Adverse childhood experiences: a retrospective study to understand their associations with lifetime mental health diagnosis, self-harm or suicide attempt, and current low mental wellbeing in a male Welsh prison population

Abstract

Background: Prisoners are at increased risk of poor mental health and self-harming behaviours, with suicide being the leading cause of death in custody. Adverse childhood experiences (ACEs) such as child maltreatment are strong predictors of poor mental health and wellbeing yet despite high levels of ACEs in offender populations, relatively few studies have explored the relationships between ACEs and prisoners' mental health and wellbeing. We conducted an ACE survey with 468 male adult prisoners in a Welsh prison who were not currently considered to be at risk of self-harm and suicide and explored relationships between ACEs, lifetime mental illness diagnosis, self-harm (lifetime and lifetime in prison) or suicide attempt (lifetime and lifetime in prison), and current low mental wellbeing. Results: Most participants (84.2%) had suffered at least one ACE and 45.5% had suffered ≥4 ACEs. Prevalence of lifetime mental illness diagnosis, self-harm (lifetime and lifetime in prison) or suicide attempt (lifetime and lifetime in prison), and current low mental wellbeing increased with exposure to ACEs. For example, 2.7% of those with no ACEs reported lifetime self-harm or suicide attempt in prison compared with 31.0% (self-harm in prison) and 18.3% (suicide attempt in prison) of those with ≥4 ACEs. Compared with participants with no ACEs, those with ≥4 ACEs were four times more likely to report lifetime mental illness diagnosis and suicide attempt, and over 10 times more likely to report lifetime self-harm than those with no ACEs. Independent of lifetime mental illness diagnosis, selfharm or suicide attempt, participants with ≥4 ACEs were almost three times more likely to have current low mental wellbeing than those with no ACEs.

Epidemiology, Risk Factors, and Prevention of Suicidal Thoughts and Behaviour in Prisons: A Literature Review

“…Furthermore, half (47–58%) of prisoners with suicidal thoughts go on to attempt suicide in their lifetime ( Favril et al, 2020a ; Favril & O’Connor, 2021 ; Larney et al, 2012 ), which is roughly twice the ratio (29%) documented among adults in the general population ( Nock et al, 2008 ). When specifically considering in-prison outcomes, one in ten (9–13%) prisoners report having made a suicide attempt at some point during their incarceration ( Dudeck et al, 2011 ; Encrenaz et al, 2014 ; Favril et al, 2020b ; Ford et al, 2020 ; Sánchez et al, 2021 ). In the previous 12 months in custody, a quarter (24%) of prisoners have considered suicide ( Favril et al, 2017 ).…”

Factors associated with the transition from suicidal ideation to suicide attempt in prison

“…found among male prisoners in Europe. [23][24][25][26] Our analyses highlight two key findings. First, factors characterised by behavioural disinhibition-drug use, violent offending, and non-suicidal self-injuryeach doubled the odds of suicide attempt among prisoners with suicidal ideation, as did exposure to suicidal behaviour.…”

Developing a clinical pathway for traumatic stress in prisons

“…1 The higher prevalence of C-PTSD reflects the fact that people in the criminal justice system - including those attending police custody, courts, prisons and probation services - have often been exposed to multiple and cumulative experiences of inter-personal trauma during their childhoods, and in the rest of their lives. 2,3 High rates of psychiatric co-morbidity have also been identified amongst prisoners with PTSD, with links to suicidal behaviour, self-harm and aggression. 1 However, most people in prisons have had no prior contact with mental health services, and an under-representative proportion of prisoners receive treatment for mental health conditions, so it is likely that there are significant levels of untreated PTSD and C-PTSD in these settings.…”