Non-fatal suicidal behaviour among prisoners

The associations of poor psychiatric well-being among incarcerated men with injecting drug use histories in Victoria, Australia

BACKGROUND

Dual substance dependence and psychiatric and psychological morbidities are overrepresented in prison populations and associated with reoffending. In the context of an increasing prison population in Australia, investigating the needs of vulnerable people in prison with a dual diagnosis can help inform in-prison screening and treatment and improve prison and community service integration and continuation of care. In this study we quantified psychiatric well-being in a sample of people in prison with a history of injecting drug use in Victoria, Australia, and identified factors associated with this outcome.

METHODS AND RESULTS

Data for this paper come from baseline interviews undertaken in the weeks prior to release as part of a prospective cohort study of incarcerated men who reported regular injecting drug use prior to their current sentence. Eligible participants completed a researcher-administered structured questionnaire that canvassed a range of issues. Psychiatric well-being was assessed using the 12-item General Health Questionnaire (GHQ-12) and potential correlates were included based on a review of the literature. Of the 317 men included for analyses, 139 were classified as experiencing current poor psychiatric well-being. In the multivariate model using modified logistic regression, history of suicide attempt (aOR = 1.36, 95%CI 1.03-1.78), two or more medical conditions (aOR = 1.87, 95%CI 1.30-2.67) and use of crystal methamphetamine in the week prior to their current sentence (aOR = 1.52, 95%CI 1.05-2.22) were statistically significantly associated with current poor psychiatric well-being.

CONCLUSIONS

Comprehensively addressing the health-related needs for this vulnerable population will require a multidisciplinary approach and enhancing opportunities to screen and triage people in prison for mental health and other potential co-occurring health issues will provide opportunities to better address individual health needs and reoffending risk.

Associations between past trauma, current social support, and loneliness in incarcerated populations

Background

Prisoners are a vulnerable population with higher rates of trauma than community populations. Social support is important for both in–prison adjustment and post-release community re-entry. Loneliness, a related construct to social support, has been found to be associated with elevated rates of suicidal ideation and behavior, depression, and hopelessness in incarcerated populations.

Methods

This study explored the relationship of past physical, sexual, and crime-related trauma to current perceived social support and loneliness in a mixed-gender sample of 235 depressed prisoners enrolled in depression treatment studies.

Results

History of any trauma, regardless of type, as well as physical, sexual, and crime-related traumas were associated with lower current perceived social support scores (controlling for gender). Past sexual trauma and crime-related trauma were associated with higher levels of loneliness (controlling for gender), though history of any trauma and physical trauma was not.

Conclusion

Findings suggest that both overall trauma and specific types of trauma are linked to perceived social support and loneliness among incarcerated persons with major depressive disorder. This is the first study, to the authors’ knowledge, that specifically observed a relationship between past trauma and current social support and loneliness in prison populations. Many intervention programs for prisoners encourage them to develop non-criminogenic and substance-free social networks. These programs should be aware that individuals who have experienced interpersonal trauma may have additional interpersonal challenges, and may need strategies to address interpersonal deficits related to trauma exposure.

Electronic supplementary material

The online version of this article (doi:10.1186/2194-7899-2-7) contains supplementary material, which is available to authorized users.

Deliberate self-harm and suicide attempt in custody: distinguishing features in male inmates' self-injurious behavior

Self-injurious behavior involving deliberate self-harm and suicide attempts by inmates while under custodial authority is a major problem for prisons and jails (prevalence, legal obligation for suicide prevention, and stress for officers). The differentiation of "serious" vs. "non-serious" and often manipulative suicide attempts as distinct phenomena, each with its own clinical features, is controversially discussed in current literature and a challenge for every diagnostician. If distinct clinical presentations and histories can be observed, an estimation of the seriousness of each act of self-injurious behavior can be simplified, whereby appropriate treatment of the individual case becomes possible. The aim of the study was to find differences between self-injurious behavior of "low seriousness" (i.e. low lethality and low suicidal intent) and of "high seriousness". Therefore, inmates showing self-injurious behavior were divided into subgroups of deliberate self-harm and suicide attempters on the basis of the act's intent and lethality. This was followed by a comparison of the clinical presentations of the individual inmates constituting the subgroups. Hence, 49 inmates showing self-injurious behavior were interviewed and tested with a variety of instruments (SCID-I and II, PCL-R, BDI-II, BHS, BSS, SIS, etc.), and their prison and health files were examined. The results indicate significant correlations between seriousness and some demographic, prison-related variables as well as different measures of depression. Negative, but nonsignificant correlations could be observed with regard to cluster B personality disorders. The PCL-R total score as well as PCL-R factor 1 showed a statistical trend for negative correlations with measures of seriousness. Inmates showing deliberate self-harm and suicide attempters seem to differ in a number of ways. Implications on how the individual prisoner should be treated are discussed.