Allison Mary Kathryn, Fradley Marley F, Norris Whitney K, Zielinski Melissa J
Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Eur J Psychotraumatol. 2025 Dec;16(1):2447187. doi: 10.1080/20008066.2024.2447187. Epub 2025 Sep 2.
Incarcerated women commonly report lifetime sexual violence victimization, have high rates of many physical and mental illnesses, and ultimately return to their communities with significant healthcare needs. This study qualitatively examined formerly incarcerated women sexual violence survivors' health service utilization and perceived barriers to accessing health care - including primary care, mental health care, and substance use treatment services - three-to-five years post-release. We conducted semi-structured qualitative interviews and administered self-report surveys with 65 women. Interviews revealed some barriers that were consistent across healthcare service type, including health insurance coverage, healthcare costs, competing obligations, care interruptions, and intrapersonal factors; other barriers were unique to service type. Although women reported barriers to primary care engagement, most still reported engagement. However, relatively few were attending any form of specialty mental health care - ongoing psychiatric care was especially uncommon - despite that many participants were experiencing mental and/or behavioural health concerns. Very few had received evidence-based trauma therapy and treatment for sexual violence victimization specifically was rarely mentioned. Participants reported significant barriers to accessing therapy, including interpersonal factors and competing obligations that interfere with appointment attendance. This study reveals the need for behavioural healthcare - including treatment for sexual violence victimization - and healthcare navigation resources in the years following incarceration, as well as the need for new models of mental health care management, to improve healthcare access for this underserved population.
被监禁的女性普遍报告称曾遭受过终身性暴力侵害，患有多种身心疾病的比例很高，最终回到社区时有着大量的医疗保健需求。本研究定性考察了曾被监禁的女性性暴力幸存者在获释三至五年后对医疗服务的利用情况以及她们所感知到的获得医疗保健（包括初级保健、心理健康护理和药物使用治疗服务）的障碍。我们对65名女性进行了半结构化定性访谈并开展了自我报告调查。访谈揭示了一些在各类医疗服务中都存在的障碍，包括医疗保险覆盖范围、医疗费用、相互冲突的责任义务、护理中断以及个人因素；其他障碍则因服务类型而异。尽管女性报告了参与初级保健存在障碍，但大多数人仍表示参与了。然而，相对较少的人接受任何形式的专科心理健康护理——持续的精神病护理尤其少见——尽管许多参与者都存在心理和/或行为健康问题。很少有人接受过循证创伤治疗，专门针对性暴力侵害的治疗很少被提及。参与者报告称在获得治疗方面存在重大障碍，包括人际因素和干扰就诊的相互冲突的责任义务。本研究表明，在监禁后的几年里需要行为医疗保健（包括针对性暴力侵害的治疗）和医疗保健导航资源，以及需要新的心理健康护理管理模式，以改善这一服务不足人群获得医疗保健的情况。
