Body pack in sick bodies: a retrospective study of somatic and psychiatric comorbidities among body-packers

PURPOSE

Body-packing means concealing packets of illicit psychoactive substances in the digestive or genital system. The purpose of this paper is to investigate profiles of body-packers and comorbidities associated with body-packing.

DESIGN/METHODOLOGY/APPROACH

A retrospective study (2005-2016) was conducted among all patients hospitalized for suspicion of body-packing in the Geneva hospital prison unit (n=287). Data were extracted from medical records and included demographics, somatic/psychiatric diseases, suicidal ideation and psychological distress.

FINDINGS

Body-packers were mostly young men (mean age=33.4). A total of 42.2 percent of the participants had at least one psychiatric or somatic comorbidity reported during incarceration (somatic: 28.2 percent, psychiatric: 18.8 percent). The most frequent somatic diseases were infectious (10.5 percent), cardiovascular (10.1 percent), and endocrinological (4.2 percent) diseases, and more precisely HIV (4.5 percent), hepatitis B (3.5 percent), hepatitis C (1.4 percent), high blood pressure (8.0 percent) and diabetes (4.2 percent). The most frequent psychiatric conditions were substance use disorders (10.5 percent) and mood disorders (8.0 percent). Depressed mood/psychological distress and suicidal ideation were frequently reported during hospitalization (27.2/6.6 percent). Comorbidities were associated with demographics: Females were more likely to have somatic and psychiatric diseases detected during hospitalization in detention and participants from Western, educated, industrialized, rich and democratic countries were more likely to report diseases known before detention.

ORIGINALITY/VALUE

Body-packers bear a heavy burden of disease and psychological distress. This vulnerable subgroup of incarcerated people has been overlooked in previous research and their health needs are not correctly understood. This study was a first step to improve their health care and reintegration.

Suicide Screening Tools for use in Incarcerated Offenders: A Systematic Review

Self-inflicted deaths in prisons in England and Wales, recently reported as the highest in over a decade, are a significant cause of mortality. A lack of guidelines surrounding the screening and identification of suicide risk of new prisoners along with a dearth of effective screening tools indicate the need for review. Our aims are to examine findings on the effectiveness of prison specific suicide screening tools used with adult prisoners. Papers were identified via systematic searches of databases, scanning grey literature, and reference checking. Included studies were published over the period between 2000-2016. PRISMA guidelines were followed. Studies were selected based on population - adult imprisoned offenders; intervention - suicide screening tool; comparators - participants screened vs. not screened outcome - suicide or attempted suicide. Data was extracted manually. A narrative synthesis presented the findings between different screening tools. Eight screening tools were critically appraised. Evidence suggested that the VISCI and Dutch screening tools are most effective in identifying those at risk and reducing suicide and/or self-harm behavior. Variance in methodological quality and associated factors indicate the need for further development of prospective studies to develop robust screening tools. This study is registered with PROSPERO (CRD42016035471).

Association of Overcrowding and Turnover with Self-Harm in a Swiss Pre-Trial Prison

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.

Suicide in Illinois, 2005-2010: A reflection of patterns and risks by age groups and opportunities for targeted prevention

BACKGROUND

Suicide accounts for two thirds of all deaths from intentional or violence-related injury and is a leading cause of death in the United States. Patterns of suicide have been well described among high-risk groups, but few studies have compared the circumstances related to suicides across all age groups. We sought to understand the epidemiology of suicide cases in Illinois and to characterize the risks and patterns for suicide among different age groups.

METHODS

We used suicide data collected from the Illinois Violent Death Reporting System to assess demographics, method of suicide, circumstances, and mental health status among different age groups.

RESULTS

Between 2005 and 2010, 3,016 suicides were reported; 692 (23%) were female, and the median age (n = 3,013) was 45 years (range, 10-98 years). The most common method/weapon types were hanging/strangulation (33%), firearm (32%) and poisoning (21%). Hanging was more common (74%) among young people aged 10 to 19 years, while firearm use was more common among elderly persons age 65 years and older (55%). The percentage of victims within an age group experiencing a crisis within two weeks before committing suicide was highest among 10- to 14-year-olds, while the risk factor of having a family member or friend die in the past 5 years was highest among older victims.

CONCLUSION

The final analysis demonstrated age-related trends in suicide in Illinois, suggesting prevention programs should tailor services by age.

LEVEL OF EVIDENCE

Epidemiologic study, level IV.