Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK.
Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK.
Lancet Psychiatry. 2021 Jun;8(6):512-520. doi: 10.1016/S2215-0366(21)00082-1. Epub 2021 May 13.
The prevalence of head injury is estimated to be as high as 55% in women in prison and might be a risk factor for violent offending, but evidence is equivocal. The extent of persisting disability is unknown, making decisions about service needs difficult. The UN recognises vulnerabilities in women in prison, but does not include head injury. This study aimed to investigate relationships among head injury, comorbidities, disability, and offending in women in prison.
In this cross-sectional study, women were recruited between Feb 2, 2018, and Sept 30, 2019, from four prisons across Scotland, UK: Her Majesty's Prison (HMP) Cornton Vale, Her Majesty's Young Offenders Institute Polmont, HMP Edinburgh, and HMP Greenock (detaining approximately 355 individuals at the time of recruitment). Women were included if they were aged older than 16 years, fluent in English, able to participate in face-to-face assessment and provide informed consent, and did not have a severe acute disorder of cognition or communication. Head injury, cognition, disability, mental health, and history of abuse and problematic substance use were assessed by interview. History of head injury was assessed with the Ohio State University Traumatic Brain Injury Identification method and disability was assessed with the Glasgow Outcome at Discharge Scale. Comparisons were made between women with and without a history of significant head injury.
We recruited 109 (31%) of the 355 women in these prisons. The sample was demographically representative of the approximately 400 individuals in women's prisons in Scotland. Significant head injury (SHI) was found in 85 (78%) of 109 women, of whom 34 (40%) had associated disability. Repeat head injury was reported in 71 (84%) of the 85 women with SHI and, in most cases, this resulted from domestic abuse that had occurred over many years. Women with a history of SHI were significantly more likely to have a history of violent offences than those without a history of SHI (66 [79%] of 85 women in the SHI group vs 13 [54%] of 24 women in the no-SHI group had committed a violent offence; odds ratio [OR] 3·1, 95% CI 1·2-8·1). This effect remained significant after adjusting for current factors (3·1, 1·1-9·0), including comorbidities associated with post-traumatic stress disorder, and was no longer statistically significant after adjusting for historical factors (3·3, 1·0-10·9), such as abuse as a child or adult. Women with SHI had spent longer in prison than women without SHI after adjustment for current (rate ratio 3·4, 1·3-8·4) or historical (3·5, 1·3-9·2) risk factors.
It is recognised that women in prison are vulnerable because of histories of abuse and problematic substance use; however, history of SHI needs to be included when developing criminal justice policy, interventions to reduce mental health morbidity, and assessment and management of risk of violent offending.
The Scottish Government.
据估计，监狱中女性头部受伤的患病率高达 55%，这可能是暴力犯罪的一个风险因素，但证据尚存在争议。持续性残疾的程度尚不清楚，这使得服务需求的决策变得困难。联合国认识到监狱中女性的脆弱性，但没有包括头部受伤。本研究旨在调查监狱中女性头部受伤、合并症、残疾和犯罪之间的关系。
在这项横断面研究中，我们于 2018 年 2 月 2 日至 2019 年 9 月 30 日从英国苏格兰的 4 所监狱（赫迈厄尼监狱（HMP）科顿谷、女王陛下青年罪犯学院波利蒙特、爱丁堡 HMP 和格林诺克 HMP）招募了女性囚犯：HM 监狱（HMP）科顿谷、HM 陛下青年罪犯学院波利蒙特、HMP 爱丁堡和 HMP 格林诺克（在招募时，这四所监狱分别关押了大约 355 名女性）。符合以下条件的女性可以入组：年龄大于 16 岁，能说流利的英语，能够参加面对面评估并提供知情同意，并且没有严重的急性认知或沟通障碍。通过访谈评估头部受伤、认知、残疾、心理健康以及滥用和问题物质使用史。通过俄亥俄州立大学创伤性脑损伤识别方法评估头部受伤史，通过格拉斯哥出院结局量表评估残疾程度。对有和没有显著头部受伤史的女性进行了比较。
我们从这些监狱的 355 名女性中招募了 109 名（31%）。该样本在人口统计学上代表了苏格兰女性监狱中大约 400 名女性。109 名女性中有 85 名（78%）有显著头部受伤史（SHI），其中 34 名（40%）有相关残疾。71 名（84%）有 SHI 的女性报告了重复头部受伤，这主要是由于多年来的家庭暴力。与没有 SHI 史的女性相比，有 SHI 史的女性更有可能有暴力犯罪史（SHI 组的 85 名女性中有 66 名[79%]，无 SHI 组的 24 名女性中有 13 名[54%]有暴力犯罪史；优势比[OR]3.1，95%置信区间[CI]1.2-8.1）。在调整当前因素（OR 3.1，1.1-9.0）后，包括与创伤后应激障碍相关的合并症，这种影响仍然显著，在调整历史因素（OR 3.3，1.0-10.9）后，如儿童或成人时期的虐待，这种影响不再具有统计学意义。在调整当前（风险比 3.4，1.3-8.4）或历史（3.5，1.3-9.2）风险因素后，有 SHI 的女性在监狱中服刑的时间比没有 SHI 的女性长。
人们认识到，由于有滥用和问题物质使用史，监狱中的女性很脆弱；然而，在制定刑事司法政策、干预措施以减少心理健康发病率以及评估和管理暴力犯罪风险时，需要考虑到头部受伤史。
苏格兰政府。
