Distinguishing prisoners who think about suicide from those who attempt suicide

Abstract

Background Many people who consider suicide do not translate these intentions into action. Although prisoners constitute a particularly high-risk group for suicide, little is known about the factors that distinguish those who think about suicide from those who attempt suicide. Methods Participants were 1326 adult offenders (1203 men) randomly selected from 15 Belgian prisons, representing 14% of the national prison population. Multivariate regression analysis compared prisoners who attempted suicide (n = 277) with those who thought about suicide but never made an attempt (n = 312) on a range of established risk factors. Results Among the 589 participants reporting a lifetime history of suicidal ideation (44% of the total sample), almost half (47%) had made a suicide attempt. Relative to those who only thought about suicide, participants who attempted suicide were more likely to be violent offenders (aOR 2.33, 95% CI 1.49–3.62) and have a history of non-suicidal self-injury (aOR 3.19, 95% CI 2.09–4.86). The presence of self-reported mental disorder diagnosis (aOR = 2.84, 95% CI 1.91–4.24) and illicit substance abuse (aOR = 2.01, 95% CI 1.24–3.28) also independently differentiated prisoners who attempted v. considered suicide. Conclusion This study provides preliminary evidence that behavioural and mental health factors are implicated in the transition from thoughts to acts of suicide in prisoners. Prospective studies are warranted to explore whether these risk factors predict progression from ideation to action over time.

What differentiates prisoners who attempt suicide from those who experience suicidal ideation? A nationally representative study

“…Respondents were asked whether they had ever been told by a mental health professional, such as a psychiatrist or psychologist, that they had one or more of the following mental disorders: depressive disorder; bipolar disorder; psychotic disorder; posttraumatic stress disorder (PTSD); anxiety (e.g., panic) disorder; personality (e.g., antisocial or borderline) disorder; other mental disorders not listed. The wording of the question and choice of a self-report measure of lifetime psychiatric diagnoses is consistent with previous prison research (Binswanger et al, 2010;Favril & O'Connor, 2019).…”

“…However, our literature review identified only three studies adopting an ideation-to-action framework to discern risk of suicide in prisoners (see Table 1 for a summary). Results suggest that, relative to those who only think about suicide, prisoners who also attempt suicide are significantly more likely to report traumatic brain injury, non-suicidal self-injury, violent offending, indicators of childhood trauma, substance abuse, and certain mental disorders (Favril et al, 2020;Favril & O'Connor, 2019;Larney et al, 2012). These studies further indicate that approximately half (47-58%) of those who considered suicide had progressed to making a suicide attempt at some point.…”

“…Next, all predictor variables (regardless whether they significantly distinguished between ideators and attempters at the bivariate level) were entered into a multivariate logistic regression to determine their independent contributions. Consistent with earlier work (Favril et al, 2020), we additionally examined men and women separately due to the marked sex differences in suicidal outcomes among prisoners (Favril & O'Connor, 2019;Jenkins et al, 2005). Robust standard errors were estimated for the final multivariate model given the clustered nature of the data (i.e., prisoners nested within prisons), which violates the assumption of independence.…”

“…Specifically, the survey asked respondents whether they had ever attempted suicide (no/yes) and followed up by asking those who did not provide a positive response to this question whether they ever considered suicide (no/yes). In line with Favril and colleagues (Favril et al, 2020;Favril & O'Connor, 2019), both dichotomous items were used to categorize participants in three mutually exclusive groups: those without any suicidal history (controls), those who had thought about suicide but never made a suicide attempt (ideators), and those who had experienced suicidal ideation and attempted suicide in the past (attempters).…”

“…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 (Larney et al, 2012), Belgium (Favril & O'Connor, 2019), England and Wales (Jenkins et al, 2005), Italy (Sarchiapone et al, 2009), and New Zealand (Favril et al, 2020) suggest that at least one-third (34-44%) of prisoners seriously considered suicide in their lifetime, and one-fifth (15-22%) has ever attempted suicide. These suicide-related exposures are among the strongest risk factors for suicide in prisoners (Fazel et al, 2008), which concurs with a process-oriented view of suicide risk.…”