Caravaca Sanchez Et Al 2022 The Prevalence of Prison Based Physical and Sexual Victimization in Males and Females A

1130358
research-article2022
TVAXXX10.1177/15248380221130358Trauma, Violence, & AbuseCaravaca-Sánchez et al.
Review Manuscript
TRAUMA, VIOLENCE, & ABUSE
The Prevalence of Prison-based

2023, Vol. 24(5) 3476–3492
© The Author(s) 2022
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DOI: 10.1177/15248380221130358
https://doi.org/10.1177/15248380221130358
in Males and Females: A Systematic journals.sagepub.com/home/tva
Review and Meta-Analysis
Francisco Caravaca-Sánchez1 ,
Eva Aizpurua2, and Nancy Wolff3
Abstract
This systematic review investigated the prevalence of prison-based interpersonal harm by type of victimization (physical and
sexual) and sex, along with the heterogeneity among studies using meta-regression. Using Preferred Reporting Items for
Systematic Reviews and the Meta-Analysis guidelines, 24 articles met the selection criteria. Study quality was assessed using
the Joana Briggs Institute (20.8% deemed low quality, 33.3% moderate, and 45.9% high). Searches were conducted in Criminal
Justice Abstracts, PsycINFO, PubMed, and Web of Science. The 24 articles comprised 36 separate samples inclusive of 23,967
incarcerated individuals. The random-effects pooled prevalence estimate of prison-based physical victimization was 18.8%,
with slightly higher rates for females (20.3%) than males (18.1%). For sexual victimization, the pooled prevalence estimate
was 12.4%, with higher rates among females (15.3%) than males (9.7%). For females, younger individuals reported higher
rates of physical and sexual victimization and studies using smaller samples had higher rates of physical victimization. Rates of
physical and sexual victimization for men were higher if perpetrators included residents and staff, the recall period was since
admission, data was collected using self-administered surveys, and in low-quality studies (sexual victimization only). Rates
of prison-based interpersonal harm, while high, varied significantly by type of victimization, sex, and study methodology.
High heterogeneity will be reduced only if future studies adhere to best methodological practices in defining and collecting
data on interpersonal harm and consistently test risk and prevention factors instrumental to prevention efforts. Study
limitations include the exclusion of unpublished and non-English-language studies, small sample sizes for female studies, and
methodological “noise” within the literature that reduce predictive precision.
Keywords
PRISMA, physical victimization, sexual victimization, prisons, incarcerated individuals.
Introduction improve safety conditions for incarcerated persons (Auty

et al., 2017). Interpersonal harm raises public health con-
Nearly 11 million people are held in penal institutions world- cerns because of its impact on physical, mental, and emo-
wide (Walmsley & Helen, 2021). Females represent 7% of tional health of incarcerated people (Wolff, 2022; Wolff
the global prison population and their proportion is rising in et al., 2009), most of whom will return to the community
most countries (Walmsley, 2017). Globally, the U.S. incar- (Li, 2018). These concerns are especially elevated for incar-
cerates the largest number of people at approximately cerated people because they are more likely to have experi-
2.1 million, followed by China (1.7 million) and Brazil enced trauma in childhood (Dalsklev et al., 2021; Wolff
(0.8 million). Interpersonal harm (inclusive of physical, sex- et al., 2020, 2021) and adulthood while living in the
ual, and/or emotional victimization perpetrated by other
prison residents or correctional staff) is not uncommon dur-
ing incarceration. In fact, it is a preventable public health
1
problem (Wolff, 2022). Over the past 20 years, researchers Pablo de Olavide University, Sevilla, Spain
2
Trinity College Dublin, Dublin, Ireland
have increasingly focused on interpersonal safety inside pris- 3
Rutgers, The State University of New Jersey, Piscataway, USA
ons (Wooldredge, 2020), in part because of public concern
about prison rape (Gaes & Goldberg, 2004). Yet, even with Corresponding Author:
Francisco Caravaca-Sánchez, Department of Social Work and Social
legislative action like the Prison Rape Elimination Act in Services, Pablo de Olavide University, Ctra. de Utrera, 1, Sevilla, 41013,
the United States (Smith, 2020), prison-based interpersonal Spain.
harm continues despite efforts by prison administrators to Email: [email protected]
Caravaca-Sánchez et al. 3477
community (Caravaca-Sánchez & Wolff, 2018; Karlsson & found that men who engaged in prison-based violence were
Zielinski, 2020). younger, convicted of nonviolent offenses, and had lower
Rates of interpersonal harm are higher in prisons than in social support. This review excluded studies of incarcerated
communities (Wolff et al., 2009). According to studies con- females. More recently, Steiner and colleagues (2017) con-
ducted in the United States, rates of prison-based physical ducted a systematic review of 16 prison-based victimization
victimization range from 13.0% to 28.4% (Lahm, 2009; studies (6 inclusive of incarcerated women) published
Listwan et al., 2014) compared to 2.9% and 3.8% of males between 1980 and 2014 exploring the characteristics of vic-
and females, respectively, victims of physical violence tims. These studies empirically tested a disparate array of
among the general population in the United States (Smith possible associations between individual and prison-level
et al., 2018). Sexual victimization rates in prisons are lower, attributes and prison-based victimization (including property
ranging from 0.9% to 12.3% (Kerbs & Jolley, 2007; Listwan victimization). Only a few of these individual and prison
et al., 2014), but are still higher than the 2.4% and 1.6% for attributes were found to be statistically and consistently sig-
females and males, respectively, estimated for the general nificant. In general, mental illness, prior victimization,
population (Smith et al., 2018). Due to methodological dif- younger age, and higher education levels elevated the risk of
ferences (e.g., operationalization of victimization, modes of victimization. More strained relations between residents and
data collection), the prevalence rates of interpersonal harm staff also elevated the risk of prison-based victimization.
estimated for prison populations vary widely across studies While the literature on prison-based interpersonal harm
(Gaes & Goldberg, 2004; Jones & Pratt, 2008; Wolff, Jing, & has been advancing, much remains unknown about the prev-
Bachman, 2008). alence of prison-based victimization by type and sex and
To our knowledge, the largest study designed to estimate what accounts for the heterogeneity across the studies. The
rates of physical and sexual victimization was conducted in aim of the present study is to conduct a systematic review
the United States (Wolff et al., 2009, 2021) enrolling a total and meta-analysis of the prison-based prevalence studies
of 6,964 males from 12 adult prisons and 564 women from published worldwide from 1990 to 2021 to (a) estimate the
one prison (the population of prisons within a single state pooled prevalence of prison interpersonal harm by type of
prison system). This large-scale study found that 35.3% and victimization; (b) compare pooled prevalence of prison-
10.3% of male residents reported an event of physical or based interpersonal harm by type of victimization and sex;
sexual victimization perpetrated by another resident or staff and (c) assess the heterogeneity among studies using meta-
member, respectively, during the past 6 months while incar- regression. Evaluating the literature in this way helps to
cerated (Wolff et al., 2009). Wolff et al. (2021) reported that better understand and improve the social utility of the evi-
24.0% and 24.5% of females reported being harmed physi- dence-base to inform prevention practices and policies.
cally or sexually, respectively, by another resident or staff
member during the past 6 months while incarcerated.
Interpersonal harm can have serious and enduring health Method
and mental health consequences (Rivara et al., 2019). Prison-
based victimization, including physical and sexual victim-
Search Strategy
ization, has been found to be positively associated with a The search set was publications in peer-reviewed journals
range of negative outcomes among males and females from January 1, 1990, through October 31, 2021, that esti-
including mental health disorders (e.g., depression or anxi- mated the prevalence of prison-based physical or sexual vic-
ety) (Azimi et al., 2021), substance use (Teasdale et al., timization among incarcerated males and females. The
2016), and suicide attempts (Caravaca-Sánchez, Barry, et al., search was conducted at the end of 2021.
2021; Sánchez et al., 2018). This is again concerning because Searches were performed using the following databases:
behavioral health problems are densely concentrated among Criminal Justice Abstracts, PsycINFO, PubMed, and Web of
correctional samples worldwide (Baranyi et al., 2018; Facer- Science. Additional studies were identified by examining the
Irwin et al., 2019; Mundt et al., 2018; Zhong et al., 2021), reference lists of relevant articles and from general searches
elevating public health concerns because of prevalent but (using the same key words that we used for the four data-
preventable prison-based harm. bases) on Google, Google Scholar, and ResearchGate. The
literature search for each database was conducted using a
combination of terms: offender “or” criminal “or” prisoner
The Current Review “or” inmate “and” prison “or” incarcerated “and” victim-
Two systematic reviews of prison-based interpersonal harm ization “or” violence “or” assault “or” abuse “or” physical
have been conducted. Schenk and Fremouw (2012) reviewed “or” sexual. Searches were restricted to English language
20 studies of prison violence (including also verbal and prop- abstracts.
erty victimization) published from 1990 to 2011 exploring This combination of searches resulted in the identification
the characteristics of incarcerated people who are more likely of 861 potentially relevant records. After duplicate records
to perpetrate violent acts while incarcerated. Overall, they were removed, 246 records remained and were screened
3478 TRAUMA, VIOLENCE, & ABUSE 24(5)
using inclusion/exclusion criteria. This involved reviewing et al. (2012) explored prison-based sexual victimization
titles and abstracts of all articles for relevance to prison vic- using a sample of 170 females. Approximately one in four
timization. Full-text copies were reviewed if relevance could participants were victims of sexual victimization since incar-
not be determined based on abstract information. ceration, although roughly half of the sample also reported
sexual victimization during childhood. Only the prison-
based sexual victimization (24.2%) was included in our
Inclusion/Exclusion Criteria
analysis.
Inclusion criteria were (a) studies presenting primary data Some authors report prevalence rates of victimization
related to sexual or physical victimization of incarcerated disaggregated by type of perpetrator (staff or resident) and
individuals (referred to as “residents”) during incarceration, an overall (inclusive) victimization estimate. In these cases,
(b) published in English language peer-reviewed journals, the overall prevalence rate for the specific type of victim-
and (c) samples drawn from the general prison population in ization was included. For instance, Wolff et al. (2009)
separate units of male or female prisons. Exclusion criteria reported prevalence of physical victimization among males
included cases where it was not possible to calculate prison during the past 6 months while incarcerated by perpetrator:
victimization rates because different types of victimization 20.7% resident-on-resident and 25.2% staff-on-resident.
(e.g., physical and sexual victimization) were collapsed into The overall (inclusive) rate (35.3%) was included in the
a single prevalence rate (Kuo, 2020; Kuo et al., 2014; Pérez review as it best measures the rate of physical victimization
et al., 2010; Van Voorhis, 1993), a sample was divided into or during incarceration.
focused on specific subgroups (e.g., based on race or age)
(Jenness et al., 2019; Klatt et al., 2016; Wooldredge &
Steiner, 2012), or the study either was not published in a
Duplicate Samples
peer-reviewed journal (Beck & Harrison, 2007; Beck & Several of the identified articles reanalyzed a single, unique
Johnson, 2012; Butler & Milner, 2003; Rantala, 2018), was sample. In these cases, the most recently published article
non-empirical (e.g., a literature review about the topic) based on the unique sample was selected for inclusion. For
(Hensley & Tewksbury, 2002; Karlsson & Zielinski, 2020; example, novel studies conducted in the United States (e.g.,
Steiner et al., 2017), measured vicarious victimization Struckman-Johnson & Struckman-Johnson, 2000, 2002)
(Daquin et al., 2016; Saum et al., 1995) or emotional victim- explored prison-based rates of sexual victimization among
ization only (Kerley et al., 2009), blended male and female incarcerated males and females. This review included the
samples (Banbury, 2004; Daquin & Daigle, 2018), or focused most recent paper published based on a single sample of
on individuals incarcerated in jails (Grosholz & Semenza, males and females (Struckman-Johnson & Struckman-
2021). Authors were contacted by email if studies combined Johnson, 2006). Lahm (2008, 2009) published two articles
males and females into a single category (Banbury, 2004; exploring physical victimization since incarceration among a
Daquin & Daigle, 2018; Wooldredge & Steiner, 2014) as the sample of 1,054 males in 30 prisons, only the most recent
current review focuses on prevalence of victimization esti- version published in 2009 was included. Similarly, Wolff
mates by sex. et al. (2006, 2007) estimated rates of physical or sexual vic-
timization during the past 6 months among 6,964 males and
564 females. The most recent papers were included in the
Reporting of Prevalence Rates current review (Wolff et al., 2009, 2021). Duplicate samples
Victimization histories of incarcerated people have been were also found outside of the United States. For instance, in
delineated by: childhood victimization (in the community Spain, Caravaca-Sánchez and Wolff (2018, 2019) collected
and under juvenile justice supervision), adulthood victimiza- data from 2,484 males and 225 females housed in eight
tion prior to incarceration, and victimization during incar- facilities and explored rates of physical and sexual victim-
ceration. Some of the screened articles reported rates of ization in prison. Exclusively, the 2019 article (Caravaca-
physical or sexual victimization: (a) exclusively during Sánchez et al., 2019) was included in the current review.
childhood (Caravaca-Sánchez et al., 2019; Driessen et al., Based on the criterion of unique samples, six studies
2006; Johnson et al., 2006; Tripodi & Pettus-Davis, 2013); (Caravaca-Sánchez & Wolff, 2016; Lahm, 2008; Struckman-
(b) during childhood and adulthood but exclusively prior to Johnson & Struckman-Johnson, 2000, 2002; Wolff et al.,
incarceration (Tripodi & Pettus-Davis, 2013; Wolff & Shi, 2006, 2007) were excluded from the current review.
2012); (c) during childhood and during imprisonment Further, some authors used the same sample but reported
(Caravaca-Sánchez & Wolff, 2016; Walsh et al., 2012); and findings on a subset of the larger sample. For example,
(d) during childhood and adulthood prior to prison and dur- Caravaca-Sánchez et al. (2014) reported rates of prison-
ing incarceration (Caravaca-Sánchez & Wolff, 2018; Wolff based physical victimization using a subsample of 270 males
et al., 2009). For this study, reported victimization rates were from a larger sample of 2,740 that was reported in a study by
disentangled to include only adulthood victimization that Caravaca-Sánchez et al. (2019). In such a case, only the
occurred while incarcerated in prisons. For example, Walsh study based on the full sample was included. In the United
States, studies conducted by Wolff and colleagues compared (Appendix C) and 9 (Appendix D) reporting prison-based
prison physical (Blitz et al., 2008) and sexual (Wolff et al., sexual victimization for males and females, respectively.
2007) victimization for males and females with mental disor- When prevalence estimates were reported separately for
ders to those without mental disorders in a state prison sys- males and females, they were treated as different samples in
tem. One year later, the same authors published an article the statistical analyses. As a consequence, the number of
reporting data of physical and sexual victimization by samples (n = 36) is greater than the number of studies (n = 24).
race/ethnicity (non-Hispanic White, African American, and
Hispanic) (Wolff, Shi, & Blitz, 2008). However, data for the
Quality of Included Studies
whole sample was published later (Wolff et al., 2009) and
such data was included in the current review. Similarly, Study quality was assessed using the Joana Briggs Institute
Wooldredge and Steiner (2012) explored differences in (JBI) critical appraisal tool for prevalence studies (Munn
physical victimization between non-White Latinos and et al., 2014). The JBI tool has been used to evaluate studies
African Americans, and 2 years later they published another in systematic meta-analysis of incarcerated samples (Carter
article reporting physical victimization for the full sample et al., 2022; Fazel et al., 2017). The JBI tool uses nine criteria
(Wooldredge & Steiner, 2014); only the later article was items appraising study methods, results, and overall study
included in the current review. details. Example items include “adequate sample size,”
“valid and reliable measures for outcomes,” and “adequate
response rate” with four response options: “yes,” “no,”
Data Extraction “unclear,” and “not applicable.” Each of the nine items
A standardized form was used to extract the relevant data. receives a quality score of 0 (indicator not present or met or
Specifically, information was extracted on the authors, years unclear) or 1 (indicator applicable and met). All 24 studies
of publication, countries, sample sizes, response rates (this in our final sample were assessed independently by the three
information was either computed or provided by the authors authors. In cases of interrater discrepancies, the mode from
when it was not available in the original manuscript), resi- all three ratings was used. The total quality score for each
dents’ average age, number of enrolled prisons, type of vic- study is the sum of the individual item scores. Consistent
timization (physical or sexual), timeframe for measuring with a recent systematic review (Cao et al., 2021), the total
prison victimization, mode(s) of data collection, prevalence quality scores were classified into three mutually exclusive
of victimization (%), and number of people who reported categories: “low quality” (a score ≤3; n = 5; 20.8%), “mod-
victimization (n). When this information was not available, erate quality” (a score between 4 and 6; n = 8; 33.3%), and
the number of people victimized during incarceration was “high quality” (a score ≥7; n = 11; 45.9%) (See Appendix E
calculated based on the reported proportions and sample for supporting information). In the current review, quality
sizes (this information might not be perfectly accurate when scores ranged from 3 to 9, with a mean score of 5.75
there was missing data at the item level). The first author (SD = 2.11). The interrater reliability was 77% (95% confi-
conducted the initial data extraction. In case of uncertainty, dence interval [CI] [59–88]).
the other two authors were consulted. The data extracted
from the identified articles were subdivided into four groups
according to the type of prison-based victimization: (a) phys-
Data Analysis
ical victimization among males, (b) physical victimization A random effects model was used to determine pooled prev-
among females, (c) sexual victimization among males, and alence rates and 95% CI for each group. The Cochran’s Q
(d) sexual victimization among females. test (Cochran, 1954) was used, with a significance level of
p < .10, to assess the presence of heterogeneity as recom-
mended by the Cochrane Handbook (Higgins et al., 2008).
Study Selection
Heterogeneity was quantified by using I2 statistics (Higgins
The current review was conducted following the Preferred et al., 2008), which shows the amount of heterogeneity,
Reporting Items for Systematic Reviews and the Meta- ranging from 0% to 100%, with larger values indicating
Analysis (PRISMA) guidelines (Moher et al., 2009) to screen higher heterogeneity. I2 values ≥75% indicate high hetero-
and identify relevant papers on prison-based victimization. geneity (Higgins et al., 2008). The studies included in our
An initial selection based on the title and abstract was com- analysis had high heterogeneity (see Figures 2 and 3).
piled using Mendeley software. The results are summarized Random-effects models were computed, in which the
in the PRISMA diagram (Figure 1). As shown, our review estimated size of the prevalence rate is proportional to the
resulted in 24 studies measuring prison-based victimization respective analytical weight for all studies included in the
that met the inclusion criteria. From these 24 studies, a total meta-analysis (Borenstein et al., 2007). Both the sources of
of 36 subgroups were obtained: 12 (Appendix A) and 5 heterogeneity by subgroup and meta-regression analyses
(Appendix B) studies reporting physical prison-based vic- used continuous (with the exception of subgroup analyses),
timization for males and females, respectively, and 10 dichotomous, and ordinal variables. Continuous variables
Figure 1. Systematic literature search flow of finding relevant studies on the prevalence of prison-based victimization.
were used for sample size, response rates, average age, 95% CIs (Li et al., 2021). We conducted all statistical analy-
number of prisons enrolled, and number of items used for ses using the “OpenMeta Analyst” software (version 3.1) for
measuring victimization. The following were analyzed as Windows (Brown University, 2018).
dichotomous: geographical location (U.S. studies [coded
as 0] vs. rest of the world [coded as 1]), data collection mode
(self-administered survey [coded as 0] vs. interviewer- Results
administered [coded as 1]), and definition of perpetrator
(resident only [coded as 0] vs. resident or staff [coded as 1]).
Description of Included Studies
The ordinal variables included: period for measuring victim- The systematic literature search returned 246 distinct records,
ization (since admission [coded as 0] vs. past year [coded of which 48 full texts were assessed (see Figure 1 for flow
as 1], past 6 months [coded as 2], and past 3 months [coded chart of screening process). We identified a total of 24 cross-
as 3]), and quality assessment (low [coded as 0], moderate sectional studies (supporting information, Appendix F)
[coded as 1] and high [coded as 2]. In line with previous including data on 23,967 incarcerated individuals, 21,146
studies, subgroup analysis or sensitivity analysis was per- (88.2%) males and 2,821 (11.8%) females, based on 36 sepa-
formed to explore heterogeneity reporting effect sizes and rate samples. Of the 24 included studies, 14 investigated
Figure 2. Meta-analysis of the prevalence of physical victimization during incarceration by sex (females vs. males). Ev refers to the
number of individuals who reported victimization and Trt is the sample size for each study. Black boxes represent study estimates; their
size is proportional to the respective analytical weight. Lines through the boxes represent the 95% CIs around the study estimates. The
diamonds represent the mean estimate and its 95% CIs. The vertical dashed line indicates the mean estimate. CI = confidence interval.
Figure 3. Meta-analysis of the prevalence of sexual victimization during incarceration by sex (females vs. males). Ev refers to the
number of individuals who reported victimization and Trt is the sample size for each study. Black boxes represent study estimates; their
size is proportional to the respective analytical weight. Lines through the boxes represent the 95% CIs around the study estimates. The
diamonds represent the mean estimate and its 95% CIs. The vertical dashed line indicates the mean estimate. CI = confidence interval.
male-only samples and 8 female-only samples. Two studies distribution was nearly balanced, with 13 studies measuring
sampled both males and females but analyzed them sepa- resident-on-resident victimization and 11 measuring victim-
rately. Regarding victimization type, six studies explored ization inclusive of another resident or a staff member.
physical victimization only and eight explored sexual vic- For 10 of the 24 studies, the reflection period for prison
timization only. Ten studies explored physical and sexual victimization was “since admission.” Defined periods were
victimization separately. In terms of perpetrator type, the used in the remaining 14 studies: in the “past year” was used
Table 1. Pooled Prevalences for Prison-Based Physical and ranging from 4.5% (95% CI [1.9–7.1%]) (Hensley et al.,
Sexual Victimization. 2003) to 24.5% (95% CI [20.9–28.0%]) (Wolff et al., 2021)
Physical Sexual and showing high heterogeneity (I2 = 92.8%; p < .001).
% [95% CI] % [95% CI] Among males, 10 studies were identified with a total of
14,420 male residents (mean age: 36.7; SD = 7.5 years). The
Overall 18.8 [12.5–25.0%] 12.4 [9.2–15.6%] random effects pooled prevalence rate was 9.7% (95% CI
Sex of residents [5.7–13.8%]), ranging from 0.9% (95% CI [0.04–1.3%])
Female 20.3 [10.8–29.7%] 15.3 [10.2–20.5%]
(Listwan et al., 2014) to 26.0% (95% CI [13.8–38.2%])
Male 18.1 [10.4–25.9%] 9.7 [5.7–13.8%]
(Papadakaki et al., 2019), with very high heterogeneity
Note. CI = confidence interval. (I2 = 99.0%; p < .001).
in 3 studies,1 “past 6 months” in 7, and “past 3 months” in 4 Sensitivity Analysis

(see Appendix G for supporting information). 18 surveys In order of assess the robustness of the meta-analysis, we con-
were self-administered. Specifically, 16 studies used paper- ducted four sensitivity analyses (physical and sexual victim-
and-pencil surveys and 2 used Audio-Computer-Administered ization for females and males) by excluding the studies one
Self-Interviewing (A-CASI) (Wolff et al., 2009, 2021). The by one in each step and then generating meta-analysis results
other six studies administer the surveys using face-to-face based on the remaining studies. The meta-analysis results are
interviews. The vast majority of the included studies (n = 17) consistent for physical and sexual victimization during incar-
were conducted in the United States, with the remaining ceration for females and males (See Appendix H).
seven studies conducted in European countries (n = 6, Spain,
Greece, and Kosovo) and Asia (n = 1, South Korea).
Subgroup Analysis
Physical Victimization Using subgroup analysis, we investigated possible explana-
tions for between-study variation in physical and sexual vic-
For the full sample, the overall pooled prevalence estimate of timization rates for males and females (Table 2). For females,
prison-based physical victimization was 18.8% (95% CI higher rates of physical victimization were found by perpe-
[12.5–25.0%]), with very high levels of heterogeneity among trator type, either resident-on-resident or staff-on-resident
studies (I2 = 99.3%; p < .001) (see Table 1 and Figure 2). For perpetrator (24.8%; 95% CI [10.8, 35.7%]), during the past
females only, there were five studies reporting any prison- 3 months (26.4%; 95% CI [19.9, 33.0%]), and in countries
based physical victimization comprising a sample of 1,635 other than the United States (25.3%; 95% CI [21.0, 29.6%]).
females (mean age: 36.9; SD = 0.8 years). The pooled preva- For prison-based sexual victimization, rates were higher for
lence of prison-based physical victimization for females was females during the past 6 months (18.2%; 95% CI [11.0,
20.3% (95% CI [10.8–29.7%]), ranging from 5.9% (95% CI 25.4%]) and in the United States (16.4%; 95% CI [9.8,
[3.4–8.4%]) (Wooldredge & Steiner, 2014) to 26.4% (95% 23.0%]). Compared to studies assessed as low quality, stud-
CI [19.9–33.0%]) (Caravaca-Sánchez, Vidovic, et al., 2021). ies with moderate (17.1%; 95% CI [0.8, 25.4%]) and high
Heterogeneity was very high (I2 = 96.3%; p < .001). Among (16.8%; 95% CI [12.1, 21.4%]) quality scores had higher
males, 12 studies measuring physical victimization in prison rates of sexual victimization. However, these subgroup
enrolled 20,485 individuals (mean age: 37.0; SD = 7.2 years). (including physical and sexual victimization) analyses had
The pooled prevalence estimate for males was 18.1% (95% overlapping CIs.
CI [10.4–25.9%]), with individual study estimates ranging For males, physical victimization rates were relatively
from 7.0% (95% CI [6.3–7.7%]) (Wooldredge & Steiner, higher for the following attributes: resident or staff perpetra-
2014) to 35.3% (95% CI [34.2–36.4%]) (Wolff et al., 2009), tor (23.2%; 95% CI [16.9, 29.5%]), victimization recall over
with very high heterogeneity (I2 = 99.5%; p < .001). the past 6 months (20.5%; 95% CI [4.0, 37.1%]), question-
naire was self-administered (18.6%; 95% CI [9.4, 27.9%]),
study was conducted outside the United States (19.5%; 95%
Sexual Victimization
CI [12.3, 26.7%]), and low-quality studies (20.0%; 95% CI
For males and females combined, the overall pooled [12.2, 27.8%]) (overlapping Cis in all cases except for perpe-
prevalence estimate of sexual victimization was 12.4% (95% trator type). For sexual victimization reported by male resi-
CI [9.2–15.6%]), with very high levels of heterogeneity dents, the rate was marginally higher for studies conducted in
(I2 = 98.5%; p < .001) (see Table 1 and Figure 3). The nine the United States (12.7%; 95% CI [6.0, 19.4%]) relative to
studies reporting prevalence estimates for prison-based sex- other countries, although CIs overlapped. Rates were also
ual victimization among females included 2,483 individuals relatively higher for resident-on-resident perpetrator (16.2%;
(mean age: 36.7; SD = 1.5 years). The random effects pooled 95% CI [12.7, 20.7%]), victimization recall since admission
prevalence rate equaled 15.3% (95% CI [10.2–20.5%]), to prison (19.1%; 95% CI [14.6, 23.5%]), self-administered
Table 2. Subgroup Analyses of Prevalence of Physical and Sexual Victimization Among Females and Males.
Females Males
Physical (n = 5) Sexual (n = 9) Physical (n = 12) Sexual (n = 10)
Variable/Study
Characteristic n k % [95% CI] n k % [95% CI] n k % [95% CI] n k % [95% CI]
Question about perpetrator type
Resident only 672 2 13.3 [6.4, 18.7] 1183 4 15.6 [6.9, 24.3] 7,233 5 11.0 [7.5, 14.6] 431 4 16.2 [12.7, 20.7]
Resident or staff 963 3 24.8 [10.8, 35.7] 1300 5 15.3 [9.1, 21.4] 13,252 7 23.2 [16.9, 29.5] 14,018 6 7.9 [2.9, 12.5]
Reflection period for victimization
Since admission — — — 1186 5 14.4 [6.5, 22.2] 1,051 2 17.3 [15.0, 19.6] 2,154 4 19.1 [14.6, 23.5]
Past year — — — — — — 2,732 3 17.6 [5.5, 29.8] 1,707 2 0.6 [0.2, 1.1]
Past 6 months 1,461 4 18.8 [8.2, 29.5] 1123 3 18.2 [11.0, 25.4] 15,331 4 20.5 [4.0, 37.1] 9,448 2 8.2 [4.1, 12.3]
Past 3 months 174 1 26.4 [19.9, 33.0] 174 1 11.5 [6.8, 16.2] 1,371 3 15.4 [8.0, 22.8] 1,140 2 4.7 [1.2, 7.7]
Mode
Self-administered 1,635 5 20.3 [10.8, 29.7] 2,483 9 15.3 [10.2, 20.5] 18,610 9 18.6 [9.4, 27.9] 12,371 6 13.2 [9.9, 16.6]
Interviewer-administered — — — — — — 1,875 3 16.6 [2.5, 30.8] 2,078 4 6.1 [2.6, 9.5]
Region
United States 1,236 3 17.0 [4.4, 29.7] 2084 7 16.4 [9.8, 23.0] 15,910 8 17.5 [6.8, 28.2] 10,775 6 12.7 [6.0, 19.4]
Other countries 399 2 25.3 [21.0, 29.6] 399 2 11.8 [8.6, 14.9] 4,575 4 19.5 [12.3, 26.7] 3,674 4 6.1 [3.4, 8.8]
Quality assessment
Low — — — 245 1 4.5 [1.9, 7.1] 100 1 20.0 [12.2, 27.8] 366 3 17.5 [11.9, 23.2]
Moderate — — — 505 3 17.1 [0.8, 25.4] 2,929 4 15.8 [5.8, 25.7] 3.692 4 9.2 [1–7, 20.1]
High 1,635 5 20.3 [10.8, 29.7] 1,733 5 16.8 [12.1, 21.4] 17,456 7 19.3 [8.1, 30.4] 10.391 3 7.7 [4.7, 10.8]
Note. n = number of residents; k = number of studies included; CI = confidence interval.
3483
Table 3. Meta-Regression Analyses of Sources of Heterogeneity in the Prevalence of Physical and Sexual Victimization During
Incarceration in Female Residents.
Physical Sexual
Variable/Study Characteristic β 95% CI SE p β 95% CI SE p

Sample size (continuous) −.002 −0.002, −0.001 0.001 ≤.001 .001 −0.001, 0.003 0.001 .186
Response rate (continuous) −.003 −0.008, 0.001 0.002 .149 −.001 −0.004, 0.002 0.003 .509
Mean age of resident (continuous) −.336 −0.402, −0.269 0.034 ≤.001 −.026 −0.044, −0.008 0.007 .006
Number of prisons enrolled (continuous) −.013 −0.046, 0.019 0.017 .416 −.004 −0.013, 0.005 0.005 .378
Number of items used to measure .019 0.004, 0.044 0.012 .094 .007 −0.007, 0.020 0.007 .394
victimization (continuous)
Resident only (ref)
Resident or staff .116 0.012, 0.220 0.053 .029 .009 −0.095, 0.077 0.041 .841
Since admission — — — — −.006 −0.068, 0.086 0.033 .562
Past year — — — — — — — —
Past 6 months (ref for physical)
Past 3 months .081 −0.175, 0.336 0.131 .537 −.009 −0.123, 0.109 0.051 .658
Region
United States (ref)
Other countries .070 −0.010, 0.151 0.041 .085 −.015 −0.103, 0.069 0.041 .602
Quality assessment
Low — — — — −.014 −0.176, 0.148 0.083 .867
Moderate — — — — .011 −0.072, 0.094 0.042 .798
High (ref) — — — —
Note. Since all the studies enrolling females used self-administered surveys, this variable was not included in the models. CI = confidence interval;
SE = standard error.
questionnaires (13.2%; 95% CI [9.9, 16.6%]), and low-qual- SE = 0.811, p ≤ .001), past 6 months (β = −.329, 95% CI
ity studies (17.5%; 95% CI [11.9, 23.2%]). [−0.452, −0.205], SE = 0.063, p ≤ .001) and past 3 months
(β = −.150, 95% CI [−0.203, −0.096], SE = 0.027, p ≤ .001).
Meta-Regression Analysis Rates were also lower when the data was collected using
face-to-face interviews (β = −.089, 95% CI [−0.177, −0.006],
The results of the meta-regression analysis for females and SE = 0.042, p = .035), but higher among low quality studies
males are provided in Tables 3 and 4, respectively. Among (β = .139, 95% CI [0.037, 0.242], SE = 0.052, p = .008).
females, rates of prison-based physical victimization were
higher when studies had smaller sample sizes (β = −.002,
95% CI [−0.002, −0.001], SE = 0.001, p ≤ .001), residents Discussion
were younger (β = −.336, 95% CI [−0.402, −0.269], To our knowledge, this is the first systematic review of the
SE = 0.034, p ≤ .001), and when the perpetrator included prevalence of prison-based physical and sexual victimiza-
resident or staff (β = .116, 95% CI [0.012, 0.220], SE = 0.053, tion that includes a sufficient number of samples to perform
p = .029). Sexual victimization rates were higher among data synthesis, meta-analyses, and a quantitative assessment
younger incarcerated females (β = −.026, 95% CI = −0.044, of sources of heterogeneity between studies. The overall
−0.008, SE = 0.007 p = .006). evidence presented herein is based on 36 samples enrolling
For males (Table 4), higher rates of physical victimiza- nearly 24,000 males and females residing in prisons located
tion were found when fewer prisons were enrolled in the in eight countries. Several findings are noteworthy. First, a
study (β = −.004, 95%% CI [−0.008, −0.001], SE = 0.002, significant proportion of individuals reported being victim-
p = .009) and when the perpetrator included resident or staff ized while incarcerated, with rates of prison-based physical
(β = .121, 95% CI [0.049, 0.193], SE = 0.037, p ≤ .001). In victimization (18.8%) estimated higher than sexual victim-
contrast, sexual victimization rates were lower when the ization (12.4%) among males and females. Second, the
perpetrator included resident or staff (β = −.271, 95% CI prevalence of prison-based victimization is higher among
[−0.319, −0.222], SE = 0.025, p ≤ .001). Rates of victim- females than males. Specifically, compared to their male
ization were lower for all timeframes other than “since counterparts, female prison residents have prevalence rates
admission”: past year (β = −2.218, 95% CI [−0.317, −0.539], of physical and sexual victimization that are, respectively,
Table 4. Meta-Regression Analyses of Sources of Heterogeneity in the Prevalence of Physical and Sexual Victimization During
Incarceration in Male Residents.
Physical Sexual
Variable/Study Characteristic β 95% CI SE p β 95% CI SE p

Sample size (continuous) .001 −0.001, 0.003 0.001 .112 .001 −0.002, 0.004 0.002 .547
Response rate (continuous) .001 −0.002, 0.003 0.001 .604 −.002 −0.004, 0.001 0.001 .099
Mean age of resident (continuous) −.002 −0.007, 0.003 0.003 .448 .001 −0.008, 0.010 0.005 .888
Number of prisons enrolled −.004 −0.008, −0.001 0.002 .009 .017 −0.028, 0.062 0.023 .450
(continuous)
Number of items used to measure .020 −0.002, 0.043 0.012 .079 .017 −0.047, 0.081 0.033 .602
victimization (continuous)
Resident only (ref)
Resident or staff .121 0.049, 0.193 0.037 ≤.001 −.271 −0.319, −0.222 0.025 ≤.001
Since admission (ref)
Past year .045 −0.104, 0.194 0.076 .554 −2.128 −0.317, −0.539 0.811 ≤.001
Past 6 months .052 −0.072, 0.176 0.063 .410 −.329 −0.452, −0.205 0.063 ≤.001
Past 3 months .043 −0.114, 0.200 0.080 .594 −.150 −0.203, −0.096 0.027 ≤.001
Method
Self-administered (ref)
Interview −.006 −0.129, 0.118 0.063 .930 −.089 −0.177, −0.006 0.042 .035
Region
United States (ref)
Other countries .018 −0.008, 0.120 0.052 .723 −.040 −0.109, 0.028 0.035 .249
Quality assessment
Low .012 −0.180, 0.205 0.098 .900 .139 0.037, 0.242 0.052 .008
Moderate −.027 −0.138, 0.085 0.057 .641 .061 −0.026, 0.147 0.044 .170
High (ref)
Note. CI = confidence interval; SE = standard error.
12 and 58% higher. Third, and although these differences (sample of former state prison residents; Beck & Johnson,
were not significant in the regression analyses, male and 2012), and 2011–2012 (prison sample; Beck et al., 2013).
female prison residents in other countries reported higher Depending on the sample (current or former prison resi-
physical victimization rates than their counterparts in the dents), the U.S. national prevalence estimates for prison-
United States. Yet, rates of sexual victimization were higher based sexual victimization ranged from 4.0% (2011–2012
among incarcerated males and females in the United States sample) to 9.6% (2008 sample). In Australia, two regional
than their peers in other countries. Table 5 summarizes our surveys of sexual violence were conducted. These surveys
findings and provides implications of the review for prac- probed sexual assault in prisons located in New South Wales
tice, policy, and research. and Queensland in 2006 (Richters et al., 2008) through 2008
Our pooled estimates of in-prison victimization are based (Butler et al., 2010). Overall, 2.7% of prison residents
on peer-reviewed studies that drew their samples from pools reported having been sexually assaulted since they were
of residents residing in a selected subset or a full sample of incarcerated and 8.6 and 11.0% of people incarcerated in
prisons within state correctional systems. Excluded from our New South Wales and Queensland, respectively, reported
sample were three surveys of sexual victimization within that they had been threatened with sexual assault. These
national/regional prison systems. These surveys were national/regional estimates, also characterized by method-
excluded from our sample because the findings were not ological variation, are lower than our pooled prevalence rate
published in peer-reviewed journals. But it is useful to com- of 12.4%. The deviation between the U.S. national estimate
pare these global system estimates to our pooled estimates and our pooled rate is likely driven in part by methodological
based on studies of individual prisons or state prison sys- “noise” (the majority of studies in our sample did not adhere
tems. The most comprehensive and methodologically to best practices in victimization data collection methodol-
sophisticated national survey of prison-based sexual victim- ogy; the study with the closest methodological parity esti-
ization was conducted by the U.S. Bureau of Justice Statistics mated a sexual victimization rate for a state correctional
(BJS) in 2007 (prison sample; Beck & Harrison, 2007), 2008 system at 10.3% (Wolff et al., 2009) and in part by
Table 5. Implications of the Research for Practice, Policy, and Research.
Finding Implications
(a) Prison-based victimization is 5–6 times higher in prison (a) There is an urgent need for sustained trauma-informed
populations than the general population. It is a public treatment in correctional settings for those individuals who
health problem of global proportions. are victimized while incarcerated.
(b) Rates of prison-based victimization are higher among (b) Systemic efforts by prison administrators to reduce
females (especially younger women) than males. prison-based victimization should, at least initially, focus
on protecting younger residents. The development of
prevention interventions will be enhanced when the
evidence base adheres to best methodological practices
and consistently tests risk and prevention factors that are
instrumental to the prevention of harm.
(c) Study methodology systematically impacts the estimated (c) Methodology matters. More high-quality studies (e.g., larger,
rate of victimization. Lower quality studies produce higher random samples, consistent behavior-based definitions of
estimates of sexual victimization for males. Definition of victimization, inclusive definitions of perpetrator, self-
perpetrator (with or without staff) for males and females, administrated surveys) are needed to improve the reliability
reflection period for victimization (for males), and survey and precision of the estimated prevalence rates.
administration mode (for males) have significant but (d) To increase comparability across studies, guidelines are
inconsistent impacts on the rate of prevalence. needed on best practices for defining and measuring
(d) The high heterogeneity among prison-based prevalence prison-based victimization and collecting valid and reliable
studies compromises the precision of prevalence self-report data in correctional settings.
estimates and the utility of the evidence.
(e) Too few prison-based studies collected data on mental (e) More rigorous and theoretically grounded predictive
health status, prior victimization, and gender identity/ studies of prison-based victimization are needed. These
sexual orientation—risk factors with a strong relationship studies need to widen the theoretical frame to include
with prison- and community-based victimization. theories used to predict victimization in the community and
universally include predictors of vulnerability such as mental
illness, prior victimization, gender identity, and sexual
orientation. This evidence is needed to design, implement,
and disseminate prison-based interventions that protect
residents from harm while they are incarcerated.
inter-prison variation in sexual victimization rates. 2018). The human toll associated with these elevated preva-
Significant variation in the prevalence of sexual victimiza- lence rates is staggering. Of the nearly 11 million people
tion has been found across prisons in each of the prison resi- incarcerated in prisons worldwide (Walmsley & Helen,
dent surveys conducted by the BJS. In the 2011–2012 BJS 2021), we estimate that 2 million experienced physical vic-
survey, among the 233 prisons surveyed, 11 male prisons and timization and 1.3 million experienced sexual victimization
one female prison were classified as high-rate prisons for while they were incarcerated. That translates into nearly
resident-on-resident sexual violence, whereas 8 male and 145,000 incarcerated females who experienced physical vic-
four female prisons were designated as high-rate prisons for timization and 109,000 who experienced sexual victimiza-
staff sexual misconduct (Beck et al., 2013). Similar inter- tion based on a current custodial worldwide population of
prison variation in rates of sexual victimization (Wolff et al., 714,000 (Walmsley, 2017).
2006) and physical victimization (Wolff et al., 2007) were Several sources of heterogeneity among studies were
found within a single state correctional system. identified and their impact on rates of physical or sexual vic-
Despite substantial differences in the methodologies timization were consistent with the literature. Specifically,
across the included studies, our quantitative analysis reveals females and younger aged residents (among females) had
high rates of prison-based victimization for incarcerated significantly higher rates of physical and sexual victimiza-
males and females relative to levels of victimization reported tion, consistent with previous reviews (Steiner et al., 2017;
in the general population. For instance, based on U.S. com- Wolff, 2022). New to the literature is our finding that the
munity samples, the prevalence of sexual victimization was estimated prevalence rates of physical victimization for
estimated at 2.0% (Smith et al., 2018). Comparing our pooled females was higher in studies using smaller sample sizes,
prison-based estimates to these community-based rates, the while rates for males were higher in studies including fewer
point prevalence for prison-based sexual victimization was 6 prisons, controlling for other methodological differences.
times larger. Similarly, prison-based rates of physical victim- The way victimization was measured also significantly
ization were approximately 5 times larger than comparable influenced the estimated rate of prison-based sexual and
rates for the general population in United States (Smith et al., physical victimization (Wolff, Jing, & Bachman, 2008).
First, as would be expected, the shorter the period of reflec- 10 studies and should be interpreted with caution (Thompson
tion (e.g., 3 months) for exposure to victimization in prison, & Higgins, 2002). Regarding the analysis of sex, the number
the lower the estimated prevalence of victimization. For of studies estimating prison-based physical victimization for
example, for males, sexual victimization was estimated in males (n = 9) was almost double that for females (n = 5).
19.1% since admission (an undefined reflection period) Thus, the comparison of pooled prevalence estimates
declining significantly to 4.7% when measured over the past between males and females should be interpreted as prelimi-
3 months. The reflection time pattern, however, was not lin- nary, with greater weight given to the ranges. Second,
ear or consistent across types of victimization and sex in part although we employed a rigorous search strategy that
because of small sample sizes. Second, sexual victimization included four major databases (Criminal Justice Abstracts,
rates for males doubled in studies that collected data using PsycINFO, PubMed, and Web of Science) and scanned refer-
self-administered surveys compared to studies using per- ence lists of relevant studies and reviews (e.g., Hensley &
sonal interviews (13.2 and 6.1%, respectively). This finding Tewksbury, 2002; Steiner et al., 2017; Wooldredge, 2020), it
is consistent with the survey research literature that high- is important to note that our exclusion of non-English lan-
lights the importance of data collection mode(s) on data guage studies might have missed additional studies. Further,
quality. Self-administered surveys have been shown to pro- our review included only articles published in peer-review
duce higher estimates of victimization (Laaksonen & journals. The authors are aware that this exclusion criterion
Heiskanen, 2014), and with less social desirability bias has resulted in the omission of relevant research such as grey
(Krumpal, 2013). Although self-administered interviews literature (dissertations or conference proceedings) or gov-
might be less affected by measurement error (e.g., reduced ernment documents from the United States (Beck et al.,
social desirability bias, absence of interviewer effects), they 2013; Beck & Harrison, 2007; Beck & Johnson, 2012) or
often produce lower response rates, which can increase non- Australia (Butler et al.; 2010; Richters et al., 2008). These
response error. They can also limit participation of groups exclusion and inclusion criteria are consistent with standard
with low literacy or technology use levels, further increasing practices but the sample of studies would have been larger if
the risk of nonresponse error. Further research is needed to a more inclusive search strategy had been employed, increas-
explore potential differences within self-administered modes ing the analytic power of the analysis but potentially the het-
(e.g., paper-and-pencil, CASI, A-CASI) and their impact on erogeneity across the studies. This is an area for future
victimization rates (see, e.g., Wolff et al., 2015). Third, there investigation. Third, the questions about victimization varied
was a positive correlation between the quality of the study among studies, with some using summary terms like “physi-
and the estimated prevalence rate. For example, relative to cally assaulted” (Listwan et al., 2014) or “sexually assaulted”
low quality studies, rates of prison-based sexual victimiza- (Caravaca-Sánchez et al., 2019) to query victimization, while
tion among female residents estimated by high quality stud- others framed questions around behaviors, such as being
ies were almost 4 times larger. Paradoxically, among males, “hit, kicked, punched” or “forced to have oral sex” (Wolff,
rates of sexual victimization were over nearly 2 times higher Jing, & Bachman, 2008). This type of variation was not con-
among low quality studies, compared with high quality ones. trolled for in our analysis. Statistical heterogeneity was
Finally, rates of physical victimization were statistically investigated using the methodology from previous system-
higher in studies that defined perpetrators inclusive of resi- atic reviews among incarcerated samples (Favril et al., 2020;
dents or correctional staff compared to those studies that Fazel et al., 2017) but more research is warranted on the
omitted correctional staff as potential perpetrators or did not impact of the definition of victimization on estimated rates of
specify who the perpetrator was. Oddly, sexual victimization prevalence (Wolff et al., 2008, 2022). Fourth, testing for
rates for males were lower in studies that more inclusively associations between risk and protection factors and prison-
defined perpetrators to include correctional staff. This result based victimization was sharply limited by data availability.
reflects the impact of a single study where the victimization This literature also is characterized by significant heteroge-
question did not specifically define perpetrator as staff or neity in terms of sample size and composition (blending
resident (it was implied) and sexual victimization was males and females, blending perpetrator types), measure-
defined narrowly as “sexual assault” (Listwan et al., 2014). ment of the dependent variable (victimization), and model
In this study, less than 1% of respondents reported being specification (inclusion of different mixes of personal- and
sexually assaulted, although 23% reported witnessing a sex- prison-attributes or attributes measured differently across
ual assault. Based on this evidence, to improve the precision studies). Most of the attributes tested in the 16 studies
of future prevalence estimates, researchers estimating prison- reviewed by Steiner et al. (2017) were either not significantly
based rates of victimization should delimit the reflection associated with victimization or the significance or direction
period to a specific time period (e.g., 3, 6, and 12 months), of the association was inconsistent. Some factors found to be
use self-administered questionnaires, and use an inclusive significant such as age, race, education, type of offense (e.g.,
and explicit definition of perpetrators and victimization. violent), and number of times in prison (Steiner et al., 2017)
Some limitations warrant discussion. First, some of the may be too global to strategically improve resident classifi-
analyses for incarcerated females were based on fewer than cation systems in an effort to prevent victimization. For this
reason, more recent research has focused on mental illnesses et al., 2022; Fazel et al., 2017), study quality was assessed
and prior victimization, factors known to increase the risk of using the JBI critical appraisal tool, a global assessment tool.
victimization in the community (Ports et al., 2016; Teplin Other critical assessment tools might have given a more
et al., 2005). For example, several studies have found previ- nuanced understanding of the heterogeneity in quality of the
ous victimization exposure (e.g., childhood victimization or studies (Crowe et al., 2012) and should be considered in
adulthood prior to prison) to be a strong predictor of prison- future studies. The last limitation, related to all the above
based victimization among females and males (Caravaca- limitations, is the high, unexplained heterogeneity across the
Sánchez & Wolff, 2016, 2018; Wolff et al., 2007, 2009, 2021; studies that limits the precision of the meta-analytic results
Wood, 2013; Wood & Buttaro, 2013). Prior victimization and poses interpretive challenges. Although we tested sev-
and mental illness, however, were tested only in a minority eral methodological characteristics as possible sources of
of the studies included in our sample. There is also growing between-study heterogeneity, other moderators were not
evidence indicating that sexual orientation and gender iden- considered, such as sentencing policies and prison regimes.
tity are risk factors for abuse within prisons (Beck et al., Also, predictive uncertainties persist because known meth-
2013; Jenness, 2021). Future prison-based victimization odological heterogeneity across the studies in data and study
prevalence studies need to more closely investigate the design attributes remain uncontrolled. This limitation, how-
extent to which LGBTQ+ status elevates the risk of harm for ever, is common in prevalence studies (Migliavaca et al.,
physical and sexual victimization by other residents and cor- 2022), with the median heterogeneity estimated at 96.9%
rectional staff. The inconsistency across the studies regard- (based on a review of 134 published studies). Still, taken
ing attributes of the individual and prison used to predict together, our results should be interpreted with caution,
victimization limits systematic analysis (Wolff, 2022). There focusing not just on the average pooled estimates but also at
is simply not enough useful information across the predictive the dispersion around the estimate. It should also signal the
studies to examine factors that could be used instrumentally need for future studies to conform to best practices when col-
to prevent or reduce prison-based victimization. More con- lecting harm data and designing prison-based harm studies.
sistency in the selection and measurement of instrumental
risk and protective predictors in future studies will improve
the range and quality of future meta-analytic reviews and the
Conclusion
utility of the evidence to inform prevention strategies. Fifth, Victimization is commonplace inside prisons around the world
our study focused exclusively on prison-based physical and and it is a preventable public health problem. Our systematic
sexual victimization reflecting the definition of victimization review shows elevated rates of prison-based victimization, as
in the majority of prison-based studies. Yet there is emerging well as significant variation in prevalence rates by type of
evidence showing that emotional victimization, inclusive of victimization, sex, and study methodology. Methodological
bullying and harassment, and property theft are common- heterogeneity, in particular, is compromising the utility of sci-
place in prison (Listwan et al., 2014; Wooldredge & Steiner, ence to inform best practices in correctional settings.
2012). Using a more inclusive definition of victimization Specifically, our ability to identify risk and protective factors to
will provide a more realistic and accurate portrayal of prison- advance interventions to better protect incarcerated people is
based victimization. Sixth, the studies included in our sample constrained by the lack of consistent specification of predictor
did not collect information about the characteristics of the models across studies. Robust evidence to guide protective
perpetrators, which limited our ability to explore variation in interventions will only be available when individual studies
victimization by the sex of the perpetrator. Future studies collect data in ways that increase precision (e.g., a defined
would benefit from collecting information from the victims reflection period, self-administered survey modes) and about
about the characteristics of those who did the harming. attributes that have been found to consistently predict victim-
Further, research on victimization has historically assumed ization in a small number of high-quality studies, particularly
that victims are only victims, never perpetrators. Future mental illness and prior victimization. In the meantime, the evi-
research should relax this assumption by asking residents dence shows that, at a minimum, efforts should focus on pro-
parallel questions about the perpetration of sexual and physi- tecting younger residents. This evidence also tells us that, in
cal violence. For example, in the past 6 months, have you the absence of stopping prison-based victimization, there is
ever “slapped, hit, kicked, or bit” another resident. To pre- an urgent need for sustained trauma-informed treatment for
vent victimization, more information is needed about the those individuals who are victimized by other residents and
motivation and characteristics of those who do the harming. correctional staff while they are incarcerated. This is a public
Interventions designed to prevent prison-based victimization health problem of global proportions.
will be more effective when they reflect an understanding of
victimization from the perspectives of the wounded and the Declaration of Conflicting Interests
wounding. Lastly, in line with prior systematic reviews and The author(s) declared no potential conflicts of interest with respect
meta-analysis conducted among incarcerated samples (Carter to the research, authorship, and/or publication of this article.
Funding Butler, T., Richters, J., Yap, L., Papanastasiou, C., Richards, A.,
Schneider, K., Grant, L., Smith, A., & Donovan, B. (2010).
The author(s) received no financial support for the research, author-
Sexual health and behaviour of Queensland prisoners with
ship, and/or publication of this article.
Queensland and New South Wales comparisons. National Drug
Research Institute, Curtin University, and School of Public
ORCID iDs Health and Community Medicine, University of New South
Francisco Caravaca-Sánchez https://orcid.org/0000-0002-1209 Wales.
-2657 Cao, J., Lee, C. -Y., Liu, X., & Gonzalez-Guarda, R. M. (2021).
Nancy Wolff https://orcid.org/0000-0003-2345-9095 Risk and protective factors associated with intimate partner vio-
lence against Chinese women: A systematic review. Trauma,
Supplemental Material Violence, & Abuse. Advance online publication https://doi.
org/10.1177/15248380211030235
Supplemental material for this article is available online. Caravaca-Sánchez, F., Barry, T. J., Aizpurua, E., & Ricarte, J. J.
(2021). Mental health, substance abuse, prison victimization
Note and suicide attempts amongst incarcerated women. European
1. Listwan and colleagues (2014) defined the time period as in Journal of Criminology. Advance online publication. https://
“past 12 months” instead of the past year. doi.org/10.1177/14773708211028471
Caravaca-Sánchez, F., Falcón-Romero, M., & Luna-Maldonado, A.
(2014). Physical attacks in prison, mental illness as an associated
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/0093854814551601 Author Biographies
Wolff, N., & Shi, J. (2012). Childhood and adult trauma experiences Francisco Caravaca-Sánchez is an associate professor in the
of incarcerated persons and their relationship to adult behav- Department of Social Work and Social Services at Pablo Olavide
ioral health problems and treatment. International Journal of University, in Seville (Spain). He earned a PhD from University of
Environmental Research and Public Health, 9(5), 1908–1926. Murcia in Forensic Sciences and a second PhD from the Pablo de
https://doi.org/10.3390/ijerph9051908 Olavide University in Social Work. His research interests include
Wolff, N., Shi, J., & Blitz, C. L. (2008b). Racial and ethnic dis- prediction of violence in individuals with mental illness and sub-
parities in types and sources of victimization inside prison. stance use in the criminal justice system and general population.
The Prison Journal, 88(4), 451–472. https://doi.org/10.1177
/0032885508325392 Eva Aizpurua is currently a research scientist at Meta. She earned
Wolff, N., Shi, J., & Siegel, J. A. (2009). Patterns of victimiza- her PhD in Criminology from the University of Castilla-La Mancha
tion among male and female inmates: Evidence of an endur- (Spain) and worked as a Postdoctoral Scholar at the University of
ing legacy. Violence and Victims, 24(4), 469–484. https://doi. Northern Iowa and Trinity College Dublin. Her research interests
org/10.1891/0886-6708.24.4.469 include victimization, public opinion on crime and criminal justice,
Wood, S. R. (2013). Dual severe mental and substance use disorders and survey research methods.
as predictors of federal inmate assaults. The Prison Journal,
93(1), 34–56. https://doi.org/10.1177/0032885512467312 Nancy Wolff, economist, is a distinguished professor in the Edward
Wood, S. R., & Buttaro, A. (2013). Co-occurring severe mental J. Bloustein School of Planning and Public Policy and director of
illnesses and substance abuse disorders as predictors of state the Bloustein Center for Survey Research. Her areas of expertise
prison inmate assaults. Crime & Delinquency, 59(4), 510–535. include measuring the prevalence of physical, sexual, and emo-
https://doi.org/10.1177/0011128712470318 tional trauma among incarcerated populations and testing the cost-
Wooldredge, J. (2020). Prison culture, management, and in-prison effectiveness of trauma and addiction interventions, as well as inter-
violence. Annual Review of Criminology, 3(1), 165–188. ventions designed to build emotional resiliency and assist with the
https://doi.org/10.1146/annurev-criminol-011419-041359 re-entry from prison to the community.

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1130358

TRAUMA, VIOLENCE, & ABUSE

The Prevalence of Prison-based

in Males and Females: A Systematic journals.sagepub.com/home/tva

Review and Meta-Analysis

Introduction improve safety conditions for incarcerated persons (Auty

in 3 studies,1 “past 6 months” in 7, and “past 3 months” in 4 Sensitivity Analysis

Note. n = number of residents; k = number of studies included; CI = confidence interval.

Variable/Study Characteristic β 95% CI SE p β 95% CI SE p

Variable/Study Characteristic β 95% CI SE p β 95% CI SE p

Note. CI = confidence interval; SE = standard error.

Table 5. Implications of the Research for Practice, Policy, and Research.

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