Associate professor evaluates PTSD assessment tools in U.S. prison system

Research & Innovation

Brian Hudgins | July 10, 2023

Post-traumatic stress disorder is prevalent in prison populations. The National Institutes of Health estimates 18 percent of male inmates and 40 percent of female inmates suffer from PTSD. Matthew Logan, associate professor in the School of Criminal Justice, recently addressed the use and uniformity of PTSD assessment tools in The Prison Journal.

Logan worked alongside Andrea Hazlewood and primary author Brandon Dulisse from the University of Tampa to catalog how PTSD is assessed throughout state prisons and the federal prison system. The authors collected data from six U.S. states and the federal system to evaluate PTSD measurement methods at a variety of facilities in California, Florida, Georgia, Ohio, Pennsylvania, Texas and the federal system.

“When most offenders enter prison, they undergo an intake assessment,” Logan said. “This is largely done for security placement – by classifying inmates based on (security) risk. There could be many reasons for differences in how PTSD is assessed, including regional resource differences.”

The two most common methods for measuring PTSD during intake are structured clinical interviews and self-report surveys – which is consistent with assessments used outside prison. “PTSD is an umbrella term,” Logan said. “Prisons are by design difficult places to live. They can exacerbate those symptoms. It is not a static situation. You could enter prison with mild PTSD, receive treatment and get better … or get worse.”

Often, that better or worse answer is tied to a mental health issue being recognized in the earliest intake stages. “Mental health (issues) largely go undiagnosed,” Logan said.

“The point of the paper is to see how much consistency is there (among institutions),” Logan said. "There is not a lot of consistency. When you don’t have that consistency, it is like comparing apples and oranges. That poses challenges for policymakers and stakeholders with respect to implementing evidence-based practices.”

The authors were not able to collect information directly from prisoners. To get a wide-scope view of PTSD measurement tools, the focus centered on states with significant prison populations and the federal system. According to the study results, about half of states and the federal system use a specific PTSD assessment tool upon intake, while the rest rely upon clinical interviews – with some reserving the possibility to refer individual prisoners for future PTSD evaluation. 

Data collection of trauma-related criteria was divided. States such as Texas, California and Ohio primarily relied on clinician analysis for PTSD diagnoses, while Florida, Pennsylvania and the federal system relied upon scores from electronic self-reported assessments. Georgia’s Next Generation Assessment is used as both a traditional risk-assessment as well as a referral system for additional mental health screening.

Among those top six prison populations and the federal prison system, there are only four current PTSD assessment tools that are used universally upon intake. The study authors identified significant variation in the overall number of questions asked, score ranges and thresholds used to diagnose PTSD – and even variations in the overall time to administer the assessment tool.

Based on those assessments, the study authors made four suggestions for facility administrators to consider: 

1. Make assessments uniform between states, but especially within state jurisdictions. 
2. Assessments should be empirically validated.
3. Assessments measuring the complex nature of PTSD should be measured at more than just during intake into the correctional setting. 
4. A useful PTSD assessment for prisons should be able to measure severity and subclinical aspects of PTSD, rather than present a simple diagnosis based on a dichotomous threshold score.