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Vanhaesebrouck A, Fovet T, Melchior M, Lefevre T. Suicide following a conviction, solitary confinement, or transfer in people incarcerated: A comprehensive retrospective cohort study in France, 2017-2020. Suicide Life Threat Behav 2024; 54:450-459. [PMID: 38357968 DOI: 10.1111/sltb.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/08/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Suicide rates are higher in prison than in the general population in most countries. The proximity of some suicides to prison events has only received little attention in comparative studies. The aim of this study was to assess the relationship between suicide and four prison events: conviction, disciplinary solitary confinement, nondisciplinary solitary confinement and inter-prison transfer, in a national retrospective cohort study of people in prison. METHODS All incarcerations in France that occurred during 2017-2020 were eligible. Data were collected from an administrative database of the National Prison Service. Survival bivariate and multivariate analyses were performed with a Cox regression model. RESULTS Of 358,522 incarcerations were included, among which 469,348 events and 449 suicides occurred. In multivariate analysis, suicide risk was higher the first day of disciplinary solitary confinement (HR = 42.1 [21.5-82.7] and HR = 119.0 [71.5-197.9], before and after a government decree on the disciplinary system, respectively. It was higher within 2 weeks after a transfer (HR = 3.5 [2.3-5.2])) or entry in nondisciplinary solitary confinement (HR = 6.7 [3.4-13.3]) and lower within 2 weeks after a conviction (HR = 0.6 [0.4-1.0]). CONCLUSION Solitary confinement and transfer were found to be precipitating factors of suicide in people who are incarcerated. These results offer interesting perspectives on prevention.
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Affiliation(s)
- Alexis Vanhaesebrouck
- Interdisciplinary Research Institute On Social Issues (IRIS), UFR SMBH, Sorbonne Paris North University, UMR 8156-997, Paris, France
- Department of Legal and Social Medicine, Jean-Verdier Hospital (AP-HP), Bondy, France
- Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Sorbonne University, INSERM, Paris, France
| | - Thomas Fovet
- Univ. Lille, Inserm, CHU Lille, U1172 - Lille Neuroscience & Cognition, Lille, France
| | - Maria Melchior
- Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Sorbonne University, INSERM, Paris, France
| | - Thomas Lefevre
- Interdisciplinary Research Institute On Social Issues (IRIS), UFR SMBH, Sorbonne Paris North University, UMR 8156-997, Paris, France
- Department of Legal and Social Medicine, Jean-Verdier Hospital (AP-HP), Bondy, France
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Vanhaesebrouck A, Fovet T, Melchior M, Lefevre T. Risk factors of suicide in prisons: a comprehensive retrospective cohort study in France, 2017-2020. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02661-x. [PMID: 38592476 DOI: 10.1007/s00127-024-02661-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/10/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Suicide is a leading cause of death in prison and the suicide rates are several times higher in the prison population than in the general population in most countries. Of the studies that have investigated risk factors for suicide in prison, few have controlled for possible confounding factors. The aim of this study is to identify risk factors of suicide among people in French prisons, over a four-year period. METHODS All incarcerations that occurred in France during 2017-2020 were eligible. Sociodemographic, criminal and prison characteristics were collected for each incarceration from data of the National Prison Service. Survival univariate and multivariate analyses were performed with a Cox regression model. RESULTS 358,522 incarcerations were included, of which 449 ended in suicide during the follow-up. The median length of prison stay was 5.1 months. The median age at prison entry was 30 years and 95.8% of incarcerations involved men. The overall suicide rate was 173 [157-189] per 100,000 person-years. Factors associated with suicide in the multivariate model (p < 0.05) were the early stage of incarceration and in particular the first week (HR = 7.6 [5.4-10.8]), violent offences and in particular homicide (HR = 3.0 [2.1-4.2]), French (HR = 1.7 [1.2-2.4]) and other European nationalities (HR = 2.1 [1.4-3.3]), age above 40 (HR = 2.0 [1.5-2.6]), pre-trial incarceration (HR = 1.8 [1.4-2.3]), being separated (HR = 1.6 [1.1-2.3] and having a high school diploma (HR = 1.4 [1.0-1.8]). CONCLUSIONS Factors associated with suicide in prison are complex and involve individuals' criminal history as well as conditions of incarceration. These characteristics may be relevant to focus suicide prevention efforts.
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Affiliation(s)
- Alexis Vanhaesebrouck
- Interdisciplinary Research Institute On Social Issues (IRIS), UFR SMBH, Sorbonne Paris North University, UMR 8156‑997, Aubervilliers, France.
- Department of Legal and Social Medicine, Jean-Verdier Hospital (AP-HP), Bondy, France.
- Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Sorbonne University, INSERM, Paris, France.
| | - Thomas Fovet
- CHU Lille, U1172-Lille Neuroscience & Cognition, University Lille, INSERM, 59000 , Lille, France
| | - Maria Melchior
- Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Sorbonne University, INSERM, Paris, France
| | - Thomas Lefevre
- Interdisciplinary Research Institute On Social Issues (IRIS), UFR SMBH, Sorbonne Paris North University, UMR 8156‑997, Aubervilliers, France
- Department of Legal and Social Medicine, Jean-Verdier Hospital (AP-HP), Bondy, France
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Alcántara-Jiménez M, Torres-Parra I, Guillén-Riquelme A, Quevedo-Blasco R. Los Factores Psicosociales en el Suicidio de Presos en Prisiones Europeas: una Revisión Sistemática y Metaanálisis. ANUARIO DE PSICOLOGÍA JURÍDICA 2023. [DOI: 10.5093/apj2022a13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Soins psychiatriques en détention : quelles spécificités ? ANNALES MÉDICO-PSYCHOLOGIQUES, REVUE PSYCHIATRIQUE 2023. [DOI: 10.1016/j.amp.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Raddi S, Baralla F, D’Argenio A, Traverso S, Sarchiapone M, Marchetti M. Do Homicide Perpetrators Have Higher Rates of Delayed-Suicide Than the Other Offenders? Data from a Sample of the Inmate Population in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16991. [PMID: 36554869 PMCID: PMC9778990 DOI: 10.3390/ijerph192416991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Homicide-suicide can be defined as homicide followed by the suicide of the perpetrator shortly afterward. In the so-called "homicide-delayed suicide", homicide and suicide occur but within a wide and not strictly defined timeframe. This study analyzes data concerning the suicide of 667 inmates in Italy between 2002 and 2015, considering homicide perpetrators compared to all offenders. The analyses revealed that inmates who had committed homicide were more likely to commit suicide (71% versus 45%; χ2 = 10.952, p = 0.001) and the odds of suicide increase concerning 1.58 times among homicide perpetrators. The time-to-suicide interval after homicide ranges between 0 to 9.125 days (mean = 1.687,9; SD = 2.303,1). Moreover, the intimate-homicide offenders who committed suicide had a significantly shorter survival time after the offense than did the other non-intimate offenders who died by suicide (t test, t = -3.56, df = 90, p = 0.001). The link between homicide and higher suicide risk in homicide perpetrators should be highlighted because of all the homicide offenders passing through the criminal justice system. Superior knowledge about the path of homicide-delayed suicide will be of particular use to professionals in evaluating and treating homicide inmates.
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Affiliation(s)
- Silvia Raddi
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Francesca Baralla
- Department of Humanities, Social Sciences and Education—SUSeF, University of Molise, 86100 Campobasso, Italy
| | - Alberto D’Argenio
- Department of Neuroscience, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Simona Traverso
- Department of Medical Science, Chirurgical and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
| | - Marco Marchetti
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
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Vanhaesebrouck A, Tostivint A, Lefèvre T, Melchior M, Khireddine-Medouni I, Chee CC. Characteristics of persons who died by suicide in prison in France: 2017-2018. BMC Psychiatry 2022; 22:11. [PMID: 34983453 PMCID: PMC8729083 DOI: 10.1186/s12888-021-03653-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In northern countries, suicide rates among prisoners are at least three times higher for men and nine times higher for women than in the general population. The objective of this study is to describe the sociodemographic, penal, health characteristics and circumstances of suicide of French prisoners who died by suicide. METHODS This study is an intermediate analysis of the French epidemiological surveillance program of suicides in prison. All suicides in prison in 2017-2018 in France were included in the study. Archival sociodemographic and penal data and specific data on the circumstances of the suicidal act were provided by the National Prison Service. Health data was provided by physicians working in prison using a standardized questionnaire. RESULTS In 2017-2018, 235 prisoners died by suicide. The suicide rate was 16.8/10 000 person-years. Among suicide cases, 94.9% were male, 27.2% were under 30, 25.1% were aged 30 to 39, 27.7% were aged 40 to 49 and 20.0% were 50 or older. At the time of suicide, 48.5% were on custodial remand. Incarceration is associated with a threefold increase in the frequency of anxio-depressive disorders (24.6% in prison versus 8.2% before prison). The week before the suicidal act, 60% of prisoners visited the health unit and a significant event was detected for 61% of all cases. Suicide was less than 1 week after prison entry for 11.9% of prisoners, corresponding to a suicide rate 6.4 (CI95% [4.3 - 9.5]) times higher than for the remaining time in prison, and was more than 1 year after entry for 33.7% of them. CONCLUSIONS The high frequency of events the week before suicide in our study suggests that events in prison could play a role in the occurrence of suicides. Comparative studies are needed to further explore the time association between events and suicide in prison. As most of prisoners who died by suicide visited the health unit the week before suicide, the identification of triggering factors could help psychiatrists and other health professionals to assess the short-term risk of suicide and to implement preventive measures.
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Affiliation(s)
- Alexis Vanhaesebrouck
- Interdisciplinary Research Institute On Social Issues (IRIS), UFR SMBH, Université Sorbonne Paris Nord, UMR 8156-997, Paris, France. .,Department of Legal and Social Medicine, Hôpital Jean-Verdier (AP-HP), 93140, Bondy, France. .,Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Sorbonne Université, INSERM, Paris, France.
| | - Amélie Tostivint
- grid.494228.10000 0004 0639 9788Health division of the National Prison Service, Ministry of Justice, Paris, France
| | - Thomas Lefèvre
- grid.462844.80000 0001 2308 1657Interdisciplinary Research Institute On Social Issues (IRIS), UFR SMBH, Université Sorbonne Paris Nord, UMR 8156-997 Paris, France ,grid.414153.60000 0000 8897 490XDepartment of Legal and Social Medicine, Hôpital Jean-Verdier (AP-HP), 93140 Bondy, France
| | - Maria Melchior
- grid.418241.a0000 0000 9373 1902Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Sorbonne Université, INSERM, Paris, France
| | | | - Christine Chan Chee
- grid.457361.2National Agency of Public Health (Santé Publique France), Saint-Maurice, France
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Bukten A, Stavseth MR. Suicide in prison and after release: a 17-year national cohort study. Eur J Epidemiol 2021; 36:1075-1083. [PMID: 34427828 PMCID: PMC8542551 DOI: 10.1007/s10654-021-00782-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/29/2021] [Indexed: 11/11/2022]
Abstract
Background People in prison have an extremely high risk of suicide. The aim of this paper is to describe all suicides in the Norwegian prison population from 2000 to 2016, during and following imprisonment; to investigate the timing of suicides; and to investigate the associations between risk of suicide and types of crime. Methods We used data from the Norwegian Prison Release study (nPRIS) including complete national register data from the Norwegian Prison Register and the Norwegian Cause of Death Register in the period 1.1.2000 to 31.12.2016, consisting of 96,856 individuals. All suicides were classified according to ICD-10 codes X60-X84. We calculated crude mortality rates (CMRs) per 100,000 person-years and used a Cox Proportional-Hazards regression model to investigate factors associated with suicide during imprisonment and after release reported as hazard ratios (HRs). Results Suicide accounted for about 10% of all deaths in the Norwegian prison population and was the leading cause of death in prison (53% of in deaths in prison). The CMR per 100,000 person years for in-prison suicides was 133.8 (CI 100.5–167.1) and was ten times higher (CMR = 1535.0, CI 397.9–2672.2) on day one of incarceration. Suicides after release (overall CMR = 82.8, CI 100.5–167.1) also peaked on day one after release (CMR = 665.7, CI 0–1419.1). Suicide in prison was strongly associated with convictions of homicide (HR 18.2, CI 6.5–50.8) and high-security prison level (HR 15.4, CI 3.6–65.0). Suicide after release was associated with convictions of homicide (HR 3.1, CI 1.7–5.5). Conclusion There is a high risk of suicide during the immediate first period of incarceration and after release. Convictions for severe violent crime, especially homicide, are associated with increased suicide risk, both in prison and after release. Supplementary Information The online version contains supplementary material available at 10.1007/s10654-021-00782-0.
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Affiliation(s)
- Anne Bukten
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway. .,Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway.
| | - Marianne Riksheim Stavseth
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.,Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
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Radeloff D, ten Hövel M, Brennecke G, Stoeber FS, Lempp T, Kettner M, Zacher H, von Klitzing K, Bennefeld-Kersten K. Suicide after reception into prison: A case-control study examining differences in early and late events. PLoS One 2021; 16:e0255284. [PMID: 34343175 PMCID: PMC8330938 DOI: 10.1371/journal.pone.0255284] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/13/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Prisoners constitute a high-risk group for suicide, with suicide rates about 5 to 8 times higher than in the general population. The first weeks of imprisonment are a particularly vulnerable time, but there is limited knowledge about the risk factors for either early or late suicide events. METHODS Based on a national total sample of prison suicides in Germany between 2005 and 2017, suicides within the first 2 (4 and 8) weeks after reception into prison were matched by age and penalty length with cases that occurred later. Factors that potentially influence the timing of suicide were investigated. RESULTS The study has shown that 16.7% (31.5%) of all 390 suicides in German prisons occurred within the first two weeks (two months) of imprisonment. Factors that facilitate adaptation to the prison environment (e.g. prior prison experience) were negatively associated with early suicide events. Factors that hindered the adaptation process (e.g. withdrawal from illicit drugs) were observed more frequently in early suicide events than in late ones. These factors are active at different times of imprisonment. CONCLUSION At reception, particular attention should be paid to the following factors associated with early suicide events: widowed marital status, lack of prison experience, and drug dependency.
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Affiliation(s)
- Daniel Radeloff
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | - Marian ten Hövel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
- Chair for Work and Organizational Psychology, Institute of Psychology, Leipzig University, Leipzig, Germany
| | - Gerald Brennecke
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Franziska S. Stoeber
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Lempp
- Clementine Children’s Hospital, Frankfurt/Main, Germany
| | - Mattias Kettner
- Institute of Forensic Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Hannes Zacher
- Chair for Work and Organizational Psychology, Institute of Psychology, Leipzig University, Leipzig, Germany
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
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Zhong S, Senior M, Yu R, Perry A, Hawton K, Shaw J, Fazel S. Risk factors for suicide in prisons: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e164-e174. [PMID: 33577780 PMCID: PMC7907684 DOI: 10.1016/s2468-2667(20)30233-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Rates of suicide among people in prison are elevated compared with people of similar age and sex who are living in the community. Improving assessments and interventions to reduce suicide risk requires updated evidence on risk factors. We aimed to examine risk factors associated with suicide in prisoners. METHODS We did an updated systematic review and meta-analysis of risk factors for suicide among people in prison. We searched five biblographic databases for articles published between Jan 1, 2006, and Aug 13, 2020, and one database for articles published between Jan 1, 1973, and Aug 13, 2020. Eligible studies reported risk factors in individuals who died by suicide while in prison and in controls from the general prison population. Two reviewers independently extracted data for each study using a standardised form. We calculated random-effects pooled odds ratios (ORs) for the association of suicide with demographical, clinical, criminological, and institutional risk factors, and investigated heterogeneity using subgroup and meta-regression analyses. This systematic review is registered with PROSPERO, CRD42020137979. FINDINGS We identified 8041 records through our searches, and used 77 eligible studies from 27 countries, including 35 351 suicides, in the main analysis. The strongest clinical factors associated with suicide were suicidal ideation during the current period in prison (OR 15·2, 95% CI 8·5-27·0), a history of attempted suicide (OR 8·2, 4·4-15·3), and current psychiatric diagnosis (OR 6·4, 3·6-11·1). Institutional factors associated with suicide included occupation of a single cell (OR 6·8, 2·3-19·8) and having no social visits (OR 1·9, 1·5-2·4). Criminological factors included remand status (OR 3·6, 3·1-4·1), serving a life sentence (OR 2·4, 1·3-4·6), and being convicted of a violent offence, in particular homicide (OR 3·1, 2·2-4·2). INTERPRETATION Several modifiable risk factors, such as psychiatric diagnosis, suicidal ideation during the current period in prison, and single-cell occupancy, are associated with suicide among people in prison. Preventive interventions should target these risk factors and include improved access to evidence-based mental health care. Understanding other factors associated with suicide might improve risk stratification and resource allocation in prison services. FUNDING Wellcome Trust, National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley.
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Affiliation(s)
- Shaoling Zhong
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | | | - Rongqin Yu
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amanda Perry
- Department of Health Sciences, University of York, York, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Jenny Shaw
- University of Manchester, Greater Manchester Mental Health Trust, Manchester, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
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Fritz FD, Fazel S, Benavides Salcedo A, Henry P, Rivera Arroyo G, Torales J, Trujillo Orrego N, Vásquez F, Mundt AP. 1324 prison suicides in 10 countries in South America: incidence, relative risks, and ecological factors. Soc Psychiatry Psychiatr Epidemiol 2021; 56:315-323. [PMID: 32405788 DOI: 10.1007/s00127-020-01871-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Although suicide rates of prison populations and incidence factors have been reported for high-income countries, data from low- and middle-income regions are lacking. The purpose of the study was to estimate suicide rates among prison populations in South America, to examine prison-related factors, and to compare suicide rates between prison and general populations. METHODS In this observational study, we collected the numbers of suicides in prison, rates of prison occupancy, and incarceration rates from primary sources in South America between 2000 and 2017. We compared suicide rates among prisoners with incidence rates in the general populations by calculating incidence rate ratios. We assessed the effect of gender, year, incarceration rates and occupancy on suicide rates in the prison populations using regression analyses. RESULTS There were 1324 suicides reported during 4,437,591 person years of imprisonment between 2000 and 2017 in 10 South American countries. The mean suicide rate was 40 (95% CI 16-65) per 100,000 person years for male and female genders combined. The pooled incidence rate ratio of suicide between prison and general populations was 3.9 (95% CI 3.1-5.1) for both genders combined, 2.4 (95% CI 1.9-3.1) for men and a higher ratio in women (13.5, 95% CI 6.9-26.9). High occupancies of prisons were associated with lower incidence of suicide (β = - 58, 95% CI - 108.5 to - 7.1). CONCLUSIONS Suicides during imprisonment in South America are an important public health problem. Suicide prevention strategies need to target prison populations.
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Affiliation(s)
- Francesco Domenico Fritz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,Department of Psychiatry, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Paulette Henry
- Department of Sociology, University of Guyana, Georgetown, Guyana
| | - Guillermo Rivera Arroyo
- Department of Psychology, Private University of Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia
| | - Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Natalia Trujillo Orrego
- Mental Health Research Group, National Faculty of Public Health, University of Antioquia, Medellin, Colombia
| | - Freddy Vásquez
- Suicide Prevention Program, National Institute for Mental Health, Lima, Peru
| | - Adrian P Mundt
- Medical Faculty, Universidad Diego Portales, Santiago, Chile. .,Medical Faculty, Universidad San Sebastián, Puerto Montt, Chile.
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11
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Gentile G, Nicolazzo M, Bianchi R, Bailo P, Boracchi M, Tambuzzi S, Zoja R. Mortality in Prisons: The Experience of the Bureau of Legal Medicine of Milan (Italy) (1993-2017) : Suicides and natural deaths in prison. MEDICINE, SCIENCE, AND THE LAW 2021; 61:67-76. [PMID: 33591876 DOI: 10.1177/0025802420934266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We undertook a retrospective analysis of deaths that took place in prisons in Milan between 1993 and 2017, by identifying cases from a total of 24,101 autopsies that were performed at the Section of Forensic Medicine of the University of Milan. From the archives of this institution, we found 227 autopsy reports relating to deaths that had taken place in one of Milan's three detention facilities. These deaths were divided into two types: natural deaths (n=135; 59.5%) and violent deaths (n=92; 40.5%). The groups have different characteristics: while natural deaths mostly resulted from cardiovascular diseases, suicides were mainly the result of hanging. Further, people who died by suicide often had a history of psychiatric disease and/or drug abuse, and over a quarter of them had previous suicide attempts and/or had declared suicidal intentions. This study confirms the need for good quality healthcare services for prisoners, given that they remain a population at high risk of early death.
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Affiliation(s)
- Guendalina Gentile
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
| | - Marta Nicolazzo
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
| | - Rachele Bianchi
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
| | - Paolo Bailo
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
| | - Michele Boracchi
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
| | - Stefano Tambuzzi
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
| | - Riccardo Zoja
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
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Bird SM. Fatal accident inquiries into 83 deaths in Scottish prison custody: 2010-2013. BJPsych Open 2020; 6:e132. [PMID: 33121556 PMCID: PMC7745234 DOI: 10.1192/bjo.2020.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/02/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The only non-legal reference in Lord Cullen's Review of fatal accident inquiry (FAI) Legislation in Scotland (2009) was my audit of FAIs into 97 deaths in prison custody in Scotland, 1999-2003: recommending that waiting time from prisoner death to end of FAI should be less than 1 year for 90% of FAIs, and epidemiological rules for FAIs to have a written determination versus formal findings. AIMS Audit of FAIs into 83 deaths in Scottish prison custody in the period 2010-2013. METHOD Assessement of waiting times from prisoner death to end of FAI; dissemination of written determinations; self-inflicted death rate per 1000 prisoner-years; cause of natural deaths; and yellow card submissions. Detailed cross-checking was nec37essary between Scottish Prison Service and courts' websites and the Scottish Fatalities Investigation Unit. RESULTS Of 83 FAIs into deaths in Scottish prison custody, 2010-2013, 37 (45%) were long-awaited (ongoing >2 years after the prisoner's death); 16 (19%, 95% CI 11-28%) beyond 3 years. Of 37 long-awaited FAIs, 27 made written determinations but only 12 of these (44%) were published. Self-inflicted deaths numbered 36: 1.1 per 1000 prisoner-years (95% CI 0.75-1.48). Of 47 deaths from natural causes, cardiovascular disease accounted for 23 (49%, 95% CI 34-63%); liver disease was implicated in 10 of 47. To support pharmacovigilance, submissions were made to Medicines and Healthcare Regulatory Agency for eight deaths (10%, 95% CI 4-19%). CONCLUSIONS FAIs into prisoner deaths in Scotland are too long-awaited given that four (5%) identified precautions that could have prevented death.
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Affiliation(s)
- Sheila M. Bird
- Cambridge University's MRC Biostatistics Unit, UK; and Edinburgh University's College of Medicine and Veterinary Medicine, UK
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13
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[Health care delivery and psychiatric hospitalizations in the prisons of the North of France: An observational study]. Rev Epidemiol Sante Publique 2020; 68:273-281. [PMID: 32900559 DOI: 10.1016/j.respe.2020.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/22/2020] [Accepted: 06/24/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In French prisons, psychiatric care for inmates is organized into three levels: ambulatory care within each jail in "unités sanitaires en milieu pénitentiaire" (USMP: sanitary units in correctional settings), day hospitalizations in the 28 services médico-psychologiques régionaux (SMPR, "regional medical-psychological services") and full-time hospitalizations in one of the nine "unités d'hospitalisation spécialement aménagées" (UHSA: specially equipped hospital units). Despite high prevalence of mental disorders among French prisoners, the efficiency of these specialized psychiatric care units has been insufficiently studied. The main goal of this study is to describe full-time psychiatric hospitalizations for inmates in the twenty prisons located in the North of France. METHODS We conducted a descriptive study based on medical and administrative data and survey results. The following data were collected for each prison regarding 2016: 1) number and occupancy rates for mental health professionals and 2) psychiatric hospitalization rates (in the UHSA of Lille-Seclin and the general psychiatric hospitals). RESULTS Provision of care is incomplete: the vacancy rate in the health units studied reaches 40 %. Moreover, access to UHSA is unequal: it varies pronouncedly according to the location of the prison; only inmates in prisons close to the UHSA benefit from satisfactory access. CONCLUSION Access to psychiatric care for inmates remains problematic in France, particularly due to a lack of mental health professionals in USMPs, the overload of patients in UHSAs and the distance of theses facilities from certain prisons and jails.
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Moser DA, Glaus J, Frangou S, Schechter DS. Years of life lost due to the psychosocial consequences of COVID-19 mitigation strategies based on Swiss data. Eur Psychiatry 2020; 63:e58. [PMID: 32466820 PMCID: PMC7303469 DOI: 10.1192/j.eurpsy.2020.56] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The pandemic caused by coronavirus disease 2019 (COVID-19) has forced governments to implement strict social mitigation strategies to reduce the morbidity and mortality from acute infections. These strategies, however, carry a significant risk for mental health, which can lead to increased short-term and long-term mortality and is currently not included in modeling the impact of the pandemic. METHODS We used years of life lost (YLL) as the main outcome measure, applied to Switzerland as an example. We focused on suicide, depression, alcohol use disorder, childhood trauma due to domestic violence, changes in marital status, and social isolation, as these are known to increase YLL in the context of imposed restriction in social contact and freedom of movement. We stipulated a minimum duration of mitigation of 3 months based on current public health plans. RESULTS The study projects that the average person would suffer 0.205 YLL due to psychosocial consequence of COVID-19 mitigation measures. However, this loss would be entirely borne by 2.1% of the population, who will suffer an average of 9.79 YLL. CONCLUSIONS The results presented here are likely to underestimate the true impact of the mitigation strategies on YLL. However, they highlight the need for public health models to expand their scope in order to provide better estimates of the risks and benefits of mitigation.
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Affiliation(s)
- Dominik A. Moser
- Institute of Psychology, University of Bern, Bern, Switzerland
- Department of Psychiatry, Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Jennifer Glaus
- Department of Psychiatry, Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Sophia Frangou
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel S. Schechter
- Department of Psychiatry, Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New YorkUSA
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Radeloff D, Stoeber F, Lempp T, Kettner M, Bennefeld-Kersten K. Murderers or thieves at risk? Offence-related suicide rates in adolescent and adult prison populations. PLoS One 2019; 14:e0214936. [PMID: 30943261 PMCID: PMC6447226 DOI: 10.1371/journal.pone.0214936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 03/23/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose Prisoners have a higher risk of suicide compared to non-incarcerated individuals. One aim of suicide prevention for prisoners is to identify risk factors in order to put stronger support mechanisms in place for the more vulnerable detainees. This study investigates the suicide risk (SR) in offence-related sub-populations in a representative German sample and differentiates between SR for adolescent and adult prisoners. Methods Conducting a national study with data from public German records on the entire prison population from 2000 to 2016 and suicide numbers in German prisons in the same period, SR was calculated for the total male prison population as well as for both subgroups, adolescent and adult male prisoners. Results In the study period, male prisoners spent 959.584 life years (LY) in German criminal detention. Among those, 524 prisoners died of suicide. SR was higher for detainees imprisoned for an offence resulting in extensive physical harm for another person, e.g. homicide (suicide rate = 134,8 suicides per 100.000 LY; OR = 2,47; CI95%: 1,98–3,08), bodily injury (suicide rate = 87,3; OR = 1,60; CI95%: 1,29–1,99), and sexual offences (suicide rate = 84,2; OR = 1,54; CI95%: 1,18–2,01) compared with the SR of the total prison population (suicide rate = 54.6). Age differences between offence-related SR were found for theft, with adolescents (suicide rate = 69,3; OR = 1,25; CI95%: 0,85–1,84) showing higher SR than adults (suicide rate = 38,2; OR = 0,7; CI95%: 0,54–0,92). Conclusion The index offence of detainees is associated with SR and age-related differences exist. Suicide prevention in prisons should take both into account to determine populations at risk.
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Affiliation(s)
- Daniel Radeloff
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | - Franziska Stoeber
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Lempp
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Mattias Kettner
- Institute of Forensic Medicine, Goethe University Frankfurt, Frankfurt, Germany
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Calati R, Ferrari C, Brittner M, Oasi O, Olié E, Carvalho AF, Courtet P. Suicidal thoughts and behaviors and social isolation: A narrative review of the literature. J Affect Disord 2019; 245:653-667. [PMID: 30445391 DOI: 10.1016/j.jad.2018.11.022] [Citation(s) in RCA: 279] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/27/2018] [Accepted: 11/03/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Social isolation is one of the main risk factors associated with suicidal outcomes. The aim of this narrative review was to provide an overview on the link between social isolation and suicidal thoughts and behaviors. METHODS We used the PubMed database to identify relevant articles published until April 13, 2018. We focused on: (a) systematic reviews, meta-analyses, and narrative reviews; (b) original observational studies with large samples (N ≥ 500); and (c) qualitative studies. We included all relevant suicidal outcomes: suicidal ideation (SI), suicidal planning, non-suicidal self-injury, deliberate self-harm, suicide attempt (SA), and suicide. RESULTS The main social constructs associated with suicidal outcomes were marital status (being single, separated, divorced, or widowed) and living alone, social isolation, loneliness, alienation, and belongingness. We included 40 original observational studies, the majority of them performed on adolescents and/or young adults (k = 23, 57.5%). Both the objective condition (e.g., living alone) and the subjective feeling of being alone (i.e., loneliness) were strongly associated with suicidal outcomes, in particular with SA and SI. However, loneliness, which was investigated in most studies (k = 24, 60%), had a major impact on both SI and SA. These associations were transculturally consistent. LIMITATIONS Confounding factors can limit the weight of the results obtained in observational studies. CONCLUSIONS Data from the observational studies suggest that both objective social isolation and the subjective feeling of loneliness should be incorporated in the risk assessment of suicide. Interventional studies targeting social isolation for suicide prevention are needed.
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Affiliation(s)
- Raffaella Calati
- INSERM, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France; Department of Psychiatry, Mount Sinai Beth Israel, New York, USA.
| | - Chiara Ferrari
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Marie Brittner
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Osmano Oasi
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Emilie Olié
- INSERM, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - André F Carvalho
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Philippe Courtet
- INSERM, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
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Eck M, Scouflaire T, Debien C, Amad A, Sannier O, Chan Chee C, Thomas P, Vaiva G, Fovet T. [Suicide in prison: Epidemiology and prevention]. Presse Med 2019; 48:46-54. [PMID: 30685227 DOI: 10.1016/j.lpm.2018.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/20/2018] [Accepted: 11/07/2018] [Indexed: 11/18/2022] Open
Abstract
Suicide is one of the most important causes of death in prison around the world. In France, suicide rate for prisoners is 18.5 suicides per 10,000 inmates: seven times more common than in the general population. Among the risk factors identified in the literature, those most strongly associated with suicide in prison are physical isolation in custody, psychiatric history and history of suicide attempts. The prevention of suicide in prison involves several measures including treatment of psychiatric disorders, improvement of living conditions in custody, social support of prisoners and use of specific tools and programs by prison supervisors. No program for prevention of suicidal recurrence has ever been implemented. We propose to adapt « VigilanS », a program already applied in the general population, to the prison population.
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Affiliation(s)
- Marion Eck
- CHU Lille, Pôle de Psychiatrie, unité CURE, 59000 Lille, France.
| | | | | | - Ali Amad
- CHU Lille, Pôle de Psychiatrie, unité CURE, 59000 Lille, France; Univ. Lille, CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), 59000 Lille, France
| | - Olivier Sannier
- Médecin conseil, Ecopolis, 53, avenue de l'Europe, 80000 Amiens, France
| | - Christine Chan Chee
- Santé publique France, direction des maladies non transmissibles et traumatismes, 94415 Saint Maurice, France
| | - Pierre Thomas
- CHU Lille, Pôle de Psychiatrie, unité CURE, 59000 Lille, France; Univ. Lille, CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), 59000 Lille, France
| | - Guillaume Vaiva
- CHU Lille, Pôle de Psychiatrie, unité CURE, 59000 Lille, France; Univ. Lille, CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), 59000 Lille, France
| | - Thomas Fovet
- CHU Lille, Pôle de Psychiatrie, unité CURE, 59000 Lille, France; Univ. Lille, CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), 59000 Lille, France
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Favril L, Wittouck C, Audenaert K, Vander Laenen F. A 17-Year National Study of Prison Suicides in Belgium. CRISIS 2018; 40:42-53. [PMID: 30052079 DOI: 10.1027/0227-5910/a000531] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Suicide is a leading cause of mortality in prisoners worldwide, yet empirical data on this matter are lacking in Belgium. AIMS This study sought to describe characteristics associated with a consecutive series of suicides in Belgian prisons from 2000 to 2016 inclusive, in order to inform suicide prevention strategies. METHOD All documented cases of suicide ( N = 262) were reviewed using a standardized assessment checklist. Official records were abstracted for prisoners' sociodemographic, criminological, and clinical information, as well as for suicide-related characteristics. RESULTS Over the 17-year study period, suicides accounted for one third of all deaths in Belgian prisons. The average annual suicide rate in Belgium from 2000 to 2016 was 156.2 per 100,000 prisoners. Examination of all cases highlights both individual (psychiatric disorders and a history of suicide attempt) and situational (the early period of incarceration, interfacility transfers, and placement in solitary confinement) factors common in many prison suicides; some of them amenable to (clinical) management, which presents several potential avenues for suicide prevention. LIMITATIONS Given the absence of a matched control group, no conclusions could be ascertained regarding risk factors. CONCLUSION Suicide is a common, preventable cause of death among prisoners in Belgium. The results underscore the timely need for national standards and guidelines for suicide prevention in Belgian prisons.
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Affiliation(s)
- Louis Favril
- 1 Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Belgium
| | - Ciska Wittouck
- 2 Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Kurt Audenaert
- 2 Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Freya Vander Laenen
- 1 Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Belgium
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19
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Sánchez FC, Fearn N, Vaughn MG. Risk Factors Associated With Near-Lethal Suicide Attempts During Incarceration Among Men in the Spanish Prison System. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2018; 62:1452-1473. [PMID: 28129703 DOI: 10.1177/0306624x16689833] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Studies conducted worldwide indicate that near-lethal suicide attempts are common among incarcerated populations. However, little research attention has been focused on the Spanish prison population. To address this gap in the literature, data were drawn from a sample of men ( N = 2,270) incarcerated in seven prisons in Spain. We compared sociodemographic, criminal/offense, health and mental health, and life events in prison variables between inmates who reported making near-lethal suicide attempts ( n = 616) and those who did not ( n = 1,654) during their current incarceration term. A series of binary and multiple logistic regression analyses indicated that a variety of variables were associated ( p values < .001) with near-lethal suicide attempts, including prior-to-prison employment status, family members in prison, recidivist in prison, childhood trauma, work status in prison, and disciplinary infractions. Our study findings are discussed in light of developing more effective strategies and prevention interventions to reduce attempted suicide in the Spanish Prison System.
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Fazel S, Ramesh T, Hawton K. Suicide in prisons: an international study of prevalence and contributory factors. Lancet Psychiatry 2017; 4:946-952. [PMID: 29179937 PMCID: PMC6066090 DOI: 10.1016/s2215-0366(17)30430-3] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prison suicide rates, rate ratios, and associations with prison-related factors need clarification and updating. We examined prison suicide rates in countries where reliable information was available, associations with a range of prison-service and health-service related factors, how these rates compared with the general population, and changes over the past decade. METHODS We collected data for prison suicides in 24 high-income countries in Europe, Australasia, and North America from their prison administrations for 2011-14 to calculate suicide rates and rate ratios compared with the general population. We used meta-regression to test associations with general population suicide rates, incarceration rates, and prison-related factors (overcrowding, ratio of prisoners to prison officers or health-care staff or education staff, daily spend, turnover, and imprisonment duration). We also examined temporal trends. FINDINGS 3906 prison suicides occurred during 2011-14 in the 24 high-income countries we studied. Where there was breakdown by sex (n=2810), 2607 (93%) were in men and 203 (7%) were in women. Nordic countries had the highest prison suicide rates of more than 100 suicides per 100 000 prisoners apart from Denmark (where it was 91 per 100 000), followed by western Europe where prison suicide rates in France and Belgium were more than 100 per 100 000 prisoners. Australasian and North American countries had rates ranging from 23 to 67 suicides per 100 000 prisoners. Rate ratios, or rates compared with those in the general population of the same sex and similar age, were typically higher than 3 in men and 9 in women. Higher incarceration rates were associated with lower prison suicide rates (b = -0·504, p = 0·014), which was attenuated when adjusting for prison-level variables. There were no associations between rates of prison suicide and general population suicide, any other tested prison-related factors, or differing criteria for defining suicide deaths. Changes in prison suicide rates over the past decade vary widely between countries. INTERPRETATION Many countries in northern and western Europe have prison suicide rates of more than 100 per 100 000 prisoners per year. Individual-level information about prisoner health is required to understand the substantial variations reported and changes over time. FUNDING Wellcome Trust and the UK National Institute for Health Research (NIHR).
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Affiliation(s)
- Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Taanvi Ramesh
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK
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21
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Favril L, Vander Laenen F, Vandeviver C, Audenaert K. Suicidal ideation while incarcerated: Prevalence and correlates in a large sample of male prisoners in Flanders, Belgium. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 55:19-28. [PMID: 29157508 DOI: 10.1016/j.ijlp.2017.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 09/05/2017] [Accepted: 10/03/2017] [Indexed: 05/22/2023]
Abstract
Prisoners constitute a high-risk group for suicide. As an early stage in the pathway leading to suicide, suicidal ideation represents an important target for prevention, yet research on this topic is scarce in general prison populations. Using a cross-sectional survey design, correlates of suicidal ideation while incarcerated were examined in a sample of 1203 male prisoners, randomly selected from 15 Flemish prisons. Overall, a lifetime history of suicidal ideation and attempts was endorsed by 43.1% and 20.3% of respondents, respectively. Approximately a quarter of all prisoners (23.7%) reported past-year suicidal ideation during their current incarceration, which was significantly associated with both imported vulnerabilities (psychiatric diagnoses and a history of attempted suicide) and variables unique to the prison experience (lack of working activity, exposure to suicidal behaviour by peers, and low levels of perceived autonomy, safety and social support) in the multivariate regression analysis. A first-ever period of imprisonment and a shorter length of incarceration (≤12months) were also associated with increased odds of recent suicidal ideation. Collectively, the current findings underscore the importance of both vulnerability factors and prison-specific stressors for suicidal ideation in prisoners, and hence the need for a multi-faceted approach to suicide prevention in custodial settings. In addition to the provision of appropriate mental health care, environmental interventions that target modifiable aspects of the prison regime could provide a substantial buffer for the onset and persistence of suicidal ideation in this at-risk population.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Belgium.
| | - Freya Vander Laenen
- Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Belgium
| | - Christophe Vandeviver
- Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Belgium
| | - Kurt Audenaert
- Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences, Ghent University, Belgium
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Bartoli C, Berland-Benhaim C, Tuchtan-Torrents L, Kintz P, Leonetti G, Pelissier-Alicot AL. Suicide by Medication Overdose in Prison: A Study of Three Cases. J Forensic Sci 2017; 63:1316-1320. [DOI: 10.1111/1556-4029.13671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Christophe Bartoli
- CNRS; EFS; ADES; Aix Marseille Univ; Marseille France
- Service de Médecine Légale; APHM, CHU Timone; Marseille France
| | | | - Lucile Tuchtan-Torrents
- CNRS; EFS; ADES; Aix Marseille Univ; Marseille France
- Service de Médecine Légale; APHM, CHU Timone; Marseille France
| | - Pascal Kintz
- X-Pertise Consulting; 84 route de Saverne 67205 Oberhausbergen France
- IML; Strasbourg France
| | - Georges Leonetti
- CNRS; EFS; ADES; Aix Marseille Univ; Marseille France
- Service de Médecine Légale; APHM, CHU Timone; Marseille France
| | - Anne-Laure Pelissier-Alicot
- Service de Médecine Légale; APHM, CHU Timone; Marseille France
- INSERM; INMED; 1 Aix Marseille Univ, CNRS, EFS, ADES; Marseille France
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Suicide of isolated inmates suffering from psychiatric disorders: when a preventive measure becomes punitive. Int J Legal Med 2017; 132:1225-1230. [DOI: 10.1007/s00414-017-1704-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Fjeldsted R, Teasdale TW, Jensen M, Erlangsen A. Suicide in Relation to the Experience of Stressful Life Events: A Population-Based Study. Arch Suicide Res 2017; 21:544-555. [PMID: 27849449 DOI: 10.1080/13811118.2016.1259596] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Stressful life events have been associated with high risk of suicidal behavior. The aim of this study was to examine whether persons who died by suicide in Denmark had more frequently been exposed to stressful life events, specifically divorce, death of a close relative, exposure to violence, and imprisonment, when compared to gender and age-matched controls. Data from Danish national registers were obtained for the period of 2000-2010 and a nested case-control design was applied. The association between exposure to stressful life events and suicide was examined using logistic regression analysis. In all, 7,115 suicides were identified during the 11 years of follow-up. For each of these, 20 age- and gender-matched controls were randomly selected (n = 142,300). Cases who died by suicide had an odds ratio of 9.3 (CI-95%: 7.8-11.0) of having been exposed to imprisonment five or more times when compared to controls. People who died by suicide had 1.5-fold (CI-95%: 1.3-1.6) higher risk of having experienced a divorce. Stressful life events, such as divorce and imprisonment, were more frequent in temporal proximity to the date of death among the suicide cases than for end of exposure for controls (p < .001 and p < .001, respectively). Our findings confirm that, using nationwide data, stressful life events are positively associated to subsequent suicide. Causal pathways linking the two may, however, be indirect.
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Ayhan G, Arnal R, Basurko C, About V, Pastre A, Pinganaud E, Sins D, Jehel L, Falissard B, Nacher M. Suicide risk among prisoners in French Guiana: prevalence and predictive factors. BMC Psychiatry 2017; 17:156. [PMID: 28464856 PMCID: PMC5414209 DOI: 10.1186/s12888-017-1320-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 04/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide rates in prison are high and their risk factors are incompletely understood. The objective of the present study is to measure the risk of suicide and its predictors in the only prison of multicultural French Guiana. METHODS All new prisoners arriving between September 2013 and December 2014 were included. The Mini International Neuropsychiatric Interview (MINI) was used and socio-demographic data was collected. In order to identify the predictors of suicide risk multivariate logistic regression was used. RESULTS Of the 707 prisoners included 13.2% had a suicidal risk, 14.0% of whom had a high risk, 15.1% a moderate risk and 41.9% a low risk. Predictive factors were depression (OR 7.44, 95% CI: 3.50-15.87), dysthymia (OR 4.22, 95% CI: 1.34-13.36), panic disorder (OR 3.47, 95% CI: 1.33-8.99), general anxiety disorder (GAD) (OR 2.19, 95% CI: 1.13-4.22), men having been abused during childhood (OR 21.01, 95%, CI: 3.26-135.48), having been sentenced for sexual assault (OR 7.12, 95% CI: 1.98-25.99) and smoking (OR 2.93, 95%, CI 1.30-6.63). CONCLUSION The suicide risk was lower than in mainland France, possibly reflecting the differences in the social stigma attached to incarceration because of migrant populations and the importance and trivialization of drug trafficking among detainees. However, there were no differences between nationalities. The results reemphasize the importance of promptly identifying and treating psychiatric disorders, which were the main suicide risk factors.
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Affiliation(s)
- Gülen Ayhan
- Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Avenue des Flamboyants, BP 6006, 97 306, Cayenne CEDEX, France.
| | - Romain Arnal
- Centre d’Investigation Clinique Antilles-Guyane, CIC INSERM 1424, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana France
| | - Célia Basurko
- Inserm CIC 1424, Centre d’Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Avenue des Flamboyants, BP 6006, 97 306 Cayenne CEDEX, France
| | - Vincent About
- Unité de Soins et de Consultations Ambulatoires, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana France
| | - Agathe Pastre
- Unité de Soins et de Consultations Ambulatoires, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana France
| | - Eric Pinganaud
- Centre d’Investigation Clinique Antilles-Guyane, CIC INSERM 1424, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana France
| | - Dominique Sins
- Centre d’Investigation Clinique Antilles-Guyane, CIC INSERM 1424, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana France
| | - Louis Jehel
- Équipe IPSOM, INSERM 1178, Paris, France ,Department of Psychiatry, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique France
| | | | - Mathieu Nacher
- Inserm CIC 1424, Centre d’Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Avenue des Flamboyants, BP 6006, 97 306 Cayenne CEDEX, France ,EA3593, Université de Guyane, Cayenne, French Guiana France
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Krüger S, Priebe S, Fritsch R, Mundt AP. Burden of separation and suicide risk of prisoners with minor children. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 52:55-61. [PMID: 28395894 DOI: 10.1016/j.ijlp.2017.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 02/06/2017] [Accepted: 03/23/2017] [Indexed: 06/07/2023]
Abstract
The present study aimed to explore the burden of separation from children and its relationship with suicide risk in prisoners with minor children at the moment of admission into the penal justice system. Suicide risk was assessed using the Mini International Neuropsychiatric Interview in newly admitted female (n=198) and male (n=229) prisoners in Santiago de Chile. The burden of separation from minor children was rated on a numeric rating scale. Both genders showed high burden of separation from children at imprisonment. Mothers had significantly lower suicide risk than women without children. The relative risk was 0.31 (95% CI [0.16-0.6], p<0.001) to show 'high suicide risk'. There was no difference of suicide risk between imprisoned fathers and male prisoners without children. Within the group of fathers, the suicide risk associated with the burden of separation. Our study indicates that strengthening the parent role and facilitating parent-child contacts during imprisonment could be an important element of suicide prevention interventions.
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Affiliation(s)
- Sinja Krüger
- Klinik für Psychiatrie und Psychotherapie, Charité Campus Mitte Universitätsmedizin Berlin, Germany; Departamento de Psiquiatría y Salud Mental, Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, UK
| | - Rosemarie Fritsch
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Adrian P Mundt
- Facultad de Medicina, Universidad Diego Portales, Chile; Facultad de Medicina, Universidad San Sebastián, Chile.
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Fazel S, Hayes AJ, Bartellas K, Clerici M, Trestman R. Mental health of prisoners: prevalence, adverse outcomes, and interventions. Lancet Psychiatry 2016; 3:871-81. [PMID: 27426440 PMCID: PMC5008459 DOI: 10.1016/s2215-0366(16)30142-0] [Citation(s) in RCA: 395] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/18/2016] [Accepted: 06/10/2016] [Indexed: 11/15/2022]
Abstract
More than 10 million people are imprisoned worldwide, and the prevalence of all investigated mental disorders is higher in prisoners than in the general population. Although the extent to which prison increases the incidence of mental disorders is uncertain, considerable evidence suggests low rates of identification and treatment of psychiatric disorders. Prisoners are also at increased risk of all-cause mortality, suicide, self-harm, violence, and victimisation, and research has outlined some modifiable risk factors. Few high quality treatment trials have been done on psychiatric disorders in prisoners. Despite this lack of evidence, trial data have shown that opiate substitution treatments reduce substance misuse relapse and possibly reoffending. The mental health needs of women and older adults in prison are distinct, and national policies should be developed to meet these. In this Review, we present clinical, research, and policy recommendations to improve mental health care in prisons. National attempts to meet these recommendations should be annually surveyed.
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Affiliation(s)
- Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
| | - Adrian J Hayes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Katrina Bartellas
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Massimo Clerici
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Robert Trestman
- Correctional Managed Health Care, University of Connecticut Health Center, Farmington, CT, USA
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Early Loss of Blood-Brain Barrier Integrity Precedes NOX2 Elevation in the Prefrontal Cortex of an Animal Model of Psychosis. Mol Neurobiol 2016; 54:2031-2044. [PMID: 26910819 PMCID: PMC5355521 DOI: 10.1007/s12035-016-9791-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/11/2016] [Indexed: 12/29/2022]
Abstract
The social isolation rearing of young adult rats is a model of psychosocial stress and provides a nonpharmacological tool to study alterations reminiscent of symptoms seen in psychosis. We have previously demonstrated that social isolation in rats leads to increased oxidative stress and to cerebral NOX2 elevations. Here, we investigated early alterations in mRNA expression leading to increased NOX2 in the brain. Rats were exposed to a short period of social isolation (1 week) and real-time polymerase chain reaction (PCR) for mRNA expression of genes involved in blood-brain barrier (BBB) formation and integrity (ORLs, Vof 21 and Vof 16, Leng8, Vnr1, and Trank 1 genes) was performed. Real-time PCR experiments, immunohistochemistry, and Western blotting analysis showed an increased expression of these genes and related proteins in isolated rats with respect to control animals. The expression of specific markers of BBB integrity, such as matrix metalloproteinase 2 (MMP2), matrix metalloproteinase 9 (MMP9), occludin 1, and plasmalemmal vesicle associated protein-1 (PV-1), was also significantly altered after 1 week of social isolation. BBB permeability, evaluated by quantification of Evans blue dye extravasation, as well as interstitial fluid, was significantly increased in rats isolated for 1 week with respect to controls. Isolation-induced BBB disruption was also accompanied by a significant increase of Interleukin 6 (IL-6) expression. Conversely, no differences in NOX2 levels were detected at this time point. Our study demonstrates that BBB disruption precedes NOX2 elevations in the brain. These results provide new insights in the interplay of mechanisms linking psychosocial stress to early oxidative stress in the brain, disruption of the BBB, and the development of mental disorders.
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Psychiatrie en milieu pénitentiaire : une sémiologie à part ? ANNALES MEDICO-PSYCHOLOGIQUES 2015. [DOI: 10.1016/j.amp.2015.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gherman C, Chiroban O. Causes of death among detainees: a statistical study on the casework of the Forensic Medicine Institute in Cluj-Napoca during the period 2000-2014. ACTA ACUST UNITED AC 2015; 88:314-20. [PMID: 26609263 PMCID: PMC4632889 DOI: 10.15386/cjmed-444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/23/2015] [Indexed: 11/23/2022]
Abstract
Background and aims The detainees’ right to healthcare is granted by laws, in accordance with EU directives and recommendations to which our country has consented. Prison population is a particularly vulnerable and marginalized group characterized by mortality rates different from the general population. This study aims at providing a picture of the causes of death, quality of healthcare and measures needed to reduce the number of in-prison deaths, including legal medicine expertise in view of sentence postponement/interruption. Methods The present paper is based on the statistical analysis of in-prison deaths casework recorded at the Forensic Medicine Institute of Cluj-Napoca and provided by territorially subordinated counties forensic services. The data collected cover over 15 years (2000–2014), a period long enough for significant retrospective statistical analysis. Results The total number of deaths among the inmates was 113, the majority of male sex (110). Distribution by age groups shows a greater incidence among inmates aged 50 to 59 years (32 cases, 28.31%), followed by those in their 40s’ (30 cases, 26.54%) and 30s’ (25 cases, 22.12%). The most frequent pathological causes of death were cardiovascular (53 cases) followed by tumors (26 cases) and infectious diseases. A significant number of deaths were due to violent causes (14 cases-12,38%). Conclusions Special problems are raised by the high number of deaths among prisoners, especially at a young age, while the high frequency of violent deaths from self- or non-self-inflicted traumatic causes requires supervision, monitoring and continuous analysis. Despite recent improvements, healthcare in prisons still poses some problems, mainly regarding diagnosis and treatment of heart diseases, neurosurgery and cancer.
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Affiliation(s)
- Cristian Gherman
- Department of Community Medicine, Forensic Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ovidiu Chiroban
- Department of Community Medicine, Forensic Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Duthé G, Hazard A, Kensey A. Suicide des personnes écrouées en France : évolution et facteurs de risque. POPULATION 2014. [DOI: 10.3917/popu.1404.0519] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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