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Kappes JR, Huber DA, Kirchebner J, Sonnweber M, Günther MP, Lau S. Self-Harm Among Forensic Psychiatric Inpatients With Schizophrenia Spectrum Disorders: An Explorative Analysis. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:352-372. [PMID: 34861802 DOI: 10.1177/0306624x211062139] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The burden of self-injury among offenders undergoing inpatient treatment in forensic psychiatry is substantial. This exploratory study aims to add to the previously sparse literature on the correlates of self-injury in inpatient forensic patients with schizophrenia spectrum disorders (SSD). Employing a sample of 356 inpatients with SSD treated in a Swiss forensic psychiatry hospital, patient data on 512 potential predictor variables were retrospectively collected via file analysis. The dataset was examined using supervised machine learning to distinguish between patients who had engaged in self-injurious behavior during forensic hospitalization and those who had not. Based on a combination of ten variables, including psychiatric history, criminal history, psychopathology, and pharmacotherapy, the final machine learning model was able to discriminate between self-injury and no self-injury with a balanced accuracy of 68% and a predictive power of AUC = 71%. Results suggest that forensic psychiatric patients with SSD who self-injured were younger both at the time of onset and at the time of first entry into the federal criminal record. They exhibited more severe psychopathological symptoms at the time of admission, including higher levels of depression and anxiety and greater difficulty with abstract reasoning. Of all the predictors identified, symptoms of depression and anxiety may be the most promising treatment targets for the prevention of self-injury in inpatient forensic patients with SSD due to their modifiability and should be further substantiated in future studies.
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Affiliation(s)
| | | | | | | | | | - Steffen Lau
- Psychiatric University Hospital Zurich, Switzerland
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2
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Young JT, Borschmann R, Heffernan E, Spittal MJ, Brophy L, Ogloff JRP, Moran P, Armstrong G, Preen DB, Kinner SA. Contact with Mental Health Services After Acute Care for Self-Harm Among Adults Released from Prison: A Prospective Data Linkage Study. Suicide Life Threat Behav 2020; 50:990-1006. [PMID: 32359122 DOI: 10.1111/sltb.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the care pathway and rate and predictors of mental health care contact within seven days of discharge from acute care following self-harm. METHOD In a representative cohort of adults released from prisons in Queensland, Australia, we probabilistically linked person-level, statewide ambulance, emergency department, and hospital records, both prospectively and retrospectively, and community mental health service and Medicare records prospectively, to baseline survey data. We fit multivariate modified log-linked Poisson regression models to examine the association between sociodemographic, health, and criminal justice factors and mental health care contact after self-harm. RESULTS Of 217 discharges from acute care following self-harm, 55% (n = 119) received mental health care within seven days of discharge. Mental health care contact was associated with substance use disorder (adjusted relative risk (ARR) = 0.48; 95% CI: 0.27-0.85), dual diagnosis (ARR = 0.58; 95% CI: 0.41-0.82), physical health-related functioning (ARR = 0.98; 95% CI: 0.97-0.99), being female (ARR = 1.39; 95% CI: 1.02-1.90), being identified as at risk of self-harm by correctional authorities (ARR = 1.50; 95% CI: 1.07-2.09), and prior engagement with state-funded mental health care (ARR = 1.55; 95% CI: 1.08-2.22). CONCLUSION Our findings highlight the need to improve the integration of community mental health care for people who present to acute care following self-harm with a recent history of incarceration, particularly for men and those with substance use disorder or dual diagnosis.
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Affiliation(s)
- Jesse T Young
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Vic., Australia.,School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Rohan Borschmann
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Vic., Australia.,Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry, The University of Melbourne, Parkville, Vic., Australia
| | - Ed Heffernan
- School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia
| | - Lisa Brophy
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Mind Australia, Heidelberg, Vic., Australia.,School of Allied Health, La Trobe University, Bundoora, Vic., Australia
| | - James R P Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology & Victorian Institute of Forensic Mental Health, Alphington, Vic., Australia
| | - Paul Moran
- Department of Population Health Sciences, Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gregory Armstrong
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Stuart A Kinner
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Vic., Australia.,Mater Research Institute-UQ, University of Queensland, South Brisbane, Qld, Australia.,Griffith Criminology Institute, Griffith University, Mt Gravatt, Qld, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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3
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Ford K, Bellis MA, Hughes K, Barton ER, Newbury A. Adverse childhood experiences: a retrospective study to understand their associations with lifetime mental health diagnosis, self-harm or suicide attempt, and current low mental wellbeing in a male Welsh prison population. HEALTH & JUSTICE 2020; 8:13. [PMID: 32533348 PMCID: PMC7291757 DOI: 10.1186/s40352-020-00115-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 05/31/2020] [Indexed: 06/03/2023]
Abstract
BACKGROUND Prisoners are at increased risk of poor mental health and self-harming behaviours, with suicide being the leading cause of death in custody. Adverse childhood experiences (ACEs) such as child maltreatment are strong predictors of poor mental health and wellbeing yet despite high levels of ACEs in offender populations, relatively few studies have explored the relationships between ACEs and prisoners' mental health and wellbeing. We conducted an ACE survey with 468 male adult prisoners in a Welsh prison who were not currently considered to be at risk of self-harm and suicide and explored relationships between ACEs, lifetime mental illness diagnosis, self-harm (lifetime and lifetime in prison) or suicide attempt (lifetime and lifetime in prison), and current low mental wellbeing. RESULTS Most participants (84.2%) had suffered at least one ACE and 45.5% had suffered ≥4 ACEs. Prevalence of lifetime mental illness diagnosis, self-harm (lifetime and lifetime in prison) or suicide attempt (lifetime and lifetime in prison), and current low mental wellbeing increased with exposure to ACEs. For example, 2.7% of those with no ACEs reported lifetime self-harm or suicide attempt in prison compared with 31.0% (self-harm in prison) and 18.3% (suicide attempt in prison) of those with ≥4 ACEs. Compared with participants with no ACEs, those with ≥4 ACEs were four times more likely to report lifetime mental illness diagnosis and suicide attempt, and over 10 times more likely to report lifetime self-harm than those with no ACEs. Independent of lifetime mental illness diagnosis, self-harm or suicide attempt, participants with ≥4 ACEs were almost three times more likely to have current low mental wellbeing than those with no ACEs. CONCLUSIONS Male prisoners that have suffered multiple ACEs are substantially more likely to have lifetime mental illness diagnosis, self-harm or suicide attempt, and to have current low mental wellbeing whilst in prison. Findings suggest that trauma-informed approaches are needed in prisons to support prisoner mental health and wellbeing.
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Affiliation(s)
- Kat Ford
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP UK
| | - Mark A. Bellis
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP UK
- World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Policy and International Health Directorate, Public Health Wales, Wrexham, LL13 7YP UK
| | - Karen Hughes
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP UK
- World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Policy and International Health Directorate, Public Health Wales, Wrexham, LL13 7YP UK
| | - Emma R. Barton
- World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Policy and International Health Directorate, Public Health Wales, Wrexham, LL13 7YP UK
| | - Annemarie Newbury
- World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Policy and International Health Directorate, Public Health Wales, Wrexham, LL13 7YP UK
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Ryland H, Gould C, McGeorge T, Hawton K, Fazel S. Predicting self-harm in prisoners: Risk factors and a prognostic model in a cohort of 542 prison entrants. Eur Psychiatry 2020; 63:e42. [PMID: 32342827 PMCID: PMC7242092 DOI: 10.1192/j.eurpsy.2020.40] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background. Self-harm is common in prisoners. There is an association between self-harm in prisoners and subsequent suicide, both within prison and on release. The aim of this study is to develop and evaluate a prediction model to identify male prisoners at high risk of self-harm. Methods. We developed an 11-item screening model, based on risk factors identified from the literature. This screen was administered to 542 prisoners within 7 days of arrival in two male prisons in England. Participants were followed up for 6 months to identify those who subsequently self-harmed in prison. Analysis was conducted using Cox proportional hazard regression. Discrimination and calibration were determined for the model. The model was subsequently optimized using multivariable analysis, weighting variables, and dropping poorly performing items. Results. Seventeen (3.1%) of the participants self-harmed during follow up (median 53 days). The strongest risk factors were previous self-harm in prison (adjusted hazard ratio [aHR] = 9.3 [95% CI: 3.3–16.6]) and current suicidal ideation (aHR = 7.6 [2.1–27.4]). As a continuous score, a one-point increase in the suicide screen was significantly associated with self-harm (HR = 1.4, 1.1–1.7). At the prespecified cut off score of 5, the screening model was associated with an area under the curve (AUC) of 0.66 (0.53–0.79), with poor calibration. The optimized model saw two items dropped from the original screening tool, weighting of risk factors based on a multivariable model, and an AUC of 0.84 (0.76–0.92). Conclusions. Further work is necessary to clarify the association between risk factors and self-harm in prison. Despite good face validity, current screening tools for self-harm need validation in new prison samples.
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Affiliation(s)
- Howard Ryland
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | | | - Keith Hawton
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Cumming C, Kinner SA, McKetin R, Li I, Preen D. Methamphetamine use, health and criminal justice system outcomes: A systematic review. Drug Alcohol Rev 2020; 39:505-518. [DOI: 10.1111/dar.13062] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Craig Cumming
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western Australia Perth Australia
| | - Stuart A. Kinner
- Centre for Adolescent HealthMurdoch Children's Research Institute Melbourne Australia
- Melbourne School of Population and Global HealthThe University of Melbourne Melbourne Australia
- Griffith Criminology InstituteGriffith University Brisbane Australia
- School of Public Health and Preventive MedicineMonash University Melbourne Australia
- Mater Research Institute‐UQUniversity of Queensland Brisbane Australia
| | - Rebecca McKetin
- National Drug and Alcohol Research CentreUNSW Sydney Sydney Australia
| | - Ian Li
- School of Population and Global HealthUniversity of Western Australia Perth Australia
| | - David Preen
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western Australia Perth Australia
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Incidence and general hospital costs of self-harm across England: estimates based on the multicentre study of self-harm. Epidemiol Psychiatr Sci 2020; 29:e108. [PMID: 32160934 PMCID: PMC7214546 DOI: 10.1017/s2045796020000189] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS The aim of this study was to estimate incidence of self-harm presentations to hospitals and their associated hospital costs across England. METHODS We used individual patient data from the Multicentre Study of Self-harm in England of all self-harm presentations to the emergency departments of five general hospitals in Oxford, Manchester and Derby in 2013. We also obtained cost data for each self-harm presentation from the hospitals in Oxford and Derby, as well as population and geographical estimates from the Office for National Statistics. First, we estimated the rate of self-harm presentations by age and gender in the Multicentre Study and multiplied this with the respective populations to estimate the number of self-harm presentations by age and gender for each local Clinical Commissioning Group (CCG) area in England. Second, we performed a regression analysis on the cost data from Oxford and Derby to predict the hospital costs of self-harm in Manchester by age, gender, receipt of psychosocial assessment, hospital admission and type of self-harm. Third, the mean hospital cost per age year and gender were combined with the respective number of self-harm presentations to estimate the total hospital costs for each CCG in England. Sensitivity analysis was performed to address uncertainty in the results due to the extrapolation of self-harm incidence and cost from the Multicentre Study to England. RESULTS There were 228 075 estimated self-harm presentations (61% were female) by 159 857 patients in 2013 in England. The largest proportions of self-harm presentations were in the age group 40-49 years (30%) for men and 19-29 years (28%) for women. Associated hospital costs were approximately £128.6 (95% CI 117.8-140.9) million in 2013. The estimated incidence of self-harm and associated hospital costs were lower in the majority of English coastal areas compared to inland regions but the highest costs were in Greater London. Costs were also higher in more socio-economically deprived areas of the country compared with areas that are more affluent. The sensitivity analyses provided similar results. CONCLUSIONS The results of this study highlight the extent, hospital costs and distribution of self-harm presentations to hospitals in England and identify potential sub-populations that might benefit from targeted actions to help prevent self-harm and assist those who have self-harmed. They can support national as well as local health stakeholders in allocating funds and prioritising interventions in areas with the greatest need for preventing and managing self-harm.
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Bedell PS, So M, Morse DS, Kinner SA, Ferguson WJ, Spaulding AC. Corrections for Academic Medicine: The Importance of Using Person-First Language for Individuals Who Have Experienced Incarceration. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:172-175. [PMID: 30699100 DOI: 10.1097/acm.0000000000002501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This Invited Commentary addresses the use of labels and their impact on people involved in the criminal justice system. There are 2.2 million adults incarcerated in the United States and close to 6.6 million under correctional supervision on any day. Many of these people experience health inequalities and inadequate health care both in and out of correctional facilities. These numbers are reason enough to raise alarm among health care providers and criminal justice researchers about the need to conceptualize better ways to administer health care for these individuals. Using terms like "convict," "prisoner," "parolee," and "offender" to describe these individuals increases the stigma that they already face. The authors propose that employing person-first language for justice-involved individuals would help to reduce the stigma they face during incarceration and after they are released. Coordinated, dignified, and multidisciplinary care is essential for this population given the high rates of morbidity and mortality they experience both in and out of custody and the many barriers that impede their successful integration with families and communities. Academic medicine can begin to address the mistrust that formerly incarcerated individuals often have toward the health care system by using the humanizing labels recommended in this Invited Commentary.
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Affiliation(s)
- Precious S Bedell
- P.S. Bedell is research coordinator II, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, doctoral student, Warner School of Education and Human Development, and Diversity and Inclusive Climate Leadership Fellowship Fellow 2018-2020, University of Rochester, Rochester, New York. M. So is research assistant, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia; ORCID: https://orcid.org/0000-0002-3639-0472. D.S. Morse is associate professor of psychiatry and medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York. S.A. Kinner is National Health and Medical Research Council Research Fellow and Group Leader, Justice Health, Centre for Adolescent Health, Murdoch Children's Research Institute, and head, Justice Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia; ORCID: https://orcid.org/0000-0003-3956-5343. W.J. Ferguson is professor of family medicine and community health and director of academic programs, Health and Criminal Justice Program, University of Massachusetts Medical School, Worcester, Massachusetts. A.C. Spaulding is associate professor of epidemiology, Rollins School of Public Health, and medicine (joint), Emory University School of Medicine, and adjunct associate professor of medicine, Morehouse School of Medicine, Atlanta, Georgia
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8
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Butler A, Young JT, Kinner SA, Borschmann R. Self-harm and suicidal behaviour among incarcerated adults in the Australian Capital Territory. HEALTH & JUSTICE 2018; 6:13. [PMID: 30109499 PMCID: PMC6091405 DOI: 10.1186/s40352-018-0071-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/03/2018] [Indexed: 06/03/2023]
Abstract
BACKGROUND Suicide is the leading cause of death in prisons worldwide. Improved understanding of the factors associated with suicide is necessary to inform targeted suicide prevention and interventions. Here we aim to (a) document the prevalence of suicide attempts, suicidal ideation, self-harm, and mental disorder; and (b) identify demographic, mental health, and criminal justice correlates of suicidal ideation, in a sample of incarcerated adults in Australia. METHODS Data were obtained from the 2016 Detainee Health and Wellbeing Survey conducted in the Alexander Maconochie Centre, the Australian Capital Territory's only adult prison. Interviews with 98 incarcerated adults were conducted in October 2016. Descriptive statistics were calculated for all measures. Crude differences between participants who reported experiencing suicidal ideation in their lifetime and those who did not were compared using Fisher's exact test. RESULTS Nearly half of the participants (48%, n = 47) reported lifetime suicidal ideation and 31% (n = 30) reported attempting suicide at some point in their lives. Eighteen participants (18%) reported a lifetime history of having engaged in self-harm. Factors significantly associated with suicidal ideation included lifetime history of mental disorder, self-harm, experiencing a drug overdose, and being hospitalized in the past 12 months. CONCLUSION The burden of suicidal ideation and prior suicide attempts among people in prison is substantial. Incarceration is a pivotal opportunity to identify people with a history of mental health problems and target interventions aimed at reducing adverse outcomes including suicide mortality.
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Affiliation(s)
- Amanda Butler
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC Canada
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jesse T. Young
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Stuart A. Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Australia
- Griffith Criminology Institute, Griffith University, Mt Gravatt, Australia
- Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rohan Borschmann
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Australia
- Health Service and Population Research Department; Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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Baggio S, Gétaz L, Tran NT, Peigné N, Chacowry Pala K, Golay D, Heller P, Bodenmann P, Wolff H. Association of Overcrowding and Turnover with Self-Harm in a Swiss Pre-Trial Prison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040601. [PMID: 29584625 PMCID: PMC5923643 DOI: 10.3390/ijerph15040601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 11/16/2022]
Abstract
Self-harm is a common issue in detention and includes both suicidal and non-suicidal behaviours. Beyond well-known individual risk factors, institutional factors such as overcrowding (i.e., when the prison population exceeds its capacity) and turnover (i.e., the rate at which the prison population is renewed), may also increase the risk of self-harm. However, these factors are understudied or previous studies reported inconsistent findings. This study investigated the association of self-harm with overcrowding and turnover in the largest pre-trial Swiss prison in Geneva. Data were collected yearly between 2011 and 2017. Measures included self-harm (all kinds of self-injuring acts requiring medical attention, including self-strangulations and self-hangings). We performed meta-regressions to analyse the relationships between self-harm and institutional factors. Self-harm events were frequent, with a prevalence estimate of 26.4%. Overcrowding and turnover were high (average occupation rate of 177% and average turnover of 73%, respectively). Overcrowding and turnover were significantly associated with self-harm (respectively b = 0.068, p < 0.001 and (b = 1.257, p < 0.001). In both cases, self-harm was higher when overcrowding and turnover increased. Overcrowding and turnover raise important human rights concerns and have damaging effects on the health of people living in detention. Identification of and care for this vulnerable population at risk of self-harm are needed and institutional factors should be addressed.
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Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals & University of Geneva, 1225 Geneva, Switzerland.
- Life Course and Inequality Research Centre, University of Lausanne, 1015 Lausanne, Switzerland.
| | - Laurent Gétaz
- Division of Prison Health, Geneva University Hospitals & University of Geneva, 1225 Geneva, Switzerland.
| | - Nguyen Toan Tran
- Division of Prison Health, Geneva University Hospitals & University of Geneva, 1225 Geneva, Switzerland.
- Australian Centre for Public Population Health Research, Faculty of Health, University of Technology, 2007 Sydney, Australia.
| | - Nicolas Peigné
- Division of Prison Health, Geneva University Hospitals & University of Geneva, 1225 Geneva, Switzerland.
| | - Komal Chacowry Pala
- Division of Prison Health, Geneva University Hospitals & University of Geneva, 1225 Geneva, Switzerland.
| | - Diane Golay
- Division of Prison Health, Geneva University Hospitals & University of Geneva, 1225 Geneva, Switzerland.
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals & University of Geneva, 1225 Geneva, Switzerland.
| | - Patrick Bodenmann
- Vulnerable Population Center, Department of Ambulatory Care and Community Medicine, Lausanne University Hospital & University of Lausanne, 1011 Lausanne, Switzerland.
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals & University of Geneva, 1225 Geneva, Switzerland.
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