Mental health disorders are more prevalent among incarcerated individuals than in the general population, and disorders related to substance use are especially prevalent among incarcerated women. Yet little research has focused on how women’s mental health changes or persists following incarceration and during re-entry.
In a new study, researchers explored the mental health of incarcerated women in Santiago, Chile, before they were released and at several times after release. Most women’s mental health symptoms were stable during the first year after release, but pre-release screening missed women with increasingly severe symptoms and with substance dependency during re-entry. In addition, women were provided mental health care services at alarmingly low rates, researchers found.
The study was conducted by researchers at Rutgers University-Newark, New York University (NYU), Pontificia Universidad Católica de Chile, Fundación Colunga, and Universidad Diego Portales. It is published in Social Psychiatry and Psychiatric Epidemiology.
“The almost 20% of women in our study with persistent substance use disorders had higher rates of recidivism, arrests, reincarceration, and victimization after being released,” says Pilar Larroulet, assistant professor of criminal justice at Rutgers University-Newark, who coauthored the study. “Addressing these disorders is particularly important due to their high prevalence in this population and to their role in women’s successful re-entry into society.”
In Chile, women make up less than 10% of the prison population but have experienced a more rapid rise in incarceration rates and higher rates of turnover (returning to prison after release) than men. As in other countries, incarcerated women come primarily from disadvantaged communities, and compared to men, have lower levels of education, are older, and are more likely to have children. They are also at greater risk of mental health disorders.
In this work, researchers interviewed 200 Chilean women released from prison facilities in Santiago between September 2016 and March 2017. The women had served custodial sentences of at least 30 days and were released on parole or finished their sentence. Researchers assessed them based on three indicators of mental health: a checklist of symptoms before release and one week, two months, six months, and a year after release; self-reported suicide attempts; and substance use dependence.
Researchers divided the women into three groups based on the trajectories of their mental health-related symptoms after release: 86% had a stable low severity trajectory, nearly 7% reported increasing severity, and more than 7% had a high and stable trajectory of severe symptoms. Women in the study had been highly victimized prior to their most recent incarceration, with almost half having suffered some sort of sexual abuse and only one in 10 saying they had never experienced physical violence.
Experiences of victimization were associated with having increasingly severe symptoms, suicidal attempts, and persistent substance dependence. In addition, women who said they had attempted suicide and had persistent substance use dependence self-reported substantially more victimization during follow-up interviews. The study also found that:
Although for most of the women, the severity of mental health symptoms decreased immediately after release, pre-release screening missed women with increasing severity of symptoms and substance use, the study found. This is likely because most incarcerated individuals leave the criminal justice system without being assessed for mental health problems, even when they show symptoms. The specific needs of women are often overlooked due to their minority status in the criminal justice system, despite evidence suggesting that women express the need for services.
Women with increasing and high levels of severity of mental health systems had more previous sentences, more reported suicidal attempts after release, more persistent substance dependence, and more recidivism. These findings are consistent with the revolving door hypothesis, which posits that people with short sentences and high reincarceration rates present more mental health care needs. Alternatives to incarceration, including community-based treatments and programs, should be considered for these individuals, the authors suggest.
“The success of re-entry depends on the resources of individuals, communities, and broader societal structures,” explains Ignacio Bórquez, Ph.D. candidate at NYU’s Grossman School of Medicine, who coauthored the study. “Incarceration could act as a touch point to provide gender- and trauma-informed care to people who are otherwise difficult to reach.”
Among the study’s limitations, the authors note that the number of women studied was relatively small and the study relied on self-reports on sensitive topics, which may introduce bias. In addition, interviewing the women one year after they were released may not have captured long-term changes in their mental health outcomes and use of services.
The study was funded by the San Carlos de Maipo and Colunga Foundation, the Inter-American Development Bank, the Division on Women and Crime from the American Society of Criminology, Agencia Nacional de Investigación y Desarrollo Millennium Science Initiatives, and FONDECYT Chile.
Social Psychiatry and Psychiatric Epidemiology
Trajectories of mental health symptoms, suicide attempts and substance use disorders among women after prison release in Santiago, Chile
25-Mar-2025