Pattern of self-injurious behavior and suicide attempts in Italian custodial inmates: A cluster analysis approach

Bani, Marco; Travagin, Gabriele; Monticelli, Michele; Valsecchi, Manuela; Truisi, Emanuele; Zorzi, Federico; Strepparava, Mariagrazia; Clerici, Massimo; Mazza, U; Rezzonico, Giorgio

doi:10.1016/j.ijlp.2018.12.008

Cited by 12 publications

(15 citation statements)

References 46 publications

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“…Instead, the cumulative survival probability at the end of the follow-up was calculated: the overall SSHB rate at the end of the present study was 15%. This estimate is significantly higher if compared to that calculated in a recent Italian study on a sample with 40% of foreigner individuals, that was about 5% after 1 year of follow-up (Bani et al, 2019). However, previous evidence reported higher self-harm rates amongst foreigner detainees than Italian ones, consistent with our results (Antigone Association et al, 2019).…”

Section: Discussionsupporting

confidence: 81%

The impact of trauma, substance abuse, and psychiatric illness on suicidal and self-harm behaviours in a cohort of migrant detainees: An observational, prospective study

Marchi

Artoni

Longo

et al. 2020

Int J Soc Psychiatry

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Background: According to the WHO, detainees attempt suicide ten times more than the general population. Aims: To investigate the impact of migration trauma on Suicidal and Self-Harm Behaviours (SSHB) of migrants in jail and to explore how substance use and other psychiatric features affect this relationship. Methods: Prospective cohort study, conducted at the ‘Sant’Anna’ jail in Modena (Italy) between February 2017 and September 2019. Socio-demographic, psychiatric features and records of previous SSHB were collected. Experience of migration-related trauma was assessed with the LiMEs (List of Migration Experiences) checklist. Participants were followed-up for the occurrence of further SSHB. Survival analysis was performed and Cox’s Hazard Ratios (HR) were used as a measure of association of comparisons. Results: Amongst the 112 subjects (96% male, median age 33), the prevalence of any mental disorder was 26% and of substance abuse 59%. History of SSHB was present in 36% of the sample. Median follow-up time was 80 days. During follow-up, 11 events were observed (of which three were suicide attempts). Cumulative survival probability was 85%. Having experienced trauma related to war and violence was significantly associated with SSHB, HR: 7.05. No SSHB were recorded amongst subjects without substance abuse. Conclusions: Migrants in custody who experienced trauma in the post-migration period, attempt SSHB seven times more frequently than those without traumas at any time. War trauma and post-migration trauma due to exposure to violence seem to be more strongly associated with SSHB, also controlling for psychiatric diagnosis, ongoing psychopharmacological therapy and substance abuse. Further research and possible intervention programs should focus on addressing post-migration living-difficulties.

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Section: Discussionsupporting

confidence: 81%

The impact of trauma, substance abuse, and psychiatric illness on suicidal and self-harm behaviours in a cohort of migrant detainees: An observational, prospective study

Marchi

Artoni

Longo

et al. 2020

Int J Soc Psychiatry

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“…We included 35 studies reported in 38 articles in the metaanalysis (appendix pp 4-5), comprising a total of 663 735 prisoners, 9•6% of whom were women (figure 1). 5,[21][22][23][24][25][26][27][28][29][30][31][32][40][41][42][43][44][45][46][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] Included studies were done across 20 countries (11 [31%] in England and Wales) and published from 1972 to 2020. Median sample size was 785 (IQR 142-2119), ranging from 60 to 263 794 prisoners.…”

Section: Resultsmentioning

confidence: 99%

“…This method is consistent with policy and reporting in many prison jurisdictions, including in England and Wales, which has the largest prison population in western Europe. 1 In three instances, 21,28,31 both suicide attempt and nonsuicidal selfinjury were investigated in the same study sample. To avoid double counting of participants, we contacted the authors from these three studies for data on an aggregated outcome measure of any selfharm: suicide attempt, nonsuicidal selfinjury, or both.…”

Section: Discussionmentioning

confidence: 99%

“…We contacted the authors of studies that did collect information on selfharm in prison but only reported prevalence, 27 analysed a lifetime history as the outcome variable, 21,28-30 adopted a cluster analytical approach, 31 or used a subsample of prisoners (those who committed violent acts while incarcerated) as the comparison group. 32…”

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

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Risk factors for self-harm in prison: a systematic review and meta-analysis

Favril

Hawton

et al. 2020

The Lancet Psychiatry

167

121

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Background Self-harm is a leading cause of morbidity in prisoners. Although a wide range of risk factors for self-harm in prisoners has been identified, the strength and consistency of effect sizes is uncertain. We aimed to synthesise evidence and assess the risk factors associated with self-harm inside prison.Methods In this systematic review and meta-analysis, we searched four electronic databases (PubMed, Embase, Web of Science, and PsycINFO) for observational studies on risk factors for self-harm in prisoners published from database inception to Oct 31, 2019, supplemented through correspondence with authors of studies. We included primary studies involving adults sampled from general prison populations who self-harmed in prison and a comparison group without self-harm in prison. We excluded studies with qualitative or ecological designs, those that reported on lifetime measures of self-harm or on selected samples of prisoners, and those with a comparison group that was not appropriate or not based on general prison populations. Data were extracted from the articles and requested from study authors. Our primary outcome was the risk of self-harm for risk factors in prisoners. We pooled effect sizes as odds ratios (OR) using random effects models for each risk factor examined in at least three distinct samples. We assessed study quality on the basis of the Newcastle-Ottawa Scale and examined between-study heterogeneity. The study protocol was registered with PROSPERO, CRD42018087915. FindingsWe identified 35 independent studies from 20 countries comprising a total of 663 735 prisoners, of whom 24 978 (3•8%) had self-harmed in prison. Across the 40 risk factors examined, the strongest associations with self-harm in prison were found for suicide-related antecedents, including current or recent suicidal ideation (OR 13•8, 95% CI 8•6-22•1; I²=49%), lifetime history of suicidal ideation (8•9, 6•1-13•0; I²=56%), and previous self-harm (6•6, 5•3-8•3; I²=55%). Any current psychiatric diagnosis was also strongly associated with self-harm (8•1, 7•0-9•4; I²=0%), particularly major depression (9•3, 2•9-29•5; I²=91%) and borderline personality disorder (9•2, 3•7-22•5; I²=81%). Prison-specific environmental risk factors for self-harm included solitary confinement (5•6, 2•7-11•6; I²=98%), disciplinary infractions (3•5, 1•2-9•7; I²=99%), and experiencing sexual or physical victimisation while in prison (3•2, 2•1-4•8; I²=44%). Sociodemographic (OR range 1•5-2•5) and criminological (1•8-2•3) factors were only modestly associated with selfharm in prison. We did not find clear evidence of publication bias.Interpretation The wide range of risk factors across clinical and custody-related domains underscores the need for a comprehensive, prison-wide approach towards preventing self-harm in prison. This approach should incorporate both population and targeted strategies, with multiagency collaboration between the services for mental health, social care, and criminal justice having a key role.Funding Wellcome Trust.

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“…Maladaptation can take the form of violence, self-aggression, anxiety, depression, psychological stress, and suicide (4). According to the importation model, however, suicides in prisons are explained by the demographic, social, and psychosocial characteristics of the prisoners themselves, i.e., the majority of prisoners belong to a particularly vulnerable group and thus bring the risk of suicide from outside into prison (3,6); this assumption is supported by the fact that suicides inside and outside prisons are subject to the same risk factors (e.g., male sex, mental illness, and high propensity to violence) (4). Both models have weaknesses.…”

Section: Introductionmentioning

confidence: 99%

High Quality of Life Reduces Depression, Hopelessness, and Suicide Ideations in Patients in Forensic Psychiatry

et al. 2020

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Background: Suicides are more common in forensic patients than in the general population. Two reasons for this discrepancy are discussed: (1) Suicides are the consequence of maladaptation to the restrictive living conditions in forensic psychiatry, and (2) suicides are explained by the demographic, social, and psychosocial characteristics of the inmates themselves, i.e., suicides happen because the inmates belong to a particularly vulnerable group. Therefore, the present study aimed to analyze the relationship between quality of life, as an indicator of the restrictive living conditions, and hopelessness, depression, and suicide ideations in a sample of forensic patients. Methods: We assessed quality of life with a German version of the Measuring the Quality of Prison Life questionnaire that had been adapted to forensic hospitals (MQPL-forensic) and depressive symptoms with the Beck Depression Inventory, hopelessness with the Beck Hopelessness Scale, and suicide ideations with the Beck Scale for Suicide Ideation. The study included a total of 159 patients in 12 German forensic psychiatric hospitals who had been admitted in accordance with Section 64 of the German Criminal Code. We analyzed the relationships between quality of life and depression, hopelessness, and suicide ideations on the patient and hospital levels. Hospital characteristics were generated by aggregating the MQPL-forensic variables measured at the patient level. Results: In generalized estimating equation models, the MQPL-forensic total score and almost all the subscale scores were significant negative predictors of depressive symptoms, hopelessness, and suicide ideations at the patient and hospital levels. At the patient level, patients who experienced a supportive welcome at the hospital, good relationships with their therapists, respectful interactions, transparent decisions, and supportive therapeutic approaches were significantly less depressed, less hopeless, and less likely to consider suicide. At the hospital level, good relationships with therapists and respectful interactions were significant negative predictors of these variables.

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Pattern of self-injurious behavior and suicide attempts in Italian custodial inmates: A cluster analysis approach

Cited by 12 publications

References 46 publications

The impact of trauma, substance abuse, and psychiatric illness on suicidal and self-harm behaviours in a cohort of migrant detainees: An observational, prospective study

The impact of trauma, substance abuse, and psychiatric illness on suicidal and self-harm behaviours in a cohort of migrant detainees: An observational, prospective study

Risk factors for self-harm in prison: a systematic review and meta-analysis

High Quality of Life Reduces Depression, Hopelessness, and Suicide Ideations in Patients in Forensic Psychiatry

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