Background: Female prisoners are significantly more likely to have head injury (HI) than the general population. The rate of HI amongst female prisoners in Scotland is particularly high. Little research exists on HI in female offenders. As a result, the impact of HI on this small but vulnerable group in society is unknown. There may be an unmet need within prison services in terms of interventions for female prisoners with HI.
Aim: To investigate HI-related disability and impairment in the Scottish female prison population.
Methods: 62 female prisoners were recruited across three Scottish prisons. A self-report measure of HI was combined with measures of cognition, daily executive problems, psychological distress, post-traumatic stress disorder (PTSD) and HI-related disability.
Results: A history of moderate-severe HI (d = 1.06; 95% CI = 0.20 to 1.91) or multiple-mild HI (d = 0.73, 95% CI = 0.005 to 1.45) was associated with significantly greater self-reported dysexecutive difficulties. A greater proportion of individuals with moderate-to-severe HI (93.8%) were rated as ‘disabled’ compared to individuals with no or single mild HI (63.6%); χ2 (1, N=27) = 3.9, p = 0.04, Cramer’s V = 0.38. When controlling for potential confounding factors such as PTSD, substance use and demographic factors, these associations became non-significant and PTSD symptom severity was the only significant predictor of dysexecutive difficulties (B = 0.34; SE = 0.12; p = 0.005). Age at first HI had significant negative associations with disability level (OR = 1.10; 95% CI = 1.02 - 1.19; p < 0.009) and self-reported dysexecutive problems (B = -0.52; SE = 0.18 p = 0.0061), independently of psychological distress, PTSD symptom severity, substance use history and demographic factors.
Conclusions: HI in childhood is associated with long-lasting executive difficulties and disability in female prisoners. PTSD appears to drive the association between moderate-severe/multiple-mild HI and dysexecutive difficulties. Trauma-informed education programmes regarding HI-related disability and executive difficulties may be useful for women in prison
