychological distress score for those exposed to non-partner sexual violence was 13.88 (t = −5.18; SD = 6.06), compared with 9.34 (SD = 6.02) among those not exposed. Finally, the mean psychological distress score for individuals exposed to prison employee–perpetrated sexual violence was 16.06 (t = −5.32; SD = 4.89), compared with 10.04 (SD = 6.21) for those without exposure (see Table 3).

Table 3.

Bivariate Associations Between IPV, NPSV, PSV, Suicidal Ideation, and Psychological Distress (K6; N = 201).

Violence Exposure	Suicidal Ideation			Distress (K6)
Violence Exposure	n	%	χ²	p	M (SD)	t	p
IPV*	54	54.2	23.54(1, 201)	<.01	12.67(6.22)	−4.45(3, 201)	<.01
No IPV	64	45.8			8.76 (5.99)	−4.45(3, 201)
NPV*	40	52.6	23.00(1, 201)	<.01	13.88(6.06)	−5.18(3, 201)	<.01
No NPV	36	47.4			9.34(6:02)	−5.18(3, 201)	<.01
PSV*	22	64.7	19.6(1, 201)	<.01	16.06(4.89)	−5.32(3, 201)	<.01
No PSV	12	35.3			10.04 (6.21)	−5.32(3, 201)	<.01

Note. IPV = intimate partner violence; NPV = non-partner sexual violence; PSV = prison sexual violence.

Significant at p < .05.

Multivariate Associations Between Violence Exposure and Mental Health Symptoms

Multivariate regression results are presented in Table 4. Linear regression results suggested that exposure to IPV, non-partner sexual violence, and prison employee–perpetrated sexual violence was significantly associated with higher levels of psychological distress. Individuals with IPV, non-partner violence, and prison sexual violence exposure, on average, report higher distress scores than those without exposure to such violence, adjusting for the effects of sexual orientation, gender, age, race/ethnicity, education, income, and time incarcerated on psychological distress. No significant interaction effects for gender were found (see Table 4 for final model results without interaction terms).

Table 4.

Multivariate Associations Between Violence Exposure, Psychological Distress, and Suicidal Ideation (N = 201).

Domographics/Violence Exosure	Psychological Distress (K6)					Suicidal Ideation
Domographics/Violence Exosure	B	SE	95% CI	t	p	OR	SE	p	95% CI
Age	−0.10*	0.03	[−0.16, −0.04]	−3.32	<.05	1.00	0.01	.93	[0.97, 1.02]
Race	0.21	0.95	[−1.65, 2.08]	0.23	.82	0.81	0.40	.61	[0.37, 1.79]
Gender	−1.28	0.91	[−3.07, 0.51]	−1.42	.16	0.77	0.39	.49	[0.36, 1.64]
Sexual orientation	−0.58	1.10	[−2.74, 1.57]	−0.53	.59	2.99*	0.44	<.05	[1.28 7.01]
Household income	−0.35	0.36	[−1.06, 0.35]	−0.98	.33	1.17	1.02	.31	[0.86, 1.59]
Education	−0.02	0.49	[−0.99, 0.95]	−0.04	.97	0.83	0.72	.40	[0.55, 1.27]
Time incarcerated	−0.32	0.37	[−1.06, 0.41]	−0.87	.38	1.02	0.01	.92	[0.74, 1.40]
IPV	2.43*	0.97	[0.52, 4.33]	2.51	<.05	4.37*	0.45	<.05	[1.83, 10.46]
Non-partner sexual violence	2.36*	1.01	[0.37, 4.35]	2.34	<.05	1.87	0.39	.11	[0.87, 4.03]
Prison employee sexual violence	4.70*	1.24	[2.24, 7.15]	3.76	<.01	2.88*	0.49	<.05	[1.01, 7.56]
R ²		.26				.22
Model fit		F = 6.54***				χ² = 49.74***

Note. CI = confidence interval; OR = odds ratio.

p < .05. ***p < .001.

Binary logistic regression results suggested that IPV and prison employee–perpetrated sexual violence were significantly associated with increased odds for past-year suicidal ideation, controlling for demographic variables. Specifically, participants with exposure to IPV were over four times as likely to report past-year suicidal ideation (odds ratio [OR] = 4.37; 95% confidence interval [CI] = [1.83, 10.46]) compared with participants without IPV exposure. Similarly, participants with experiences of prison employee–perpetrated sexual violence had nearly three times the odds of past-year suicidal ideation than participants without such exposures (OR = 2.88; 95% CI = [1.01, 7.56]), controlling for other variables in the model. No significant interaction effects for gender were found.

Discussion

Consistent with prior research on individuals with incarcerated histories, this study found overall high rates of IPV (58.7%), non-partner sexual violence (37.8%), and prison employee–perpetrated sexual violence (16.9%) in a sample of formerly incarcerated men and women. Prior studies have documented rates of physical and sexual violence exposure ranging between 60% and 94% among incarcerated women (Messina & Grella, 2006). Our findings extend this knowledge to include formerly incarcerated men, in addition to women. This study also assessed interaction effects of gender between violence exposures and suicidal ideation and psychological distress. However, interaction terms for gender were not significant in any of the models. Consistent with prior studies focusing on solely women, which reveal the pervasiveness psychological distress among persons with sexual victimization histories, psychological distress was significantly associated with all forms of sexual victimization, regardless of gender.

This study also highlights notable group differences in exposure to each form of violence based on salient demographic factors. Our hypothesis that there would be group differences in exposure across all three forms of violence based on age, gender, race/ethnicity, and sexual orientation was partially supported. Younger (current age) participants were more likely to report prison employee–perpetrated sexual violence than their older counterparts. Consistent with prior studies using samples of incarcerated individuals (e.g., Bloom et al., 2003; DeHart, 2008; Radatz & Wright, 2017), women reported significantly higher rates of IPV and non-partner sexual violence than men; however, there were no significant gender differences in exposure to prison employee–perpetrated sexual violence. Prior studies have found that incarcerated women experience higher rates of sexual coercion in prison by fellow inmates compared with men, and that men experience higher rates of sexual coercion in prison by prison employees. Conflicting findings across studies may be attributed to differences in definitions of sexual violence across studies: Some studies include “rape” in the definition, whereas others use “sexual coercion,” among other terms.

Contrary to other research studies (Black et al., 2011; Wolff et al., 2007a), race was not significantly associated with any of the three forms of violence assessed in this study. Prior research suggests that Native American women among the general population experience sexual victimization at significantly higher rates than any other ethnic groups, followed by multiracial women (Black et al., 2011). On the contrary, other studies using populations with incarceration histories suggest non-Hispanic White women experience higher rates of sexual violence than other racial/ethnic groups (Wolff, et al., 2007a). The lack of differences by race/ethnicity found in this study may be due to the possibility of incarceration acting as a proxy for a variety of other social factors that are associated with violence exposure. By using a formerly incarcerated sample, we may not be able to detect significant racial differences in sexual violence exposure. Furthermore, the lack of significance between race/ethnicity and sexual violence in this study may also be attributed to the inability to detect such difference given the small sample sizes between racial and ethnic groups.

This study did find that higher levels of education and income were significantly associated with prison employee–perpetrated sexual violence, which is consistent with prior research (Beck et al., 2014; Wolff et al., 2007b). There are limited explanations in prior studies for the significance in association between higher levels of income and education and further study is needed to understand this link. It is likely that there are other unmeasured, contextual factors (e.g., demographics, types of crimes/offenses committed) associated with income and education that might also be associated with experiencing prison employee–perpetrated sexual violence. Future research is needed to understand the context and nature of prison employee–perpetrated sexual violence to better understand which populations may be most at risk to experiencing this form of violence.

Studies by Brown and Herman (2015), which studies incarcerated women, and Walters et al. (2013), which studies sexual victimization by sexual orientation, have found that sexual minority men and women experience sexual violence at higher rates compared with heterosexual men and women. Our findings show sexual minority men and women reported higher rates of sexual victimization by a non-partner, though significance was not found between sexual orientation and IPV or prison violence. Although the current study’s findings extend this knowledge to include both sexual minority men and women who were formerly incarcerated, and may account for the differences in significance reported for IPV and prison violence across studies, further research is needed to explain this difference, particularly in larger samples.

Additional research is required to understand contextual differences in prison sexual violence exposure, including why higher levels of education, income, and sexual minority status may increase risk for sexual victimization while in prison. One hypothesis is that higher levels of education, higher levels of income, and sexual minorities, are minority demographics within the prison population (Rabuy & Kopf, 2017; Meyer et al., 2017) and as such, those minority populations may be seen as targets for sexual violence by perpetrators. However, future studies are needed to explore this hypothesis and provide a deeper understanding into the association between income, education, sexual orientation, and prison sexual violence, including mediating variables affecting this relationship. This will aid in the understanding of these vulnerable populations and in protective measures that may be taken.

This study also highlights notable mental health needs among incarcerated individuals who have experienced IPV, non-partner sexual violence, and prison employee–perpetrated sexual violence. Consistent with prior research, results reveal that formerly incarcerated men and women with histories of interpersonal violence (IPV, non-partner sexual violence, and prison employee–perpetrated sexual violence) experience significantly higher levels of psychological distress and increased risk for suicidal ideation, with the exception of non-partner sexual violence. These findings suggest the need for targeted, trauma-informed mental health treatment among survivors of interpersonal violence while incarcerated, as well as comprehensive post-release mental health services geared toward addressing trauma histories and mitigating psychological distress and suicide risk.

Correctional facilities are often ill-equipped to address trauma exposure among incarcerated men and women. Findings suggest the need for enhanced responses to inmates’ histories of interpersonal violence. These efforts might include screening inmates for histories of interpersonal violence to better ascertain physical health, mental health, and other service needs, in addition to assessing risk for revictimization within correctional facilities.

Limitations

There are several limitations for consideration when interpreting study findings. First causal relationships between study variables cannot be established due to the study’s cross-sectional design. The sample was recruited using non-probability sampling methods and as such, selection bias into the study is a potential limitation. In addition, only English-speaking participants were included in the sample and thus, findings are not generalizable to non-English-speaking populations. In addition, no participants identified as transgender or non-binary and small sample sizes within racial/ethnic groups prevented us from understanding differences in both exposure to violence and associated mental health symptoms across various racial/ethnic identities (e.g., Black/African American, Latino/a, Asian and Pacific Islander, White non-Hispanic) and gender identities. Future research is needed to understand potential differences in violence exposure and associated mental health symptoms within larger samples of formerly incarcerated individuals from various racial/ethnic and gender minority groups. In addition, our measures of non-partner sexual violence may include incidents of prison employee–perpetrated sexual violence, as we did not explicitly ask participants to report on their experiences with individuals who were not prison employees.

Relatedly, the measure of prison employee–perpetrated sexual violence captured only sexual victimization experiences perpetrated by prison employees and not by other inmates, which comprise a large proportion of sexual victimization experiences among incarcerated individuals. Further research is needed to better understand individual experiences of sexual violence by other inmates, in addition to prison employees, to adequately capture individuals’ full range of sexual victimization experiences while incarcerated. Finally, while we assessed and controlled for participants’ total years incarcerated, we were not able to assess the length of time since incarceration at the time of the study, which is important to understand current mental health symptoms.

Conclusion

Findings from this study identify a set of mental health outcomes that are associated with violence among those that have incarceration histories. These findings can inform state and federal prison policies on providing treatment within correctional facilities and assist correctional facilities in developing intake protocols and screenings for histories of violence. Consistent with prior studies, we found that adverse mental health symptoms are prominent in populations with IPV and sexual violence histories. Furthermore, prior histories with violence may leave survivors vulnerable to revictimization within prisons/jails and inadequate resources within correctional facilities may leave the effects of victimization untreated. Both proactive measures in correctional facilities need to be taken to protect survivors of interpersonal violence from revictimization within prisons/jails and appropriate mental health services need to be provided to treat mental health symptoms of interpersonal violence. Findings from this study can help to inform PREA and related federal policy on sexual violence and to address interpersonal violence histories among inmates. There were some inconsistencies with prior studies based on demo-graphic characteristics and experiences with violence; however, education remained significantly associated with sexual violence perpetrated by a prison employee. One area to explore in future research is deepening the understanding of this association. Is education linked to another characteristic not yet studied? Do higher levels of education act as a distinguishing factor, marking someone a target for sexual violence and, if so, why? Limited research in this area makes this association unclear and deepening this knowledge can only aid in further understanding of this vulnerable population and what measures correctional facilities should take to protect those at risk of sexual victimization and treat those who become victims of such violence.

Footnotes

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) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by internal funding from the University of Maryland School of Social Work, through the Competitive and Innovative Research (CIR) Award to DeVylder and Graduate Research Assistantship to Fedina.

ORCID iDs

Madeleine Newman

Lisa Fedina

Boyoung Nam

Author Biographies

Madeleine Newman, MSW, both works at the Crohn’s & Colitis Foundation and conducts research with Dr. Lisa Fedina at the University of Michigan School of Social Work. Her research focuses on sexual violence and the criminal justice system.

Lisa Fedina, PhD, MSW, is an assistant professor at the University of Michigan School of Social Work. She received her PhD in Social Work from the University of Maryland, Baltimore. Her research focuses on gender-based violence, health care, and criminal justice systems responses to violence and victimization. She previously served survivors of human trafficking, intimate partner violence, and sexual assault and led community organizing and policy advocacy initiatives to address gender-based violence.

Boyoung Nam, MSW, PhD, is an assistant professor at Yonsei University Department of Social Welfare. She received her PhD in Social Work from the University of Maryland, Baltimore. Her research focuses on mental health among racial/ethnic minorities, suicidal ideation and behaviors, help-seeking behaviors and mental health service utilization, and protective factors of mental health outcomes, including resilience.

Jordan DeVylder, PhD, MSSW, MS, is an associate professor at the Fordham University Graduate School of Social Service. He received his MSW and PhD in Social Work from Columbia University, and MS in Cognition & Brain Science from Georgia Institute of Technology. His research is focused on social epidemiology and preventive mental health. He is the principal investigator of the Survey of Police-Public Encounters, an epidemiological survey study conducted to better understand the mental health correlates of police violence in U.S. cities.

Binta Alleyne-Green, PhD, MSW, earned her Master of Social Work Degree from Clark Atlanta University and PhD from the University of Tennessee Knoxville and currently is an assistant professor at Fordham University Graduate School of Social Service. Her research focuses on the impact of relationship violence on risk behaviors among minority adolescent females.

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