Mental disorders and risk of suicide attempt in prisoners

Abstract

Background: Mental disorders are overrepresented in prisoners, placing them at an increased risk of suicide. Advancing our understanding of how different mental disorders relate to distinct stages of the suicidal process—the transition from ideation to action—would provide valuable information for clinical risk assessment in this high-risk population. Methods: Data were drawn from a representative sample of 1212 adults (1093 men) incarcerated across 13 New Zealand prisons, accounting for 14% of the national prison population. Guided by an ideation-to-action framework, three mutually exclusive groups of participants were compared on the presence of mental disorders assessed by validated DSM-IV diagnostic criteria: prisoners without any suicidal history (controls; n = 778), prisoners who thought about suicide but never made a suicide attempt (ideators; n = 187), and prisoners who experienced suicidal ideation and acted on such thoughts (attempters; n = 247). Results: One-third (34.6%) of participants reported a lifetime history of suicidal ideation, of whom 55.6% attempted suicide (19.2% of all prisoners). Suicidal outcomes in the absence of mental disorders were rare. Whilst each disorder increased the odds of suicidal ideation (OR range 1.73–4.13) and suicide attempt (OR range 1.82–4.05) in the total sample (n = 1212), only a select subset of disorders was associated with suicide attempt among those with suicidal ideation (n = 434). Drug dependence (OR = 1.65, 95% CI 1.10-2.48), alcohol dependence (OR = 1.89, 95% CI 1.26-2.85), and posttraumatic stress disorder (OR = 2.09, 95% CI 1.37-3.17) distinguished attempters from ideators. Conclusion: Consistent with many epidemiological studies in the general population, our data suggest that most mental disorders are best conceptualized as risk factors for suicidal ideation rather than for suicide attempt. Once prisoners consider suicide, other biopsychosocial factors beyond the mere presence of mental disorders may account for the progression from thoughts to acts of suicide.

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

“…Identifying what factors may precipitate the transition from thought to enactment could elucidate points at which to disrupt this trajectory of risk. In light of this, recent work [6][7][8][9] suggests that brain injury, interpersonal violence, non-suicidal self-injury, childhood adversity, trauma, substance abuse, and certain mental disorders increase the risk of suicide attempt among prisoners with suicidal ideation. Although these risk factors largely mirror those found for behavioural enaction in the general population [10][11][12][13][14][15][16], epidemiological data suggest that prisoners are twice as likely as non-incarcerated adults to act on their suicidal thoughts [5][6][7][8][9].…”

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

“…Our data align with epidemiological [35][36][37][38] and meta-analytical 10 evidence indicating that virtually all mental disorders increase the risk of subsequent suicidal ideation, but only a select few-those characterised by anxiety and poor impulse control-predict the transition to suicide attempt. This finding was recently replicated in a representative national sample of 1212 New Zealand prisoners, 8 in that most mental disorders were not associated with suicide attempt above and beyond their relationship with suicidal ideation.…”

“…Ethical approval for the study was A total of 1203 men were included in the analyses, equating to an 85% response rate-which tallies with the 78-85% documented in similar large-scale prison studies. 6,8,19 The sample accounts for one-third (33%) of all men physically residing in the 15 selected prisons who were eligible to participate during the data collection period, and represents 12% of the average daily population of male prisoners in Belgium at that time. 18…”

“…Identifying what factors may precipitate the transition from thought to enactment could elucidate points at which to disrupt this trajectory of risk. In light of this, recent work [6][7][8][9] suggests that brain injury, interpersonal violence, non-suicidal self-injury, trauma, and substance abuse increase the risk of suicide attempt among prisoners with suicidal ideation. These risk factors largely mirror those found for behavioural enaction in the general population, [10][11][12][13][14][15] albeit their background prevalence is much higher among prisoners.…”

“…These risk factors largely mirror those found for behavioural enaction in the general population, [10][11][12][13][14][15] albeit their background prevalence is much higher among prisoners. A central limitation of these studies, however, relates to the assessment of prisoners' suicidal outcomes on a lifetime basis, [6][7][8][9] hence providing limited information concerning what factors are associated with behavioural enaction while incarcerated. Consequently, the potential role of prison-specific influences (e.g.…”