The relevance of suicidal behaviour in jail and prison suicides.

PURPOSE: Suicide rates in correctional institutions have been increasing during the last decades. There has been little interest in whether suicidal ideation and intent has been documented by non-medical prison staff (reports of attempted suicide, suicide threats, self-harm), and whether these signs of suicidality had the consequence of adequate intervention efforts. METHODS: The personal files of inmates who committed suicide in the 29 Austrian jails and prisons during the last 25 years (1975-1999) were included. We analysed personal characteristics, criminological data, circumstances of custody and information about psychiatric disorders and treatment. RESULTS: Of a total of 250 suicides, 220 personal files were available and included. Suicide attempts were known in 50% of all suicides and 37% had expressed suicidality. In >20%, non-medical staff had documented signs of suicidality, but no further preventive action (e.g. referral to psychiatric care) had taken place. CONCLUSION: Signs of suicidality play an important role in vulnerability profiles for jail and prison suicides and should have the minimal consequence of further psychiatric care.     

Suicide in Thailand during the period 1998-2003

The aim of this study was to examine the characteristic features of suicides in Thailand between 1998 and 2003. Collected data during 1998-2003 from the Bureau of Policy and Strategy, Ministry of Public Health were analyzed to reveal the mortality from suicide according to age, gender, rate and methods of suicides. Suicide rates were found to have increased to a peak of 8.6 per 100 000 (5290 suicides) in 1999 and then to have decreased to 7.1 per 100 000 in 2003. The average suicide rate during 1998-2003 was 7.9 per 100 000 with a male to female ratio of 3.4:1. Male suicide reached a peak for those aged 25-29 years (21.9 per 100 000) while female suicide showed less variation with age. Hanging was the most common method used, followed by ingestion of agricultural toxic substances. Suicide was most prevalent in upper northern region where HIV infection might be related to the high prevalence. Suicide prevention program should focus on males in early adulthood, and particular measures should be conducted to reduce risk factors related to HIV infection among people in northern Thailand.     

Suicide in New South Wales Prisons, 1995-2005: towards a better understanding

OBJECTIVES: This paper reports on a review of suicides in New South Wales (NSW) prisons from 1 January 1995 to 31 December 2005 in an attempt to gain a better understanding of the nature and quality of the problem of suicide among prisoners. METHOD: All deaths in NSW prisons for the period were reviewed. Those identified as self-inflicted, with a coronial finding of death by suicide or those awaiting a coronial hearing but reported as possible death by suicide were included. A data set was collected on each case and entered into a database. RESULTS: A total of 92 cases were identified as deaths by suicide in NSW prisons from 1 January 1995 to 31 December 2005, representing 41% of all deaths in custody for the period. CONCLUSION: The rate of suicide in NSW prisons has been declining over the past 10 years, but remains approximately 10-fold that of the NSW community. Suicide was the leading cause of death among NSW inmates from 1995 to 2005. Suicide is a rare event, making its prediction a difficult task, with the prison environment a further compounding factor. This review highlights a number of factors, which appear to be common in many cases. Increased monitoring during the first week of incarceration may be an effective intervention. It is recommended that consideration be given to the length of time spent on remand and the value of custodial sentences of 相似文献   

The Balkan Piedmont: male suicide rates pre-war, wartime, and post-war in Serbia and Montenegro.

The epidemiology of suicide in Serbia and Montenegro from 1989 to 2003, a period of civil war, is presented. Following the break-up of former Yugoslavia, Serbia and Montenegro underwent a period of war from 1991-1994 and another in 1999. During the war years, the number of suicides increased, reaching its peak in 1993. Male suicides outnumbered female suicides by a ratio of 2:1. Male suicides decreased slightly after the war of 1991-1994 only to rise in 1997 and continue at this higher level throughout the nineties. In Serbia alone, male suicide reached its peak in 2002 (nearly 29/100,000). The methods of suicide changed significantly, with the use of firearms doubling during and after the war years. Speculations are offered about the findings, many consistent with Durkheim's classical hypothesis concerning suicide and unpopular wars.     

Prevalence of psychiatric disorders in New Zealand prisons: a national study

OBJECTIVE: The paper describes the methodologies and results obtained on a large cohort of prison inmates in New Zealand who were screened for psychiatric disorder. METHOD: All women and remanded male inmates in New Zealand prisons, and a randomly selected cohort of 18% of sentenced male inmates were interviewed. Interviewers used the Composite International Diagnostic Interview - Automated to establish DSM-IV diagnoses, and the Personality Disorders Questionnaire to identify personality disorder. All prisons in New Zealand were visited. RESULTS: The results indicate markedly elevated prevalence rates for major mental disorder in the prison population when compared with community samples. This is especially the case for substance misuse, psychotic disorders, major depression, bipolar disorder, obsessive- compulsive disorder and posttraumatic stress disorder. Of particular concern is not only the increased prevalence rates for schizophrenia and related disorders but also the high level of comorbidity with substance misuse disorders demonstrated by this group. While 80.8% of inmates diagnosed with bipolar disorder were receiving psychiatric treatment in the prison, only 46.4% of depressed inmates and 37% of those suffering from psychosis were receiving treatment. Maori inmates were grossly overrepresented in the remand, female and male sentenced inmate population compared with the general population. CONCLUSIONS: A significant increase in provision of mental health services is required to cope with the high number of mentally ill inmates. The level of need demonstrated by this study requires a level of service provision that is quite beyond the capacity of current forensic psychiatry services, Department of Corrections Psychological Services or the prison nursing and medical officers. The elevated rates of common mental disorders argues for the use of improved psychiatric screening instruments, improved assessment and treatment capacities in the prison and an increased number of forensic psychiatric inpatient facilities to care for those psychotic inmates who are too unwell to be treated in the prison.     

Is there a relationship between elderly suicide rates and smoking? A cross‐national study

BACKGROUND: An independent relationship between smoking cigarettes and completed suicides has been reported in several cohort and case-control studies of younger subjects, but this relationship has rarely been examined in the elderly. METHODS: The relationship between the prevalence of smoking in males and females and suicide rates in males and females in the age-bands 65-74 years and 75 + years was examined using national-level aggregate data from the World Health Organisation and the United Nations Development Programme websites. In addition to univariate analysis, multivariate analysis were conducted to ascertain an independent relationship between the prevalence of smoking and elderly suicide rates. RESULTS: The main findings were: (i) on univariate analysis, the prevalence of smoking in males was positively correlated with suicide rates in males aged 65-74 years and males aged 75 + years, but this relationship was absent in females and (ii) on multivariate analysis there was no independent relationship between the prevalence of smoking in males and suicide rates in males in both the elderly age-bands. CONCLUSIONS: There is a case for examination of the relationship between smoking and elderly suicides in individual-level cohort or case-control studies because of the potential methodological difficulties in cross-national studies using national- level aggregate data, paucity of cohort or case-control studies at an individual-level in the elderly, and the observation of an independent relationship between smoking and completed suicides in individual-level cohort and case-control studies in younger age groups.     

Rates of sexual victimization in prison for inmates with and without mental disorders

OBJECTIVE: This study estimated the rates of sexual victimization among prison inmates with and without a mental disorder. METHODS: The study sampled inmates aged 18 or older in 13 prisons within a single mid-Atlantic state prison system (12 facilities for men and one for women). A total of 7,528 inmates completed the survey instrument, which was administered by audio-computer-assisted technology. Of the 6,964 male respondents, 58.5% were African American, 16.2% were non-Hispanic white, 19.8% were Hispanic, and 5.5% were of another race or ethnicity. Of the 564 female respondents, 48.4% were African American, 30.9% were non-Hispanic white, 14.4% were Hispanic, and 7.3% were of another race or ethnicity. Mental disorder was based on self-reported previous mental health treatment for particular mental disorders. Sexual victimization was measured by using questions adapted from the National Violence Against Women and Men surveys. RESULTS: Approximately one in 12 male inmates with a mental disorder reported at least one incident of sexual victimization by another inmate over a six-month period, compared with one in 33 male inmates without a mental disorder. Among those with a mental disorder, sexual victimization was three times as high among female inmates (23.4%) as among male inmates (8.3%). African-American and Hispanic inmates with a mental disorder, independent of gender, reported higher rates of sexual victimization than their non-Hispanic white counterparts. CONCLUSIONS: Prisons are hazardous places. Steps must be taken to protect inmates from predators inside prison, to screen them for posttraumatic stress disorder, to provide trauma-related treatment, and to keep them safe.     

The Christchurch prisons psychiatric epidemiology study: methodology and prevalence rates for psychiatric disorders

An investigation into psychiatric morbidity in the prisons in Christchurch, New Zealand is described. There are no previously published epidemiology studies concerning New Zealand prison inmates. A total of 225 inmates were approached to take part in the study representing a census of female inmates and remanded males and a randomly selected cohort of 125 sentenced males. Interviewers administered the Composite International Diagnostic Instrument – Automated (CIDI-A), a structured interview that generated both DSM-III-R and ICD 10 diagnoses. Interviews were completed on 183 inmates. Results reveal high lifetime and current prevalence rates for drug and alcohol abuse and dependence as well as high current and lifetime prevalence rates for affective disorders. Schizophrenia had a lifetime prevalence rate of 5% in the sentenced male population. Comparison with community epidemiological figures for psychiatric disorder reveal elevated lifetime and current prevalence rates among prison inmates for all major psychiatric diagnoses except generalized anxiety disorder. Implications for future treatment and service planning in forensic psychiatry are discussed with particular reference to a national epidemiology study of major psychiatric disorder in New Zealand prisons. Copyright © 1999 Whurr Publishers Ltd.     

The Balkan Piedmont: Male Suicide Rates Pre-war,Wartime, and Post-war in Serbia and Montenegro

The epidemiology of suicide in Serbia and Montenegro from 1989 to 2003, a period of civil war, is presented. Following the break-up of former Yugoslavia, Serbia and Montenegro underwent a period of war from 1991–1994 and another in 1999. During the war years, the number of suicides increased, reaching its peak in 1993. Male suicides outnumbered female suicides by a ratio of 2:1. Male suicides decreased slightly after the war of 1991–1994 only to rise in 1997 and continue at this higher level throughout the nineties. In Serbia alone, male suicide reached its peak in 2002 (nearly 29/100,000). The methods of suicide changed significantly, with the use of firearms doubling during and after the war years. Speculations are offered about the findings, many consistent with Durkheim's classical hypothesis concerning suicide and unpopular wars.     

The relationship between suicide rates and age: an analysis of multinational data from the World Health Organization

BACKGROUND: Suicide rates generally increase with age. With the emergence of studies from several countries without an increase in suicides rates with aging, a cross-national study examining the relationship between suicide rates and age was undertaken. METHODS: The relationship between suicide rates and age was examined by ascertaining suicide rates in both sexes in seven age-bands 16-24 years, 25-34 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years and 75+ years, from the World Health Organization website for all the listed countries (N = 62). RESULTS: The main findings were: (i) there was a significant increase in suicide rates with increasing age in males and females in 25 and 27 countries respectively; (ii) there was no significant increase in suicide rates with increasing age in males and females in 31 and 29 countries respectively; (iii) suicide rates were the highest in the younger age-bands in countries without a significant increase in male suicides rates with increasing age; (iv) countries without a significant increase in the suicide rate with increasing age in both sexes, females only and males only demonstrated regional clustering; and, (v) in a small number of countries suicide rates declined with increasing age. CONCLUSIONS: Potential explanations for regional and cross-national variations in the relationship between suicide rates and age require further study.     

Firearm-related suicide among young african-american males

National trends in firearm-related suicides among African-American and white males in the age groups 15 to 19 years and 20 to 24 years from 1979 to 1997 were examined. The rates and percentages of suicide by firearms increased significantly more among African-American males than among white males. During the 19-year period, firearms accounted for about 70 percent and 64 percent of all suicides among males aged 15 to 19 years and 20 to 24 years, respectively. The results support the Surgeon General's 1999 call for greater awareness of the suicide risk among African-American males.     

Carceral suicides--some exceptions and paradoxes

Beginning with Daniel's findings and recommendations regarding prison suicides, this commentary extends the discussion to include jail suicides. Some paradoxes and exceptions to general trends and recommendations are highlighted to advance the discussion on demographic correlates, screening methods, and interventions intended to prevent suicide in jails and prisons.     

Prevalence and characteristics of mental disorders in jails and prisons

PURPOSE OF REVIEW: The published literature from 2004 on mental disorders in jails and prisons was reviewed. RECENT FINDINGS: A number of important studies on prisoner suicide, older prisoners, prison medical services and inmate mental health are highlighted, which provide useful potential interventions to improve the care of mentally ill prisoners. Relevant pieces on ethical issues are also discussed. SUMMARY: Despite increasing prison populations worldwide and robust evidence that serious mental disorders are common in inmates in Western countries, many key issues in the treatment of mentally disordered prisoners remain unanswered. In addition, the evidence base on the nature and prevalence of mental disorders in prisoners in non-Western countries remains small.     

Jailhouse Blues revisited

Background: Over the past decades a number of studies have appeared on suicide among persons in jail and prison remand settings, and sentenced prisoners. In these papers contradictory views concerning the relation between suicide risk and length of custody were published. Methods: This article reports on a study that investigated all suicides (n=206) in all 29 Austrian jails and prisons between 1975 and 1996. The authors demonstrate the necessity to calculate the hazard that reflects the suicide risk in relation to time. Results: The results suggest three different periods of high suicide risk: immediately after admission and 2 months thereafter for prisoners on remand; for long-term prisoners the suicide risk correlates with the length of the sentence and slightly increases with the time of custody. Conclusions: With this knowledge, suicide prevention programmes in prisons and jails could be made more effective and economic. Accepted: 6 June 2001     

Suicide in Hungarian Huntington's disease patients

We studied 96 families with Huntington's disease (HD). There were 396 deaths reported in 195 males and 201 females. Family history and clinical information about the deceased were collected and 40 suicides were found. Suicide occurred most frequently in the early or late stages of the disease; age at onset was slightly lower among those who committed suicide. Of the 40 subjects who committed suicide, 34 were male and 6 were female; this was not significantly different to the expected ratio based on suicide in the general population. Those who committed suicide had a smaller number of children than other HD patients. No significant relationship was shown between the sex of the affected parent and suicide. Four suicides occurred in hospital. Suicide among patients with HD is more common than in the general population. Knowledge about the high suicide risk in this disease is important for genetic counseling.     

Review of completed suicides in the California Department of Corrections and Rehabilitation, 1999 to 2004

OBJECTIVE: The purpose of this extended review is to assist health care managers, clinicians, prison administrators, and custody staff in identifying and responding effectively to prisoners who present a substantial risk of suicide in the foreseeable future. METHODS: The California Department of Corrections and Rehabilitation (CDCR) is the largest state-operated prison system in the country, with a census range of 155,365 to 163,346 prisoners between 1999 and 2004. The authors conducted a review of all 154 suicides that occurred in CDCR during this period and examined several factors related to the suicide, including demographic characteristics of the inmate, health care information, suicide method, custody information, and emergency response. RESULTS: The analysis of trends in this six-year review reveals that prisoners who completed suicide were similar to those who took their lives in the community in age distribution and mental health factors. The analysis also found that this group of prisoners who committed suicide had other characteristics or commonalities related specifically to their incarceration. In this review 60% of the suicides were judged to have been foreseeable, preventable, or both. CONCLUSIONS: Although suicide is not predictable, the terms "foreseeable" and "preventable" are used to indicate cases in which the risk of suicide was elevated or events occurred that should have triggered clinical or custodial reactions that would have reduced the likelihood of completed suicide. This review provides clues to recognize inmates at elevated risk and identifies some of the health care practices and conditions of confinement to consider for provision of an adequate suicide prevention program.     

1324 prison suicides in 10 countries in South America: incidence,relative risks,and ecological factors

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.

     

A study of coroner's records of suicide in young people, 1986-88 in Western Australia.

Coroner's records of 25 consecutive suicides aged 15-19 years and 43 aged 20-24 years were compared with 68 suicides aged 45-59 years to identify associated clinical and psychosocial factors. Male: female ratios were 2.6:1, 5.1:1 and 3.5:1 respectively. The most common method of suicide in males in all three age groups was CO poisoning using motor vehicles. In females the teenage group used mainly active methods, whilst in the 20-24 and 45-49 years age groups the most common method was overdosage. Over 90% of each age group had some identifiable psychiatric symptomatology. In each age group the commonest symptoms were minor affective symptoms. In each group the pattern was mainly of associated multiple rather than single psychosocial factors. In each group disruption of interpersonal relationships (boy-girlfriend, de facto, marital, family) was the predominant stressor. Compared with the 45-59 year group the following associated factors were significantly greater in (a) 15-19 years: personality/conduct disorders, unemployment and legal/disciplinary problems, and (b) 20-24 years: drug abuse and unemployment. Although the two younger groups had significantly more unemployment than the older group, only the 20-24 years group had significantly more unemployment compared with community age norms. Preventive implications of the findings are discussed.     

Do monthly or seasonal variations exist in suicides in a high-risk setting?

An unequal distribution of suicides over months and seasons has been a consistent finding in epidemiological surveys on suicide. Jails and prisons are a high-risk setting for suicide all over the world. The high prevalence of both outward and self-directed violence in prison populations indicates dysfunctional central serotonin (5-HT) neurotransmission and, therefore, could account for an unequal distribution of suicides over months and seasons due to underlying bioclimatic factors. Within a total survey of suicides in the Austrian penitentiary system, the weekly, monthly and seasonal distribution of custodial suicides between 1947 and 1999 was studied. After an explorative comparison of suicide distribution over weekdays, months and seasons of the year by chi2-tests, a harmonic Poisson regression model was performed to detect seasonality of suicides. No unequal distribution of suicides was evident over the 53-year period. A limitation of this study was its sample size of 412, a low number compared with population-based samples, where a spring suicide peak was consistently found. An explanation for lacking seasonality could be that bioclimatic factors are less relevant in urban, industrialized areas, where jails and prisons usually are located. One of the core characteristics of penal institutions is the limited possibility for communication and social interaction. This social isolation is independent of seasonal changes. If the individual's possibilities for social interactions are limited, the influence of seasonal changes in social activities may be less relevant. This could explain the absence of seasonal changes in custodial suicide incidence.