Traumatization and mental distress in long-term prisoners in Europe
| Published date | 01 October 2011 |
| Date | 01 October 2011 |
| DOI | 10.1177/1462474511414782 |
| Subject Matter | Articles |
Article
Punishment & Society
13(4) 403–423
! The Author(s) 2011
Traumatization and
Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav
mental distress in
DOI: 10.1177/1462474511414782
pun.sagepub.com
long-term prisoners
in Europe
Manuela Dudeck
University of Greifswald, Germany
Kirstin Drenkhahn
Free University of Berlin, Germany
Carsten Spitzer
University Medical Centre Hamburg-Eppendorf, Germany
Sven Barnow
University of Heidelberg, Germany
Daniel Kopp
University of Greifswald, Germany
Philipp Kuwert
University of Greifswald, Germany
Harald J. Freyberger
University of Greifswald, Germany
Frieder Du
¨ nkel
University of Greifswald, Germany
Abstract
This article investigates the prevalence of traumatization and mental distress in a sample
of 1055 male European long-term prisoners as part of a wider study of the living
conditions of prisoners serving sentences of at least five years in Belgium, Croatia,
Denmark, England, Finland, France, Germany, Lithuania, Poland, Spain and Sweden.
Data were collected in a written survey using the Posttraumatic Diagnostic Scale
Corresponding author:
Manuela Dudeck, Klinik und Poliklinik fu¨r Psychiatrie und Psychotherapie der Ernst-Moritz-Arndt-Universita¨t
Greifswald am Hanseklinikum Stralsund, Rostocker Chaussee 70, 18435 Stralsund, Germany.
Email: manuela.dudeck@uni-greifswald.de
404
Punishment & Society 13(4)
(PDS), the Brief Symptom Inventory (BSI) as well as questions on attempted suicide and
auto-aggressive behaviour. Participants experienced a mean of three traumatic events,
with 14 per cent developing a Posttraumatic Stress Disorder (PTSD) subsequently. In
each national sample, more than 50 per cent of the participants were in need of treat-
ment because of psychological symptoms and nearly one-third had attempted suicide.
Keywords
long-term imprisonment, mental health, psychopathology, PTSD, suicide
Introduction
Traumatic experiences are a basic part of human life and have intensive effects. In
spite of the human ability to survive and to adapt, traumatic incidents may change
a person’s psychological, physiological and social balance to such a degree that the
memory of a particular event overshadows all other experiences and affects the
ability to cope with reality (Van Der Kolk et al., 2000).
The definition of ‘trauma’ is much debated in medical and legal literature. In the
diagnostic sense of the International Classification of Diseases (ICD-10; WHO,
2007), a trauma is an event or a situation of either brief or long duration and of
an exceptionally threatening or catastrophic nature that is likely to cause pervasive
distress in almost anyone (ICD-10, F43.1). These events include natural disasters,
physical or sexual abuse, war, imprisonment and life-threatening diseases. Thus,
‘trauma’ means a vital experience of discrepancy between threatening aspects of the
situation and the individual’s ability to cope (Fischer and Riedesser, 1998). This
differs from the meaning of ‘trauma’ or ‘traumatic’ in everyday language. The
derived concept of Posttraumatic Stress Disorder (PTSD) as well as the reliability
and validity of its diagnostic criteria are still controversial. According to the ICD-
10, PTSD comprises a range of defined symptoms such as intrusions, avoidance
and numbing as well as a constant hyperarousal.
Findings from epidemiological research on traumatization and PTSD suggest
that PTSD is an important health problem. Nearly 95 per cent of all people expe-
rience a trauma at least once in their lifetime. In the general population, 2–14 per
cent develop a PTSD (Kessler et al., 1995; Maercker et al., 2008). The high prev-
alence of 14 per cent has been found in a representative survey in the USA where
many participants named regional natural catastrophes such as hurricanes in
Florida as well as serving in the armed forces deployed in an armed conflict as
a cause. However, Maercker et al. (2008) were able to show that the
prevalence of PTSD in a German population where those experiences are not rel-
evant is considerably lower. Where prisoners are concerned, it is by now undis-
puted that their prevalence rates are distinctly higher at 4–21 per cent (Breslau
et al., 1998; Goff et al., 2007; Maercker et al., 2008). Beyond the development of
Dudeck et al.
405
Table 1. Prevalence of mental disorders in prisoners in Europe
Mood
Substance
Psychotic
(affective)
Anxiety
Personality
abuse
disorders
disorders
disorders
disorders
Author
Country
N
(%)
(%)
(%)
(%)
(%)
Andersen et al. (1996)
DK
228a
44
7
10
16
17
Birmingham et al. (1996)
GB
569a
–
24
27
34
38
Brooke et al. (1996)
GB
750a
38
5
22
18
11
Carra´ et al. (2004)
IT
990
47
1
5
2
4
Dudeck et al. (2009)
DE
102
64
0
12
22
80
Falissard et al. (2006)
FR
800
14
12
21
21
–
Farrell et al. (2002)
GB
503
29
10
–
–
–
Fotiadou et al. (2006)
GR
80a
53
11
28
38
38
Harsch et al. (2006)
DE
56
68
–
11
3
34
Joukamaa (1995)
FI
283
44
3
–
6
17
Konrad (2004)
DE
100b
57
9
34
10
–
Langeveld and Melhus (2004)
NO
40
90
32
–
–
80
Missoni et al. (2003)
DE
108a
13
6
48
20
–
Von Scho¨nfeld et al. (2006)
DE
76
64
4
12
17
43
Sørland and Kjelsberg (2009)
NO
42c
74
–
33
33
21
Watzke et al. (2006)
DE
366
60
0.5
6
7
26
Note: aPre-trial detention; bImprisonment for fine defaulters; cPre-trial detainees younger than 20 years; – not
explored. Country abbreviations: DE: Germany, DK: Denmark, FI: Finland, FR: France, GB: Great Britain, GR:
Greece, IT: Italy, NO: Norway.
PTSD, traumatization is a risk factor for many mental disorders often con-
nected with suicidality (Peleikis et al., 2005; Spataro et al., 2004; Spitzer et al.,
2008).
Previous surveys show a considerably increased prevalence of mental disorders
in prisoners as compared to the general population. Frequencies vary from 38 per
cent to 98 per cent (see Table 1). Irrespective of the research design (sample size,
methodology or instruments) the most frequent diagnoses are substance abuse and
personality disorders (antisocial and/or borderline). There is also a link to trauma-
tization because persons with antisocial personality traits or even an antisocial
personality disorder report significantly more experience of neglect and abuse
(Cima et al., 2008; Krischer and Sevecke, 2008). Considering that antisocial behav-
iour, personality pattern and cognition and substance abuse have been identified as
among the most important risk factors for delinquent behaviour (Andrews et al.,
2006; Gendreau et al., 1996; Hanson and Morton-Bourgon, 2004; Lipsey and
Derzon, 1998), traumatization therefore adds to this risk. As neglect and abuse
would most probably have happened in the family or the immediate social envi-
ronment, these psychiatric findings also reflect criminological findings on the
importance of caring and monitoring in the family.
406
Punishment & Society 13(4)
While there are several studies on the prevalence of particular diagnoses, there is
little comparative research on the broader concept of the psychological well-being
of prisoners. Three German surveys found mental distress requiring treatment in
55–86 per cent of the participants. Suicidality was increased by a factor of 10
compared to the general population. Children were more stressed than adults
(Blocher et al., 2001; Ko¨hler et al., 2004; Missoni and Konrad, 2008; for North
America see Brink et al., 2001; Hodgins and Cote, 1992; Powell et al., 1997; Teplin
et al., 1994).
Given that there are several studies where diagnostic criteria are unclear, sam-
ples are small and strongly selected or professional standards are not adhered to in
the diagnostic process, one might question some of the conclusions of these studies
(Drenkhahn and Dudeck, 2007; Konrad, 2000). In addition, there are no interna-
tionally comparative data on provisions for offender treatment in general and
mental health care in particular, or on the prevalence of specific mental disorders
in prisoners, even though European rules on imprisonment stipulate the same
standard of treatment for prisoners as for the general population.
Consequently, this study is the first to use self-report instruments to investigate
the prevalence of trauma and of PTSD as well as psychological problems of pris-
oners in 11 European countries. It is part of an international project on long-term
imprisonment and human rights in ten member states of the European Union
(Belgium, Denmark, Finland, France, Germany, Lithuania, Poland, Spain,
Sweden and the United Kingdom) and one candidate country (Croatia). The over-
all aim of this research is a description of living conditions of male long-term
prisoners and an analysis of whether or not these conditions are in accordance
with the European Convention on Human Rights and its accompanying recom-
mendations for prisons and prisoners: that is, Rec(2006)2 on the European Prison
Rules (below: EPR) and Rec(2003)23 on the management by prison administra-
tions of life sentence and other long-term prisoners (below: Recommendation on
long-term prisoners).
The data presented in this article are part of a data set derived from this
research.
European recommendations on health care in prison
With regard to mental health care, the EPR set explicit requirements in Part III on
health: according to Rule 42.3, the duties of the medical practitioner at the exam-
ination after admission cover the diagnosis and treatment of mental illness as well
as the identification of psychological or other stress caused by the deprivation of
liberty. The medical practitioner is responsible for ensuring that mental health care
meets the standards that...
To continue reading
Request your trial