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Mundt AP, Cifuentes-Gramajo PA, Baranyi G, Fazel S. Worldwide incidence of suicides in prison: a systematic review with meta-regression analyses. Lancet Psychiatry 2024; 11:536-544. [PMID: 38823401 DOI: 10.1016/s2215-0366(24)00134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Suicide is a leading cause of death during imprisonment. This systematic review aimed to synthesise available evidence of prison suicide incidence worldwide. METHODS We systematically searched the scientific literature, data repositories, and prison system reports, supplemented by correspondence with prison administrations. We included reports on people living in prison but excluded studies in preselected groups (by age or offence type). Absolute numbers and incidence rates of suicide mortality per 100 000 person-years by sex and country were extracted from 2000 to 2021. IQRs were used to describe the suicide incidence in different world regions. Incidence rate ratios comparing suicides of people living in prison with age-standardised general populations were calculated. We conducted meta-regression analyses on national-level and prison-level factors to examine heterogeneity. The study protocol was pre-registered with PROSPERO, CRD42021296819. FINDINGS We included three scientific studies, 124 official reports, and 11 datasets from email correspondence. Between 2000 and 2021, there were 29 711 reported suicides during 91·2 million person-years of imprisonment in 82 jurisdictions worldwide (sex-specific data available for 13 289 individuals: 12 544 [94·4%] male and 745 [5·6%] female individuals). There were large variations between countries, with most studies reporting suicide rates in the range of 24-89 per 100 000 person-years in both sexes (22-86 in male individuals and 25-107 in female individuals). In meta-regression analyses, Europe (vs other regions), high-income countries (vs low-income and middle-income countries), and countries with lower incarceration rates (vs those with higher incarceration rates) had higher suicide rates. Incidence rate ratios between people who are incarcerated and age-standardised general populations in the same jurisdictions were typically in the range of 1·9-6·0 in male and 10·4-32·4 in female individuals. INTERPRETATION Prison services worldwide, and particularly in Europe, should prioritise suicide prevention. Assessment and management of suicide risk in female individuals living in prison need particular attention due to excess mortality relative to community-based populations. Interpretation of synthesised data needs to be done with caution due to high heterogeneity between jurisdictions. FUNDING Agencia Nacional de Investigación y Desarrollo, Economic and Social Research Council, and Wellcome Trust.
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Affiliation(s)
- Adrian P Mundt
- Facultad de Medicina, Universidad Diego Portales, Santiago, Chile; Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Pablo A Cifuentes-Gramajo
- Doctorado en Psicoterapia, Medical Faculties and Faculties of Social Sciences, Universidad de Chile and Pontificia Universidad Católica de Chile, Quetzaltenango, Guatemala; Dirección General del Sistema de Investigación, Centro Universitario de Occidente, Universidad de San Carlos de Guatemala, Quetzaltenango, Guatemala
| | - Gergő Baranyi
- Centre for Research on Environment, Society and Health, University of Edinburgh, Edinburgh, UK; Centre for Longitudinal Studies, Institute of Education, University College London, London, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
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Zielinski MJ, Jahangir T, Praseuth A, Wilson S, McLaughlan CL. Mental Health, Drug Use, and Programming: Applying a Needs Assessment Framework in Arkansas' Largest Jail. JOURNAL OF CORRECTIONAL HEALTH CARE 2024; 30:206-215. [PMID: 38842733 DOI: 10.1089/jchc.23.12.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Jail programming is rarely informed by site-specific health needs, diagnostic-specific screening tools that are validated, or the input of incarcerated individuals. Using the community needs assessment (CNA) framework, we aimed to fill these gaps among people incarcerated in the Pulaski County Regional Detention Facility (PCRDF), Arkansas' largest jail. Participants were 179 adults at the PCRDF who completed surveys and open-ended questions focused on (a) their mental and behavioral health and (b) programming needs at the facility. Using a concurrent transformative mixed-methods design, we descriptively analyzed surveys and conducted content analysis of the open-ended questions. Over half of participants reported clinically significant anxiety (62.6%), post-traumatic stress disorder (53.1%), and/or depression (50.3%) symptoms; positive substance use disorder screening was especially common (91.7%). Nearly all (97%) individuals queried desired more programming, with the most desired being mental health and substance use programs. Other desired programs included physical health, education, community reintegration, family support, recreation, nutrition, religious/spiritual services, and meditation. Our CNA ensured the input of those directly impacted during program-focused decision making and identified strategies to effectively implement and sustain jail-based programs. Such assessments can be a potential mechanism for addressing the burden of mental and behavioral health problems in jail populations.
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Affiliation(s)
- Melissa J Zielinski
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Tasfia Jahangir
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Amanda Praseuth
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Stephanie Wilson
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cassandra L McLaughlan
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Blees A, Jakobowitz S, Hofer J, Konrad N, Krebs J, Opitz-Welke A. Self-harm among inmates of the Berlin prison system. Front Psychiatry 2024; 15:1362188. [PMID: 38757137 PMCID: PMC11096798 DOI: 10.3389/fpsyt.2024.1362188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Self-harming behavior in prisoners is a prevalent phenomenon, with international studies estimating a 4% prevalence rate. However, studies on self-injurious behavior in the German prison system are currently lacking. Therefore, our study aims to conduct an initial assessment. Methods The Criminological Service for the Berlin Prison System distributed questionnaires on incidents of self-harm to all Berlin prisons, except for juvenile detention centers. The questionnaires were supplemented with medical data, such as psychiatric diagnoses and medication. Results 62 questionnaires were returned, which could be attributed to 52 inmates. Compared to the average population in the Berlin prison system, the study sample exhibited variations in age, gender distribution and nationality. 94% of the inmates received a psychiatric diagnosis. Two-thirds of the male inmates had substance use disorders, while 83% of the female inmates had emotionally unstable personality resp. borderline disorders. Prior to self-harm, 87% of the inmates were administered psychiatric medication. Discussion Our study found similarities between the study population and international studies in the distribution of certain characteristics. We assume that many of the postulated risk factors can also apply to Berlin prisoners. However, the study is limited by the small number of cases and the absence of a control group.
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Affiliation(s)
- Alexander Blees
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Berlin, Germany
| | - Sharon Jakobowitz
- Criminological Service for the Berlin Prison System and Social Services of the Judiciary, Berlin, Germany
| | - Jakob Hofer
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Berlin, Germany
| | - Norbert Konrad
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Berlin, Germany
| | - Julia Krebs
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Berlin, Germany
| | - Annette Opitz-Welke
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Berlin, Germany
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Poulter M, Coe S, Graham CAM, Leach B, Tammam J. A systematic review of the effect of dietary and nutritional interventions on the behaviours and mental health of prisoners. Br J Nutr 2024:1-14. [PMID: 38682285 DOI: 10.1017/s0007114524000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Prisoners experience a higher burden of poor health, aggressive behaviours and worsening mental health than the general population. This systematic review aimed to identify research that used nutrition-based interventions in prisons, focusing on outcomes of mental health and behaviours. The systematic review was registered with Prospective Register of Systematic Reviews on 26 January 2022: CRD42022293370. Inclusion criteria comprised of current prisoners with no limit on time, location, age, sex or ethnicity. Only quantitative research in the English language was included. PubMed/Medline, Web of Science, EMBASE, PsycINFO and CINAHL were searched, retrieving 933 results, with 11 included for qualitative synthesis. Studies were checked for quality using the revised tool to assess risk of bias in randomised trials or risk of bias in non-randomised studies of interventions tool. Of the included studies, seven used nutritional supplements, three included diet changes, and one used education. Of the seven supplement-based studies, six included rule violations as an outcome, and only three demonstrated significant improvements. One study included mental health as an outcome; however, results did not reach significance. Of the three diet change studies, two investigated cognitive function as an outcome, with both reaching significance. Anxiety was included in one diet change study, which found a significant improvement through consuming oily fish. One study using diet education did not find a significant improvement in overall mental resilience. Overall, results are mixed, with the included studies presenting several limitations and heterogeneity. Future research should aim to consider increased homogeneity in research design, allowing for a higher quality of evidence to assess the role nutrition can play in improving the health of prisoners.
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Affiliation(s)
- Matthew Poulter
- Centre for Nutrition and Health, Faculty of Health & Life Sciences, Oxford Brookes University, OX3 0BP, Oxford, UK
| | - Shelly Coe
- Centre for Nutrition and Health, Faculty of Health & Life Sciences, Oxford Brookes University, OX3 0BP, Oxford, UK
| | - Catherine Anna-Marie Graham
- Centre for Nutrition and Health, Faculty of Health & Life Sciences, Oxford Brookes University, OX3 0BP, Oxford, UK
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), 6354Vitznau, Switzerland
- Lake Lucerne Institute AG, Rubistrasse 9, 6354Vitznau, Switzerland
| | - Bethan Leach
- Practice Plus Group, Hawker House 5-6 Napier Court, Napier Rd, Reading, BerkshireRG1 8BW, UK
| | - Jonathan Tammam
- Centre for Nutrition and Health, Faculty of Health & Life Sciences, Oxford Brookes University, OX3 0BP, Oxford, UK
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Santoriello C, De Rosa C, Rufo C, Romano F, Termoli G, Fiorillo G, Caprio L, Vitolo M, Pagano AM. Suicide Risk Screening and Assessment before and after the COVID-19 Pandemic in New Inmates. Healthcare (Basel) 2024; 12:100. [PMID: 38201006 PMCID: PMC10779268 DOI: 10.3390/healthcare12010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/26/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Suicide is the main cause of death in Italian prisons. The largest number of inmates who killed themselves was recorded during three years of the COVID-19 pandemic. This study aimed to explore psychosocial risk factors for suicide among inmates incarcerated before and after the onset of COVID-19. (2) Methods: At prison reception, inmates underwent clinical interviews and were assessed using the Blaauw Scale and Suicide Assessment Scale. Psychological distress, measured by the Symptom Checklist-90-R, was compared between inmates admitted before and after COVID-19. Regression analyses were run to examine psychosocial vulnerabilities associated with suicidal intent in newly incarcerated individuals at risk of suicide. (3) Results: Among the 2098 newly admitted inmates (93.7% male) aged 18 to 87 years (M = 39.93; SD = 12.04), 1347 met the criteria for suicide risk, and 98 exhibited high suicidal intent. Inmates who entered prison after the onset of COVID-19 were older and had fewer social relationships. They had a higher prevalence of recidivism and substance abuse, along with elevated levels of psychological distress. An increase in perceived loss of control, anergia, obsessive-compulsive symptoms, phobic anxiety, and paranoid ideation emerged as the factors most strongly associated with high suicidal intent. (4) Conclusions: These findings support the value of psychosocial screening in promptly identifying inmates at risk of suicide, enabling the implementation of targeted, multi-professional interventions. Future research should replicate these results, with a focus on longitudinal studies that monitor the same inmates throughout their incarceration period.
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Affiliation(s)
- Carmen Santoriello
- Unità Operativa Semplice Dipartimentale U.O.S.D. Department of Adults and Minors Healthcare, Criminal Area, Local Health Authority of Salerno, 84132 Salerno, Italy
| | | | | | | | | | | | | | | | - Antonio Maria Pagano
- Unità Operativa Semplice Dipartimentale U.O.S.D. Department of Adults and Minors Healthcare, Criminal Area, Local Health Authority of Salerno, 84132 Salerno, Italy
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Kaggwa MM, Chaimowitz GA, Erb B, Prat S, Davids A, Moulden H, Robbins A, Bradford J, Mamak M, Olagunju AT. Self-harming behaviors and forensic system-related factors: an analysis of the Ontario review board database. BMC Psychiatry 2023; 23:913. [PMID: 38057757 PMCID: PMC10698976 DOI: 10.1186/s12888-023-05394-4] [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: 07/26/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND In Canada, ensuring public safety, and the safety and well-being of accused individuals under the jurisdiction of the provincial review board are very important. While previous studies have reported a significant risk of self-harming behaviors (non-suicidal self-injury and suicide attempt) in forensic psychiatric settings, no large population study has assessed any relationship between forensic system-related factors and self-harming behaviors. A better understanding of these factors can help clinicians implement protective measures to mitigate self-harming behaviors or actions. METHODS Using the Ontario Review Board (ORB) database covering 2014-2015 period (n = 1211, mean age = 42.5 ± 13.37 years, males = 86.1%), we analyzed the prevalence and factors associated with self-harming behaviors, emphasizing the characterization of the forensic system-related factors (ORB status, legal status, type of offense, previous criminal history, and victim relationship). The relationships between the forensic system-related factors and self-harming behaviors were explored using five separate logistic regression models, controlling for clinical and sociodemographic characteristics. RESULTS Approximately 4% of the individuals in the forensic system over the study period engaged in self-harming behaviors Among the studied patients, individuals determined to be unfit to stand trial and inpatients were significantly more likely to have self-harming behaviors. There was no significant relationship between the type of offence, victim relationship, and previous criminal history with self-harming behavior. CONCLUSION Forensic psychiatry inpatients should have close observation, screening, monitoring, and individual tailored management strategies for self-harming behaviors. The findings of this study indicate that forensic system-related factors, especially those that pertain to the status of individuals in the forensic system (i.e., unfit to stand trial and being an inpatient) are more responsible for self-harming behaviors among forensic patients in Ontario.
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Affiliation(s)
- Mark Mohan Kaggwa
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada.
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada.
- Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Gary Andrew Chaimowitz
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - Bailea Erb
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - Sébastien Prat
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - Arianna Davids
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - Heather Moulden
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - Amara Robbins
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - John Bradford
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Division of Forensic Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Mini Mamak
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - Andrew Toyin Olagunju
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, 5000, Australia
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Vorstenbosch E, Rodríguez-Liron A, Vicens-Pons E, Félez-Nóbrega M, Escuder-Romeva G. Suicide risk in male incarcerated individuals in Spain: clinical, criminological and prison-related correlates. BMC Psychol 2023; 11:282. [PMID: 37735464 PMCID: PMC10514969 DOI: 10.1186/s40359-023-01315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Prison suicide is a complex phenomenon that may be influenced by individual, clinical, social and environmental factors. In Spain, few studies have explored the relationship with institutional, prison-related variables. The aim of this study is to examine correlates of suicide in a sample of male incarcerated individuals from 5 Spanish penitentiary centers. METHODS This present study entails a secondary data analysis, using data from the Prevalence of mental disorders in prisons study. This is a cross-sectional multicenter study conducted in 2007-2008 across 5 penitentiary centers in Spain. The Spanish version of the Plutchik suicide risk scale was used to assess the risk of suicide (those scoring ≥ 6 were considered to be at risk of suicide). Sociodemographic, clinical, criminological and prison-related data were collected via face-to face interviews and criminological data were confirmed using penitentiary records. RESULTS The final sample included 707 male incarcerated individuals (mean age 36.79 years ± 9.90 years). Several significant correlates associated with higher risk of suicide were identified including criminological factors (having committed a violent offense, being a recidivist), clinical factors (family history of mental disorders, the presence of mental disorders, having physical conditions, contact with a mental health specialist, medication treatment in the last 12 months), and prison-related determinants (workshop/training course participation) was significantly associated with lower suicide risk. CONCLUSIONS Several correlates within a comprehensive range of sociodemographic, criminological, clinical and prison-related variables were identified. This information is primordial for preventing suicide and reducing the existing risk. The findings may contribute to developing effective suicide prevention programs within Spanish prison services. Importantly, future research must continue to investigate the nature of suicidal outcomes among incarcerated individuals.
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Affiliation(s)
- Ellen Vorstenbosch
- Parc Sanitari Sant Joan de Déu, Research, Teaching and Innovation Unit, C/ Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Spain.
- Instituto de Salud Carlos III, Centre for Biomedical Research On Mental Health (CIBERSAM), C/ Monforte de Lemos 3-5, 28029, Madrid, Spain.
| | - Ariadna Rodríguez-Liron
- Parc Sanitari Sant Joan de Déu, Research, Teaching and Innovation Unit, C/ Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Spain
| | - Enric Vicens-Pons
- Parc Sanitari Sant Joan de Déu, Research, Teaching and Innovation Unit, C/ Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Spain
| | - Mireia Félez-Nóbrega
- Parc Sanitari Sant Joan de Déu, Research, Teaching and Innovation Unit, C/ Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Spain
- Instituto de Salud Carlos III, Centre for Biomedical Research On Mental Health (CIBERSAM), C/ Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Gemma Escuder-Romeva
- Parc Sanitari Sant Joan de Déu, Research, Teaching and Innovation Unit, C/ Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Penitentiary Psychiatric Hospitalization Unit of Catalonia, Carretera de Martorell a Capellades, Km 23, 08635, Sant Esteve Sesrovires, Spain
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Skowroński B, Talik EB. Factors related to personal quality of life in prison inmates. Int J Occup Med Environ Health 2023; 36:291-302. [PMID: 37194668 PMCID: PMC10464816 DOI: 10.13075/ijomeh.1896.01961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/04/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES The aim of the study was to analyze the determinants of prison inmates' personal quality of life (PQoL). MATERIAL AND METHODS Three hundred ninety men imprisoned in penitentiary institutions were assessed. Data were collected by means of the the Sense of Quality of Life Questionnaire, the General Self-Esteem Scale, the Social Support Scale, the Resiliency Assessment Scale, the Trait Personality Inventory, which have high validity and reliability. All models were specified in structural equations modeling using Mplus v. 8.2. RESULTS The positive correlates of PQoL are: self-efficacy, social support, and ego-resiliency. The negative correlate of PQoL is trait depression. The study confirmed that 2 factors affected ego-resiliency: self-efficacy and trait depression. CONCLUSIONS All significant factors, such as self-efficacy, social support, ego-resiliency, or trait depression, should be taken into account in rehabilitation programs. Int J Occup Med Environ Health. 2023;36(2):291-302.
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Affiliation(s)
- Bartłomiej Skowroński
- University of Warsaw, Institute of Social Prevention and Resocialization, Faculty of Applied Social Sciences and Resocialization, Warsaw, Poland
| | - Elżbieta Barbara Talik
- The John Paul II Catholic University of Lublin, Department of Clinical Psychology, Lublin, Poland
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McTernan N, Griffin E, Cully G, Kelly E, Hume S, Corcoran P. The incidence and profile of self-harm among prisoners: findings from the Self-Harm Assessment and Data Analysis Project 2017-2019. Int J Prison Health 2023; 19:565-577. [PMID: 37125411 DOI: 10.1108/ijph-02-2023-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE Internationally, rates of suicide and lifetime self-harm are higher in prisoners compared to the general population. This study aims to identify specific characteristics of self-harming behaviour and to establish a profile of prisoners who engage in self-harm. DESIGN/METHODOLOGY/APPROACH Data from the Self-Harm Assessment and Data Analysis Project (SADA) on self-harm episodes in prisons in the Republic of Ireland during 2017-2019 was used. Annual rates per 1,000 were calculated by age and gender. FINDINGS The rate of self-harm between 2017 and 2019 was 31 per 1,000 prisoners for men and six times higher at 184 per 1,000 prisoners for women. The rate of self-harm was twice as high among prisoners on remand than sentenced prisoners (60.5 versus 31.3 per 1,000). The highest rates of self-harm among sentenced prisoners were observed among 18-29-year-old men (45 per 1,000) and women (125 per 1,000). The rate of self-harm was higher among women prisoners in all age groups. Contributory factors associated with self-harm were mainly related to mental health but also linked to a prisoner's environment and relationships. PRACTICAL IMPLICATIONS There is a need to ensure access to timely and suitable mental health services, including both appropriate referral and provision of evidence-based mental health interventions to address the needs of these cohorts. ORIGINALITY/VALUE To the best of the authors' knowledge, this is the first national study to systematically examine incidence and patterns of self-harm among the prison population in Ireland. The recording of severity/intent of each episode is novel when assessing self-harm among the prison population.
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Affiliation(s)
- Niall McTernan
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Eve Griffin
- National Suicide Research Foundation, University College Cork, Cork, Ireland and School of Public Health, University College Cork, Cork, Ireland
| | - Grace Cully
- National Suicide Research Foundation, University College Cork, Cork, Ireland and School of Public Health, University College Cork, Cork, Ireland
| | | | | | - Paul Corcoran
- National Suicide Research Foundation, University College Cork, Cork, Ireland and School of Public Health, University College Cork, Cork, Ireland
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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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Depression in Male Inmates. Clin Pract 2022; 13:1-13. [PMID: 36648841 PMCID: PMC9844394 DOI: 10.3390/clinpract13010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/18/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction: The prevalence of psychiatric morbidity is high among incarcerated individuals. Severe mental disorder is five to ten times higher among prisoners compared to the general population. Several factors are held to be responsible for the high prevalence of depression in prison: mainly poor living conditions (narrow room, loss of privacy), limited interpersonal relationships, and lack of mental health access. Inmates are at increased risk of all-cause mortality, suicide, self-harm, violence, and victimization while those with mental disorders are involved in conflicts and are more likely to be charged with prison rules. Purpose: To explore depression among male inmates. Methods and material: In the study, 101 male inmates were enrolled. Data were collected by the completion of a “self-rating depression scale (SDS)-Zung” which included participants’ characteristics. The statistical significance level was p < 0.05. Results: Of the 101 participants, 51.4% of inmates were under 40 years old, 54.5% were married, 45.6% had been convicted of homicide and 38.6% had a life sentence. Normal depression levels were experienced by 62.4% of the participants, while 21.8% were mildly depressed, 14.9% were moderately depressed and 1.0% severely depressed. Foreign prisoners had statistically significant higher scores of depression compared to Greeks (median 48 vs. 45, p = 0.012); those suffering from a chronic disease compared to those who did not (median 48 vs. 45, p = 0.038); those who had spent time in solitary confinement compared to those who had not (median 46 vs. 43.5, p = 0.038) as well as those who had not considered harming themselves compared to those who had thought of it (median 46 vs. 44, p = 0.017). Conclusion: Given that prison populations are marginalized and deprived of the rights that people in the community benefit from, establishing the prevalence of depression in male inmates and its associated characteristics may help to formulate recommendations for future prison health care services. Clinical, research, and policy efforts are needed to improve prison mental health.
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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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13
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Favril L, Shaw J, Fazel S. Prevalence and risk factors for suicide attempts in prison. Clin Psychol Rev 2022; 97:102190. [PMID: 36029609 DOI: 10.1016/j.cpr.2022.102190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/28/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Abstract
Suicidal behaviour represents a substantial burden of morbidity and mortality in prisons worldwide. We aimed to synthesise the evidence on prevalence and risk factors for suicide attempts during incarceration. In this systematic review and meta-analysis, we searched four bibliographic databases for studies (published up to May 31, 2022) reporting on adults sampled from the general prison population who attempted suicide while incarcerated and an unselected comparison group. A total of 20 studies comprising 19,882 individuals (6.5% women) in 20 countries were eligible for inclusion. The pooled prevalence of suicide attempts during incarceration was 8.6% (95% CI 6.1-11.2) in men and 12.2% (95% CI 7.1-17.2) in women. Across all 36 risk factors studied, the strongest associations were found for suicidal ideation, previous self-harm, and markers of psychiatric morbidity. Prison-related risk factors included solitary confinement, victimisation, and poor social support while incarcerated. Sensitivity analyses indicate that risk factors for near-lethal suicide attempts are similar to those for suicide attempts more generally. In addition to providing a synthesis of previous work, our systematic review highlights several key limitations of the extant literature, which provide directions for future research.
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Affiliation(s)
- Louis Favril
- Faculty of Law and Criminology, Ghent University, Ghent, Belgium.
| | - Jenny Shaw
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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14
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Lawson SG, Lowder EM, Ray B. Correlates of suicide risk among Black and White adults with behavioral health disorders in criminal-legal systems. BMC Psychiatry 2022; 22:163. [PMID: 35246077 PMCID: PMC8895515 DOI: 10.1186/s12888-022-03803-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/19/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Adults with behavioral health disorders in criminal-legal systems are at heightened risk of suicide relative to the general population. Despite documented racial disparities in criminal processing and behavioral health treatment, few studies have examined racial differences in suicide risk in this already high-risk population. This study examined 1) the correlates of suicide risk in this population overall and by race and 2) the moderating role of race in these associations. METHODS We investigated correlates of clinician-rated suicide risk at baseline in a statewide sample of 2,827 Black and 14,022 White adults with criminal-legal involvement who engaged in community-based behavioral health treatment. Regression-based approaches were used to model suicide risk and test for evidence of interaction effects. RESULTS Findings showed the strongest correlates of suicide risk were greater behavioral health needs, evidence of self-harm, and a primary mental health diagnosis or co-occurring diagnosis. In race-specific analyses, correlates of suicide risk were mostly similar for both Black and White clients, with a couple exceptions. Interaction terms testing between-group effects on correlates of suicide risk were non-significant. CONCLUSIONS Adults with behavioral health disorders in criminal-legal systems experience similar risk factors for suicide as the general population. Similar to prior research, we found that Black adults, in particular, are at lower risk for suicide overall. Contrary to expectations, we found similarities in correlates of suicide risk across race in our sample of felony-level adults with behavioral health disorders in the criminal-legal system. Prior research shows that behavioral health professionals should be cognizant of cultural factors when developing a comprehensive approach to suicide care and treatment. Our findings show correlates of suicide risk are largely stable in Black and White adults involved in criminal-legal systems, suggesting culturally responsive treatment for suicide risk should target shared risk factors.
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Affiliation(s)
- Spencer G. Lawson
- grid.17088.360000 0001 2150 1785School of Criminal Justice, Michigan State University, East Lansing, MI USA
| | - Evan M. Lowder
- grid.22448.380000 0004 1936 8032Department of Criminology, Law and Society, George Mason University, Fairfax, VA USA
| | - Bradley Ray
- grid.62562.350000000100301493Division for Applied Justice Research, RTI International, Research Triangle Park, NC USA
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15
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A National Study of Suicidal Ideation and Suicide Attempt Among Incarcerated People in Iran. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00773-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Favril L. Epidemiology, Risk Factors, and Prevention of Suicidal Thoughts and Behaviour in Prisons: A Literature Review. Psychol Belg 2021; 61:341-355. [PMID: 34900324 PMCID: PMC8622377 DOI: 10.5334/pb.1072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/19/2021] [Indexed: 12/21/2022] Open
Abstract
Suicide is a global public health concern that affects all echelons of society, albeit not equally so. Compared with adults in the general population, incarcerated offenders are at increased risk to consider, attempt, and die by suicide, which represents a substantial burden of morbidity and mortality in prisons worldwide. This review synthesises recent literature pertaining to the epidemiology, risk factors, and prevention of suicidal thoughts and behaviour among prisoners, and outlines a framework which emphasises the interplay between individuals (importation) and their surroundings (deprivation). The available evidence suggests that prison-specific stressors may exacerbate risk of suicide in an already vulnerable population characterised by complex health and social care needs. Emerging data point to differential mechanisms through which prisoners come to think about suicide and subsequently progress to suicidal behaviour. As risk of suicide is determined by a complex web of synergistically interacting factors, its management and prevention demands a cross-sectoral policy and service response that includes targeted interventions aimed at high-risk prisoners in combination with population strategies that promote the health and wellbeing of all people in prison.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, BE
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17
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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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18
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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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19
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Key R, Underwood A, Farnham F, Marzano L, Hawton K. Suicidal behavior in individuals accused or convicted of child sex abuse or indecent image offenses: Systematic review of prevalence and risk factors. Suicide Life Threat Behav 2021; 51:715-728. [PMID: 33811669 DOI: 10.1111/sltb.12749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 10/29/2020] [Accepted: 12/09/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE An emerging body of research indicates that child sex abuse (CSA) offenders are at high risk of suicide when their offenses come to light and that those accused of accessing indecent images of children (IIOC) are at particular risk. METHODS We conducted a systematic review and narrative synthesis on suicide rates and risk factors in this population of offenders. A keyword search of bibliographic databases (PsycINFO, Ovid, MEDLINE, Embase, PILOTS, SCIE, the Cochrane Central Register of Controlled Trials [CENTRAL] and CINAHL) was conducted. RESULTS Eighteen articles were included in the review, with eleven studies meeting criteria for quality assessment. The risk of suicide in perpetrators of CSA and IIOC might be over 100 times that of the general population, although estimates vary widely between studies. Several complex, interlinking factors were identified as associated with risk, including shame, unique demographic characteristics of the offenders, absence of prior criminal contact, and the impact of a criminal investigation. CONCLUSIONS The review identified factors that may have practical, clinical, and operational implications in the prevention of suicide in CSA and IIOC perpetrators. Exploring the impact of the investigation itself on suicide risk, including potential operational strategies and clinical input to reduce risk, should be a priority.
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Affiliation(s)
- Rebecca Key
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Alan Underwood
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Frank Farnham
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK.,UCL Department of Security and Crime Science, London, UK
| | | | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
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20
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Stoliker BE, Verdun-Jones SN, Vaughan AD. Psychological and Sociological Perspectives on Suicide: A Multi-Level Examination of Suicidal Thoughts and Attempted Suicide among Prisoners. Arch Suicide Res 2021; 25:596-628. [PMID: 32169027 DOI: 10.1080/13811118.2020.1738294] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Informed by psychological and sociological perspectives, the present study aimed to improve knowledge on the nature of suicidal thoughts and attempted suicide among adult prisoners. Analyzing data from a nationally representative sample of 18,185 prisoners housed in 287 state and 39 federal prisons across the United States highlight: (a) key micro-level factors associated with suicidal thoughts and attempted suicide, along with some distinct predictive patterns for suicidal thoughts versus attempted suicide; (b) similarities and differences between male and female prisoners concerning the predictive patterns of suicidal thoughts and attempted suicide; (c) the relationship between macro-level prison characteristics and prisoner suicidality. Discussion points toward a direction for future research on prisoner suicidality, as well as recommendations for managing at-risk prisoners.
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21
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Morthorst BR, Mehlum L, Pàlsson SP, Mühlmann C, Hammerlin Y, Madsen T, Nordentoft M, Erlangsen A. Suicide Rates in Nordic Prisons 2000-2016. Arch Suicide Res 2021; 25:704-714. [PMID: 32252604 DOI: 10.1080/13811118.2020.1746943] [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] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare suicide rates of people in prison and the general population in the Nordic countries. METHODS Data on deaths by suicide and person-years for people in prison and the general population were obtained for the Nordic countries during 2000-2016. Age-standardized rate ratios were calculated. RESULTS The suicide rate in the Nordic countries overall was 110.1 (95% CI = 98.1, 122.2) per 100,000 person-years for people in prison. A significant decline was noted for the suicide rate of people in prison between 2000 and 2016 (p < 0.0001). The age-standardized mortality ratio was 7.4 (95% CI = 5.9-8.2) for males and 17.8 (95% CI = 7.3-33.2) for females in Denmark, Iceland, and Norway. CONCLUSION Despite a decreasing trend over time, excess suicide mortality was noted for people in prison.
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22
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Stephenson T, Leaman J, O'Moore É, Tran A, Plugge E. Time out of cell and time in purposeful activity and adverse mental health outcomes amongst people in prison: a literature review. Int J Prison Health 2021; 17:54-68. [PMID: 33634654 DOI: 10.1108/ijph-06-2020-0037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to synthesise the available peer-reviewed literature on the impact of time out of cell (TOOC) and time in purposeful activity (TIPA) on adverse mental outcomes amongst people in prison. DESIGN/METHODOLOGY/APPROACH The outcomes of interest of this literature review were mental health, suicide, deliberate self-harm (DSH) and violence. Exposures of interest were TOOC, TIPA or a partial or indirect measure of either. In total, 14 studies were included. An abbreviated review methodology was used because of time constraints. FINDINGS There was consistent evidence of an association between lower TOOC and TIPA and worse mental health and higher suicide risk. Limited evidence suggests a link between TOOC and DSH. No evidence was identified regarding the relationship between TOOC/TIPA and violence. RESEARCH LIMITATIONS/IMPLICATIONS A lack of longitudinal studies prevents conclusions regarding causality. Significant heterogeneity of mental health outcomes limits the comparability of studies. PRACTICAL IMPLICATIONS These findings highlight the importance of considering the impact of TOOC and TIPA on adverse mental outcomes for prisoners when designing prison regimes, including during urgent adaptation of such regimes in response to Covid-19. They are likely to be of interest to practitioners and policymakers concerned with prison regime design. ORIGINALITY/VALUE This paper is the first to synthesise the existing literature on the impact of TOOC and TIPA on mental health outcomes.
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Affiliation(s)
- Thomas Stephenson
- South London and Maudsley NHS Foundation Trust, London, UK and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jane Leaman
- National Health and Justice Team, Public Health England, London, UK
| | - Éamonn O'Moore
- National Health and Justice Team, Public Health England, London, UK and is Director at WHO UK Collaborating Centre for Health in Prisons Programme, Public Health England, London, UK
| | - Anh Tran
- Department of Research, Translation and Innovation Division, Public Health England, London, UK
| | - Emma Plugge
- WHO UK Collaborating Centre for Health in Prisons Programme, Public Health England, London, UK and School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
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23
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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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Quality of Life and Its Correlates in People Serving Prison Sentences in Penitentiary Institutions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041655. [PMID: 33572346 PMCID: PMC7916129 DOI: 10.3390/ijerph18041655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of the study was to analyze the determinants of prison inmates' quality of life (QoL). METHODS 390 men imprisoned in penitentiary institutions were assessed. Data were collected by means of the Sense of Quality of Life Questionnaire (SQLQ), general self-efficacy scale (GSES), resilience assessment scale (RAS-25), social support scale (SSS), intensity of religious attitude scale (IRA), SPI/TPI, and COPE Inventory, measures that have high validity and reliability. All models were specified in a path analysis using Mplus version 8.2. RESULTS The positive correlates of QoL are: self-efficacy, social support, intensity of religious attitude, trait and state depression, resilience, and the following coping strategies, which are at the same time mediators between the variables mentioned above and QoL: behavioral disengagement, turning to religion, planning, and seeking social support for instrumental reasons. CONCLUSIONS In penitentiary practice, attention should be devoted to depressive individuals, and support should be provided to them in the first place because depressiveness is the strongest negative correlate of important aspects of prisoners' QoL. All the remaining significant factors, namely: self-efficacy, social support, intensity of religious attitude, and the following coping strategies: turning to religion, planning, and seeking social support for instrumental reasons, should be taken into account in rehabilitation programs.
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25
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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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Perry AE, Waterman MG, Dale V, Moore K, House A. The effect of a peer-led problem-support mentor intervention on self-harm and violence in prison: An interrupted time series analysis using routinely collected prison data. EClinicalMedicine 2021; 32:100702. [PMID: 33681733 PMCID: PMC7910675 DOI: 10.1016/j.eclinm.2020.100702] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Levels of mental disorder, self-harm and violent behaviour are higher in prisons than in the community. The purpose of this study was to determine whether a brief peer-led problem-support mentor intervention could reduce the incidence of self-harm and violence in an English prison. METHODS An existing intervention was adapted using a theory of change model and eligible prisoners were trained to become problem-support mentors. Delivery of the intervention took two forms: (i) promotion of the intervention to fellow prisoners, offering support and raising awareness of the intervention but not delivering the skills and (ii) delivery of the problem-solving therapy skills to selected individual prisoners. Training and intervention adherence was measured using mentor log books. We used an Interrupted Time Series (ITS) design utilizing prison data over a 31 month period. Three ITS models and sensitivity analyses were used to address the impact across the whole prison and in the two groups by intervention delivery. Outcomes included self-harm and violent behaviour. Routine data were collected at monthly intervals 16 months pre-, 10 months during and six months post-intervention. Qualitative data measured the acceptability, feasibility, impact and sustainability of the intervention. A matched case-control study followed people after release to assess the feasibility of formal evaluation of the impact on re-offending up to 16 months. FINDINGS Our causal map identified that mental health and wellbeing in the prison were associated with environmental and social factors. We found a significant reduction in the incidence of self-harm for those receiving the full problem-solving therapy skills. No significant reduction was found for incidence of violent behaviour. INTERPRETATION Universal prison-wide strategies should consider a series of multi-level interventions to address mental health and well-being in prisons. FUNDING Research Champions Fund and the Economic and Social Research Council Impact Acceleration Account Fund, University of York, UK.
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Affiliation(s)
- Amanda E. Perry
- Department of Health Sciences, University of York, York YO10 5DD, UK
- Corresponding author.
| | | | - Veronica Dale
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | | | - Allan House
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
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Abstract
BACKGROUND Many people who consider suicide do not translate these intentions into action. Although prisoners constitute a particularly high-risk group for suicide, little is known about the factors that distinguish those who think about suicide from those who attempt suicide. METHODS Participants were 1326 adult offenders (1203 men) randomly selected from 15 Belgian prisons, representing 14% of the national prison population. Multivariate regression analysis compared prisoners who attempted suicide (n = 277) with those who thought about suicide but never made an attempt (n = 312) on a range of established risk factors. RESULTS Among the 589 participants reporting a lifetime history of suicidal ideation (44% of the total sample), almost half (47%) had made a suicide attempt. Relative to those who only thought about suicide, participants who attempted suicide were more likely to be violent offenders (aOR 2.33, 95% CI 1.49-3.62) and have a history of non-suicidal self-injury (aOR 3.19, 95% CI 2.09-4.86). The presence of self-reported mental disorder diagnosis (aOR = 2.84, 95% CI 1.91-4.24) and illicit substance abuse (aOR = 2.01, 95% CI 1.24-3.28) also independently differentiated prisoners who attempted v. considered suicide. CONCLUSION This study provides preliminary evidence that behavioural and mental health factors are implicated in the transition from thoughts to acts of suicide in prisoners. Prospective studies are warranted to explore whether these risk factors predict progression from ideation to action over time.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Belgium
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, UK
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Favril L, O’Connor RC, Hawton K, Vander Laenen F. Factors associated with the transition from suicidal ideation to suicide attempt in prison. Eur Psychiatry 2020; 63:e101. [PMID: 33183374 PMCID: PMC7737175 DOI: 10.1192/j.eurpsy.2020.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although research has identified a wide range of risk factors for suicidal behavior in prisoners, it does not establish who is most likely to act on their suicidal thoughts while incarcerated. METHODS Self-report data were collected from a random sample of 1,203 adult men incarcerated across 15 prisons in Belgium, who represent 12% of all male prisoners nationwide. RESULTS One-third (33%) of participants reported having suicidal thoughts during their incarceration, of whom 26% attempted suicide in prison (9% of all prisoners). Factors independently associated with suicide attempt among prisoners with suicidal ideation were violent offending (adjusted odds ratio [aOR] = 2.64, 95% confidence interval [CI] 1.33-5.23), in-prison drug use (aOR = 2.30, 95% CI 1.25-4.22), exposure to suicidal behavior (aOR = 1.96, 95% CI 1.04-3.68), and a lifetime history of nonsuicidal self-injury (aOR = 1.90, 95% CI 1.08-3.36). While related to suicidal thoughts, markers of psychiatric morbidity and aspects of the prison regime were not associated with the progression to suicide attempt. CONCLUSIONS Many prisoners who think about suicide do not attempt suicide while incarcerated. Factors associated with suicidal ideation are distinct from those that govern the transition to suicidal behavior. Our findings lend support to the hypothesis that behavioral disinhibition might act as a catalyst in the translation of suicidal thoughts into action.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Rory C. O’Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Freya Vander Laenen
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, Ghent, Belgium
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Favril L, Stoliker B, Vander Laenen F. What Differentiates Prisoners Who Attempt Suicide from Those Who Experience Suicidal Ideation? A Nationally Representative Study. Suicide Life Threat Behav 2020; 50:975-989. [PMID: 32364639 DOI: 10.1111/sltb.12638] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/23/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Many people who think about suicide do not engage in suicidal behavior. Identifying risk factors implicated in the process of behavioral enaction is crucial for suicide prevention, particularly in high-risk groups such as prisoners. METHOD Cross-sectional data were drawn from a nationally representative sample of 17,891 prisoners (79% men) in the United States. We compared prisoners who attempted suicide (attempters; n = 2,496) with those who thought about suicide but never made an attempt (ideators; n = 1,716) on a range of established risk factors. RESULTS More than half (59%) of participants who experienced suicidal ideation had also attempted suicide. Violent offending, trauma, brain injury, alcohol abuse, and certain mental disorders distinguished attempters from ideators. CONCLUSION Our results fit within recent ideation-to-action theories that emphasize the role of a capability for suicide in the transition from thoughts to acts of suicide.
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Affiliation(s)
- Louis Favril
- Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Bryce Stoliker
- School of Criminology, Simon Fraser University, Burnaby, BC, Canada
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Favril L, Indig D, Gear C, Wilhelm K. Mental disorders and risk of suicide attempt in prisoners. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1145-1155. [PMID: 32144468 DOI: 10.1007/s00127-020-01851-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mental disorders are overrepresented in prisoners, placing them at an increased risk of suicide. Advancing our understanding of how different mental disorders relate to distinct stages of the suicidal process-the transition from ideation to action-would provide valuable information for clinical risk assessment in this high-risk population. METHODS Data were drawn from a representative sample of 1212 adults (1093 men) incarcerated across 13 New Zealand prisons, accounting for 14% of the national prison population. Guided by an ideation-to-action framework, three mutually exclusive groups of participants were compared on the presence of mental disorders assessed by validated DSM-IV diagnostic criteria: prisoners without any suicidal history (controls; n = 778), prisoners who thought about suicide but never made a suicide attempt (ideators; n = 187), and prisoners who experienced suicidal ideation and acted on such thoughts (attempters; n = 247). RESULTS One-third (34.6%) of participants reported a lifetime history of suicidal ideation, of whom 55.6% attempted suicide at some point (19.2% of all prisoners). Suicidal outcomes in the absence of mental disorders were rare. Whilst each disorder increased the odds of suicidal ideation (OR range 1.73-4.13) and suicide attempt (OR range 1.82-4.05) in the total sample (n = 1212), only a select subset of disorders was associated with suicide attempt among those with suicidal ideation (n = 434). Drug dependence (OR 1.65, 95% CI 1.10-2.48), alcohol dependence (OR 1.89, 95% CI 1.26-2.85), and posttraumatic stress disorder (OR 2.09, 95% CI 1.37-3.17) distinguished attempters from ideators. CONCLUSION Consistent with many epidemiological studies in the general population, our data suggest that most mental disorders are best conceptualized as risk factors for suicidal ideation rather than for suicide attempt. Once prisoners consider suicide, other biopsychosocial factors beyond the mere presence of mental disorders may account for the progression from thoughts to acts of suicide.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, Gent, Belgium.
| | - Devon Indig
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Kay Wilhelm
- Discipline of Psychiatry, University of Notre Dame, Notre Dame, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Walker T, Shaw J, Gibb J, Turpin C, Reid C, Gutridge K, Abel K. Lessons Learnt From the Narratives of Women Who Self-Harm in Prison. CRISIS 2020; 42:255-262. [PMID: 32845178 DOI: 10.1027/0227-5910/a000714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: In England and Wales, women in prison make up a minority (<5%) of the total custodial population, yet acts of self-harm are around five times more common among incarcerated women. While there has been a multiagency effort to improve how acts of self-harm are documented across prisons, the patterns and functions of self-harm for women in prison have not yet been fully addressed. Aims: We aimed to determine the patterns, prevalence, and functions of self-harm among women in prison through a mixed-methods study. Method: A total of 108 women with a history of self-harm were interviewed across three female prisons. Participants completed a structured questionnaire detailing their experiences of self-harm across prison and community settings. Results: We found that women in prison who frequently self-harmed disclosed high levels of trauma: past experiences of domestic violence (81.5%), childhood sexual abuse (66.7%), and adult sexual abuse (60.2%). Prevalent methods of recent in-prison acts of self-harm involved cutting, followed by ligaturing. Limitations: The study used a cross-sectional design, self-reported data, and featured a subset of women identified as being at high-risk of self-harm. Conclusion: Motivations behind acts of self-harm by women in prison are complex. Triggers appear to be past trauma, deteriorating mental health, and separation from children or family.
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Affiliation(s)
- Tammi Walker
- Department of Psychology, University of Manchester, UK
| | - Jenny Shaw
- Offender Health Research Network, University of Manchester, UK
| | - Jonathan Gibb
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Clive Turpin
- Greater Manchester Mental Health Trust, Prestwich, Manchester, UK
| | - Catherine Reid
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Kerry Gutridge
- Centre for Women's Mental Health, University of Manchester, UK
| | - Kathryn Abel
- Centre for Women's Mental Health, University of Manchester, UK
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Favril L, Yu R, Hawton K, Fazel S. Risk factors for self-harm in prison: a systematic review and meta-analysis. Lancet Psychiatry 2020; 7:682-691. [PMID: 32711709 PMCID: PMC7606912 DOI: 10.1016/s2215-0366(20)30190-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/30/2020] [Accepted: 04/20/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Self-harm is a leading cause of morbidity in prisoners. Although a wide range of risk factors for self-harm in prisoners has been identified, the strength and consistency of effect sizes is uncertain. We aimed to synthesise evidence and assess the risk factors associated with self-harm inside prison. METHODS In this systematic review and meta-analysis, we searched four electronic databases (PubMed, Embase, Web of Science, and PsycINFO) for observational studies on risk factors for self-harm in prisoners published from database inception to Oct 31, 2019, supplemented through correspondence with authors of studies. We included primary studies involving adults sampled from general prison populations who self-harmed in prison and a comparison group without self-harm in prison. We excluded studies with qualitative or ecological designs, those that reported on lifetime measures of self-harm or on selected samples of prisoners, and those with a comparison group that was not appropriate or not based on general prison populations. Data were extracted from the articles and requested from study authors. Our primary outcome was the risk of self-harm for risk factors in prisoners. We pooled effect sizes as odds ratios (OR) using random effects models for each risk factor examined in at least three distinct samples. We assessed study quality on the basis of the Newcastle-Ottawa Scale and examined between-study heterogeneity. The study protocol was registered with PROSPERO, CRD42018087915. FINDINGS We identified 35 independent studies from 20 countries comprising a total of 663 735 prisoners, of whom 24 978 (3·8%) had self-harmed in prison. Across the 40 risk factors examined, the strongest associations with self-harm in prison were found for suicide-related antecedents, including current or recent suicidal ideation (OR 13·8, 95% CI 8·6-22·1; I2=49%), lifetime history of suicidal ideation (8·9, 6·1-13·0; I2=56%), and previous self-harm (6·6, 5·3-8·3; I2=55%). Any current psychiatric diagnosis was also strongly associated with self-harm (8·1, 7·0-9·4; I2=0%), particularly major depression (9·3, 2·9-29·5; I2=91%) and borderline personality disorder (9·2, 3·7-22·5; I2=81%). Prison-specific environmental risk factors for self-harm included solitary confinement (5·6, 2·7-11·6; I2=98%), disciplinary infractions (3·5, 1·2-9·7; I2=99%), and experiencing sexual or physical victimisation while in prison (3·2, 2·1-4·8; I2=44%). Sociodemographic (OR range 1·5-2·5) and criminological (1·8-2·3) factors were only modestly associated with self-harm in prison. We did not find clear evidence of publication bias. INTERPRETATION The wide range of risk factors across clinical and custody-related domains underscores the need for a comprehensive, prison-wide approach towards preventing self-harm in prison. This approach should incorporate both population and targeted strategies, with multiagency collaboration between the services for mental health, social care, and criminal justice having a key role. FUNDING Wellcome Trust.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Rongqin Yu
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, Warneford Hospital, University of Oxford, Oxford, UK
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
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Stoliker BE, Verdun-Jones SN, Vaughan AD. The relationship between age and suicidal thoughts and attempted suicide among prisoners. HEALTH & JUSTICE 2020; 8:14. [PMID: 32572829 PMCID: PMC7310337 DOI: 10.1186/s40352-020-00117-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/11/2020] [Indexed: 05/30/2023]
Abstract
BACKGROUND Suicide is a major problem across the lifespan, yet rates are highest among middle-aged and older adults; a trend which remains relatively stable across varying sociological settings, including prisons. Despite this understanding, there is limited knowledge on the nature of suicidal thoughts and attempts among older prisoners, especially with respect to how they compare to younger counterparts. The present study aimed to increase insight into the relationship between age and suicidal thoughts and attempted suicide among prisoners, with particular focus on factors that may explain age-based variability. RESULTS Cross-sectional data were drawn from a nationally representative sample of 18,185 prisoners housed within 326 prisons across the United States. In general, analyses revealed that: (a) attempted suicide was more commonly reported among younger prisoners, while suicidal ideation was more commonly reported among older prisoners; (b) the relationship between age and probability of reporting suicidal thoughts and behavior is curvilinear; (c) younger and older prisoners exhibit somewhat differing predictive patterns of suicidal thoughts and behavior (e.g., physical illness is directly associated with suicidal history for younger prisoners, whereas the effect of physical illness on suicidal history for older prisoners is mediated by depression). CONCLUSIONS There is evidence to suggest that suicidal thoughts and behavior may manifest differently for younger and older prisoners, with differing patterns of risk. More research is needed on age-based variability in suicidal thoughts and attempted suicide among prisoners, as well as those factors that might explain this variability. Importantly, future research must continue to investigate the nature of suicidal thoughts and behavior among older prisoners.
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Affiliation(s)
- Bryce E Stoliker
- School of Criminology, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Simon N Verdun-Jones
- School of Criminology, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada
| | - Adam D Vaughan
- School of Criminal Justice, Texas State University, San Marcos, TX, 78666, USA
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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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Golshani S, Ghanbari S, Firoozabadi A, Shakeri J, Hookari S, Rahami B, Sadeghi Bahmani D, Brand S. Dissociative Symptoms and Self-Reported Childhood and Current Trauma in Male Incarcerated People with Borderline Personality Disorder - Results from a Small Cross-Sectional Study in Iran. Neuropsychiatr Dis Treat 2020; 16:2407-2417. [PMID: 33116540 PMCID: PMC7586052 DOI: 10.2147/ndt.s266016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/28/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is evidence that incarcerated people show higher rates of symptoms of psychopathology. In the present study, we assessed male Iranian incarcerated people with borderline personality disorders (BPD) and investigated the occurrence of past and current trauma and their associations with dissociative experiences. METHODS A total of 69 male Iranian incarcerated people (mean age: 33.76 years) diagnosed with PBD completed questionnaires covering sociodemographic information, dissociative experiences, and past and current traumatic events. RESULTS Participants reporting the occurrence of childhood trauma also reported the occurrence of adulthood trauma. Dissociation and adulthood trauma were associated in a U-shaped, non-linear fashion: Low and high adulthood trauma were associated with higher dissociation. Younger age, the presence of childhood trauma, and being single or divorced predicted adulthood trauma. CONCLUSION The pattern of results suggests that both childhood and adulthood trauma are highly prevalent among male incarcerated people, while the association between adulthood trauma and dissociation appeared to be more complex. When treating male incarcerated people, a complex interplay between past and current traumas and dissociation should be considered.
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Affiliation(s)
- Sanobar Golshani
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sahel Ghanbari
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Firoozabadi
- Research Center for Psychiatry and Behavioral Sciences, Department of Psychiatry, Hafez Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jalal Shakeri
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sarah Hookari
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bahareh Rahami
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Dena Sadeghi Bahmani
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,University of Basel, Psychiatric Clinics (UPK), Center for Affective-, Stress- and Sleep Disorders (ZASS), Basel 4002, Switzerland
| | - Serge Brand
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,University of Basel, Psychiatric Clinics (UPK), Center for Affective-, Stress- and Sleep Disorders (ZASS), Basel 4002, Switzerland.,Department of Sport, Exercise, and Health, Division of Sport Science and Psychosocial Health, University of Basel, Basel, Switzerland.,Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Facer-Irwin E, Blackwood NJ, Bird A, Dickson H, McGlade D, Alves-Costa F, MacManus D. PTSD in prison settings: A systematic review and meta-analysis of comorbid mental disorders and problematic behaviours. PLoS One 2019; 14:e0222407. [PMID: 31557173 PMCID: PMC6762063 DOI: 10.1371/journal.pone.0222407] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/28/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose Prevalence rates of PTSD are higher in the prison population than in the community. We sought to systematically review the extent to which this disorder is associated with other mental health disorders and problematic suicidal or aggressive behaviours in the prison population. Methods Studies reporting a relationship between PTSD and comorbid mental disorders and/or problematic behaviours in imprisoned adolescent and adult populations were identified from four bibliographic indexes. Primary studies involving clinical interviews, validated instruments leading to DSM or ICD diagnoses, or validated self-report questionnaires such as the PTSD checklist were included. Random-effects meta-analysis was conducted where possible. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results This review identified 36 studies, with a combined sample of 9594 participants, (6478 male and 2847 female prisoners) from 11 countries. Thirty-four of the identified studies employed a cross-sectional design. We identified significant associations between PTSD and comorbid mental disorders including depression (OR = 3.4, 95% confidence interval (CI): 2.3–4.9), anxiety (OR = 2.9, 95% confidence interval (CI): 1.8–4.7) and substance use (OR = 1.9, 95% confidence interval (CI): 1.5–2.4). We also identified significant associations between PTSD and suicidality (OR = 3, 95% confidence interval (CI): 2.4–3.8) and aggressive behaviours (this latter finding was not subject to meta-analysis). Significant methodological heterogeneity was identified between studies. Conclusions High rates of psychiatric comorbidity among prisoners with PTSD, and links to suicidal behaviour, self-harm and aggressive behaviour, provide further support for the need for trauma-informed treatment approaches in prisons. However, significant gaps in the current evidence were apparent. In particular, a lack of large, longitudinal studies meant that the temporal relationships between PTSD and relevant outcomes cannot currently be determined.
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Affiliation(s)
- Emma Facer-Irwin
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
- * E-mail:
| | - Nigel J. Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Annie Bird
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Daniel McGlade
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Filipa Alves-Costa
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Deirdre MacManus
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
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Voulgaris A, Hartwig S, Konrad N, Opitz-Welke A. Influence of drugs on prison suicide - A retrospective case study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 66:101460. [PMID: 31706407 DOI: 10.1016/j.ijlp.2019.101460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Abstract
The prevalence of mental disorders and comorbidity with substance abuse and personality disorders is high in prisoners. Furthermore, drug abuse in prison is a widespread problem throughout prisons around the world. In this retrospective study, we analyzed the prison deaths over six years (2012-2017). For each death, we collected data of the Berlin prison system, the prison hospital and the State Institute for Forensic and Social Medicine Berlin and the Institute of Legal Medicine and Forensic Sciences, Charité Medical University Berlin. In total, 33 prisoners died during our study period, of which 24 committed suicide. In 25% of the suicide cases, forensic toxicology reports were positive for drugs without cases of lethal intoxication. A direct influence of drug intoxication on prisoner deaths and suicide was not common in our data. Small sample size, a missing control group, and the retrospective study design limit generalizability of the results.
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Affiliation(s)
- A Voulgaris
- Institute for Sexual Medicine and Forensic Psychiatry, University Hospital Hamburg Eppendorf, Germany.
| | - S Hartwig
- Institute for Legal Medicine, Charité University Berlin, Germany
| | - N Konrad
- Institute for Forensic Psychiatry, Charité University Berlin, Germany
| | - A Opitz-Welke
- Institute for Forensic Psychiatry, Charité University Berlin, Germany
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Opitz-Welke A, Lehmann M, Seidel P, Konrad N. Medicine in the Penal System. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:808-814. [PMID: 30642429 DOI: 10.3238/arztebl.2018.0808] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 02/12/2018] [Accepted: 07/12/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Infectious diseases, substance dependencies, and dental diseases are the most important health problems affecting incarcerated persons. In Germany, for example, prisoners are 48 to 69 times more likely to be infected with the hepatitis C virus (HCV) than the general population, and 7 to 12 times more likely to be infected with the human immunodeficiency virus (HIV). The prevalence of mental illnesses is also markedly higher in the incarcerated than in the general population. METHODS This review is based on pertinent publications retrieved by a selective search in two databases (PubMed and Google Scholar) for any of the terms "health care," "primary health care," "mental health care"; "infectious disease," "opioid maintenance treatment," and "severe mental disorder" in conjunction with "prison," "jail," "detention," and "incarceration." RESULTS Among prisoners in German prisons, approximately 20% consume heroin, 20-50% suffer from alcohol dependency and abuse, and 70-85% smoke. The prevalence of tuberculosis in German prisons in 2002 was 0.1%. The provision of needles to incarcerated persons has a preventive effect on infection with hepatitis C, hepatitis B, and HIV, yet programs of this type have been discontinued in most penal facilities. In a systematic review, psychotic disorders were found in 3.6% (95% confidence interval [CI]: [3.1; 4.2]) of male inmates and 3.9% [95% CI: 2.7; 5.0] of female inmates. 25% of incarcerated persons suffer from attention-deficit-hyperac- tivity disorder. Persons recently released from prison have an above average mortality, largely due to drug intoxication. CONCLUSION An analysis of medical prescribing data reveals deficiencies in the provision of HCV treatment to all affected persons and in the provision of substitution treatment to persons with opiate dependency. In view of the known risks associated with imprisonment, greater emphasis should be placed on the provision of treatment for infectious diseases, substance dependencies, and mental illness, both in prison and in outpatient care after release.
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Affiliation(s)
- Annette Opitz-Welke
- Prison Hospital Berlin, JVA Plötzensee, Berlin; Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin
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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: 286] [Impact Index Per Article: 57.2] [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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Non-suicidal self-harm in prison: A national population-based study. Psychiatry Res 2019; 272:216-221. [PMID: 30590275 DOI: 10.1016/j.psychres.2018.12.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/29/2018] [Accepted: 12/19/2018] [Indexed: 11/23/2022]
Abstract
Prisoners are at risk of self-harm during incarceration, yet national estimates of the rate and risk factors of self-harm are rare. We aimed to examine the rate and risk factors of self-harm on aggregate and by sex using a national population-based study design. Israel Prison Service data were examined on all persons incarcerated for a criminal offense 2009-2015 (N = 263,794). Self-harm was ascertained from real-time recorded observations. The study covariates were: demographic, criminal history, and prison environment factors. The association between the risk of self-harm and study covariates was estimated with relative risks and their corresponding 95% confidence intervals fitted with a Poisson regression model. During the seven-year study period of 237,945 (91%) males and 25,849 (9%) females, 1761 inmates (0.7%) inflicted self-harm. In the total population, among females and males the relative risk of self-harm was statistically significantly (FDR P < 0.05) consistently associated with: involvement in prison misconduct, violent behavior, and verbal threats of self-harm. Risk factors that occur during incarceration may offer immediate information to assess the risk of self-harm and to develop prevention strategies.
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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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Opitz-Welke A, Konrad N, Welke J, Bennefeld-Kersten K, Gauger U, Voulgaris A. Suicide in Older Prisoners in Germany. Front Psychiatry 2019; 10:154. [PMID: 30984041 PMCID: PMC6449439 DOI: 10.3389/fpsyt.2019.00154] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/01/2019] [Indexed: 01/15/2023] Open
Abstract
As in many countries, the numbers of older prisoners are rising in Germany, but scientific information on this group is scarce. For the current study, a survey was used that included all prison suicides in Germany between the years of 2000 and 2013. Suicide rates of the elderly prisoners exceeded the suicide rates of the general population and the same age group. We observed a continuous decrease in the suicide rate of elderly prisoners. When compared to the younger suicide victims in prison, significantly more elderly suicide victims were: female, of German nationality, remand prisoners, or serving a life sentence. In Germany, elderly prisoners are a vulnerable subpopulation of the prison population. Higher suicide rates than in the same age group in the general population indicate unmet needs regarding mental disorders and their specific treatment.
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Affiliation(s)
- Annette Opitz-Welke
- Justizvollzugskrankenhaus in der JVA Plötzensee, Berlin, Germany.,Institut fúr Forensische Psychiatrie der Charité Berlin, Berlin, Germany
| | - Norbert Konrad
- Institut fúr Forensische Psychiatrie der Charité Berlin, Berlin, Germany
| | | | | | - Ulrich Gauger
- Institut fúr Forensische Psychiatrie der Charité Berlin, Berlin, Germany
| | - Alexander Voulgaris
- Institut für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
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Biddle P, Dyer W, Hand R, Strinati C. Reflections on a project to prevent suicide and self-harm among prisoners identified as high risk in two prisons in Northern England. HEALTH & JUSTICE 2018; 6:22. [PMID: 30511204 PMCID: PMC6755593 DOI: 10.1186/s40352-018-0080-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/13/2018] [Indexed: 06/03/2023]
Abstract
BACKGROUND This article critically explores the implementation and evaluation of a project designed, delivered and evaluated by frontline staff to improve prison responses to prisoner suicide and self-harm. We begin by evidencing the need for the project and detail its content, delivery and attempts at evaluation. We draw on the reflections of the three practitioners most closely involved in its development, delivery and review in order to explore lessons learned for future staff-led projects including those aimed at tackling prison suicide and self-harm. RESULTS Findings from staff reflections suggest that the development, implementation and evaluation of the project were influenced by a combination of issues around: project focus, communication and professional relationships, the institutional environment, funding and time, roll-out and evaluation, and the need for a 'champion' role. CONCLUSIONS There is limited evidence that the project left a modest positive legacy in terms of impact. A more substantial legacy of the project is provided in terms of actionable learning points for future projects of this nature.
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Affiliation(s)
- Paul Biddle
- Department of Social Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST UK
| | - Wendy Dyer
- Department of Social Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST UK
| | - Richard Hand
- Tees Esk & Wear Valley NHS Foundation Trust, Roseberry Park Hospital, Middlesbrough, TS4 3AF UK
| | - Charlitta Strinati
- Tees Esk & Wear Valley NHS Foundation Trust, Roseberry Park Hospital, Middlesbrough, TS4 3AF UK
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O’Connor RC, Portzky G. Looking to the Future: A Synthesis of New Developments and Challenges in Suicide Research and Prevention. Front Psychol 2018; 9:2139. [PMID: 30538647 PMCID: PMC6277491 DOI: 10.3389/fpsyg.2018.02139] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/17/2018] [Indexed: 12/13/2022] Open
Abstract
Suicide and attempted suicide are major public health concerns. In recent decades, there have been many welcome developments in understanding and preventing suicide, as well as good progress in intervening with those who have attempted suicide. Despite these developments, though, considerable challenges remain. In this article, we explore both the recent developments and the challenges ahead for the field of suicide research and prevention. To do so, we consulted 32 experts from 12 countries spanning four continents who had contributed to the International Handbook of Suicide Prevention (2nd edition). All contributors nominated, in their view, (i) the top 3 most exciting new developments in suicide research and prevention in recent years, and (ii) the top 3 challenges. We have synthesized their suggestions into new developments and challenges in research and practice, giving due attention to implications for psychosocial interventions. This Perspective article is not a review of the literature, although we did draw from the suicide research literature to obtain evidence to elucidate the responses from the contributors. Key new developments and challenges include: employing novel techniques to improve the prediction of suicidal behavior; testing and applying theoretical models of suicidal behavior; harnessing new technologies to monitor and intervene in suicide risk; expanding suicide prevention activities to low and middle-income countries; moving toward a more refined understanding of sub-groups of people at risk and developing tailored interventions. We also discuss the importance of multidisciplinary working and the challenges of implementing interventions in practice.
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Affiliation(s)
- Rory C. O’Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Gwendolyn Portzky
- Unit for Suicide Research, Flemish Centre of Expertise in Suicide Prevention, Ghent University, Ghent, Belgium
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Castelpietra G, Egidi L, Caneva M, Gambino S, Feresin T, Mariotto A, Balestrieri M, De Leo D, Marzano L. Suicide and suicides attempts in Italian prison epidemiological findings from the "Triveneto" area, 2010-2016. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 61:6-12. [PMID: 30454560 DOI: 10.1016/j.ijlp.2018.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/20/2018] [Accepted: 09/19/2018] [Indexed: 06/09/2023]
Abstract
The aim of this observational study was to assess rates of suicide and suicide attempts, in relation to gender, age, place of birth and security levels, in north-eastern Italian prisons during 2010-2016, and investigate associations with prison overcrowding, offence type and prior self-harm and suicide attempts. The study was based on individual data on suicides and suicide attempts from 16 prisons, with an average yearly number of 3900 inmates during the study period, for all prisons combined. Descriptive and binomial regression analyses were performed. Rates of suicide and suicide attempts in Triveneto prisons were 1and 15 per 1000 inmates, respectively. >90% of suicides and suicide attempters were men aged between 21 and 49 years old, and most had committed violent offenses. Only half the prisoners who died by suicide and 30% of those who made a suicide attempt in custody were Italians. 'Cooperative witnesses' had the highest mean suicide attempt rate (30/1000 inmates). Fourteen per cent of suicides and 19% of attempters had a prior history of suicide attempts and self-injury. In binomial regression analyses, predictors of suicidal behaviour were being a male inmate in standard security conditions, with a mean age of 30 years. The study highlighted that there is a need for suicide prevention policies in Triveneto; these should take into account predictors of suicidal behaviours and individual characteristics of suicidal inmates. More research is warranted in order to both evaluate the effectiveness of prevention plans and better assess risk of suicide in specific groups, such as cooperative witnesses.
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Affiliation(s)
- Giulio Castelpietra
- Primary Care Service Area, Central Health Directorate, Region Friuli Venezia Giulia, Riva Nazario Sauro 8, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, ple Europa 1,Trieste, Italy.
| | - Leonardo Egidi
- Department of Economics, Business, Mathematics and Statistics 'Bruno de Finetti', University of Trieste, ple Europa 1, Trieste, Italy
| | - Marina Caneva
- Triveneto Penitentiary Headquarters, Ministry of Justice, Piazza Castello, 12, Padova, Italy
| | - Sara Gambino
- Triveneto Penitentiary Headquarters, Ministry of Justice, Piazza Castello, 12, Padova, Italy
| | - Tamara Feresin
- Primary Care Service Area, Central Health Directorate, Region Friuli Venezia Giulia, Riva Nazario Sauro 8, Trieste, Italy
| | - Aldo Mariotto
- Primary Care Service Area, Central Health Directorate, Region Friuli Venezia Giulia, Riva Nazario Sauro 8, Trieste, Italy
| | - Matteo Balestrieri
- Unit of Psychiatry, DAME, University of Udine, Piazzale Santa Maria della Misericordia, Udine, Italy
| | - Diego De Leo
- Griffith University, 170 Kessels Rd, Nathan, QLD, Australia
| | - Lisa Marzano
- Faculty of Science and Technology, Middlesex University, The Burroughs, London NW4 4BT, UK
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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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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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Fazel S, Ramesh T, Hawton K. Suicide and the criminal justice system: a more complete picture - Authors' reply. Lancet Psychiatry 2018; 5:107. [PMID: 29413127 PMCID: PMC6082336 DOI: 10.1016/s2215-0366(18)30012-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
| | - Taanvi Ramesh
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Keith Hawton
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; Centre for Suicide Research, University of Oxford, Oxford, UK
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Frangione A, Bracali L, Rosi L, Mancino M, Meschi M, Nante N, Troiano G. Prevention of suicide behind bars: first Italian results. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2017. [DOI: 10.1186/s41935-017-0028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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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: 112] [Impact Index Per Article: 16.0] [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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