Health problems and adversities experienced by incarcerated mothers: Use of a life events calendar

Abstract

Background

Incarcerated mothers frequently experience multiple adversities that negatively affect their mental and physical health, yet the timing and nature of these relationships remain underexplored.

Objective

This study aimed to examine the timing, type and extent of health problems and adversities experienced by incarcerated mothers in Australia in the five years preceding their current incarceration.

Design

A cross-sectional study with retrospective life history data using a Life Events Calendar.

Methods

Data were drawn from 120 mothers in prison who participated in a larger project on maternal incarceration and child wellbeing. Health problems and adversities occurring in the last five years before incarceration were summarised using descriptive statistics. Bivariate analyses were conducted to assess associations between specific adversities and any, physical, or mental health problems. The number of adversities experienced in each year were compared between mothers with and without health problems.

Results

Of the 119 mothers included in the analysis, 47.9% reported physical health problems, 83.2% reported mental health problems and 42.9% reported both in the last five years. The most common adversities were problematic drug use and victimisation, each reported by 84.0% of mothers. Problematic drug use was strongly associated with all categories of health problems, while death of loved ones was associated with physical health problems. Mothers with physical health problems experienced more adversities in the one to three years before incarceration, while those with mental health problems had greater adversity exposure three to five years prior.

Conclusion

Incarcerated mothers experience high levels of adversity and health problems, with mental health problems linked to earlier adversity and physical health problems linked to recent adversity. The findings underscore the need for early, holistic, and trauma-informed interventions, particularly those addressing substance use and victimisation, to improve health outcomes and intergenerational harm.

Keywords

adversity health life events calendar (LEC)life history calendar mothers prison stressful life events

Introduction

Despite men comprising the majority of the global custodial population, incarcerated women—both in Australia and other jurisdictions—represent one of the fastest-growing prison populations.^1,2 Globally, women and girls account for approximately 7.0% of the total prison population—a figure closely reflected in Australia, where women currently make up 7.7% of the prison population.^1,2

While the health of incarcerated individuals has garnered growing scholarly attention,^3,4 much of this research has focused on men. The comparatively limited studies on incarcerated women reveal that they experience complex health challenges, including high rates of mental illness, chronic conditions, infectious diseases, and substance use disorders, often surpassing those observed among incarcerated men.^3,5 Although these studies underscore pressing health concerns faced by incarcerated women in general, few have specifically examined mothers as a distinct subpopulation, even though they make up a significant proportion of the female prison population globally and nationally.^6,7 This is a critical oversight, as emerging research suggests that incarcerated mothers may face even greater health burdens.^8,9 For example, using data from the Fragile Families and Child Wellbeing Study,¹⁰ Turney and Wildeman (2015) found that formerly incarcerated mothers reported significantly higher proportion of depression, illicit drug use, heavy drinking, fair or poor health, and health limitations, compared to their non-incarcerated counterparts. Similarly, Rose and LeBel (2017) documented substantial physical and mental health concerns among incarcerated mothers who have minor children.⁸ Given that maternal ill health can have a detrimental impact on children’s health and wellbeing, it is essential to understand the specific health needs of this group to help break intergenerational cycles of disadvantage and poor health.¹¹

These health challenges must be understood in the context of the broader adversities that often shape women’s pathways to incarceration. A growing body of research points to gendered pathways to prison, with many women incarcerated for non-violent offences such as theft, fraud, or drug-related crimes—offences frequently linked to histories of poverty, homelessness, interpersonal violence, and trauma.^6,12,13 Incarcerated mothers, in particular, often contend with cumulative historical, socio-cultural and political adversities, including the ongoing impacts of intergenerational trauma, housing instability and homelessness, loss of custody and contact with children, psychological, physical or sexual violence victimisation, substance dependence, financial instability and poverty, and the breakdown of intimate relationships.^14,15 These structural conditions and related individual stressors are often compounded by policy environments that criminalise women’s survival strategies and provide limited access to health and social services.^12,14 Chronic stress resulting from sustained and cumulative adversity is an established driver of poor physical and mental health.¹⁶ It is well documented that stress can induce physiological disruptions that contribute to chronic diseases.¹⁷

While there is substantial evidence linking adversity to poor health outcomes in incarcerated populations,^3,18 research specifically focusing on incarcerated mothers or examining differences between incarcerated mothers and incarcerated women without children remains limited. Existing studies suggest that motherhood may function as a gendered social role that shapes health in distinct ways. For many women, caregiving responsibilities, separation from children, and the stigma associated with incarceration intensify psychological distress and increase their vulnerability during incarceration, particularly as imprisonment limits their ability to fulfill their motherhood role.^19,20 However, for some women, maternal identity may serve as a source of resilience and motivation for behavioural change.²⁰ These mechanisms differ from those typically observed among incarcerated fathers, whose caregiving roles, social expectations and patterns of involvement with children are structured differently.^14,21 Together these factors underscore the importance of studying incarcerated mothers as a distinct subgroup.

A smaller but growing body of work has examined the adversities that women experience over their life course—particularly during childhood and the prenatal period—and their impacts on women’s health, especially in relation to mental health and substance use.^22–25 Although women’s lives before coming to prison are frequently marked by a wide range of traumatic experiences and instability,^26,27 there is limited understanding of the recent adversities experienced by mothers prior to incarceration. This represents a critical gap, as the period leading up to incarceration for mothers is often characterised by escalating crises that compound prior trauma and may trigger new or worsen existing mental and physical health conditions.^24,28 Similarly, substance use—commonly adopted as a coping strategy among women with histories of adversity—is both a consequence and a contributor to a range of health concerns.^23,29

In addition to conceptual limitations, existing research on the health problems and adversities experienced by incarcerated women has relied heavily on cross-sectional, self-reported data, and U.S.-based samples.^3,10 These findings may not be representative of other jurisdictions due to substantial differences in healthcare provisions and costs across countries. For example, a recent report comparing the health system performance of ten high-income nations ranked Australia first in overall ranking, with particularly high performance in equity and health outcomes. In contrast, the U.S ranked the last, scoring lowest on access to care, health outcomes, and equity.³⁰ This highlights the need for more research outside the U.S. to better understand the health status of incarcerated populations in different healthcare contexts. Australia’s universal healthcare system and emphasis on equity through social welfare policies that include factors such as housing, employment, education and social participation offer unique opportunities to examine how structural supports shape the health outcomes for incarcerated mothers, and when, why, and how they fail mothers.^30,31

Most existing studies assess adversity using cumulative indices or limit their focus to a few common individual adversities, primarily childhood trauma and intimate partner violence, thereby masking the distinct impact of a broader range of specific adverse events.^22,32 A recent U.S.-based study had identified four different categories of adversity exposure (1—high adversity exposure, 2—low adversity exposure, 3—moderate deprivation, high violence exposure, and 4—high deprivation, low violence exposure) and used these categories to predict mental health and substance use disorders rather than relying on an additive measure of adverse experiences.²⁷ Although, this study examined how different levels of exposure were associated with mental health and substance use disorders, it did not include physical health problems, and it remained unclear which specific adversities were associated with the mental health and substance use problems. It is important to expand this literature by examining a wider range of individual adversities and their links to health problems, as both cumulative scores and latent class approaches can obscure important nuances. Not all adversities exert equal influence on physical and mental health, and their effects likely vary depending on their timing and the ways they interact with each other. A more nuanced understanding of the type and timing of adversity is essential for designing targeted interventions and informing effective policy responses.

This paper seeks to address these methodological and geographical gaps in the literature by exploring health problems and adversities experienced by incarcerated mothers in the five years immediately prior to their current incarceration. To achieve this, we utilise a life events calendar (LEC)— a unique method that facilitates the collection of detailed, time-specific data across a range of domains.³³ In particular, LEC enables us to capture information about the timing, type, and extent of events, such as health problems and adversities, that a person has experienced throughout their life. They have been increasingly adopted as a data collection tool to study health and behavioural trajectories among marginalised populations, including gender minorities.^34–36

Using LEC data, this study explores how adversities, experienced in the five years prior to the current incarceration, relate to incarcerated mother’s physical and mental health problems during this same period. We focused on the five years preceding mothers’ current incarceration to capture recent, temporally ordered patterns of adversity that are long enough to reflect the potential range of health problems experienced by incarcerated mothers. More specifically, we examine the frequency and type of health problems and adversities that mothers experience each year to identify patterns and periods of heightened vulnerability among this group. This approach allows for the identification of critical periods where adversity peaks, offering actionable insights for prevention, intervention and support strategies. This study examines the following research questions:

1. Which types of health problems have incarcerated mothers experienced in the five years preceding incarceration and in each year during that period?

2. What is the frequency and average number of adversities experienced by incarcerated mothers in the five years preceding incarceration and in each year during that period?

3. What is the relationship between each type of adversity and health problem experienced by incarcerated mothers in the five years preceding incarceration?

Methods

Design and participants

A cross-sectional study with retrospective life history data was used to explore the life trajectories of mothers in prison. This study included a sample of 120 mothers recruited for a larger project examining the impact of maternal incarceration on children’s outcomes (Mother and Child Wellbeing Project).

A formal power calculation was not undertaken for this study because the research involved a highly vulnerable and hard to reach population, incarcerated mothers, for whom probabilistic sampling and large-scale recruitment are not feasible. Instead, our sample size was determined pragmatically, based on the maximum number of eligible participants available during the data-collection period and consistent with accepted practice in research involving small, marginalised populations. To contextualise the adequacy of our sample, in 2020 there were 766 women in Queensland prisons, and approximately 54% of women in custody have dependent children (ABS, 2025; AIHW, 2020).^1,37 This equates to an estimated 414 mothers with children aged 0–18 years in custody at any given time. Although annual figures for mothers in custody are not available for earlier years, the total number of women in Queensland prisons has remained relatively stable (e.g., 838 in 2018, 853 in 2019, 766 in 2020; ABS, 2025). Applying the same proportion (≈54%) across these years suggests that approximately 414–461 mothers were incarcerated at any given point. Within this context, our final sample of 120 mothers represents approximately 30% of the estimated population of mothers in custody in Queensland, which is adequate to explore adversities and health experiences.

Women were eligible to participate if they were mothers to one or more children aged between 5 and 17 years at the time of interview, and they either had lived with or had regular phone calls or visits with one of their children for at least 50% of his/her life. Researchers attended each prison and discussed the project with staff members, who then placed posters about the research around the prison. Every two to four weeks, the researchers also walked around the prison and discussed the research in-person with women residing there. Women were asked to provide an expression of interest if they were interested in participating in the research. A researcher then attended the prison to speak to these women to ensure they met the inclusion criteria and complete the consenting process. The researcher scheduled an interview with each eligible woman who consented to participate. All interviews took place in a private room to ensure confidentiality. Incarcerated women were interviewed between July 2019 and March 2020, and August 2022 and February 2023. (Data collection was halted due to COVID-related restrictions and recommenced once the prisons permitted women to recommence face-to-face visits with their families). Interviews were conducted at five women’s prisons in Queensland, which has seen a rise in imprisonment of women from four percent of cases in 2005-06 to nine percent in 2018-19, when data collection began.³⁸

To collect data on various life events experienced by mothers in prison, researchers conducted an interview with mothers, where they administered a survey and LEC. This paper primarily utilises the LEC data but also relies on demographic information about the mother collected through the survey. LECs commence at the birth of the focal child – they do not capture the entirety of the mother’s life. The LEC asked mothers whether various events (e.g., legal issues with children, relationships with partners, accommodation, employment, finances, health problems and treatment, deaths, offending, alcohol and substance use, and treatment for alcohol and substance use) occurred during a focal child’s (Focal child refers to one of the mother’s children, who was aged 5 to 17 years at the time of interview, living in an informal care arrangement, without involvement of the Department of Child Safety, and the child had either lived with or had regular phone calls or visits with their mother for at least 50% of their life) life, and, if so, how old the mother was when each event occurred. Where relevant, additional questions were asked about the type of the event (e.g., the type of mental health problem). A blank LEC and the demographic section of the survey used in this study are provided in Supplementary File 1.

To administer the LEC, the researcher sat at a table with each woman – either in a side-by-side configuration or on opposite sides. The woman was able to see the LEC and point to the events and ages as the researcher filled it out. The researcher took between 45 minutes and 1.5 hours to complete the LEC with each woman, with greater time needed for women who had more children and an older focal child. Prior to administering the LECs, each researcher received a training guide and participated in in-person training about how to administer LECs. The training included researchers partaking in mock interviews with at least three mock participants. The end goal was to ensure consistency across researchers in the administration of the LEC.

As the observation period varied across mothers depending on the age of their focal child, we restricted the observation window to the five-years preceding the year of the mothers’ current incarceration. This enabled us to ensure that every participant contributed data across an equivalent timeframe and therefore had an equal opportunity to experience each maternal adversity. Because the age of the focal child determined how many years of adversity data could be captured, one mother, whose focal child was only three years old at the time of her current incarceration, could not contribute to the full five years of data. Retaining this case would have introduced a shorter and non-comparable observation period, as a result this mother was excluded, resulting in a final analytic sample of 119 mothers. This exclusion does not affect the sample or findings, as it represents less than 1% of the cohort and the excluded case did not differ in any systematic way from the broader sample (Supplemental File 2).

Although maternal adversities were assessed in the five-year period preceding the mothers’ current incarceration, we are not attempting to draw conclusions about causal patterns or pathways to incarceration, as many women (n = 52, 43.7%) experienced multiple incarcerations during this period. Rather, our focus is on identifying recent patterns of adversity—including prior incarceration—and examining how these adversities are associated with health problems among currently incarcerated mothers. We followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist in reporting this study (Supplementary File 1).³⁹

Measures

Demographic characteristics

A survey was used to collect information about the mother’s current age, educational level, ethnicity, relationship status, gender, country of birth, number of biological children, and socioeconomic status (SES). Index of Relative Socio-economic Advantage and Disadvantage [IRSAD]) was computed using the mother’s postcode before her current incarceration, derived from Socio-Economic Indexes for Areas.⁴⁰ If an individual’s place of residence before her current incarceration was ranked in the bottom three deciles of the IRSAD, they were coded as having low socioeconomic status (SES).⁴¹

Maternal adversities

Since this paper explores the relationship between adversities and health problems, we included negative life events experienced by mothers and referred to them as “maternal adversities”. The LEC was used to assess maternal adversities.

Table 1 includes the operational definitions for health problems and eight other maternal adversities experienced by the mothers that we have included in this paper. These adversities, though not a comprehensive list, represent significant negative life events identified in the literature as common in the lives of incarcerated women.^18,22,42

Table 1.

Definitions of various types of health problems and other maternal adversities.

Variables	Description
Physical health problem	Major physical health problems, including problems not formally diagnosed.
Mental health problem	Major mental health problems, including problems not formally diagnosed.
Separation from children	Living separately from one or more of her children due to incarceration, involvement with child protection services, or involvement in a child custody dispute, or where she had not lived with one or more of her children for at least one year and the reason for separation was not known. All instances of separation occurred prior to her current incarceration.
Involvement with child protection services	Notifications (not distinguishing between substantiated and unsubstantiated), investigations, or removal of children from the mothers’ care, in relation to any of her children.
Living in unstable accommodation	Living on the street or in improvised dwellings, tents, or sleepers out, or in supported accommodation for people in need (e.g., a shelter), transitional housing (e.g., a boarding house), or in any accommodation paying rent, board, or a mortgage for six months or less each time.
Financial difficulties	Having substantial debts owing (e.g., personal loans, credit card debts), or being unable to meet everyday needs (e.g., paying rent, paying for food).
Death of loved ones	Death of a partner, child, or someone the mother cared about.
Crime victimisation	Crime against the person (e.g. assault) or property (e.g., identity theft, vandalism).
Partner victimisation	Different acts of physical and psychological violence, including controlling behaviours by a partner (e.g., current or former partner) as defined by the World Health Organisation.⁴ Mothers who reported any type of victimisation were coded as “experiencing victimisation” for regression analyses.
Harmful alcohol use	Five or more standard drinks in a day.^*
Problematic drug use	Taking medication prescribed to them more often or in greater amounts than prescribed, using other’s prescribed medicines, or using non-prescription drugs or inhalants.
Prior incarceration	In prison, either sentenced or on remand, prior to their current incarceration.

*The Alcohol and Drug Foundation guidelines recommend that healthy men and women drink no more than four standard drinks on any one day to reduce the harm from alcohol-related disease or injury. https://adf.org.au/reducing-risk/alcohol/alcohol-guidelines/

Ethical considerations

Ethical approval was obtained from the Griffith University Human Research Ethics Committee (HREC 2018/067) and permission to conduct the research was granted by Queensland Corrective Services. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation, and with the Helsinki Declaration of 1964, as revised in 2008. Written informed consent was obtained from participants before the interview, and the consent forms are stored on a secure password protected server at Griffith University.

Statistical analysis

Analyses were conducted at multiple levels. To address the first research question, we examined different types of health problems experienced by mothers in the five years preceding their current incarceration, reported as “occurrence of health problems in the last five years”. We also calculated the overlap of co-occurring health problems. Descriptive statistics (frequency and proportion) were used to report the prevalence rates. The 95% Confidence Interval (CI) of a proportion, was calculated using the standard formula based on the normal approximation to the binomial distribution (also known as the Wald method).⁴³

To examine the second research question and understand the pattern of maternal adversities experienced annually over the last five years, we calculated both the proportion of mothers experiencing each adversity in each year and the mean number of adversities mothers reported each year.

To examine the third research question, three categories of health problems were used as outcome variables: any health problem, any physical health problem, and any mental health problem. A series of chi-square tests and logistic regression analyses were conducted to explore the associations between the proportion of mothers who experienced other maternal adversities and each of these health problems. Additionally, independent t-tests were used to compare the mean number of adversities experienced in each year between mothers with and without each health problem. When examining the association between adversities and any mental health problem, physical health problems were included as one of the adversities. Conversely, mental health problems were considered as an adversity when examining the association with any physical health problem. Analyses were conducted using the Statistical Package for Social Sciences (SPSS), version 30.

Findings

The study included a total of 119 mothers, aged between 21 to 54 years (M = 33.9, SD = 6.2- years). Table 2 shows that more than one-thirds (37.8%) of these mothers identified as Aboriginal and/or Torres Strait Islander. Just above 52% (n = 62) of mothers had completed up to Year 10 and 42.9% had low SES as indicated by living in disadvantaged areas before their current incarceration. About 60% of mothers (n = 69) were not currently in a relationship and a similar proportion (n = 74, 62.2%) had more than two children.

Table 2.

Socio-demographic characteristics of mothers.

Variables	Categories	n	% (95% of CI)
Age [Mean ± SD, Range]		33.9 ± 6.2 years [21 to 54 years]
Age group (years)	Less than 35	84	70.6 (62.4, 78.7)
Age group (years)	35 or older	35	29.4 (21.3, 37.6)
Ethnicity	Aboriginal and/or Torres Strait Islander	45	37.8 (29.1, 46.5)
	Non-Indigenous Australian	54	45.4 (36.5, 54.3)
	Other ^a	20	16.8 (10.1, 23.5)
Education level	Up to year 10	62	52.1 (42.7, 60.6)
Education level	Year 11 and higher ^b	57	47.9 (39.0, 56.8)
Socioeconomic status	Low	51	42.9 (34.0, 51.7)
Socioeconomic status	Others	68	57.1 (48.3, 66.0)
Relationship status (n = 116)	In a relationship	47	39.5 (30.8, 48.2)
Relationship status (n = 116)	Not in a relationship	69	58.0 (49.2, 66.8)
No. of biological children	Up to 2 children	45	37.8 (29.1, 46.5)
No. of biological children	More than 2 children	74	62.2 (53.5, 70.9)

Note. 100% of mothers identify themselves as females, and 112 mothers (93.3%) were born in Australia.

^a Other includes South Sea Islander, New Zealander, Maori, African, Indian, Chinese, or Samoan.

^b Higher education includes up to a Bachelor’s degree at university.

Occurrence of health problems in the last five years

Figure 1 illustrates the physical and mental health problems and their overlap as reported by mothers in prison. Of 119 mothers, 57 (47.9%; 95% CI: 38.9, 56.9) reported any physical health problems and 99 (83.2%; 95% CI: 76.5, 89.9) reported any mental health problems in the five years preceding their current incarceration. Nearly half of the mothers (n = 51, 42.9%) reported both physical and mental health problems, with an almost equal proportion experiencing mental health problems only (n = 48, 40.3%), in this time. On average, 74.6% of all the health problems that mothers experienced in the last five years were mental health problems.

Figure 1.

Overlap of mental and physical health problems reported by mothers in the last five years.

As can be seen in Table 3, the most commonly reported physical health problems in the last five years were musculoskeletal problems, including injuries (21.0%), followed by neurological problems, heart problems, and reproductive problems, each accounting for 9.2% (n = 11). The most reported mental health problem in the last five years was depression (65.6%), followed by anxiety (57.1%) and PTSD (30.3%).

Table 3.

Occurrence of broad and specific types of health problems in the last five years.

Physical health problems in the last five years	Total (n)	% out of total sample (95% CI) (n = 119)	% out of those reporting PH problems (95% of CI) (n = 57)
Musculoskeletal problems including injuries	25	21.0 (13.7, 28.3)	43.9 (31.0, 56.7)
Cardiovascular problems	11	9.2 (4.0, 14.5)	19.3 (9.1, 29.5)
Neurological problems	11	9.2 (4.0, 14.5)	19.3 (9.1, 29.5)
Reproductive problems	11	9.2 (4.0, 14.5)	19.3 (9.1, 29.5)
Blood and immune system disorders	8	6.7 (2.2, 11.2)	14.0 (5.0, 23.1)
Gastrointestinal problems	7	5.9 (1.7, 10.1)	12.3 (3.8, 20.8)
Respiratory problems	6	5.0 (1.1, 9.0)	10.5 (2.6, 18.5)
Eye problems	2	1.7 (-0.6, 4.0)	3.5 (-1.3, 8.3)
Neurodevelopmental and intellectual disorders	1	0.8 (-0.8, 2.5)	1.8 (-1.7, 5.2)

Mental health problems in the last five years	Total (n)	% out of total sample (95% CI) (n = 119)	% out of those reporting MH problems (95% of CI) (n = 99)
Depression	78	65.6 (57.0, 74.1)	78.8 (70.7, 86.8)
Anxiety	68	57.1 (48.3, 66.0)	68.7 (59.6, 77.8)
PTSD	36	30.3 (22.0, 38.5)	36.4 (26.9, 45.8)
Bipolar	14	11.8 (6.0, 17.6)	14.1 (7.3, 21.0)
Personality disorders	12	10.1 (4.7, 15.5)	12.1 (5.7, 18.6)
Schizophrenia	10	8.4 (3.4, 13.4)	10.1 (4.2, 16.0)
ADHD/ADD	8	6.7 (2.2, 11.2)	8.1 (2.7, 13.5)
Stress	7	5.9 (1.7, 10.1)	7.1 (2.0, 12.1)
Drug overdose including alcoholism	5	4.2 (0.6, 7.8)	5.1 (0.7, 9.4)
Suicide attempt	3	2.5 (-0.3, 5.3)	3.0 (-0.4, 6.4)
Eating disorder	2	1.7 (-0.6, 4.0)	2.0 (-0.8, 4.8)
OCD	2	1.7 (-0.6, 4.0)	2.0 (-0.8, 4.8)
Others (e.g., hypersexuality, intermittent explosive disorder)	2	1.7 (-0.6, 4.0)	2.0 (-0.8, 4.8)

Note. UTI: Urinary tract infections; PTSD: Post-traumatic stress disorder; ADHD/ADD: Attention Deficit-Hyperactivity Disorder/Attention Deficit Disorder; OCD: Obsessive Compulsive disorders.

Among mothers who reported at least one physical health problem (n = 57), the average number of distinct physical health problems they experienced in the five years prior to their current incarceration was just under two (M = 1.91, SD = 1.17, Range: 1-6). Mothers who reported any mental health problems (n = 99) experienced a slightly higher number of distinct mental health problems on average (M = 2.57, SD= 1.32, Range: 1-8). Figure 2 illustrates the distribution of these problems in the five years prior to current incarceration. One or two health problems were most common overall, with physical health problems more prevalent than mental health problems at these lower levels. However, among mothers experiencing three or more distinct health problems, mental health problems were dominant.

Figure 2.

Distinct health problems reported in the last five years.

Health problems and other maternal adversities reported in the last five years

Table 4 illustrates the association between health problems and other maternal adversities experienced in the last five years preceding the mothers’ current incarceration. Problematic drug use and victimisation were the most common adversities experienced by mothers, each accounting for 84.0%. The least commonly reported adversities across the five-year period were involvement in child protective services (38.7%), followed by harmful alcohol use (39.5%). Though even these were experienced by close to 40% of the sample.

Table 4.

Health problems and other maternal adversities reported in the last five years.

Maternal adversities	Total	Any health problem		Group diff.		Any physical health problem		Group diff.		Any mental health problem		Group diff.
	n (%)	Yes (n = 105)	No (n = 14)	χ² (φ_c)^a	OR (95% CI)	Yes (n = 57)	No (n = 62)	χ² (φ_c)^b	OR (95% CI)	Yes (n = 99)	No (n = 20)	χ² (φ_c)^c	OR (95% CI)
	n (%)	n (%)	n (%)	χ² (φ_c)^a	OR (95% CI)	n (%)	n (%)	χ² (φ_c)^b	OR (95% CI)	n (%)	No (n = 20)	χ² (φ_c)^c	OR (95% CI)
Mental health problem	99 (83.2)	-	-	-	-	51 (89.5)	48 (77.4)	3.09 (0.16)	2.3 (0.7, 7.4)	-	-	-	-
Physical health problem	57 (47.9)	-	-	-	-	-	-	-	-	51 (51.5)	6 (30.0)	3.09 (0.16)	2.3 (0.7, 7.7)
Separation from children	82 (68.9)	74 (70.5)	8 (57.1)	- (0.09)^d	1.0 (0.2, 4.8)	44 (77.2)	38 (61.3)	3.51 (0.17)	1.2 (0.4, 3.7)	69 (69.7)	13 (65.0)	0.17 (0.04)	0.7 (0.2, 2.7)
Involvement with CPS	46 (38.7)	42 (40.0)	4 (28.6)	0.68 (0.08)	1.5 (0.4, 6.4)	26 (45.6)	20 (32.3)	2.23 (0.14)	1.6 (0.6, 4.0)	41 (41.4)	5 (25.0)	1.89 (0.13)	2.7 (0.7, 10.2)
Living in unstable accommodation	57 (47.9)	50 (47.6)	7 (50.0)	0.03 (0.02)	0.6 (0.2, 2.2)	29 (50.9)	28 (45.2)	0.39 (0.06)	1.0 (0.4, 2.4)	45 (45.5)	12 (60.0)	1.41 (0.11)	0.3 (0.1, 1.1)
Financial difficulties	75 (63.0)	68 (64.8)	7 (50.0)	1.16 (0.10)	1.4 (0.4, 4.9)	38 (66.7)	37 (59.7)	0.62 (0.07)	1.3 (0.5, 3.0)	64 (64.6)	11 (55.0)	0.66 (0.08)	0.9 (0.3, 3.1)
Death of loved ones	72 (60.5)	64 (61.0)	8 (57.1)	0.08 (0.03)	1.0 (0.3, 3.4)	42 (73.7)	30 (48.4)	7.95 (0.26)	2.9 (1.3, 6.6)*	59 (59.6)	13 (65.0)	0.20 (0.04)	0.5 (0.2, 1.7)
Crime victimisation	40 (31.3)	38 (36.2)	2 (14.3)	- (0.15)^d	3.4 (0.7, 16.0)	23 (40.4)	17 (27.4)	2.22 (0.14)	1.8 (0.8, 3.9)	36 (36.4)	4 (20.0)	2.00 (0.13)	2.3 (0.7, 7.4)
Partner victimisation	96 (80.7)	85 (81.0)	11 (78.6)	-(0.02)^d	1.2 (0.3, 4.5)	44 (77.2)	52 (83.9)	0.85 (0.08)	0.7 (0.3, 1.6)	81 (81.8)	15 (75.0)	- (0.07)^d	1.5 (0.5, 4.7)
Harmful alcohol use	47 (39.5)	42 (40.0)	5 (35.7)	0.10 (0.03)	1.4 (0.4, 5.1)	21 (36.8)	26 (41.9)	0.32 (0.05)	0.8 (0.4, 1.9)	40 (40.4)	7 (35.0)	0.20 (0.04)	1.7 (0.5, 5.5)
Problematic drug use	100 (84.0)	92 (87.6)	8 (57.1)	8.55 (0.27)	4.7 (1.0, 21.8)*	52 (91.2)	48 (77.4)	4.22 (0.19)*	1.3 (0.3, 5.2)	88 (88.9)	12 (60.0)	10.35 (0.30)	5.7 (1.3, 24.6)*
Prior incarceration	52 (43.7)	48 (45.7)	4 (28.6)	1.48 (0.11)	0.8 (0.3, 6.5)	32 (56.1)	20 (32.3)	6.89 (0.24)	1.9 (0.7, 5.3)	45 (45.5)	7 (35.0)	0.74 (0.08)	1.2 (0.3, 5.2)

^aChi-square difference between any health problem and no health problems.

^bChi-square difference between any physical health problems and no physical health problems.

^cChi-square difference between any mental health problems and no mental health problems.

^dFisher- Exact test used because of low expected cell count.

Note. * p < .05, ** p <.01, *** p < .001

χ² = Pearson’s chi-square test; φ_c = Cramer’s V effect size for chi-square test; OR = Odds Ratio; CI; Confidence Interval.

Bivariate analyses identified three adversities that were significantly associated with reporting any physical health problem in the last five years. Specifically, mothers who had experienced death of loved ones (χ² [1, 119] = 7.95, p < .01), problematic drug use (χ² [1, 119] = 4.22, p < .05) and prior incarceration (χ² [1, 119] = 6.89, p < .01) were more likely to report any physical health problem in the last five years. A non-significant trend was also observed for separation from children (χ² [1, 119] = 3.51, p = .06). When these adversities were included in a multivariable logistic regression model, only death of a loved one remained significantly associated with any physical health problem (OR = 2.9, 95% CI: 1.3, 6.6, p < .05).

Regarding other health outcomes, problematic drug use was significantly associated with both any health problem (χ² [1, 119] = 8.55, p < .01) and any mental health problem (χ² [1, 119] = 10.35, p < .001) in the last five years. In regression analyses, mothers reporting problematic drug use in the last five years had significantly higher odds of reporting any health problem (OR = 4.7, 95% CI: 1.0, 21.8, p < .05) and any mental health problem (OR= 5.7, 95% CI: 1.3, 24.6, p < .05).

Table 5 presents the proportion of mothers who have experienced various maternal adversities in each of the five years preceding their current incarceration. With the exception of the death of loved ones, the number of mothers reporting adversities peaked in the year preceding their current incarceration. The most frequently reported adversities during the most recent year prior to current incarceration were mental health problems (n = 93, 78.2%), problematic drug use (n = 92, 77.3%), separation from children (n = 73, 61.3%), and victimisation (n = 73, 61.3%). Mental health problems, problematic drug use, and victimisation consistently remained the top three adversities experienced by these mothers in each of the five years prior to their current incarceration. Separation from children was the fourth most common adversity in the second year; however, in the remaining years, financial difficulties emerged as the fourth most common adversity. Across all five years, the least frequently reported adversities were involvement with child protection services and prior incarcerations. For most maternal adversities, the proportion of mothers affected increased progressively with each additional year, starting from the last of the five years prior to the mother’s current incarceration through to the most recent year.

Table 5.

Health problems and other maternal adversities reported in each year in the last five years (n = 119).

Health problems and other maternal adversities	Years prior to current incarceration
	Fifth year	Fourth year	Third year	Second year	First year
	n (%)	n (%)	n (%)	n (%)	n (%)
Mental health problems	83 (69.7)	89 (74.8)	89 (74.8)	94 (79.0)	93 (78.2)
Physical health problems	36 (30.3)	35 (29.4)	39 (32.8)	47 (39.5)	48 (40.3)
Separation from children	35 (29.5)	42 (35.3)	50 (42.0)	61 (51.3)	73 (61.3)
Involvement with child protective services	13 (10.9)	16 (13.4)	20 (16.8)	27 (22.7)	32 (26.9)
Living in unstable accommodation	25 (21.0)	20 (16.8)	30 (25.2)	27 (22.7)	34 (28.6)
Financial difficulties	46 (38.7)	52 (43.7)	57 (47.9)	56 (47.1)	64 (53.8)
Death of loved ones	23 (19.3)	20 (16.8)	16 (13.4)	35 (29.4)	22 (18.5)
Victimisation ^a	67 (56.3)	68 (57.1)	63 (52.9)	67 (56.3)	73 (61.3)
Harmful alcohol use	27 (22.7)	26 (21.8)	23 (19.3)	30 (25.2)	35 (29.4)
Problematic drug use	67 (56.3)	73 (61.3)	74 (62.2)	77 (64.7)	92 (77.3)
Prior incarceration	11 (9.2)	19 (16.0)	20 (16.8)	26 (21.8)	30 (25.2)
Numbers of mothers who have experienced at least one adversity	n = 114	n = 117	n = 116	n = 116	n = 117
Average no. of adversities [M (SD)]	3.80 (1.81)	3.93 (2.00)	4.15 (2.02)	4.72 (2.11)	5.09 (1.95)

^a For 2 (2%) mothers who could only estimate the ages victimisation occurred within the five years prior to their current imprisonment, their experiences of victimisation were not included in the analyses, as we could not determine precisely which year victimisation occurred in.

To further examine the patterns and associations between health problems and other maternal adversities experienced by incarcerated mothers, we calculated the total number of maternal adversities reported by mothers in each of the last five years preceding their current incarceration and compared the mean number of adversities between mothers with and without health problems (Table 6). Mothers who reported any physical health problems in the last five years experienced a significantly higher number of adversities in the most recent year preceding their current incarceration, compared to those without such problems (M = 5.26 vs 4.13; t = -3.44, p < .001). Significant differences in the number of adversities between mothers with and without physical health problems remained evident in the second and third years before their current incarceration. The number of adversities appeared to decline progressively with each additional year prior to their current incarceration.

Table 6.

Number of health problems and other maternal adversities reported each year in the last five years (n =119).

No. of maternal adversities	Total	Any health problem ^a		Group diff.	Any physical health problem ^b		Group diff.	Any mental health problem ^c		Group diff.
	M (SD)	Yes (n = 105)	No (n = 14)	t (δ)	Yes (n = 57)	No (n = 62)	t (δ)	Yes (n = 99)	No (n = 20)	t (δ)
	M (SD)	M (SD)	M (SD)	t (δ)	M (SD)	M (SD)	t (δ)	M (SD)	M (SD)	t (δ)
In the year prior to current incarceration	5.16 (1.96)	3.98 (1.73)	3.21 (1.89)	- 1.54 (-0.44)	5.26 (1.77)	4.13 (1.82)	-3.44 (-0.63) ***	4.35 (1.87)	3.55 (1.82)	-1.76 (-0.43)
In the second year prior to current incarceration	4.78 (2.10)	3.56 (2.29)	2.79 (1.58)	-1.44 (-0.41)	4.74 (2.20)	3.82 (1.75)	-2.52 (-0.64) *	4.03 (2.11)	3.05 (1.76)	-1.94 (-0.48)
In the third year prior to current incarceration	4.17 (2.02)	3.08 (1.84)	2.29 (1.20)	-1.58 (-0.45)	4.25 (1.98)	3.27 (1.77)	-2.83 (-0.52) **	4.02 (1.91)	2.35 (1.39)	-3.72 (-0.91) ***
In the fourth year prior to current incarceration	3.96 (2.01)	2.91 (1.83)	2.36 (1.74)	-1.08 (-0.31)	3.88 (1.98)	3.34 (1.88)	-1.52 (-0.28)	3.85 (1.91)	2.35 (1.63)	-3.28 (-0.80) **
In the fifth year prior to current incarceration	3.82 (1.80)	2.68 (1.72)	2.57 (1.74)	-0.21 (-0.06)	3.39 (1.87)	3.34 (1.82)	-0.14 (-0.26)	3.52 (1.80)	2.55 (1.82)	-2.20 (-0.54) *

Note. T = Independent samples t-test; δ = Cohen’s d.

For 2 (2%) mothers who could only estimate the ages victimisation occurred within the five years prior to their current imprisonment, their experiences of victimisation were not included in the analyses, as we could not determine precisely which year victimisation occurred in.

^aNumber of adversities did not include any physical or mental health problem experienced by the mothers during that period.

^bNumber of adversities did not include any physical health problem experienced by the mothers during that period.

^cNumber of adversities did not include any mental health problem experienced by the mothers during that period.

^* p < .05.

^** p <.01.

^*** p < .001.

Similarly, mothers reporting any mental health problem in the last five years experienced significantly more adversities in the third year prior to their current incarceration compared to those without mental health problems (M = 4.02 vs 2.35; t = -3.72, p < .001). Significant differences were also observed for mental health problems and adversities reported in the fourth and fifth years prior to their current incarceration. However, the number of adversities experienced in each year across the five-year period was not significantly different between mothers experiencing any health problems and those not experiencing any health problems.

Discussion

This study analysed available data from 119 mothers over the five years preceding their current incarceration. It provides valuable insights into the cumulative health problems and other maternal adversities experienced by incarcerated mothers in the years prior to their current incarceration. Given the limited research on incarcerated mothers, we have compared our findings with relevant studies on this group where possible, and otherwise with studies on incarcerated women more generally.

Occurrence of health problems

Consistent with limited global evidence, incarcerated mothers in this study exhibited high occurrence of mental health problems, with depression being the most commonly reported condition, followed by anxiety.⁴⁴ The observed prevalence of mental health problems in our sample (89.9%) substantially exceeds the 63.0% reported for incarcerated women in the Australian Institute of Health and Welfare report.⁶ This discrepancy may stem from methodological differences. Specifically, our study included all self-reported mental health problems, regardless of whether a formal diagnosis had been made, whereas the AIHW report considered only those conditions diagnosed or disclosed by participants to healthcare professionals. Additionally, though, it is possible that incarcerated mothers have elevated mental health problems compared to the broader population of incarcerated women.

In contrast, our study reported a slightly lower prevalence of physical health problems (56.9%) compared to 61.0% documented in the AIHW report. A Canadian study also reported a higher prevalence of physical health conditions among incarcerated women, compared to our sample; however the types of common physical health problems reported—musculoskeletal problems, neurological problems and cardiovascular problems—were consistent with those identified in our sample.⁴⁵ These variations may be attributable to differences in reference periods: the AIHW report and Canada-based study assessed lifetime prevalence,^6,45 while our study focused exclusively on a five-year period. Notably, when examining only the more recent year prior to incarceration, our findings align with national data which showed that 45% of women reported current chronic physical conditions at the time of their entry to prison.⁶

Consistent with prior research conducted among incarcerated women,⁴⁶ our study demonstrated the presence of co-morbid mental health conditions among incarcerated mothers. As the number of distinct health problems increased among incarcerated mothers, mental health problems became more dominant, underscoring the considerable burden of mental health comorbidities in this population.^44,46 These findings suggest that mental health problems may be persistent and potentially remain unresolved among incarcerated mothers. There is a need for early-intervention and sustained mental health support for incarcerated mothers, even years before their incarceration.

Although comorbidity between substance use and mental illness or various mental health conditions has been widely studied, there are limited studies that have explored the overlap between mental and physical health conditions among incarcerated mothers. Our finding of the high co-occurrence of physical and mental health problems among incarcerated mothers is consistent with findings from a study with incarcerated women in Switzerland.⁴⁷ Such comorbid conditions can exacerbate overall health outcomes and complicate treatment strategies. This underscores the need for integrated healthcare approaches targeting both physical and mental health for mothers in contact with the justice system.

Occurrence of maternal adversities

The study also highlighted the high prevalence of co-occurring maternal adversities. Mental health problems, problematic drug use, and victimisation emerged as the most frequently reported adversities among incarcerated mothers. These results echo findings from a recent qualitative study involving 126 incarcerated mothers in Ireland, which reported similar adversities.⁴² The findings highlight that these adversities are not isolated events but rather form a constellation of disadvantage that affects mothers involved with the criminal justice system.

The co-occurrence of problematic drug use and victimisation suggests the cyclical and mutually reinforcing nature of these experiences. As seen in earlier research, many women report using substances as a means of coping with trauma, including experiences of victimisation from a current or former partner.⁴² At the same time, substance use can increase vulnerability to victimisation, particularly in the context of coercive relationships, economic instability, or unstable living conditions.^48,49 This bidirectional association reinforces the need for trauma-informed, integrated support systems that can simultaneously address substance use, trauma arising from victimisation, and safety concerns.

Interestingly, despite the high prevalence of problematic drug use, fewer mothers in our sample reported harmful alcohol use. This finding aligns with national data, where only 32% of female prison entrants, where majority were mothers, were at high risk of alcohol-related harm, while 75% reported using illicit drugs in the last 12 months.⁶ Illicit drug use may be more prevalent than alcohol misuse among justice-involved mothers due to factors such as younger age, peer influence, unstable living environments, involvement in crime or sex work for income, and faster onset of dependency.⁵⁰ It is possible that the rising prices of alcohol may contribute to a shift toward drug use.^51,52 Future studies are recommended to examine the factors contributing to variations alcohol and drug use to inform more nuanced and targeted interventions.

Another important finding of this study was the temporal distribution of adversities. Except for death of loved ones, most maternal adversities peaked in the year immediately prior to incarceration. This pattern suggests that many incarcerated mothers experience a period of increased instability or crisis in the year immediately prior to the current incarceration compared to the other four years. Similar findings have been reported elsewhere; for example, a U.S.-based study found that over two-thirds of incarcerated individuals had experienced traumatic events within the year prior to incarceration in the county jail.¹⁸ Another study found that incarcerated mothers reported greater adversities, such as poverty, illness, substance abuse and victimisation in adulthood.⁵³ Similarly recent studies have highlighted high mental and physical health problems, as well as homelessness, among incarcerated individuals in the year prior to detention.^26,54 These findings support the assertion that incarceration often follows periods of acute distress resulting from recent adversities. Increased prevalence of proximal adversities preceding incarceration could also reflect increased contact with systems, particularly police and courts, or change in living conditions, which were not explored in this study.

Relationship between health problems and maternal adversities

We did not find significant differences in adversities, except for problematic drug use, between women with and without mental health problems or any health problem, possibly because a large proportion of women in our sample had any health problems. That is, there may be little variance to detect differences in adversities for mothers with and without mental health problems. The exception was problematic drug use, which was strongly associated with any health, physical, or mental health problems among incarcerated mothers. This aligns with existing research indicating that substance use is highly prevalent among incarcerated mothers and is frequently accompanied by co-occurring mental health issues—often referred to as a dual diagnosis.^44,55 Treatment for substance use disorders that fails to address underlying or concurrent mental health conditions is often less effective, reinforcing the importance of integrated, comprehensive care that address substance use along with physical and mental health needs among incarcerated mothers.

Our findings initially revealed a notable association between separation-related adversities, such as death of loved ones and previous incarceration, and physical health problems in bivariate analysis. Although the association between separation from children and physical health problems did not reach statistical significance (p = 0.06), the trend suggests a potential relationship. However, in the multivariable regression model, only death of loved ones remained significantly associated with physical health problems. This finding highlights the particularly profound impact of bereavement on physical health. The psychological stress stemming from the death of a loved one can manifest somatically, with prolonged distress contributing to immune dysregulation and heightened risk of infections, cardiovascular diseases, and metabolic disorders.^16,17 Additionally, individuals may adopt maladaptive coping behaviours (e.g., substance use) that may further compromise physical health and wellbeing.⁵⁶ These findings suggest there is a need for early interventions that can address stress and its physical health consequences among incarcerated mothers.

This study expands upon previous literature on factors associated with health problems among incarcerated mothers by exploring the frequency and extent of adversities experienced in each year of the five years prior to the mother’s current incarceration. Significant differences were noted in the number of adversities experienced only in the first and second year prior to the mothers’ current incarceration, among mothers with and without any physical health problem. In contrast, significant differences in the number of adversities experienced between mothers with and without mental health problems were observed only in the third to fifth year prior to the mothers’ current incarceration. The absence of differences in the two years preceding incarceration may reflect the high prevalence of mental health problems, limiting variability. These findings suggest that recent adversities preceding incarceration are more strongly associated with physical health problems, while earlier adversities (3 to 5 years prior) are more closely linked to mental health problems. This pattern aligns with the concept of allostatic load, where prolonged exposure to chronic stress gradually compromises mental health, while physical health problems may emerge more immediately in response to acute stressors.⁵⁷ Given that nearly all mothers reporting physical health problems also reported mental health problems, it is possible that the cumulative burden of mental health problems contributes to the development of physical health problems.

Mothers with physical or mental health problems also reported a higher number of adversities, particularly in the recent years leading up to incarceration. The cumulative adversity pattern observed in this study suggests that repeated and continued exposures to stressors may lead to chronic stress, adversely affecting both physical and mental health. This cumulative effect underscores the need for early, sustained, and holistic interventions that can address the common adversities in this population, particularly experiences of victimisation, problematic drug use, and separation from children. Since adversities tend to accumulate over time, there is a need for preventive, trauma-informed and holistic support services for incarcerated mothers. Such services should work collaboratively to prevent the need for re-telling of traumatic events to multiple services for women to access support. Providing hubs and/or multi-agency teams where women can access physical and mental health support, along with other parenting, social and community supports, may also allow women to access the services they need when they need them. In addition to service-level responses, these findings highlight the importance of addressing the broader socio-economic and sociopolitical conditions that shape women’s exposure to adversity. Strengthening access to stable housing, income support, childcare, and trauma-informed community services, along with reducing the criminalisation of women’s survival behaviours may help prevent the accumulation of adversities observed in this study.

Timely support may assist to prevent the accumulation of adversities, improve health and wellbeing outcomes for mothers, and reduce criminal justice system involvement amongst vulnerable mothers. However, for mothers already in the correctional system, it is vital that there are comprehensive efforts to address their health needs and ensure they have access to supports to address other adversities, both in prison and as they return to community. For interventions to have meaningful impact, it is essential that they are designed in partnership with mothers themselves. This is particularly important for Aboriginal and Torres Strait Islander women, where drawing on Indigenous knowledge and actively engaging Indigenous mothers in the design and implementation of programs is critical to ensuring supports are culturally safe, appropriate, and acceptable to their communities.

Strengths and limitations of the study

The findings of the study should be interpreted in light of some important limitations. First, the data collection period began from the time of the birth of the focal child, resulting in different observation periods for participants. To ensure comparability and consistency, analyses were limited to the five-year period before the current incarceration. While this approach helped to standardise the timeframe, it has excluded relevant experiences outside this window. Consequently, it was not possible to elucidate the temporal relationship between adversities and health problems Second, low SES is a well-documented determinant of poor health, yet we could not assess this factor temporally in our study. Mothers were asked to report their postcode prior to entering prison and we did not have information on changes in living conditions or SES over the previous five years. As a result, this variable could not be explored as a potential adversity associated with health problems in this study. Preliminary comparisons indicated no meaningful differences in key background characteristics between mothers with and without health problems (see Supplementary File 2 Table S1). As such, regression models included only the adversity variables, allowing us to examine the unique association of each adversity with health problems while adjusting for other adversities. We acknowledge that the absence of additional covariates limits causal interpretation, and that unmeasured background factors may partially account for some associations. Future studies with larger samples should incorporate a broader set of controls to more fully account for potential confounding. Finally, the study utilised a sample of mothers incarcerated in Queensland prisons. While the findings offer important insights, caution should be used in generalising these findings to broader populations of incarcerated mothers across different jurisdictions or settings.

Despite these limitations, the present study makes several important contributions to the literature on health problems and other maternal adversities experienced by incarcerated mothers, a topic that remains underexplored both in Australia and globally. The use of a LEC to explore the timing and co-occurrence of health problems and adversities experienced by incarcerated mothers is a novel approach in this population. By focusing on a five-year window, the analysis captures more proximal exposures that are more likely to influence current health, while minimising confounding from distant past events that may no longer be relevant or have been mitigated by time or interventions. This timeframe also helps reduce recall bias and ensures greater data accuracy. The findings on the frequency and timing of adversities provide insights into critical periods for interventions to address health challenges and adversities experienced by these mothers.

While future research with longer observation periods is needed to identify various mechanisms by which the timing and duration of adversity are linked to maternal health problems, current results suggest that interventions should address both recent and past adversities. Trauma-informed care, mental health services, and substance use treatment must be made more accessible to this population. To inform such efforts, further research should explore incarcerated mothers’ experiences with seeking healthcare or other forms of support in response to adversity. It is important to understand whether gaps in support are due to accessibility, availability, or appropriateness of services for women experiencing multiple and overlapping adversities. Finally, policies that promote mother-child contact and offer multisystemic support during re-entry can help mitigate the adverse effects of separation and improve health outcomes.

Conclusions

Incarcerated mothers represent a highly vulnerable group, with the majority reporting significant health problems, particularly mental health problems, and multiple life adversities in the five years prior to their current incarceration, including high levels of victimisation. This study highlights that problematic drug use is associated with both mental and physical health problems while death of loved ones is particularly linked to physical health problems. Mental health comorbidities are also common. Mental health problems tend to be associated with adversities experienced in the more distal past (3-5 years prior to their current incarceration), whereas physical health problems are more closely related to recent adversities. Notably, the number of adversities experienced by mothers increased progressively over the five-year period, peaking in the year immediately before their current incarceration. This temporal pattern reinforces the importance of addressing cumulative stress and the timing of adverse experiences in both research and practice. Overall, the findings underscore the need for early, holistic, and trauma-informed interventions that address the intersecting challenges of substance use, victimisation, and health problems among incarcerated mothers.

Supplemental material

Supplemental material - Health problems and adversities experienced by incarcerated mothers: Use of a life events calendar

Supplemental material for Health problems and adversities experienced by incarcerated mothers: Use of a life events calendar by Diksha Sapkota, Chantelle Baguley, Lorena Rivas, Lisa Broidy, Catrien Bijleveld, and Susan Dennison in Women’s Health.

Supplemental material

Supplemental material - Health problems and adversities experienced by incarcerated mothers: Use of a life events calendar

Footnotes

Acknowledgements

We would like to express our gratitude to Queensland Corrective Services for the support they provided to conduct this project, to Dr Kate Riseley for her invaluable contribution to the project, and to the research assistants who assisted us throughout the project. We also extend our gratitude to the women in prison who shared their personal stories with us in the hope that it would lead to better support for other mothers in prison and their children.

ORCID iD

Diksha Sapkota

Ethical considerations

Consent to participate

Written informed consent was obtained from participants before the interview, and the consent forms are stored on a secure password protected server at Griffith University.

Consent for publication

Any opinions expressed in the publication are those of the authors and do not necessarily represent the views of Queensland Corrective Services. During the preparation of this work, the authors used Microsoft Copilot to improve language, grammar use, and readability. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Author contributions

Diksha Sapkota: Conceptualisation, Formal analysis, Methodology, Visualisation, Writing – original draft; Chantelle Baguley: Project administration, Formal analysis, Validation, Writing- Reviewing and editing; Lorena Rivas: Writing – introduction, Validation, Writing-reviewing and editing; Lisa Broidy: Funding acquisition, Writing- Review and editing, Catrien Bijleveld: Funding acquisition, Writing- Review and editing; Susan Dennison: Funding acquisition, Project administration, Supervision, Writing- Review and editing.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Australian Research Council Discovery Project (DP170100649). The funder had no role in study design, the collection, analysis and interpretation of data, the writing of the report or the decision to submit the article for publication.

Declaration of conflicting interests

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

Data Availability Statement

Due to privacy, ethical and legal considerations, the data used in this paper cannot be shared without direct approval from the Chief Investigators and Queensland Corrective Services. Any researcher interested in accessing the data can submit an application to the Chief Investigator (susan.dennison@griffith.edu.au) with the relevant support and approvals.

Supplemental material

Supplemental material for this article is available online.

References

Australian Bureau of Statistics [ABS]. Prisoners in Australia. 2025.

Fair

Walmsley

. World female imprisonment list: Women and girls in penal institutions, including pre-trail detainees/remand prisoners. Institute for Crime and Justice Policy Research, 2022.

Favril

Rich

Hard

, et al. Mental and physical health morbidity among people in prisons: An umbrella review. The Lancet Public Health 2024; 9: e250–e260. https://doi.org/10.1016/S2468-2667(24)00023-9

Dolan

Wirtz

Moazen

, et al. Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees. The Lancet 2016; 388: 1089–1102. https://doi.org/10.1016/S0140-6736(16)30466-4

Norris

Kim

Osei

, et al. Health status of females who experience incarceration: A population-based retrospective cohort study. Journal of Women's Health 2021; 30: 1107–1115. https://doi.org/10.1089/jwh.2020.8943

Australian Institute of Health and Welfare (AIHW) . The health of people in Australia's prisons 2022, 2023.

Kajstura

Sawyer

. Women's mass incarceration: The whole pie 2024. Prison Policy Initiative, 2024.

Rose

LeBel

. Incarcerated mothers of minor children: Physical health, substance use, and mental health needs. Women & Criminal Justice 2017; 27: 170–190. https://doi.org/10.1080/08974454.2016.1247772

Barnes

Stringer

. Is motherhood important? Imprisoned women’s maternal experiences before and during confinement and their postrelease expectations. Feminist Criminology 2014; 9: 3–23. https://doi.org/10.1177/1557085113504450

10.

Turney

Wildeman

. Self-reported health among recently incarcerated mothers. American Journal of Public Health 2015; 105: 2014–2020. https://doi.org/10.2105/AJPH.2015.302743

11.

Aizer

Currie

. The intergenerational transmission of inequality: Maternal disadvantage and health at birth. Science 2014; 344: 856–861. https://doi.org/10.1126/science.1251872

12.

Hatton

Fisher

. Women prisoners and health justice: perspectives, issues and advocacy for an international hidden population. CRC Press, 2018.

13.

Penal Reform International . The rehabilitation and social integration of women prisoners: Implementation of the Bangkok Rules. Penal Reform International 2019.

14.

Petrillo

. The Corston Report: A review of women with particular vulnerabilities in the criminal justice system. Probation Journal 2007; 54: 285–287. https://doi.org/10.1177/02645505070540030805

15.

World Health Organisation [WHO] . Prisons and health. : World Health Organisation, 2014. [WHO].

16.

Alonzo

. The experience of chronic illness and post-traumatic stress disorder: the consequences of cumulative adversity. Social Science & Medicine 2000; 50: 1475–1484. https://doi.org/10.1016/S0277-9536(99)00399-8

17.

Candeias

Galindo

Reschke

, et al. The interplay of stress, health, and well-being: unraveling the psychological and physiological processes. Frontiers Media SA, 2024.

18.

Tripodi

Curley

Ross

. Traumatic experiences before incarceration in a county jail. Institute for Justice Research and Development, 2020.

19.

Sandberg

Agoff

Fondevila

. Doing marginalised motherhood: Identities and practices among incarcerated women in Mexico. International Journal for Crime, Justice and Social Democracy 2021; 10: 15–29. https://doi.org/10.5204/ijcjsd.v10i1.1538

20.

Sapkota

Dennison

Allen

, et al. Navigating pregnancy and early motherhood in prison: a thematic analysis of mothers’ experiences. Health & Justice 2022; 10: 32. https://doi.org/10.1186/s40352-022-00196-4

21.

Kjellstrand

Cearley

Eddy

, et al. Characteristics of incarcerated fathers and mothers: Implications for preventive interventions targeting children and families. Child Youth Serv Rev 2012; 34: 2409–2415. https://doi.org/10.1016/j.childyouth.2012.08.008

22.

Fischer

Wilson

Schofield

, et al. Exposure to childhood adversity and intimate partner violence in a sample of incarcerated women in Australia. International Journal of Offender Therapy and Comparative Criminology 2024; 69: 0306624X241270577. https://doi.org/10.1177/0306624X241270577

23.

Jones

Worthen

Sharp

, et al. Bruised inside out: The adverse and abusive life histories of incarcerated women as pathways to PTSD and illicit drug use. Justice Quarterly 2018; 35: 1004–1029. https://doi.org/10.1080/07418825.2017.1355009

24.

Kelman

Gribble

Harvey

, et al. How does a history of trauma affect the experience of imprisonment for individuals in women’s prisons: A qualitative exploration. Women & Criminal Justice 2024; 34: 171–191. https://doi.org/10.1080/08974454.2022.2071376

25.

Lereya

Wolke

. Prenatal family adversity and maternal mental health and vulnerability to peer victimisation at school. J Child Psychol Psychiatry 2013; 54: 644–652. https://doi.org/10.1111/jcpp.12012

26.

Dirkzwager

AJE

Verheij

Nieuwbeerta

, et al. Mental and physical health problems before and after detention: A matched cohort study. The Lancet Regional Health - Europe 2021; 8: 100154. https://doi.org/10.1016/j.lanepe.2021.100154

27.

Henry

. Typologies of adversity in childhood & adulthood as determinants of mental health & substance use disorders of adults incarcerated in US prisons. Child Abuse & Neglect 2020; 99: 104251. https://doi.org/10.1016/j.chiabu.2019.104251

28.

Mazher

Arai

. Behind bars: A trauma-informed examination of mental health through importation and deprivation models in prisons. European Journal of Trauma and Dissociation 2025; 9: 100516. https://doi.org/10.1016/j.ejtd.2025.100516

29.

Asberg

Renk

. Substance use coping as a mediator of the relationship between trauma symptoms and substance use consequences among incarcerated females with childhood sexual abuse histories. Substance Use & Misuse 2012; 47: 799–808. https://doi.org/10.3109/10826084.2012.669446

30.

Blumenthal

Gumas

Shah

. Mirror, mirror 2024: A portrait of the failing US health system. The Commonwealth Fund, 2024.

31.

Australian Institue of Health and Welfare . Understanding welfare and wellbeing. AIHW, 2025.

32.

Ding

Liang

, et al. The impact of prenatal stressful life events on adverse birth outcomes: A systematic review and meta-analysis. Journal of Affective Disorders 2021; 287: 406–416. https://doi.org/10.1016/j.jad.2021.03.083

33.

Roberts

. Life events calendar method. Oxford Research Encyclopedia of Criminology and Criminal Justice, 2023.

34.

Hereth

Kennedy

Garthe

, et al. Using the life history calendar to examine victimization, mental health, and seeking and attaining help among transgender women: An example of a culturally relevant adaptation. Journal of Interpersonal Violence 2024; 40: 08862605241308832–088626052413088325798. https://doi.org/10.1177/08862605241308832

35.

Eriksson

Dennison

Baguley

, et al.

The life event calendar methodology: Challenges and considerations for DLC research

Frontiers in Developmental and Life-Course Criminology. Routledge, 2023, pp. 56–66.

36.

King

Smith

. Reexploring female pathways to incarceration: Assessing the role of mental illness. International Journal of Offender Therapy and Comparative Criminology 2024; 68: 1438–1461. https://doi.org/10.1177/0306624X221144297

37.

Australian Institute of Health and Welfare (AIHW) . The health and welfare of women in Australia’s prisons, 2020.

38.

Hidderley

Jeffs

Thoms

, et al. Engendering justice: The sentencing of women and girls in Queensland. Queensland Sentencing Advisory Council, 2022.

39.

von Elm

Altman

Egger

, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008

40.

Australian Bureau of Statistics . Socio-Economic Indexes for Areas (SEIFA). Australian Bureau of Statistics, 2011.

41.

Ogilvie

Kisely

. Examining the health and criminal justice characteristics for young people on compulsory community treatment orders: an Australian birth cohort and data linkage study. International Journal of Law and Psychiatry 2022; 83: 101813. https://doi.org/10.1016/j.ijlp.2022.101813

42.

O’Malley

Devaney

Millar

. Incarcerated mothers’ experience of adversity heard using participatory mixed-method research. Probation Journal 2023; 70: 279–297. https://doi.org/10.1177/02645505221143335

43.

Yang

Black

. Using the standard Wald confidence interval for a population proportion hypothesis test is a common mistake. Teaching Statistics 2019; 41: 65–68. https://doi.org/10.1111/test.12184

44.

Sapkota

Dennison

Thompson

. Mental disorders among mothers in contact with the criminal justice system: a scoping review and meta-analysis. Community Mental Health Journal 2024; 60: 1–14. https://doi.org/10.1007/s10597-023-01222-x

45.

Nolan

Stewart

. Chronic health conditions among incoming Canadian federally sentenced women. Journal of Correctional Health Care 2017; 23: 93–103. https://doi.org/10.1177/1078345816685707

46.

Zhong

Zhu

Chen

, et al. High psychiatric morbidity and comorbidity among female prisoners in Hunan, China. Frontiers in Psychiatry 2020; 11: 11–2020, Original Research. https://doi.org/10.3389/fpsyt.2020.00271

47.

Augsburger

Neri

Bodenmann

, et al. Assessing incarcerated women’s physical and mental health status and needs in a Swiss prison: A cross-sectional study. Health & Justice 2022; 10: 8. https://doi.org/10.1186/s40352-022-00171-z

48.

Stuart

Moore

Elkins

, et al. The temporal association between substance use and intimate partner violence among women arrested for domestic violence. Journal of consulting and clinical psychology 2013; 81: 681–690. https://doi.org/10.1037/a0032876

49.

Beth

Christine

Arlene

, et al. Longitudinal predictors of domestic violence perpetration and victimization: A systematic review. Aggression and Violent Behavior 2015; 24: 261–272. https://doi.org/10.1016/j.avb.2015.06.001

50.

Johnson

. Factors associated with drug and alcohol dependency among women in prison. Trends & Issues in Crime & Criminal Justice 2006; 318.

51.

Mandal

. Rising alcohol prices driving the young towards illicit drug use. News Medical Life Sciences 2010.

52.

Lyall

Wolfson

Reid

, et al. “The problem is that we hear a bit of everything”: A qualitative systematic review of factors associated with alcohol use, reduction, and abstinence in pregnancy. International Journal of Environmental Research and Public Health 2021; 18: 3445. https://doi.org/10.3390/ijerph18073445

53.

Borja

Nurius

Eddy

. Adversity across the life course of incarcerated parents: Gender differences. Journal of Forensic Social Work 2015; 5: 167–185. https://doi.org/10.1080/1936928X.2015.1093992

54.

McNeil

De Angelis

Ó Donnghaile-Drummond

, et al. The relationship between mental health and crime. Mental Health, Crime and the Impact of Criminal Justice on the Vulnerable. Springer, 2024, pp. 1–52.

55.

Sapkota

Ogilvie

Thompson

, et al. Timing, frequency, and duration of incarceration and their impact on mental illness: Evidence from an Australian birth cohort. Journal of Criminal Justice 2024; 94: 102246. https://doi.org/10.1016/j.jcrimjus.2024.102246

56.

Jackson

Knight

Rafferty

. Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course. American journal of public health 2010; 100: 933–939. https://doi.org/10.2105/AJPH.2008.143446

57.

McEwen

Seeman

. Protective and damaging effects of mediators of stress: Elaborating and testing the concepts of allostasis and allostatic Load. Annals of the New York Academy of Sciences 1999; 896: 30–47. https://doi.org/10.1111/j.1749-6632.1999.tb08103

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.91 MB

0.10 MB

0.00 MB