Sex differences in suicide, suicidal ideation, and self-harm after release from incarceration: a systematic review and meta-analysis

How competing needs after incarceration lead to adverse health outcomes among people who use criminalized drugs

In the USA, people with a history of criminalized drug use and drug use disorders reentering the community after incarceration frequently experience adverse health outcomes including overdose, suicide, and infectious disease acquisition. This review presents a conceptual model for understanding risk pathways for these outcomes related to post-release psychosocial needs. We first summarize the literature on post-release needs experienced by people who use criminalized drugs during reentry in multiple domains, including basic needs and those related to relationships as well as medical, mental health, and substance use problems. Drawing from a socioecological model, we demonstrate how vulnerability factors related to criminal legal involvement and criminalized drug use operate at intrapersonal (i.e., individual), interpersonal, institutional, community, and policy levels to negatively affect the ability of people who use drugs to meet each of these types of needs. We present research demonstrating that when people leaving incarceration are met with the overwhelming task of addressing competing demands, they often experience strong negative affect, which can lead to risk-conferring behaviors including criminalized drug use. Competing needs also create environmental conditions that amplify risk. We argue for the importance of interventions that address determinants of post-release health at individual and social-environmental levels to prevent adverse outcomes.

Suicide Attempts Among Women Ages 18-55 Years with Opioid Use: National Addictions Vigilance Intervention and Prevention Program 2018-2020

Background: The opioid overdose crisis remains a public health concern, and rates of suicide with opioid involvement have increased. Objective: To describe the prevalence of and factors associated with self-reported past 30-day suicide attempt or attempt "only when high or in withdrawal from alcohol or drugs" among reproductive-age women with past 30-day nonmedical prescription opioid use. Methods: Estimates are reported among women 18-55 years from 338 locations in 35 states using 2018-2020 National Addictions Vigilance Intervention and Prevention Program data. Bivariate analysis and multinomial logistic regression identified prevalence of and factors associated with past 30-day suicide attempt and attempt "only when high or in withdrawal from alcohol or drugs." Results: Among 10,095 women, 2.7% reported a past 30-day suicide attempt, and 1.5% reported an attempt "only when high or in withdrawal from alcohol or drugs." The largest magnitude of association for suicide attempt was extreme alcohol problem (adjusted odds ratio [aOR] = 2.84, 95% confidence interval [CI]: 1.80-4.47), and the largest magnitude of association for attempt "only when high or in withdrawal from alcohol or drugs" was no stable living arrangement (aOR = 2.66, 95% CI: 1.78-3.98). Conclusion: Comprehensive, upstream suicide prevention initiatives and substance use treatment can address factors associated with suicide attempt among reproductive-age women.

Social Determinants of Health and Suicide-Related Outcomes: A Review of Meta-Analyses

Importance

Preventing suicide is one of the top priorities in public health policy. Identifying key social determinants of health (SDOH) in suicide risk is critical for informing clinical practices, future research, and policy solutions to prevent suicide.

Objective

To examine the associations of SDOH with suicide-related outcomes.

Data Sources

Studies published before July 2023 were searched through PubMed, PsycINFO, Embase, and Web of Science. The date of the search was August 4, 2023.

Study Selection

We included the most up-to-date meta-analyses reporting associations between SDOH and suicide-related outcomes.

Data Extraction and Synthesis

Three independent reviewers extracted data and conducted quality assessment using the Joanna Briggs Institute Checklist for Systematic Reviews and Research Syntheses.

Main Outcomes and Measures

The main outcomes of interest were suicide mortality, suicide attempt, and suicidal ideation.

Results

A total of 46 meta-analyses met inclusion criteria. For suicide mortality, justice system-involved individuals in the community, exposure to others' and parental suicide, firearm accessibility, divorce, experience in foster care, release from incarceration, and midlife (age 35-65 years) unemployment were the SDOH with consistently strong effects. Individuals released from incarceration demonstrated a high prevalence of suicide mortality (114.5 per 100 000 persons). With regard to suicide attempt, experience of childhood abuse and maltreatment and sexual assault, gender and sexual minority status, and parental suicide mortality were the strongest risk factors. The prevalence of suicide attempt among homeless individuals (28.9%; 95% CI, 21.7%-37.2%) and incarcerated female youths (27%; 95% CI, 20%-34%) and adults (12.2%; 95% CI, 7.1%-17.2%) was high. For suicidal ideation, identification as bisexual and intimate partner violence in women were the strongest risk factors. The prevalence of lifetime suicidal ideation in homeless individuals was 41.6% (95% CI, 28.6%-56.0%). Protective factors associated with reduced risk of suicide mortality were religious affiliation and being married. School connectedness showed protective associations against suicide attempt and suicidal ideation.

Conclusions and Relevance

Tailoring interventions and future research for identified priority subpopulations, such as justice system-involved individuals in the community, and implementing policy measures addressing the SDOH that showed strong associations with suicide mortality, attempts, and ideation, such as gun licensing requirements, are critical to counteracting social and environmental forces that increase suicide risk.

Relations Between Suicide Risk and Patient Safety Attitudes Among the Nursing Team in a Brazilian Context

OBJECTIVES

To analyze the aspects of suicide risks and their relation to patient safety attitudes among the nursing staff of a large public university hospital in Brazil.

METHODS

A cross-sectional and descriptive study with 226 nursing workers from a large public university hospital in Brazil. Socioprofessional information, health conditions, and family history related to suicide risk were collected through the Mini International Neuropsychiatric Interview Plus and the Safety Attitudes Questionnaire. A 95% CI was considered, and statistical tests such as the Student t test, χ 2 , analysis of variance, and multiple linear regression were used.

RESULTS

Most of the safety attitudes were below the average score considered positive (mean Safety Attitudes Questionnaire value >0.75), and 41 (18.1%) workers were considered to have any degree of suicide risk. Participants with parents or siblings who had attempted suicide were 3.44 times more likely to have moderate or high suicide risk. Negative safety attitudes were associated with health conditions and family history, considered suicide risk factors. Participants with moderate or high suicide risk were 2.83 times more likely to have worse patient safety attitudes concerning job satisfaction.

CONCLUSIONS

This study reveals significant associations between patient safety attitudes and the mental health of nursing workers, expanding the view of worker health management actions and, consequently, patient safety culture.

A scoping review of suicide prevention interventions for Latinx adults: strategies, gaps, and future directions

Suicide rates among Hispanic/Latina/o/x (Latinx) individuals in the United States have escalated significantly, becoming the fifth leading cause of death by 2020. This trend underscores the necessity for culturally responsive suicide prevention (SP) interventions tailored to Latinx persons' unique sociodemographic characteristics. We synthesized the current literature on suicide prevention (SP) interventions for U.S. Latinx adults (18+ years). Our objective is to identify strategies, culturally sensitive approaches, and interventions that mitigate suicidal ideation, attempts, and deaths among Latinx adults. Following PRISMA guidelines, we conducted a comprehensive search across six electronic databases (CINAHL Complete, PubMed, PsycINFO, SocAbstracts, Sociology Database, and Web of Science), focusing on peer-reviewed articles published between 2000 and 2024 that described or evaluated SP approaches for Latinx adults (ages 18-64) in the United States. The review was structured according to the 2022 CDC Suicide Prevention Resources for Action, Strategies and Approaches to Suicide Prevention. Our search produced 4,739 articles, of which 155 were included for full-text review. During full-text review, 34 articles were included for the final sample. We randomly selected 10 articles and coded them to check for inter-rater reliability (r = 0.90). Analysis revealed that most SP interventions for U.S. Latinx adults align with the CDC strategy to "Identify and Support People at Risk." The majority targeted late adolescents and early adults at the individual level. The predominant cultural adaptation was the translation of existing SP interventions into Spanish. These findings highlight the pressing need for more culturally responsive Latinx SP interventions that address other CDC strategies at the community and structural levels. Future research and intervention development should focus on creating comprehensive, culturally nuanced approaches that extend beyond individual-level interventions and language translation to address the complex factors contributing to Latinx adults' suicide risk.

Age-period-cohort analysis of self-harm incidence rates by gender in Iran among individuals aged 10-39 years, 1990-2019

This study investigates trends and patterns in self-harm incidence rates among individuals aged 10-39 years in Iran from 1990 to 2019. Using Age-Period-Cohort (APC) analysis, it aims to identify significant age, period, and cohort effects, and to highlight gender-specific trends for effective prevention strategies. Utilizing data from the Global Burden of Disease (GBD) study, we performed an APC analysis to assess trends in self-harm incidence rates by gender. Data was stratified into six age groups and six five-year periods, and analyzed using the APC Web Tool from the National Cancer Institute. The average incidence rates of self-harm attempts and deaths among individuals aged 10-39 years were 93.87 and 7.55 per 100,000 individuals, respectively. Females had 1.75 times higher attempt rates than males, while males had 1.62 times higher death rates. The APC analysis revealed that males experienced stable self-harm rates over time, while females showed a significant decline. Peak incidence for both genders occurred at age 22.5 years. Self-harm incidence rates show younger females are more vulnerable to self-harm, but there has been a general decline in incidences over time, particularly for more recent cohorts but the stability of rates across ages and the lower rates in more recent cohorts highlighted in male.

Comparison of the trend of suicide before and after the COVID-19 pandemic in Southeast Iran from 2016 to 2023

BACKGROUND

Suicide, as one of the most important psychological consequences of the COVID-19 pandemic, can be a threat to public health. Understanding the changes in suicide rates before and after the pandemic provides insights into the psychological effects of such crises on communities. This study aimed to compare the trends in suicide and suicide attempt rates in Southeast Iran before and after the COVID-19 pandemic, covering the period from 2016 to 2023.

METHODS

This descriptive-analytical study was conducted through a census method on 5676 individuals who attempted suicide from 2016 to 2023. Medical records of those who attempted suicide were collected from the integrated system of the Ministry of Health (SIB) during the specified years. The data was collected using a checklist and analyzed with descriptive and inferential statistical tests at the significance level of P < 0.05.

RESULTS

The findings indicate a significant increase in suicide rates after the COVID-19 pandemic, with 61.8% of the total 5,676 cases occurring post-pandemic compared to 38.2% before. The most affected demographic was young adults aged 19 to 34, whose suicide rates increased by a factor of 9.8, while women experienced a notable rise of 28.2 times in suicide rates after the pandemic. Additionally, uneducated individuals had the highest suicide rates, with a dramatic increase of 35.8 times among illiterate individuals after COVID-19, highlighting the urgent need for targeted mental health interventions and support systems.

CONCLUSION

A significant increase in suicide rates after the COVID-19 pandemic, particularly among young adults and women, highlights the urgent need for targeted mental health interventions, especially for vulnerable groups such as housewives and single individuals. Additionally, the correlation between education levels and suicide rates underscores the importance of addressing educational disparities as part of comprehensive mental health strategies.

Determinants of access to primary healthcare for formerly incarcerated women transitioning into the community: a systematic review of the literature

Background

Women with a history of incarceration experience significantly poorer health outcomes and encounter barriers to accessing healthcare, both during incarceration and after release. These challenges are more pronounced compared with both their male counterparts and women in the general population. We conducted a systematic literature review to respond to the following research questions: (1) what are the determinants of primary healthcare uptake and retention among formerly incarcerated women transitioning into the community? and (2) what are the barriers and facilitators for their access to primary healthcare postrelease?

Methods

Following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and drawing on Levesques' Patient-Centered Access to Healthcare Model, we searched and identified relevant publications from 2012 onwards in the following databases: PubMed, CINAHL, PsychInfo, Web of Science databases and Google Scholar. Records were included if they reported primary healthcare among formerly incarcerated women. Findings from the included studies were extracted and arranged under relevant themes using convergent-integrated approach.

Findings

A total of 3524 records were identified and reviewed, from which 37 publications were included in the review. Five main themes emerged as follows: (1) trends and predisposing factors, (2) barriers and facilitators to care, (3) continuity of care and arrangement between the prison and community health providers, (4) prescriptions and health insurance enrolment and (5) interventions to improve primary healthcare utilisation postrelease. Additional sub-themes, such as perceived discrimination in the healthcare system and delays in cancer screening, were identified and discussed.

Conclusion

The findings of the systematic review underscore the ongoing challenges women face in accessing primary care when transitioning from incarceration to the community. Enhancing coordination efforts between prison services and community healthcare providers requires a comprehensive assessment of women's healthcare needs during this transition, alongside evaluating the availability of transitional programmes. Further research is required to explore the long-term impact of such programmes and to address the gaps in evidence from low- and middle-income countries.

Investigating suicidal behavior among prisoners in the light of the behavioral addiction approach: results of a multicenter cross-sectional study

Introduction

The behavioral addiction model posits that repetitive suicidal behaviors can serve as maladaptive strategies for managing stress and negative emotional states, akin to substance addiction. Both behaviors involve negative emotions, offer temporary psychological relief, and persist, indicating shared neurobiological mechanisms. This study explored psychometric differences among major repeaters, occasional attempters, and non-suicidal prisoners.

Methods

A multi-centre cross-sectional survey of 363 inmates across four prisons assessed depression, cognitive-emotional regulation, impulsivity, perceived stress, lifetime non-suicidal self-injury and suicide attempts.

Results

Mild depression, moderate suicidal ideation, and moderate impulsivity were common, with nearly half of the participants having attempted suicide at least once. Hierarchical multiple regression analyses revealed that repeated suicidal behavior in the past increases susceptibility to future suicidal thoughts, with suicide attempts serving as a maladaptive emotion regulation strategy among repeated attempters.

Discussion

The results reveal differences in emotional dysregulation, impulsivity, and stress coping strategies among the studied groups, reinforcing the idea of suicidality as a form of behavioral addiction. The addiction approach helps explain the sensitivity to later suicidal thoughts in former attempters and self-harmers, offering valuable insights for tailored interventions within correctional settings.

Share of Adult Suicides After Recent Jail Release

Importance

Although people released from jail have an elevated suicide risk, the potentially large proportion of this population in all adult suicides is unknown.

Objective

To estimate what percentage of adults who died by suicide within 1 year or 2 years after jail release could be reached if the jail release triggered community suicide risk screening and prevention efforts.

Design, Setting, and Participants

This cohort modeling study used estimates from meta-analyses and jail census counts instead of unit record data. The cohort included all adults who were released from US jails in 2019. Data analysis and calculations were performed between June 2021 and February 2024.

Main Outcomes and Measures

The outcomes were percentage of total adult suicides within years 1 and 2 after jail release and associated crude mortality rates (CMRs), standardized mortality ratios (SMRs), and relative risks (RRs) of suicide in incarcerated vs not recently incarcerated adults. Taylor expansion formulas were used to calculate the variances of CMRs, SMRs, and other ratios. Random-effects restricted maximum likelihood meta-analyses were used to estimate suicide SMRs in postrelease years 1 and 2 from 10 jurisdictions. Alternate estimate was computed using the ratio of suicides after release to suicides while incarcerated.

Results

Included in the analysis were 2019 estimates for 7 091 897 adults (2.8% of US adult population; 76.7% males and 23.3% females) who were released from incarceration at least once, typically after brief pretrial stays. The RR of suicide was 8.95 (95% CI, 7.21-10.69) within 1 year after jail release and 6.98 (95% CI, 4.21-9.76) across 2 years after release. A total of 27.2% (95% CI, 18.0%-41.7%) of all adult suicide deaths occurred in formerly incarcerated individuals within 2 years of jail release, and 19.9% (95% CI, 16.2%-24.1%) of all adult suicides occurred within 1 year of release (males: 23.3% [95% CI, 20.8%-25.6%]; females: 24.0% [95% CI, 19.7%-36.8%]). The alternate method yielded slightly larger estimates. Another 0.8% of adult suicide deaths occurred during jail stays.

Conclusions and Relevance

This cohort modeling study found that adults who were released from incarceration at least once make up a large, concentrated population at greatly elevated risk for death by suicide; therefore, suicide prevention efforts focused on return to the community after jail release could reach many adults within 1 to 2 years of jail release, when suicide is likely to occur. Health systems could develop infrastructure to identify these high-risk adults and provide community-based suicide screening and prevention.

Sex-related inequalities in crude and age-standardized suicide rates: trends in Ghana from 2000 to 2019

BACKGROUND

Suicide represents a major public health concern, affecting a significant portion of individuals. However, there remains a gap in understanding the age and sex disparities in the occurrence of suicide. Therefore, this study aimed to investigate the sex-related inequalities in suicide rates in Ghana from 2000 to 2019.

METHODS

We utilized data from the WHO Health Equity Assessment Toolkit (HEAT) online software. We analysed sex differences in both crude and age-standardized suicide rates in Ghana spanning from 2000 to 2019. Crude and age-adjusted suicide rates were calculated based on the International Classification of Diseases (ICD) definition and coding of suicide mortality. We measured inequality in terms of sex. Two inequality indicators were used to examine the suicide rates: the difference (D) and the ratio (R).

RESULTS

Age-standardized and crude suicide rates in Ghana were higher among men from 2000 to 2019. Between 2000 and 2007, the age-standardized suicide rate for women rose steadily and declined slightly between 2008 and 2019. Age-standardized suicide rates for men increased consistently from 2000 to 2010, then declined steadily from 2011 to 2019. The crude suicide rates among men and women followed similar patterns. The widest absolute inequality in crude suicide rates (D) was recorded in 2013 (D=-11.91), while the smallest difference was observed in 2000 (D=-7.16). We also found the greatest disparity in age-standardized rates in 2011 (D=-21.46) and the least in 2000 (D=-14.32). The crude suicide rates increased with age for both men and women aged 15-54 years and 55-85+ years respectively. However, the increased rate was higher in men than in women across all age groups surveyed. A similar pattern was observed for relative inequality in both crude and age-standardized rates of suicide.

CONCLUSION

The suicide rate in Ghana has declined over time. Suicide is more common among older men. Inequalities in suicide rates, in both absolute and relative terms, are similar. There is a need to monitor suicide trends in Ghana, especially among older men. Moreover, the findings could serve as a basis for future studies on suicide in Ghana.

Mortality in women with a history of incarceration in Norway: a 20-year national cohort study

BACKGROUND

Women carry a substantial burden of psychiatric, somatic and lifestyle-related morbidity in the prison context. By describing causes of death and estimating the risk and burden of mortality compared with the general population, this study investigates how mortality operates in this highly marginalized and under-researched population.

METHODS

In this registry-based study of all women incarcerated in Norwegian prisons from 2000 to 2019 (N = 11 313), we calculated crude mortality rates, years of lost life and, by using mortality in age-matched women from the general population as a reference, age-standardized mortality ratios and years of lost life rates.

RESULTS

Over a mean follow-up time of 10.7 years, at a median age of 50 years, 9% of the population had died (n = 1005). Most deaths (80%) were premature deaths from an avoidable cause. Drug-induced causes and deaths from major non-communicable diseases (NCDs) were most frequent (both 32%). Compared with women in the general population, women with a history of incarceration were more likely to die from any cause. Trends in annual age-standardized years of lost life rates suggest that the mortality burden associated with major NCDs has gradually replaced drug-induced causes.

CONCLUSIONS

Women with a history of incarceration die at a greater rate than their peers and largely from avoidable causes. The profile of causes contributing to the substantial burden of mortality placed on this population has changed over time and has important implications for future efforts to reduce morbidity and the risk of premature death following release from prison.

Suicide Mortality Among Formerly Incarcerated People Compared With the General Population in North Carolina, 2000-2020

We aimed to compare rates and characteristics of suicide mortality in formerly incarcerated people with those of the general population in North Carolina. We conducted a retrospective cohort study of 266,400 people released from North Carolina state prisons between January 1, 2000, and March 1, 2020. Using direct and indirect standardization by age, sex, and calendar year, we calculated standardized suicide mortality rates and standardized mortality ratios comparing formerly incarcerated people with the North Carolina general population. We evaluated effect modification by race/ethnicity, sex, age, and firearm involvement. Formerly incarcerated people had approximately twice the overall suicide mortality of the general population for 3 years after release, with the highest rate of suicide mortality being observed in the 2-week period after release. In contrast to patterns in the general population, formerly incarcerated people had higher rates of non-firearm-involved suicide mortality than firearm-involved suicide mortality. Formerly incarcerated female, White and Hispanic/Latino, and emerging adult people had a greater elevation of suicide mortality than their general-population peers compared with other groups. These findings suggest a need for long-term support for formerly incarcerated people as they return to community living and a need to identify opportunities for interventions that reduce the harms of incarceration for especially vulnerable groups. This article is part of a Special Collection on Mental Health.

Women in acute forensic psychiatric care: comparison of clinical, sociodemographic, and detention-related characteristics in pretrial detention, sentence execution, and court-ordered treatment

Compared to men inmates, women display decreased prevalence of severe mental disorder but increased occurrence of substance use disorders (SUD) and higher rates of previous contacts with mental health services. The group of women in detention is highly heterogeneous according to the status of incarceration (pre-trial detention (PTD), sentence execution (SE) and court ordered treatments (COT)). Studies focusing on the comparison of sociodemographic patterns, detention-related and clinical variables between these groups are still lacking. We explored these parameters in 136 women admitted for acute psychiatric care in the sole Geneva forensic unit during a nine year period (2014-2023). Sociodemographic and detention-related data included age, nationality, marital status, presence of children, education attainment, most frequently speaking language, social support, employment before conviction and type of offenses. Clinical variables included the main ICD-10 diagnosis, presence of concomitant SUD, type of personality disorders, presence of suicidal thoughts and attempts at admission, as well as number and mean duration of stays. PTD and SE women had at least 9 years of formal education in 38.9% and 30.3% of cases. Most women in PTD (77.7%), SE (56.6%) and COT (56.2%) groups were Swiss or European citizens. The level of French knowledge was excellent in most of the cases. 43.8% of COT women had at least one child and this percentage is even higher for PTD and SE cases. The employment rate before conviction was also quite high, mainly for PTD and SE (61.1% and 60.6%) and, in a lesser degree, for COT (43.8%) women. Significant social support was present in the vast majority of women without any significant group difference. The distribution of type of offenses did not differ between the three types of detention with a predominance of physical violence, and drug trafficking. The number of stays during the period of reference was significantly higher in COT compared to both SE and PTD women. History of previous inpatient care was also significantly more frequent in COT that SE and PTD women. Adjustment and affective disorders were more often found in SE and PTD cases, these diagnoses were absent in the COT group. In contrast, a main diagnosis of psychotic disorders was found in 62.5% of COT cases compared to only 21.2% in SE and 24.1% in PTD cases. The number of stays, history of inpatient care and diagnosis of psychosis were independent predictors of COT status. In conclusion, the present data reveal the good social integration and emotional support of women needing acute psychiatric care in prison independently of the type of detention. Clinically, women in PTD and SE display more often emotional distress whereas those in COT suffer from acute psychotic symptoms with previous history of psychiatric care and multiple inpatient stays.

The associations between social determinants of health, mental health, substance-use and recidivism: a ten-year retrospective cohort analysis of women who completed the connections programme in Australia

BACKGROUND

Women with substance-use issues are overrepresented in prison. Research on women's recidivism often focuses on offending behaviour rather than the health and social circumstances women are experiencing when reimprisonment occurs. This study examines the relationship between social determinants of health (SDOH), mental health, substance-use and recidivism among women exiting prison with histories of substance-use.

METHODS

A retrospective cohort study of women exiting prison who completed the transitional support programme "Connections" between 2008 and 2018. Recidivism was measured up to two years post-release. Women's support needs were measured at baseline (4 weeks pre-release) and follow-up (four weeks post-release). Ongoing needs in relation to well-established SDOH were calculated if: (1) at baseline women were identified as having a re-entry need with housing, employment, finances, education, domestic violence, child-custody and social support and (2) at follow-up women reported still needing help in that area. Women's self-reported substance-use and mental health since release were captured at follow-up. Descriptive statistics were calculated for all measures. Associations between SDOH, mental health, substance-use and recidivism were estimated by multiple logistic regression, adjusting for potential confounders. We also evaluated the mediating effects of mental health on the relationship between SDOH and substance-use.

RESULTS

Substance-use was associated with increased odds of recidivism (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI) 1.1-2.9; p = 0.02). Poor mental health (AOR 2.9, 95% CI 1.9-4.6; p =  < 0.01), ongoing social support (AOR 3.0, 95% CI 1.9-5.0; p =  < 0.01), child-custody (AOR 1.9, 95% CI 1.0-3.3 p = 0.04), financial (AOR 2.0, 95% CI 1.3-3.2; p =  < 0.01) and housing (AOR 1.8, 95% CI 1.1-2.9; p = 0.02) needs were individually associated with increased odds of substance-use. Mediation analysis found mental health fully mediated the effects of ongoing housing (beta efficiency (b) = - 033, standard error (SE) 0.01; p = 0.05), financial (b = 0.15, SE 0.07; p = 0.05), child-custody (b = 0.18, SE 0.01; p = 0.05) and social support (b = 0.36, SE 0.1; p = 0.05) needs onto substance-use, and partially mediated the effects of domestic violence (b = 0.57, SE 0.23; p = 0.05) onto substance-use.

CONCLUSION

This study underscores the critical importance of addressing the interplay between SDOH, mental health, substance-use and recidivism. An approach that targets SDOH holds the potential for reducing mental distress and substance-use, and related recidivism.

Risk Factors for Suicide in Men

Suicide and the risk factors associated with it have been researched with increasing interest over the last 5 decades with respect to socioeconomic status, age, geographic location, and ethnic background. There has been less focus related to the risk factors specific to gender and how to incorporate clinical screening and interventions to reduce the mortality of suicide in males. With men accounting for a disproportionate number of deaths from suicide in the United States and worldwide, how gender could impact suicidal behavior and ideations remains a topic understudied and with great potential for significant improvement in clinical recognition and treatment.

Managed care updates of subscriber jail release to prompt community suicide prevention: clinical trial protocol

BACKGROUND

Recent jail detention is a marker for trait and state suicide risk in community-based populations. However, healthcare providers are typically unaware that their client was in jail and few post-release suicide prevention efforts exist. This protocol paper describes an effectiveness-implementation trial evaluating community suicide prevention practices triggered by advances in informatics that alert CareSource, a large managed care organization (MCO), when a subscriber is released from jail.

METHODS

This randomized controlled trial investigates two evidence-based suicide prevention practices triggered by CareSource's jail detention/release notifications, in a partial factorial design. The first phase randomizes ~ 43,000 CareSource subscribers who pass through any Ohio jail to receive Caring Contact letters sent by CareSource or to Usual Care after jail release. The second phase (running simultaneously) involves a subset of ~ 6,000 of the 43,000 subscribers passing through jail who have been seen in one of 12 contracted behavioral health agencies in the 6 months prior to incarceration in a stepped-wedge design. Agencies will receive: (a) notifications of the client's jail detention/release, (b) instructions for re-engaging these clients, and (c) training in suicide risk assessment and the Safety Planning Intervention for use at re-engagement. We will track suicide-related and service linkage outcomes 6 months following jail release using claims data.

CONCLUSIONS

This design allows us to rigorously test two intervention main effects and their interaction. It also provides valuable information on the effects of system-level change and the scalability of interventions using big data from a MCO to flag jail release and suicide risk.

TRIAL REGISTRATION

The trial is registered at clinicaltrials.gov (NCT05579600). Registered 27 June, 2023.

Managed Care Updates of Subscriber Jail Release to Prompt Community Suicide Prevention: Clinical Trial Protocol

Background

Recent jail detention is a marker for trait and state suicide risk in community-based populations. However, healthcare providers are typically unaware that their client was in jail and few post-release suicide prevention efforts exist. This protocol paper describes an effectiveness-implementation trial evaluating community suicide prevention practices triggered by advances in informatics that alert CareSource, a large managed care organization (MCO), when a subscriber is released from jail.

Methods

This randomized controlled trial investigates two evidence-based suicide prevention practices triggered by CareSource's jail detention/release notifications, in a partial factorial design. The first phase randomizes ~43,000 CareSource subscribers who pass through any Ohio jail to receive Caring Contact letters sent by CareSource or to Usual Care after jail release. The second phase (running simultaneously) involves a subset of ~6,000 of the 43,000 subscribers passing through jail who have been seen in one of 12 contracted behavioral health agencies in the 6 months prior to incarceration in a stepped-wedge design. Agencies will receive: (a) notifications of the client's jail detention/release, (b) instructions for re-engaging these clients, and (c) training in suicide risk assessment and the Safety Planning Intervention for use at re-engagement. We will track suicide-related and service linkage outcomes 6 months following jail release using claims data.

Conclusions

This design allows us to rigorously test two intervention main effects and their interaction. It also provides valuable information on the effects of system-level change and the scalability of interventions using big data from a MCO to flag jail release and suicide risk.

Trial Registration

The trial is registered at clinicaltrials.gov (NCT05579600). Registered 27 June, 2023, https://beta.clinicaltrials.gov/study/NCT05579600?cond=Suicide&term=Managed%20Care&rank=1.

Psychiatric morbidity among women in Norwegian prisons, 2010-2019: a register-based study

PURPOSE

Research suggests that women in prison have more mental health problems than men and are prone to suffer from more severe psychiatric disorders. This study utilizes national registry data to describe demographic and psychiatric gender differences in Norwegian prisons, and to investigate comorbid psychiatric disorders and time trends in psychiatric morbidity among women.

METHODS

Longitudinal data from the Norwegian Prison Release Study linked with the Norwegian Patient Registry and data from Statistics Norway provided information on health care utilization, socioeconomic status, and history of psychiatric disorders among all individuals (nwomen = 5,429; nmen = 45,432) who were incarcerated in a Norwegian prison between 2010 and 2019.

RESULTS

Women were more likely than men to have a history of any psychiatric disorder (75% vs. 59%). Substance use disorders and dual disorders were highly prevalent in both genders, yet highest among women (56 and 38% respectively, versus 43 and 24% among men). From 2010 to 2019, we found a considerable increase in the 12-month prevalence of most diagnostic categories among women entering prison.

CONCLUSION

Psychiatric and dual disorders are highly prevalent in Norwegian prisons, and especially among women. The proportion of women entering prison with a recent history of mental health problems has increased rapidly over the last decade. Women's prison institutions need to adjust health and social services, and awareness about substance use and other psychiatric disorders in order to meet the increasing proportion of women facing these challenges.