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Criminal Justice and Behavior
DOI: 10.1177/0093854807305150
2007; 34; 1385 Criminal Justice and Behavior
Nena Messina, Christine Grella, William Burdon and Michael Prendergast
and Women Drug-Dependent Prisoners
Childhood Adverse Events and Current Traumatic Distress: A Comparison of Men
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CHILDHOOD ADVERSE EVENTS AND
CURRENT TRAUMATIC DISTRESS
A Comparison of Men and
Women Drug-Dependent Prisoners
NENA MESSINA
CHRISTINE GRELLA
WILLIAM BURDON
MICHAEL PRENDERGAST
University of California, Los Angeles
This study describes the prevalence of childhood adverse events (CAEs) among men and women prisoners and assesses the
relationship of CAEs to adult symptoms of traumatic distress. Interview data for 427 men and 315 women were analyzed
assessing childhood abuse and household dysfunction, drug and criminal histories, and symptoms of traumatic distress. Women
offenders had much greater exposure to CAEs than did men and more often reported continued sexual abuse in adolescence
and as an adult. Linear regression results showed that the impact of CAEs on traumatic distress was strong and cumulative for
both men and women (greater exposure to CAEs increased the likelihood of 6 out of 7 mental health outcomes, although
women had higher levels of traumatic distress overall). The findings indicate the need for early prevention and intervention as
well as trauma-based treatment within the correctional setting.
Keywords: child abuse; trauma; gender differences
Aconsiderable amount of research during the past decade has focused on assessing the
treatment needs of drug-dependent women offenders, as compared to their male counter-
parts. One key finding from this body of literature is that drug-dependent female offenders are
more likely than male offenders to report extensive histories of emotional, physical, and sexual
abuse—between 77% and 90% (B. K. Jordan, Schlenger, Fairbank, & Caddell, 1996;
J. Jordan, Kaplan, Miller, Stiver, & Surrey, 1991; Langan & Pelissier, 2001; Messina, Burdon,
Hagopian, & Prendergast, 2006; Messina, Burdon, & Prendergast, 2003; Peters, Strozier,
Murrin, & Kearns, 1997). The consistent finding that women offenders report a higher preva-
lence of childhood abuse and maltreatment has justifiably led to an increase in research assess-
ing the long-term impact of such trauma among women. For example, histories of trauma and
abuse among women offenders have been linked to an increased likelihood of interpersonal
1385
CRIMINAL JUSTICE AND BEHAVIOR, Vol. 34 No. 11, November 2007 1385-1401
DOI: 10.1177/0093854807305150
© 2007 American Association for Correctional and Forensic Psychology
AUTHORS’ NOTE: This study was supported by an Interagency Agreement (Contract Nos. C97.355,
C98.346) between the California Department of Corrections and Rehabilitation, the Office of Substance Abuse
Programs, and University of California, Los Angeles (UCLA) Integrated Substance Abuse Programs. The find-
ings and conclusions of this article are those of the authors and do not necessarily represent the official poli-
cies of the department. Correspondence may be sent to Nena Messina, PhD, UCLA Integrated Substance Abuse
Programs, Criminal Justice Research Group, 1640 Sepulveda Blvd., Ste. 200, Los Angeles, CA 90025; e-mail:
nmessina @ucla.edu.
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violence in adolescent and adult relationships, adolescent conduct disorder, chronic addiction,
criminal activity, homelessness, and adult physical and mental health problems (Anderson,
Rosay, & Saum, 2002; Bloom, Owen, & Covington, 2004; Grella, Stein, & Greenwell, 2005;
Haller & Miles, 2004; Messina et al., 2003; Messina & Grella, 2006).
The association between childhood sexual abuse, chronic substance abuse, and crime
among women offenders has led many researchers, theorists, and clinicians to propose a
need for treatment interventions that specifically address histories of abuse and the resulting
mental and physical health issues. However, the long-term impact for male offenders with
similar histories of childhood abuse has not been sufficiently explored and is often excluded
as a focal point of men’s treatment and recovery. This is not to suggest that drug-dependent
male offenders have been understudied. In fact, until recent changes in federal guidelines
mandating the inclusion of women and minorities as research subjects, men had been typi-
cally overrepresented among substance-abusing populations (Greenfield et al., 2007).
Nevertheless, it is important to explore the health and social consequences and correspond-
ing treatment implications for both men and women who report histories of childhood abuse
and maltreatment.
A review of the existing literature on the prevalence of childhood sexual abuse of men indi-
cates that such abuse is common yet underreported, underrecognized, and undertreated
(Holmes & Slap, 1998). Although estimates vary by definitions of abuse and/or neglect, some
experts suggest that 1 in 6 males are sexually abused before the age of 16 in the United States.
This literature also suggests that boys tend to be particularly less likely than girls to report
sexual abuse because of fear of retribution, the social stigma against homosexual behavior,
the desire to appear self-reliant, and the concern about loss of independence following self-
disclosure. Messina et al. (2006) found that among a large sample of men inmates (N=
4,164), only 13% reported being sexually and/or physically abused as a child. The low per-
centage reported could be because of the fact that these particular questions were asked by
treatment personnel prior to treatment entry and not by experienced researchers. Negative
effects of childhood sexual abuse of boys includes increased likelihood of later posttraumatic
stress disorder, major depression, anxiety disorders, personality disorders, aggression, sub-
stance abuse, legal trouble, and suicide ideation (Holmes & Slap, 1998; Horwitz, Widom,
McLaughlin, & White, 2001).
Recently, a series of reports from the Adverse Childhood Experiences (ACE) study of
women and men in the general population have identified a link between childhood abuse
and lifetime physical health problems, including many of the leading causes of death in
adults (Anda et al., 2002; Dube et al., 2003; Felitti et al., 1998). Specifically, the ACE study
found a strong graded relationship between a cumulative number of events of child abuse
and household dysfunction prior to the age of 18 (e.g., emotional, physical, and sexual
abuse; parental separation or divorce; violence against mother; living with family members
with substance abuse or other psychiatric disorders; or histories of imprisonment) and mul-
tiple risk factors for the leading causes of death in adult life (Felitti et al., 1998)—including
early and chronic drug dependency (Dube et al., 2003) and histories of attempted sui-
cide, among both men and women (Dube et al., 2005). The overall findings from the
ACE study reports show that the long-term impact of child abuse and household dysfunction
on adult health and social problems are similar for both men and women. These studies, how-
ever, are specific to women and men who were sampled from a large HMO in a metropol-
itan area. Hence, the sample comprises individuals who are more socially integrated
1386 CRIMINAL JUSTICE AND BEHAVIOR
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(i.e., employed, with higher socioeconomic status, and higher levels of education) than
individuals in the criminal justice system.1
Few studies have examined gender differences of experiences of childhood maltreatment.
Hyman, Garcia, and Sinha (2006) recently conducted a retrospective analysis assessing the
relationship between indicators of childhood maltreatment and adult substance abuse among
cocaine-dependent treatment-seeking men (n=55) and women (n=32). Childhood mal-
treatment was associated with younger age of first alcohol use, which was in turn associated
with younger age of first cocaine use for both men and women. Childhood maltreatment was
also associated with overall substance abuse severity regardless of gender. However, there
were gender differences with respect to the specific types of maltreatment that were related
to outcomes and the strength of the associations. Childhood emotional abuse, sexual abuse,
and overall maltreatment were all more strongly related to outcomes among the women.
There is a strong likelihood that the link between childhood trauma and adult physical and
mental health problems will be substantially more pronounced among an offender population
because of their elevated histories of childhood trauma, substance abuse, and HIV risk behav-
iors in comparison to the general population (Bloom et al., 2004; Browne, Miller, & Maguin,
1999; Chesney-Lind & Pasko, 2004; B. K. Jordan et al., 1996; Owen & Bloom, 1995; Singer,
Bussey, Song, & Lunghofer, 1995).
Thus, Messina and Grella (2006) explored the prevalence of multiple types of childhood
traumatic events among women parolees who participated in a prison-based substance abuse
treatment program and assessed the relationship of cumulative childhood traumatic events to
adult physical and mental health problems. Eighty-four percent of the women offenders
(N=500) reported at least one traumatic event prior to the age of 16. Regression results showed
that the impact of childhood traumatic events on mental and physical health outcomes was
strong and cumulative (increasing the likelihood of 12 out of 18 health-related outcomes).
The largest effect of exposure to childhood trauma was for the five mental health outcomes
assessed. The resulting magnitude of the additive effects of exposure to multiple traumatic
events was alarming (e.g., a 980% increase in the odds of mental health treatment as an adult
relative to exposure to seven childhood traumatic events). This is a key finding with regard
to the general lack of appropriate mental health treatment available to offenders in correc-
tional treatment programs as well as to the elevated risk of recidivism associated with
co-occurring mental health and substance abuse disorders (Messina et al., 2006; Messina,
Burdon, Hagopian, & Prendergast, 2004).
This article extends the previous study on women offenders and reports on an analysis of
baseline data from the California Department of Corrections and Rehabilitation (CDCR)
Treatment Initiative evaluation to examine the prevalence of several types of childhood
adverse events (CAEs) among drug-dependent men and women offenders. Because previous
findings from the ACE study indicate that these events rarely occur in isolation and tend to
be highly correlated, we were specifically interested in examining the cumulative number of
CAEs as related to a variety of adult mental health problems (e.g., dissociation, anxiety,
depression) by gender. A comparison of the long-term mental health outcomes by gender of
victim could provide a perspective on the need for appropriate prevention and treatment
services relative to the gender of the offender.
Based on findings from previous literature of drug-dependent offenders and previous
findings from the ACE studies, three hypotheses were formulated:
Messina et al. / CHILDHOOD ADVERSE EVENTS 1387
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Hypothesis 1: Drug-dependent women offenders will report more abuse prior to the age of
16, compared with drug-dependent men offenders.
Hypothesis 2: Greater exposure to CAEs will be associated with greater histories of mental health
treatment, use of psychotropic medication, and earlier criminal and drug-using behaviors,
regardless of gender.
Hypothesis 3: Greater exposure to CAEs, combined with the preexisting substance abuse and
criminal histories among this sample, will increase the likelihood of adult mental health
disorders, regardless of gender.
METHOD
The data for this study were collected as part of three in-depth prison outcome evaluations
at two male-felon programs and a female-felon program for substance abusers in California.
The University of California, Los Angeles (UCLA), Integrated Substance Abuse Programs
(ISAP) was contracted by CDCR to evaluate these prison-based substance abuse programs
(SAPs). The UCLA Institutional Review Board reviewed and approved all study procedures,
and a federal certificate of confidentiality was obtained. These outcome studies required col-
lecting detailed interview data from SAP participants and a matched comparison group from
the general population of inmates who did not participate in a prison-based treatment
program. Baseline data from SAP participants and the matched comparison groups was
combined for the purposes of this study. Our current analyses focus on differences by
gender, not treatment group, as all data refer to events that occurred prior to incarceration or
treatment admission (with the exception of dependent measures of current psychological
status). The sample frame for the matched comparison group is limited to those individuals
who had self-reported a history of substance abuse. In addition, comparisons of background
data on men and women indicated that there was successful matching on sociodemograph-
ics (e.g., race/ethnicity, age, education, and controlling offense) with minimal significant dif-
ferences between the two groups (results not shown; see Messina et al., 2006).
PARTICIPANTS
The current study focuses on 316 women inmates (171 women who participated in the
SAP and 145 women from the general inmate population) and 425 men (280 from the SAP
and 145 from the general inmate population). All participants volunteered to be interviewed
for the study, and fewer than 3% of those approached refused to participate. Participants in
the study were predominately Black (29%, n =218), White (36%, n=265), or Hispanic
(23%, n=182); were 34 years old, on average; and had completed approximately 11 years
of education prior to their current incarceration. Half (50%, n =373) had never been mar-
ried. Forty-two percent (n=314) were employed during the 6 months prior to their current
incarceration. Participants also reported an average of 22 arrests in their lifetime. This was
primarily a stimulant-abusing population, as 33% (n=242) reported methamphetamine as
their primary drug problem and 19% (n=142) reported cocaine or crack as their primary
drug problem.
Participation in the SAPs is open to inmates who have a documented history of substance
use and abuse, and who have between 6 and 24 months left to serve on their sentence. Those
who meet these eligibility requirements are mandated into the treatment programs. However,
1388 CRIMINAL JUSTICE AND BEHAVIOR
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because of program capacity limitations, some men and women who are eligible for the SAP
remain in general population. There are also certain exclusionary criteria that preclude other-
wise eligible inmates from entering the programs (e.g., gang-related enemy situations, docu-
mented membership in a prison gang, time spent in administrative segregation for violence or
weapons charges in the past 12 months, and felony and Immigration and Naturalization
Service holds).
PROCEDURES
Client-level baseline data were collected via face-to-face interviews with the women and
men who volunteered to participate in the study. All treatment group participants were inter-
viewed at the time they entered the prison SAP (generally with 6 to 12 months remaining on
their sentence). All comparison group interviews were conducted approximately 6 months
prior to release from prison to have comparable postprison follow-up for the outcome evalu-
ations. The baseline instrument is a slightly revised version of an instrument developed by the
Institute of Behavioral Research at Texas Christian University (Broome, Knight, Hiller, &
Simpson, 1996). The instrument includes sections on sociodemographic background, family
and peer relations, health and psychological status, criminal involvement, in-depth drug-use
history, trauma history, and an AIDS-risk assessment. Administration time is approximately
70 to 90 minutes.
MEASURES
CAEs
Nine indicators of CAEs in two categories were analyzed. These variables were based on
self-reports of childhood trauma and adverse household events before the age of 16 years in
response to items from the Life Stressor Checklist–Revised (LSC-R; McHugo, Caspi, et al.,
2005; McHugo, Kammerer, et al., 2005; Wolfe & Kimerling, 1997). The LSC-R is designed
to screen for the occurrence of life events that meet the definition of “trauma” according to
the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It is composed of 30
event items that are endorsed as having occurred or not occurred, followed by subquestions
deriving age at time of first event (i.e., when the event first occurred), duration (i.e., time
between first and last occurrence), and DSM-IV criteria for life threat or emotional impact.
Information regarding the relationship to the perpetrator (someone known well versus not
known well) is embedded into the item wording when appropriate. The LSC-R has demon-
strated good criterion-related validity for post-traumatic stress disorder (PTSD) in diverse
populations and has been found to be an especially appropriate measure among those with
co-occurring substance abuse and mental health disorders with histories of interpersonal vio-
lence and abuse (McHugo, Caspi, et al., 2005). More details are provided in the descriptions
of the selected events below.
Abuse and Neglect. Emotional abuse or neglect was defined as being “emotionally
abused or neglected (e.g., being frequently shamed, embarrassed, ignored, or repeatedly
told that you were no good).”
Physical neglect was defined as “being physically neglected (e.g., not fed, not properly
clothed, or left to take care of yourself when you were too young or ill).”
Messina et al. / CHILDHOOD ADVERSE EVENTS 1389
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Physical abuse was defined as being “abused or physically attacked (not sexually) by
someone you knew (e.g., a parent, boyfriend, or husband) who hit, slapped, choked, burned,
or beat you up.”
Sexual abuse encompassed being “touched or made to touch someone else in a sexual
way because he or she forced you in some way or threatened to harm you if you didn’t” or
“forced sex (oral, anal, genital) when you didn’t want to because someone forced you in
some way or threatened to harm you if you didn’t.”
Household Dysfunction. Family violence was assessed by an item asking, “Did you ever
see violence between family members (e.g., hitting, kicking, slapping, punching)?”
Parental separation or divorce was assessed by an item asking, “Did your parents ever
separate or divorce while you were living with them?”
Incarcerated family member was defined as “a close family member being sent to jail or
prison.”
Out-of-home placement was defined as “being in foster care or put up for adoption.”
Parental substance abuse was defined as “mother or father drunk or using drugs some-
times, frequently, or always while growing up.”2
DEPENDENT VARIABLES
Midway into the study, a standardized assessment was added to the baseline interview to
assess current traumatic distress: the Trauma Symptom Checklist–40 (TSC-40). The TSC-40
is a measure that evaluates symptomatology in adults arising from childhood or adult trau-
matic experiences (Briere, 1996). It measures not only symptoms typically associated with
PTSD but also other symptom clusters found in some traumatized individuals. The TSC-40
is a 40-item self-report instrument consisting of six subscales (also the dependent variables):
Dissociation, Anxiety, Depression, Sexual Abuse Trauma Index, Sexual Problems, and Sleep
Disturbance as well as a total Traumatic Distress Score. Each symptom item is rated accord-
ing to its frequency of occurrence in the prior 2 months, using a 4-point scale ranging from
0 (never) to 3 (often). The TSC-40 was administered to a subsample of men and women (n=
376; 157 women and 215 men).3
ANALYSIS
Bivariate analyses (chi-square for two-tailed tests) were first conducted to assess the preva-
lence of CAEs between men and women. Correlations between the various CAEs were also
conducted for men and women. Fisher’s ztransformations were then computed to determine
whether the correlational coefficients for women were significantly different than those for
men. Bivariate analyses (chi-square and ttest) were further conducted to assess the range of
exposure to CAEs by demographic variables and histories of mental health treatment, use of
psychotropic medications, and age of initiation of drug use and criminal behavior by gender.
Pairwise comparisons were then conducted (one-way ANOVA) to determine whether there
was an association between the number and duration of CAEs and current traumatic distress
mean raw scores, by gender. All analyses were considered statistically significant at the
p≤.05 level. To control for inflated alpha error, we conducted Tukey-Kramer’s tests for all
post hoc comparisons.
1390 CRIMINAL JUSTICE AND BEHAVIOR
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Seven separate linear regression analyses were then conducted to assess whether expo-
sure to a range of CAEs was significantly related to adult mental health disorders while
controlling for possible confounding factors: age (continuous), education (continuous), and
race/ethnicity (with White as the referent). Main effects for gender (with female as the ref-
erent), the total number of categories of CAEs (0 to 9), and an interaction term were also
included (Total Number of CAEs ×Gender).
RESULTS
Chi-square analyses (shown in Table 1) were conducted to show the distribution of the
nine types of CAEs by gender. Men and women differed significantly on several types of
CAEs and on the cumulative number of CAEs prior to the age of 16. In support for our first
hypothesis (Hypothesis 1: Drug-dependent women offenders will report more abuse prior
to the age of 16, compared with drug-dependent men offenders), women were more likely
than men to report three of the four categories of Abuse and Neglect. Women were signif-
icantly more likely to report emotional abuse and neglect (20% versus 40%, χ2 =34.8, p <
.001), physical abuse (20% versus 29%, χ2 =7.58, p <.006), and sexual abuse (9% versus
39%, χ2 =100.80, p <.001).
With regard to the categories of Household Dysfunction, men were significantly more
likely than women to report the incarceration of a family member (42% versus 30%, χ2 =
9.88, p <.002) and parental substance abuse (54% versus 44%, χ2 =6.76, p <.009). Men
Messina et al. / CHILDHOOD ADVERSE EVENTS 1391
TABLE 1: Prevalence of Childhood Adverse Events (CAEs) by Gender
% of Men % of Women Total %
(
n
=425) (
n
=314) (
N
=743)
p
Value
Abuse and Neglect
1. Emotional abuse and neglect 20.0 39.8 28.4
p
<.001
2. Physical neglect 4.9 8.0 6.3
p
<.086
3. Physical abuse 20.2 29.0 24.0
p
<.006
4. Sexual abuse 8.5 39.2 21.5
p
<.001
Household Dysfunction
5. Family violence 49.4 45.9 47.9
p
<.339
6. Parental separation or divorce 44.6 42.3 43.6
p
<.540
7. Incarcerated family member 41.6 30.3 36.9
p
<.002
8. Out-of-home placement 12.2 16.9 14.2
p
<.074
9. Parental substance abuse 53.6 44.0 49.5
p
<.009
Childhood traumatic events
p
<.003
0 11.5 14.9 12.9
1 17.6 15.8 16.8
2 23.4 16.1 20.3
3 21.3 16.5 19.2
4 12.9 13.9 13.3
5-plusa13.3 22.8 17.4
Note
. Boldface type reflects the largest category endorsed relative to statistically significant comparisons.
a. 7.8% of the men and women reported 5 CAEs; 5.4% reported 6 CAEs; 2.9% reported 7 CAEs; and 1.4% reported
8 or 9 CAEs.
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and women did not differ with regard to reporting physical neglect, witnessing family vio-
lence, parental separation or divorce, or out-of-home placement. Women were, however,
significantly more likely than men to report five or more CAEs occurring prior to the age
of 16 (13% versus 23%, χ2 =18.37, p <.003). In addition, women were significantly more
likely than men to report continued sexual abuse (i.e., forced sex) after the age of 16 (28%
versus .7%, χ2 =124.82, p <.001). (No differences between men and women were shown
with regard to the duration of emotional abuse or neglect and physical abuse; these results
are not shown.)
Table 2 shows the correlations between categories of CAEs for men and women (corre-
lational coefficients for women are shown on the top right diagonal of the table, and coef-
ficients for men are shown on the bottom left diagonal of the table). The ACE study
previously showed that the separate categories of adverse events tended to be highly corre-
lated. As expected, the relationship between our CAE categories were significant for nearly
all of the comparisons among the men and among the women. However, ztransformations
revealed that—among 13 associations—the correlations among adverse events were signif-
icantly stronger for women than for men. For example, among women, childhood sexual
abuse was more strongly correlated with emotional abuse (z =–2.21, p<.05); physical
neglect (z =–3.61, p<.01); physical abuse (z =–4.95, p<.01); family violence (z =–2.10,
p<.05); incarcerated family member (z =–3.26, p<.01); and out-of-home placement (z =
–3.53, p<.01) than those for the men. Correlational coefficients in Table 2 that are higher
for men were not significantly different than those reported for women.
BIVARIATE COMPARISONS (χχ2 AND tTESTS)
Preliminary analyses showed that men and women differed significantly on numerous
background characteristics (findings not shown). Thus, we opted to conduct bivariate com-
parisons of background characteristics and the correlation to the number of categories of
CAEs prior to age 16 separately for men and women (shown in Tables 3 and 4). Findings
1392 CRIMINAL JUSTICE AND BEHAVIOR
TABLE 2: Relationships Between Categories of Childhood Adverse Events by Gender
12 3 4 56789
1. Emotional abuse/neglect — .266** .456** .320** .244** .166** .149** .259** .205**
2. Physical neglect .157** — .281** .271** .204** .202** .141* .369** .000
3. Physical abuse .378** .209** — .437** .286** .185** .191** .199** .123*
4. Sexual abuse .165** .009 .099* — .191** .172** .139** .248** .086
5. Saw family violence .224** .144** .228** .037 — .280** .173** .114** .222**
6. Parental separation/divorce .167** .080 .114* .050 .118* — .190** .122* .217**
7. Family member in jail/prison –.041 .094 –.010 –.103* .244** .092 — .105 .067
8. Out-of-home placement .065 .180** .223** –.010 .134** .041 .063 — .078
9. Parental substance abuse .134** .060 .139** .113* .154** .051 .087 .016 —
Note
. Correlational coefficients for women (
n
=316) are on the top diagonal and correlational coefficients for the
men (
n
= 425) are on the bottom diagonal. All events refer to when respondent was younger than 16 years old,
with the exception of parental substance abuse, which refers to when the respondent was younger than 17. The
z
transformations revealed that women yielded significantly higher correlations among adverse events than did
men (
p
<.05). The correlational coefficients that were higher for men were not significantly different from those for
the women.
*
p
<.05. **
p
<.01.
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1393
TABLE 3: Background Characteristics of Men by Number of Childhood Adverse Events (CAEs)
Number of CAEsa
Characteristics for Men 0 (
n
=49) 1 (
n
=75) 2 (
n
=100) 3 (
n
=91) 4 (
n
=55) 5-Plus (
n
=57) Total (
N
=427)b
Race/ethnicity
African American 22 19 35 31 18 25 26
Hispanic 21 31 24 26 33 12 24
White 41 43 35 33 44 51 40
Other 16 8 6 10 6 12 10
Marital status
Never married 59 49 41 59 51 54 52
Married/living as 25 20 37 19 29 28 27
Divorced/Separated/Widowed 16 31 22 22 20 18 22
Ever receive mental health treatment prior to prison*** 16 23 17 31 35 47 27
Taking psychotropic medication prior to prison** 0 5 2 7 11 14 6
M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD
Education 11.8 ± 1.5 11.1 ± 2.0 11.3 ± 1.7 11.1 ± 1.7 11.0 ± 1.5 10.9 ± 1.4 11.2 ± 1.7
Age (years)** 34.5 ± 8.4 34.8 ± 8.4 33.0 ± 8.2 31.1 ± 7.4 31.6 ± 7.2 31.1 ± 8.0 32.6 ± 8.0
Age at first arrest*** 17.3 ± 5.3 16.9 ± 5.3 15.6 ± 4.1 15.0 ± 4.4 15.0 ± 5.9 12.9 ± 2.9 15.4 ± 4.8
Number of times ever arrested 18.3 ± 42.8 13.5 ± 10.6 17.4 ± 15.5 16.3 ± 16.1 17.0 ± 10.6 22.5 ± 23.9 17.2 ± 20.9
Age at first lockup*** 17.7 ± 5.2 17.6 ± 6.1 16.0 ± 4.2 15.3 ± 4.5 15.0 ± 5.5 13.4 ± 2.8 15.9 ± 5.0
Number of times in jail/prison 14.5 ± 28.9 11.5 ± 8.7 15.9 ± 14.5 16.4 ± 16.9 17.4 ± 13.9 20.2 ± 22.4 15.8 ± 17.7
Age at first alcohol use*** 14.2 ± 2.9 13.1 ± 3.7 12.1 ± 3.5 11.7 ± 3.9 11.1 ± 3.7 10.7 ± 3.7 12.1 ± 3.8
Age at first drug use*** 13.9 ± 2.7 14.1 ± 3.0 13.2 ± 3.5 13.2 ± 3.6 12.7 ± 2.0 11.8 ± 2.8 13.2 ± 3.2
Note
. Boldface type reflects the largest category endorsed relative to statistically significant comparisons.
a. The number of categories of events was the sum total of each of the nine possible events.
b. Numbers vary slightly because of missing data.
*
p
≤.05. **
p
≤.01. ***
p
≤.001.
distribution.
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1394
TABLE 4: Background Characteristics of Women by Number of Childhood Adverse Events (CAEs)
Number of CAEsa
Characteristics for Women 0 (
n
=46) 1 (
n
=50) 2 (
n
=51) 3 (
n
=52) 4 (
n
=44) 5-Plus (
n
=72) Total (
N
=315)b
Race/ethnicity
African American 35 38 43 33 30 26 34
Hispanic 24 28 26 17 25 25 24
White 28 26 22 31 43 32 30
Other 13 8 10 19 2 17 12
Marital status
Never married 48 44 55 50 46 49 49
Married/living as 9 36 12 23 16 19 19
Divorced/separated/widowed 44 20 33 27 39 32 32
Ever receive mental health treatment 35 28 55 46 61 81 53
prior to prison***
Taking psychotropic medication 20 14 24 29 27 36 26
prior to prison
M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD
Education (years)* 11.8 ± 3.1 11.4 ± 1.9 11.2 ± 2.0 11.2 ± 1.9 11.0 ± 3.5 10.3 ± 2.1 11.1 ± 2.5
Age (years)*** 39.5 ± 9.7 35.7 ± 7.9 34.9 ± 8.3 33.0 ± 8.7 37.6 ± 10.0 34.9 ± 8.2 35.8 ± 8.9
Age at first arrest*** 26.2 ± 10.2 23.0 ± 6.7 21.3 ± 7.2 20.5 ± 7.3 21.5 ± 10.2 18.7 ± 6.7 21.6 ± 8.3
Number at times ever arrested*** 6.0 ± 4.5 9.5 ± 11.3 9.9 ± 8.1 12.4 ± 15.6 17.9 ± 26.1 21.9 ± 33.5 13.6 ± 21.6
Age at first lockup*** 26.8 ± 10.1 23.1 ± 7.3 22.7 ± 7.9 21.1 ± 6.9 22.2 ± 10.5 19.4 ± 6.5 22.3 ± 8.4
Number of times in jail/prison** 6.1 ± 7.6 8.3 ± 10.7 7.5 ± 6.5 10.1 ± 14.9 12.4 ± 15.0 15.9 ± 23.0 10.4 ± 15.2
Age at first alcohol use*** 15.7 ± 3.8 15.1 ± 3.9 14.7 ± 3.5 15.0 ± 5.1 13.1 ± 5.0 12.7 ± 5.3 14.2 ± 4.7
Age at first drug use* 16.0 ± 2.9 15.6 ± 3.9 15.2 ± 3.7 14.2 ± 3.3 14.8 ± 4.7 13.5 ± 3.9 14.7 ± 3.9
Note
. Boldface type reflects the largest category endorsed relative to statistically significant comparisons.
a. The number of categories of events was the sum total of each of the nine possible events.
b. Numbers vary slightly due to missing data.
*
p
≤.05. **
p
≤.01. ***
p
≤.001.
distribution.
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at UCLA COLLEGE SERIALS/YRL on November 26, 2007 http://cjb.sagepub.comDownloaded from
were in the expected direction and supported the second hypothesis (Hypothesis 2: Greater
exposure to CAEs will be associated with greater histories of mental health treatment, use
of psychotropic medication, and earlier criminal and drug-using behaviors, regardless of
gender). There were significant increases in the proportion of men and women who had his-
tories of mental health treatment with greater exposure to CAEs. In fact, 47% (n=27) of
the men and 81% (n=58) of the women with five or more CAEs reported mental-health-
treatment histories compared with 16% (n =8) of the men and 35% (n=16) of the women
with no CAEs. Men and women with five or more CAEs also reported the earliest and most
serious involvement in drugs and crime (e.g., age of first arrest, age of first lockup, age of
first alcohol and drug use).
There were significant increases in the proportion of men who reported use of psy-
chotropic medications with greater exposure to CAEs; however, similar increases were not
significant for the women. There were also significant increases in the mean number of
arrests and incarcerations with greater exposure to CAEs for women, but similar increases
were not significant for men.
Table 5 displays the TSC-40 Dissociation, Anxiety, Depression, Sexual Abuse Trauma
Index, Sleep Disturbance, and Sexual Problems subscales for men and women by CAEs.
Pairwise comparisons indicated that men and women with five or more CAEs generally had
higher mean raw scores on the TSC-40 subscales compared to those with fewer than three
CAEs. In sum, there were generally significant linear associations for both men and women,
with the largest mean raw score typically associated with greater exposure to CAEs.
However, mean raw scores for women were higher than those for the men on each subscale
overall. In fact, the mean raw scores for Overall Traumatic Distress were significantly higher
for women compared with men as exposure to CAEs increased (see Figure 1).
We did not consider these bivariate analyses a true test of the final hypothesis, as bivari-
ate analyses do not provide an effect size on a significant finding, nor do they allow for the
control of possibly confounding factors that may mask the significance of an association.
Therefore, multivariate analyses (i.e., linear regression) were conducted to control for addi-
tional factors that have previously been shown to be associated with adverse mental health
outcomes as well as an interaction effect.
LINEAR REGRESSIONS
Table 6 summarizes the results of the seven multiple regression models. Results for the
total number of CAEs (0 to 9), gender, and interaction term are shown for each dependent
variable. All models control for the effects of age, race or ethnicity, and education prior to
incarceration. (Full results for all models are available from the authors.) The main effect
total number of CAEs was significantly and positively related to six of the seven dependent
variables examined (Sexual Problems was not significant). Gender, or being female, was
significantly and positively related to all seven of the dependent variables examined. The
interaction term was not significantly related to any of the regression models examined.
The strength of these findings for the cumulative exposure to CAEs among this popula-
tion of men and women provide support for the final hypothesis (Hypothesis 3: Greater
exposure to CAEs, combined with the preexisting substance abuse and criminal histories
among this sample, will increase the likelihood of adult mental health disorders, regardless
of gender), although women had higher scores on all outcomes.
Messina et al. / CHILDHOOD ADVERSE EVENTS 1395
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1396
TABLE 5: Relationship of Number of Childhood Adverse Events to Trauma Symptom Checklist Disorders by Gender
0 1 2 3 4 5-Plus Total
Men Women Men Women Men Women Men Women Men Women Men Women Men Women
M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD
Dissociation 2.9 ± 3.7 3.6 ± 3.3 2.7 ± 3.1 4.8 ± 4.2 3.1 ± 3.1 6.3 ± 4.0 3.3 ± 3.0 6.3 ± 4.2 4.3 ± 3.6 8.2 ± 4.7 5.9 ± 4.2 8.6 ± 4.7 3.5 ± 3.5 6.5 ± 4.5
Anxiety 1.7 ± 2.8 3.9 ± 4.4 1.8 ± 1.9 5.2 ± 4.7 2.3 ± 2.6 5.5 ± 3.5 2.5 ± 2.8 5.6 ± 4.4 3.3 ± 2.5 9.1 ± 5.4 5.0 ± 3.7 7.5 ± 5.2 2.6 ± 2.9 6.2 ± 4.9
Depression 4.5 ± 3.8 5.8 ± 4.4 3.9 ± 3.2 7.8 ± 5.3 4.9 ± 3.9 7.8 ± 3.8 4.8 ± 3.1 8.3 ± 4.1 6.5 ± 3.1 10.7 ± 5.8 6.8 ± 4.3 11.6 ± 6.1 5.1 ± 3.6 8.9 ± 5.3
Sexual Abuse 2.3 ± 3.2 3.4 ± 3.3 2.3 ± 3.1 3.8 ± 3.3 2.5 ± 2.7 4.8 ± 2.9 2.9 ± 3.1 5.4 ± 4.0 3.0 ± 2.6 7.8 ± 4.4 4.7 ± 4.1 7.2 ± 4.2 2.8 ± 3.1 5.5 ± 4.0
Trauma Index
Sleep Disturbance 4.1 ± 4.6 4.1 ± 4.2 3.8 ± 3.8 7.9 ± 4.8 5.4 ± 4.3 7.1 ± 3.9 5.7 ± 4.6 7.7 ± 4.5 6.7 ± 4.7 10.5 ± 4.9 6.3 ± 4.5 10.1 ± 5.8 5.3 ± 4.5 8.1 ± 5.1
Sexual Problems 2.0 ± 2.4 1.7 ± 2.1 1.3 ± 2.3 1.9 ± 1.9 1.0 ± 1.8 4.5 ± 4.6 1.5 ± 1.8 3.1 ± 2.9 1.7 ± 2.3 3.5 ± 3.5 2.7 ± 3.0 3.5 ± 4.0 1.6 ± 2.2 3.1 ± 3.5
Total score 16.4 ± 15.2 20.7 ± 15.6 15.2 ± 12.6 27.5 ± 17.6 18.8 ± 13.5 32.7 ± 16.4 18.9 ± 12.5 33.4 ± 16.8 25.5 ± 13.2 44.8 ± 21.3 30.6 ± 17.6 43.9 ± 22.6 20.1 ± 14.5 34.7 ± 20.3
Note
. For men,
N
=215; for women,
N
=157. All comparisons are significant at
p
≤.01. Boldface type reflects the largest category endorsed relative to statistically significant comparisons.
distribution.
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DISCUSSION
This study specifies the prevalence of several types of adverse childhood events prior to
the age of 16 among a sample of drug-dependent men and women offenders and describes
the relationship of a cumulative number of those events to current indicators of traumatic
distress. The findings showed that generally women had higher rates of both abuse and
neglect, although on several variables of household dysfunction, men reported greater
exposure. Furthermore, there were differential associations among the types of adverse
childhood events for men and women, suggesting different areas of vulnerability for child-
hood traumatic exposure. Moreover, both men and women with more exposure to CAEs
enter the criminal justice system and initiate alcohol and drug use at earlier ages, and for
women, the number of arrests increases with greater exposure to CAEs.
Although both the number of CAEs experienced and female gender were significantly
and positively associated with the traumatic symptom outcomes, there were no significant
interactions observed between number of CAEs and gender. Thus, findings were similar to
those from the ACE study; we found strong evidence of a cumulative abuse effect for both
men and women, and they were similarly affected in adulthood by their exposure to adverse
childhood events. However, women reported longer duration of childhood sexual abuse and
continued sexual abuse after the age of 16 as well as overall higher levels of current trau-
matic distress. Previous findings have shown that men and women differ in terms of their
risk for sexual and physical abuse during their lifetime. Covington (2007) has contended
that both females and males are at risk of abuse from family members and people known
to them as young children. However, there are significant gender differences for risk of con-
tinued abuse through adolescence and during a life span.
Messina et al. / CHILDHOOD ADVERSE EVENTS 1397
Figure 1: Relationship of Number of Childhood Adverse Events to Overall Traumatic Distress by Gender
0
10
20
30
40
50
60
012345
No. of Childhood Adverse Events
Mean Raw Score
Men (N = 215)
Women (N = 157)
>
P < .001
distribution.
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at UCLA COLLEGE SERIALS/YRL on November 26, 2007 http://cjb.sagepub.comDownloaded from
Advocates for gender-responsive treatment for offenders propose a need for multilevel
program components that specifically address the devastating circumstances and the life-
long impact of childhood trauma for women. However, the current findings indicate the
need to ameliorate the consequences of childhood abuse and household dysfunction for
both men and women. Previous studies have shown that the safety and comfort of women-
only groups increase participation in treatment, such as the open discussion of sensitive
issues (e.g., histories of prostitution and sexual abuse) that women do not wish to discuss
in the presence of men (Bloom et al., 2004; Grella, Polinsky, Hser, & Perry, 1999). It is pos-
sible that the discussion of such abuse is uncomfortable for men in mixed-gender environ-
ments as well. Thus, the safety of gender-specific environments when exploring the impact
of childhood trauma might aid the recovery for offenders participating in substance abuse
treatment, either in the community or in prison.
STUDY LIMITATIONS
Some limitations of the study should be noted. First, measures of CAEs and mental
health were based on self-report. Thus, the participant’s responses could not be validated with
1398 CRIMINAL JUSTICE AND BEHAVIOR
TABLE 6: Summary of Results of Regression Models of Current Traumatic Distress (
N
==370)
Dependent Variable
R2BSEt
Value Sig.
Model 1. Dissociationa.219 .001
Number of CAEs (0 to 9) .57 .159 3.58 .001
Gender (female) 2.20 .689 3.19 .002
Interaction .15 .210 .71 .447
Model 2. Anxiety a,b,d .281 .001
Number of CAEs (0 to 9) .61 .154 3.94 .001
Gender (female) 3.22 .667 4.83 .001
Interaction –.01 .204 –.04 .965
Model 3. Depressiona,b,d .264 .001
Number of CAEs (0 to 9) .56 .177 3.15 .002
Gender (female) 2.32 .767 3.03 .003
Interaction .36 .234 1.54 .125
Model 4. Sex Abuse Trauma Indexa.217 .001
Number of CAEs (0 to 9) .39 .199 2.79 .006
Gender (female) 1.78 .233 2.87 .004
Interaction .25 .134 1.32 .187
Model 5. Sleep Disturbancea.165 .001
Number of CAEs (0 to 9) .58 .193 3.00 .003
Gender (female) 1.69 .838 2.03 .044
Interaction .26 .256 1.02 .308
Model 6. Sexual Problemsa.093 .001
Number of CAEs (0 to 9) .17 .119 1.40 .163
Gender (female) 1.32 .515 2.56 .011
Interaction .06 .157 .37 .707
Model 7. Overall Traumatic Distressa,d .271 .001
Number of CAEs (0 to 9) 2.84 .680 4.18 .001
Gender (female) 10.78 2.951 3.65 .001
Interaction .73 .901 .81 .418
Note
. All models also control for age, education, and race/ethnicity. CAEs =childhood adverse events.
a. The number of childhood traumatic events is entered as a continuous variable ranging from 0 to 9 (
df
=6).
b. Age was significantly related to Models 2 and 3.
c. Education was not significant in any model.
d. Race (White/non-White) was significantly related to models 2, 3, and 7.
distribution.
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objective measures (e.g., medical or legal records). Responses to the questions reflected the
respondent’s interpretation of the questions, including those regarding physical and sexual
assault. However, the questions regarding such abuse and household dysfunction on the
LSC-R are very specific to avoid confusion, and the LSC-R has previously demonstrated
good criterion-related validity. It is also important to consider that there may be gender dif-
ferences in the willingness to self-disclose adverse childhood events, such as sexual abuse,
which could have influenced the observed findings (Holmes & Slap, 1998). In addition, recall
and disclosure of past abusive experiences may be influenced by current mental health status.
Second, the sample size was relatively small. Multivariate analyses sometimes resulted in
small cell sizes, which could have created an inability to detect significant differences. Third,
the current study relied on baseline data from the CDCR evaluation of inmates in the
California prison system. The findings generated by this study may not be generalizable to
inmate populations in other state prisons.
POLICY IMPLICATIONS
Policy makers are becoming increasingly aware of the need to reform multiple aspects of
California’s correctional policies and, specifically, those addressing women offenders. Yet it
appears that drug-dependent men and women offenders may have similar needs with regard
to addiction and mental health issues. The contrast for men and women is the degree of
intensity of these needs and the ways in which they should be addressed by criminal justice
and treatment programs to reduce the risk of relapse and recidivism and improve prosocial
behaviors. However, even programs that provide services responsive to trauma issues may
not be able to address all of these needs because of staff capabilities and funding limitations.
The finding that mental health problems among offenders may have their origins in child-
hood events indicates the need for early prevention and intervention initiatives for girls and
boys. Nurse home visits for at-risk mothers and children and adolescent treatment programs
focused on trauma and abuse could help to reduce the incidence of child abuse as well as the
lifelong impact as a result of such abuse. Early prevention and intervention programs could
also help to alleviate the growing costs to society that are a result of the mental health prob-
lems experienced by adult offenders with such histories of abuse as well as the subsequent
effects on their children. The long-term consequences of these untreated mental health prob-
lems have implications for community health as well as for promoting positive health behav-
iors that may also help to reduce future recidivism.
CONCLUSION
Both men and women under criminal justice supervision commonly report histories
of childhood abuse and household dysfunction, even more so for those who are drug-
dependent. However, it is clear that women offenders more often report certain types of
abuse and a longer duration of abuse (e.g., sexual abuse lasting into adolescence and adult-
hood), as compared to their male counterparts. With the rising number of drug-dependent
men and women with co-occurring mental disorders entering prison-based substance abuse
programs and the higher risk of recidivism for those with comorbidity, it is important to
understand and address the potential effects of abuse throughout adulthood for both men
and women.
Messina et al. / CHILDHOOD ADVERSE EVENTS 1399
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NOTES
1. The HMO participants in the Adverse Childhood Experiences study were on average 55 years old. The majority of them
were White (73%) and were either college graduates (32%) or had attended some college (42%). A small percentage had not
graduated high school (8%), in stark contrast to our offender population (see Participant description in Methods section).
2. This variable was derived from the baseline interview, which asked about specific parental substance abuse prior to the
age of 17.
3. No significant differences were found between those who were interviewed before the Trauma Symptom Checklist–40
(TSC-40) was included in the baseline interview and those who were administered the baseline interview that included the
TSC-40.
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