Head injury in women prisoners : associations with persisting disability and violent crime, a cross-sectional study

McMillan, Tom M and Aslam, Hira and Crowe, Eimear and Seddon, Eleanor and Barry, Sarah JE (2021) Head injury in women prisoners : associations with persisting disability and violent crime, a cross-sectional study. Lancet Psychiatry. ISSN 2215-0366 (In Press)

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    Background: The prevalence of head injury (HI) 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. Further, the extent of persisting disability is unknown, making decisions about service needs difficult. The United Nations recognises vulnerabilities in women in prison, but does not include head injury. This study investigates relationships between HI, comorbidities, disability and offending in women in prison and discusses policy implications. Methods: A cross-sectional design in four Scottish prisons (HMP Cornton Vale, Greenock, Lothian and Polmont). The total number of women in Scottish prisons was around 400 and there were 355 in the prisons we recruited from. All women prisoners aged over 16 years, who were fluent in English, did not have severe communication difficulties and able to participate in the assessment were eligible. Head injury, cognition, disability, mental health and history of abuse and substance misuse was assessed by interview in 109 women. History of head injury was assessed using the Ohio State University Traumatic Brain Injury Identification method. Disability was assessed using the Glasgow Outcome at Discharge Scale. Women in prison with a history of significant head injury and those without were compared. Outcomes: The sample was demographically representative of women in prison in Scotland. Significant head injury was found in 85/109 (78%) of whom 34/84 (40%) had associated disability. Two-thirds suffered repeat head injury for many years caused by domestic abuse. Violent criminal behaviour was three times more likely (OR 3.1; 95% CI 1.2-8.1) in those with a history of significant head injury after adjusting for comorbidities, including histories of substance misuse and trauma. Characteristics of significant head injury in women in prison such as cause of injury, differ from women with head injury in the general population. Interpretation: It is recognised that women in prison are vulnerable because of histories of abuse and substance misuse, but history of significant head injury needs to be included when developing criminal justice policy, interventions to reduce mental health morbidity and assessment and management of risk for risk of violent offending.

    ORCID iDs

    McMillan, Tom M, Aslam, Hira, Crowe, Eimear, Seddon, Eleanor and Barry, Sarah JE ORCID logoORCID: https://orcid.org/0000-0003-3039-8729;