Post-Traumatic Bio-Behavioral Rehabilitation of Adult Female Victims.

OBJECTIVE: To determine if low resting basal AM cortisol and flat diurnal cortisol slope that has been reported in female abuse victims, which is dysregulated in the same way in female violent perpetrators, could be corrected and if healthier diurnal cortisol patterns are associated with less aggression in adult female victims. DESIGN AND METHODS: A non-experimental, naturalistic study evaluated if bio-behavioral rehabilitation could occur for females living in a Delaware homeless mission and participating in their programs. Basal salivary cortisol (AM, PM & slope), aggression, neurological conditions, general health, alcohol use, having been a victim of abuse, religion, spirituality and forgiveness were evaluated over one month between 2018 and 2019. RESULTS: T tests revealed significant improvement in mean cortisol (AM, PM & slope), aggression, emotional/ behavioral dyscontrol, and health over one month while participating in the mission's programs. Paired t-tests however were only significant for aggression and health. Healthier cortisol was significantly correlated with greater time since last alcohol, greater time since last abuse, less aggression, better health and greater religion, spirituality and forgiveness. CONCLUSION: Community programs could be cost effective methods of post-traumatic bio-behavioral rehabilitation. Forgiveness may play a critical role for abuse victims. A larger sample and more settings are needed, although these findings are promising.

Neurobiology of Female Homicide Perpetrators.

Neurobiology of female homicide perpetrators is not well understood. Data from private interviews and examinations of females were re-analyzed comparing those who committed homicide (n = 9); other violent crimes, no known homicide (n = 51); nonviolent crimes, no known violent convictions (n = 49); and noncriminals (n = 12). Homicide perpetrators suffered the most childhood sexual abuse (CSA); most recent abuse; had the most neurological histories, mainly traumatic brain injuries (TBIs); most health care access for abuse-related injuries; lowest AM and PM salivary cortisol; and greatest proportion who committed crime under the influence of alcohol. Only CSA, years since last abuse, TBI, neurological histories, and health care access for abuse-related injuries were significant. Those who committed homicide under the influence of alcohol suffered the most recent abuse and had the lowest AM cortisol and flattest diurnal cortisol slope (DCS) compared with others; though the n precludes determining significance. Amount of time since last abuse, AM cortisol and DCS progressively decreased as crime severity increased; other variables progressively increased as crime severity increased. These preliminary findings suggest that low AM cortisol, flat DCS, greater CSA frequency and severity, recent abuse, TBIs, and health care access for abuse-related injuries could be risk factors for females committing homicide. Further study is needed due to the small n of homicide perpetrators. Abuse victims may be at greater risk for alcohol use and cortisol dysregulation associated with perpetrating violence, especially homicide. Frontal lobe damage from TBIs may decrease ability to control behaviors associated with emotions from the limbic system. Health care providers released these women when their abuse-related injuries were not life-threatening; yet, they were life-threatening for victims of their subsequent homicides. Females accessing health care for abuse-related injuries present a critical opportunity for violent crime prevention interventions.

A Pilot Study on Sleep Quality, Forgiveness, Religion, Spirituality, and General Health of Women Living in a Homeless Mission.

This cross-sectional pilot study evaluated associations between religion/spirituality, forgiveness, sleep, and health, which were all highly correlated for adult women living in a homeless mission. While causation cannot be determined, these findings help to provide a theoretical framework for studies with stronger designs, prospective measurements, and larger sample sizes.

Risk Factors for Women Being Under the Influence of Alcohol Compared With Other Illicit Substances at the Time of Committing Violent Crimes.

PURPOSE: We investigated women under the influence of alcohol compared with other illicit substances at the time of committing a crime to identify predictors of being under the influence of alcohol and female-enacted crime. METHODS: Analyses of data, obtained from private interviews and examinations of female prison inmates, included regression analyses exploring predictors of being under the influence of alcohol at the time of the crime and predictors of violent crime. In addition, a reanalysis of a previously reported model, predicting conviction of a violent crime, was conducted including a new variable, being under the influence of alcohol at the time of the crime. RESULTS: Those under the influence of alcohol at the time of their crime had experienced greater nonfamilial childhood sexual abuse and traumatic brain injuries with loss of consciousness predating their crime. They were more likely to have committed a violent, rather than nonviolent, crime compared with those under the influence of other substances, with the latter being not significantly different for those not under the influence of any substance. Being under the influence of alcohol increased the risk of committing a violent crime, adjusting for other predictors of female violence. CONCLUSION: Women under the influence of alcohol are at a greater risk for committing violent crimes than those under the influence of other substances. Female nonfamilial childhood sexual abuse and traumatic brain injury victims were at a higher risk for being under the influence of alcohol, in comparison with other substances, at the time of committing a violent crime.

Childhood Adversity and Mental Health Correlates of Obesity in a Population at Risk.

The staggering prevalence of obesity and obesity-related health conditions takes exorbitant tolls on health care resources. This cross-sectional study with private evaluations of 636 adult inmates in a southern state prison was conducted with regressions comparing obese (body mass index [BMI] ≥ 30) to nonobese individuals to define obesity risk factors. Obese individuals more likely were female, were victims of childhood sexual abuse, suffered greater severity of childhood sexual abuse, attempted suicide, reported drug dependency, were non-Caucasian, and were older than nonobese. Psychopathy predicted lower BMI. Though obesity might be expected in victims of childhood physical abuse, traumatic brain injury, or other mental health conditions due to mobility or decision-making deficits, neither were significant. Adjusting for related variables, childhood sexual abuse remained significant. Females attempted suicide more frequently and suffered greater childhood sexual abuse.

Female children with incarcerated adult family members at risk for lifelong neurological decline.

A secondary analysis of data from adult female prison inmates in the mid-Atlantic United States defined relationships between having incarcerated adult family members during childhood and neurological outcomes. Of 135 inmates, 99 (60%) had one or more incarcerated adult family members during childhood. Regression analyses revealed that having incarcerated adult family members was related to greater frequency and severity of childhood abuse and higher incidence of neurological deficits in adulthood, especially related to traumatic brain injuries, compared to those without incarcerated adult family members. Along with being role models, adult family members impact the neurological health of children throughout their life-span.

Childhood adversity, mental health, and violent crime.

BACKGROUND: Little is understood about childhood traumatic brain injury (TBI) and lifetime violent crime perpetration. OBJECTIVES: The purpose was to evaluate TBI before the age of 15 years and other childhood environmental factors, mental health, and lifetime history of committing a violent crime. METHODS: A cross-sectional study of 636 male and female offenders from a southeastern state prison population was conducted using Chi-squared tests, t tests, and logistic regression to determine factors associated with ever committing a violent crime. RESULTS: Committing a violent crime was associated with male gender, younger age, greater childhood sexual abuse (CSA), greater childhood emotional abuse, no TBI by the age of 15 years, and greater neighborhood adversity during childhood. DISCUSSION: Although TBI has been related to violent and nonviolent crime, this study showed that absence of TBI by the age of 15 years was associated with lifetime violent crime when adjusting for CSA, childhood emotional abuse, and neighborhood adversity during childhood. This builds upon neurobehavioral development literature suggesting that CSA and the stress of violence exposure without direct physical victimization may play a more critical role in lifetime violent criminal behavior than childhood TBI. Violence risk reduction must occur during childhood focusing on decreasing adversity, especially violence exposure as a witness as well as a direct victim.

Could spirituality and religion promote stress resilience in survivors of childhood trauma?

Trauma is a precursor to many mental health conditions that greatly impact victims, their loved ones, and society. Studies indicate that neurobiological associations with adverse childhood experiences are mediated by interpersonal relationships and play a role in adult behavior, often leading to cycles of intergenerational trauma. There is a critical need to identify cost effective community resources that optimize stress resilience. Faith-based communities may promote forgiveness rather than retaliation, opportunities for cathartic emotional release, and social support, all of which have been related to neurobiology, behavior, and health outcomes. While spirituality and religion can be related to guilt, neurotic, and psychotic disorders, they also can be powerful sources of hope, meaning, peace, comfort, and forgiveness for the self and others. This article provides an overview of religion and spirituality as they relate to the neurobiology of resilience in victims of childhood trauma.

Obesity, traumatic brain injury, childhood abuse, and suicide attempts in females at risk.

PURPOSE: This study tested the hypothesis that obesity is related to history of traumatic brain injury (TBI), severity and frequency of childhood physical (CPA) and sexual abuse (CSA), and suicide attempts, adjusting for related variables in a high risk female population. DESIGN: This cross-sectional study of 81 females compared obese to non-obese. METHODS: All variables were verified by private interviews, physical examination, and documented evidence, then statistically analyzed with logistic regression. FINDINGS: Obesity at the time of interview was related to history of a decreased number of TBIs per person, greater CSA, suicide attempts, and decreased CPA, adjusting for current smoking, depression, currently using selective serotonin reuptake inhibitors, and age. CONCLUSIONS: Number of TBIs per person and CPA were inversely related to obesity, adjusting for related variables. Greater CSA frequency and severity, and having attempted suicide were significantly related to greater risk of obesity, adjusting for related variables. Though causes of obesity cannot be determined by this design, and findings should be viewed with caution, this study provides new insight into the obesity epidemic that requires further investigation. CLINICAL RELEVANCE: Rehabilitation nurses are in ideal settings when patient's conditions are less acute, providing opportunities to address complex serious underlying etiologies of obesity. Obesity has not been alleviated by teaching about diet and exercise because obesity may be the result of dietary self-medication of pain from previous experiences. CSA is a very serious problem that could precipitate suicide attempts, obesity, and multifaceted poor health outcomes throughout the life span; subsequently placing individuals at greater risk of requiring rehabilitation services.

Ethical, regulatory, and investigator considerations in prison research.

Although numbers of prison inmates are increasing rapidly, limited research addresses health-related conditions prevalent in prisons. Compelling reasons exist for prison research to address high rates of psychiatric, neurological, and other health-related conditions that may precipitate or result from incarceration, high-risk behaviors, infectious disease transmission, traumatic brain injuries, and other issues related to incarceration. Prison research is critical because inmates are frequently re-incarcerated and released, posing potential risks to themselves and the community. The purpose of this article is to provide a pragmatic overview of ethical, regulatory, and investigator considerations to facilitate critically needed research with vulnerable prison populations.

Childhood sexual abuse by a family member, salivary cortisol, and homicidal behavior of female prison inmates.

BACKGROUND: Little is understood about neuropathophysiology and neuroendocrinology associated with childhood sexual abuse by a family member in females who commit homicide. OBJECTIVES: To determine if females sexually abused by a family member as a child also experienced more childhood physical abuse, had more neurological histories including traumatic brain injuries (TBIs), displayed more homicidal behaviors, and had abnormal diurnal variation in the stress hormone cortisol compared with females not sexually abused by a family member. METHODS: A cross-sectional study was conducted with 137 female inmates, including 9 murderers and 12 noncriminal females, with logistic regression statistical analysis comparing females who have (n = 60) and have not (n = 89) been sexually abused by a family member, as determined by Muenzenmaier's Childhood Abuse Scale. RESULTS: Final multivariate logistic regression model controlling for higher numbers of incarcerated adult family members (odds ratio [OR] = 1.63, p = .01) revealed that female victims of childhood sexual abuse by a family member experienced more childhood physical abuse (OR = 1.09, p = .05), experienced more TBIs (OR = 1.49, p = .01), and displayed increased violent behaviors including homicide (OR = 1.67, p = .05) compared with those not sexually abused by a family member. In univariate analysis, females sexually abused by a family member also experienced more sexual abuse by a non-family member (OR = 1.21, p = .036), more hospital visits for abuse injuries (OR = 1.27, p = .03), and more recent abuse (OR = .95, p = .008). Childhood sexual abuse by a family member was related significantly to decreased diurnal cortisol variation (OR = .087, p = .044) when controlling for number of years since last abuse, number of incarcerated adult family members, body mass index, depression, and TBIs. DISCUSSION: Risks associated with sexual abuse by a family member should be considered for individuals and policies to prevent potential homicide by those who experienced it. Further study is needed.

Neurological function and HIV risk behaviors of female prison inmates.

The purpose of this study was to explain relationships between neurological dysfunction, HIV serological status, and HIV risk behaviors that have not been well understood. A secondary analysis was conducted on data from 117 female prison inmates. Another 18 female inmates from the same prison were further evaluated with more specific neurological, neuropsychological, and HIV risk behavior Risk Assessment Battery (RAB) measures. Neurological function, defined by valid, reliable quantitative measures of cognition, behavior/mood, cranial nerves, motor, reflexes, and sensation, was significantly correlated with HIV RAB scores (.743, p = .006), and RAB scale scores (.824, p = .001) in HIV-negative, but not HIV-positive, inmates. Specifically, the reflex deficits subscale correlated with RAB scores (.779, p = .003) and RAB scale scores (.682, p = .015) in the HIV-negative group. These findings combined with subjects' histories suggest cerebral dysfunction possibly contributes to HIV risk behaviors in certain high-risk female inmates predating HIV infection. These findings further suggest that HIV risk reduction should target neurologically impaired females as a high-risk group. Larger studies are needed to validate these findings.

Neurological correlates of high-risk behavior: a case study of Alphonse Capone.

Neurological impairment, traumatic brain injury, and childhood trauma and abuse are all associated with violent and high-risk behaviors among prison inmates. This case study examines the medical history of a notorious criminal--Alphonse Capone. Records suggest an association between Capone's declining neurological condition and an increase in high-risk behaviors. Prison, criminal, media, and medical records from the National Archives and other sources were studied to identify relationships to current research data describing neurological abnormalities of prison inmates. Healthcare providers can play a critical role in identifying at-risk youths, potentially reducing the incidence of high-risk behaviors associated with both crime and infectious disease transmission.

Women behind bars: could neurobiological correlates of past physical and sexual abuse contribute to criminal behavior?

Trauma, especially physical and sexual abuse inflicted by others, is often part of the personal histories of female prison inmates. These traumatic events have also been associated with neuropsychiatric conditions commonly found in female inmate populations. The purpose of this article is to provide a review of the literature and research findings about physical and sexual abuse perpetrated against female prison inmates predating their crimes, the neurobiological correlates, and related factors that could have contributed to criminal behaviors. This information is critical for abuse and crime prevention and rehabilitation of female victims who have become criminal offenders.

Physical and sexual abuse, salivary cortisol, and neurologic correlates of violent criminal behavior in female prison inmates.

BACKGROUND: Both physical and emotional traumas have been related to neurologic and neuroendocrine abnormalities that may be associated with violent behavior. METHODS: A modified case-control design was used for blinded comparison of 113 female inmates convicted of violent and nonviolent crimes. History of having been physically or sexually abused, neurologic history and physical examination, basal salivary cortisol levels, and associated variables were investigated to identify possible risk factors for violent compared to nonviolent criminal convictions. RESULTS: Of all inmates studied, 95% had neurologic histories predating the current crime and/or neurologic examination abnormalities. Logistic regression revealed morning cortisol levels, number of years since last abuse, number of prior suicide attempts, and traumatic brain injuries with loss of consciousness to be significantly associated with current violent convictions, with a mean of two brain injuries with loss of consciousness per subject in the violent group. CONCLUSIONS: A greater number of traumatic brain injuries with loss of consciousness and suicide attempts, more recent abuse, and low morning basal salivary cortisol levels could be associated with dangerous violent criminal behavior, including murder, in female prison inmates. Future research should investigate neuroendocrine challenges, more psychiatric and violence measures, and different populations with longitudinal designs.