Psychiatric and social aspects of suicidal behaviour in prisons

WHO Collaborating Centre, David Goldberg Centre, Institute of Psychiatry, Denmark Hill, London.
Psychological Medicine (Impact Factor: 5.43). 03/2005; 35(2):257-69. DOI: 10.1017/S0033291704002958
Source: PubMed

ABSTRACT Suicidal behaviour and completed suicide are serious problems within British prisons, leading to significant morbidity and mortality, and are the focus of major efforts towards their prevention.
To explore the demographic, social and psychiatric correlates of suicidal behaviour in prisons in England and Wales and their relationship with health service use; and to develop a combined psychosocial model of risk.
This report analyses the prevalence of suicidal ideation and suicide attempts in the ONS National Prison Survey, and their association with the presence of psychiatric disorders, personality disorder, substance abuse and social risk factors. These data were compared with data from the second national survey of psychiatric morbidity in adults living at home. In both surveys, a two-phase interviewing procedure was used, covering general health, health service use, assessment of psychiatric disorders, life events, social supports, suicidal behaviour, activities of daily living, sociodemographic data, substance abuse and intelligence.
Suicidal thoughts and suicide attempts were commoner in prisons than in the general population and these were significantly associated with higher rates of psychosis, neurosis and personality disorder in prisons. In addition, demographic and factors such as being young, single, white, leaving school early and experiencing poor social support and significant social adversity were important risk factors for suicidal thoughts. Crucially, there was no separate category of people at suicidal risk who did not have psychiatric disorders.
The high rates of suicidal behaviour in prisons cannot be addressed without adequate attention to the high rates of psychiatric disorder and vulnerability factors in prisoners.

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    • "At least one other study of suicidal ideation in prisoners has reported a lack of association with alcohol and drug use (Jenkins et al., 2005; Larney et al., 2012). Although the reason why substance abuse and suicide ideation were not significantly related is not clear, it may be that the high prevalence of problematic substance use among prisoners may mean that it is not a useful predictor of suicide ideation in this population. "
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    ABSTRACT: Purpose: Suicidal behaviour is a common in prisoners, yet little is known about the factors that may protect against thoughts of ending one’s life. The main aim of the present study was to specify and test a structural model to examine the relationship between three criminal social identity dimensions (in-group affect, in-group ties, and Cognitive Centrality) and suicide ideation while controlling for period of confinement, age, and offense type (violent vs. non-violent). Design/methodology/approach: Participants were 415 male juvenile offenders incarcerated in prisons in Khyber Pakhtunkhwa (KPK) Pakistan. A structural model was specified and tested using Mplus to examine the relationships between the three factors of criminal social identity and suicidal thoughts, while controlling for age, offender type, period of confinement, and substance dependence. Findings: The model provided an adequate fit for the data explaining 22% of variance in suicidal thoughts. In-group affect (the level of personal bonding with other criminals) exerted a strong protective effect against suicide ideation. Originality/value: The research contributes important information on suicide ideation in Pakistan, an Islamic country in which suicide is considered a sin and subsequently a criminal offence. Results indicate that Juvenile offenders’ sense of shared identity may help to prevent the development of thoughts of death by suicide. Consequently, separating and isolating young prisoners may be ill advised.
    International Journal of Prisoner Health 06/2015; 11(2). DOI:10.1108/IJPH-06-2014-0018
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    • "Complex but connected systems of health, social care and criminal justice have emerged to assist women, who, regardless of the type of setting in which they are placed, may have broadly similar care needs (Parry-Crooke, Robinson, & Zeilig, 2012). Rates of mental disorder in prison are high (Fazel & Benning, 2009; Hassan et al., 2011): psychosis in women prisoners is 30 times higher than aged-matched community samples; while personality disorder is over 15 times as high (Jenkins et al., 2005; Singleton et al., 1998). Women report extremely high rates of sexual abuse, domestic violence (>50%), substance misuse (85%), with 70% of women requiring chemical detoxification (Corston, 2007). "
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    ABSTRACT: Secure provision for women in both the Criminal Justice System and the Health Service has evolved in the last decade, in line with emerging gender-specific policy. Notable gains have been the approach to self-harm in prison and a reduction in the inappropriately high levels of secure hospital care. Although treatment pilots in UK settings are in progress, much practice remains poorly described and insufficiently evaluated. Recent strategic initiatives by both the Ministry of Justice and the Department of Health, as well as the commissioning changes that have followed the Health and Social Care Act 2012, provide a basis for reconsideration and a further paradigm shift. Suggestions for a reinvigorated model of gender-sensitive provision are made, relying on principles of resilience and autonomy.
    Journal of Forensic Psychiatry and Psychology 11/2014; Published on line August 20.2014 doi: 10.1080/14789949.2014.944202(6). DOI:10.1080/14789949.2014.944202 · 0.88 Impact Factor
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    • "We hypothesized that sex offenders would be at increased risk of suicidal behavior as compared to other types of offenders. However, we found that the overall lifetime incidence of suicide attempts (14%) among this sample of sex offenders was lower than a previous study of general offenders within the United Kingdom (20%; Jenkins et al., 2005). Furthermore, Jenkins et al. found that 6.6% of their general offender sample population made a suicide attempt in the past year, whereas only 2.5% of our sample population made an attempt while incarcerated (which was generally a much longer time frame than 1 year). "
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    ABSTRACT: Little is known about suicide attempts among sex offenders. This study examines the rates of nonfatal suicide attempts among a sample (N = 3,030) of incarcerated male sex offenders. Overall, the authors found that 14% of sex offenders in the study sample had made a suicide attempt at some point in their lives. Of those, 11% had reported a suicide attempt prior to incarceration, 0.5% had made a suicide attempt while incarcerated, and 2.5% made suicide attempts both prior to and during incarceration. Sex offenders who made suicide attempts were significantly more likely than those who did not make suicide attempts to have had an abusive childhood, a history of psychiatric problems, intellectual impairment, male victims, and related victims. Suicide attempters also scored higher on actuarial risk measures than nonattempters. No differences were found in attempter status between sex offenders who committed sex offenses against children and those who committed sex offenses against adults. A history of psychiatric problems and treatment as well as childhood abuse/neglect and perpetration against male victims predicted suicide attempter status. These findings are discussed as they pertain to suicide prevention, risk assessment, and the collateral consequences of sex offender legislation.
    Annals of Sex Research 06/2012; 25(1). DOI:10.1177/1079063212447201 · 2.21 Impact Factor
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