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. Suicide is a global public health concern (Turecki et al., 2019) which disproportionally impacts on the most vulnerable members of society, including people exposed to the criminal justice system (Webb et al., 2011). Specifically, suicide is a leading cause of death in prisoners (Favril, Wittouck, Audenaert, & Vander Laenen, 2019), with rates at least three times higher than in age-equivalent peers outside prison (Fazel, Ramesh, & Hawton, 2017). Prisoners who die by suicide only represent the tip of the iceberg; many more consider or attempt suicide without a fatal outcome. Large-scale studies from Australia

Correctional institutions in the United States witness higher rates of suicide compared with the general population, as well as a higher number of attempted suicides compared with completed cases. Prison research focused little attention on investigating the combined effects of inmate characteristics and prison context on suicide, with studies using only one level of analysis (prison or prisoner) and neglecting the nested nature of inmates in prisons. To extend this literature, multilevel modeling techniques were employed to investigate individual- and prison-contextual predictive patterns of attempted suicide using a nationally representative sample of 18,185 inmates in 326 prisons across the United States. Results revealed that several individual-level factors predicted odds for attempted suicide, such as inmate characteristics/demographics, prison experiences, having a serious mental illness, and symptoms of mental health issues. Some prison-contextual variables, as well as cross-level interaction effects, also significantly predicted odds for attempted suicide. Policy and research implications are discussed.

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IntroductionParamedics are routinely exposed to traumatic incidents that include physical injuries; these events may manifest into psychosocial injury. Proactive and preventive measures have the potential to mitigate the negative impact of exposure to traumatic events. Enhancing an individual’s capacity to effectively manage stressful/adverse life events through an online resilience resource (ORR) offers a promising option for paramedics. The aim of this study is to investigate the initial impact of an ORR on resilience and to explore the potential skill decay following this self-guided online resource among pre-employment paramedic trainees.  MethodsThrough a repeated measures design, 227 primary care paramedics from British Columbia, Canada completed a baseline resilience assessment and ORR. A subset of participants completed follow-up resilience assessments at 3 to 6 month or 9-month intervals. ResultsBetween the baseline and 3-month follow-up tests, results indicate that self-report resilience scores showed a slight improvement. However, as time increased to 6 or 9 months, a statistically significant decrease in resilience scores in comparison to the baseline was observed. ConclusionThis study presents evidence to suggest that an educational tool such as an online self-paced training program for building resilience may be an effective strategy for improving short-term personal resilience among primary care paramedic students. Given the gradual skill decay associated with an ORR, we can highlight the temporal limits of resilience training. Developing additional resilience training programs to be delivered throughout students’ pre-employment education may help reduce skill decay.

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