Psychiatric symptom severity, criminal risk, and suicidal ideation and attempts among not guilty by reason of insanity state hospital inpatients.

Abstract

Individuals forensically committed to a state hospital are at an increased risk of suicide; however, there is extremely limited research examining suicide risk estimates and risk factors among inpatients deemed not guilty by reason of insanity (NGRI). This study aimed to determine (a) rates of suicidal ideation history, suicide attempt history, and current distress due to suicidal ideation, and (b) the associations between psychiatric symptom severity, criminal risk factors, and suicide risk. NGRI inpatients (n = 207) from 2 state hospitals were administered assessments of psychiatric symptom severity and criminal risk factors (i.e., criminal tendencies and antisocial personality traits). Results indicated 46.4% of participants reported at least 1 previous suicide attempt, 58% reported previous suicidal ideation, and 10.1% reported some level of current distress due to suicidal ideation. Binary logistic regression results indicated psychiatric symptom severity, not criminal tendencies or antisocial personality traits, was associated with a greater likelihood of current distress due to suicidal ideation. There was a significant interaction between criminal tendencies and antisocial personality, which indicated that individuals higher in criminal tendencies and lower in antisocial personality traits are predicted to have the greatest probability of reporting current distress due to suicidal ideation. Additionally, psychiatric symptom severity and antisocial personality traits were associated with a greater likelihood of a suicide attempt history, whereas criminal tendencies were associated with a decreased likelihood. Clinical implications are discussed, particularly the need for suicide risk assessments and management to consider both psychiatric symptoms and criminal risk factors. (PsycINFO Database Record

Thwarted Interpersonal Needs and Suicide Ideation Distress Among Psychiatric Inpatients: The Moderating Role of Criminal Associates

“…Therefore, categorical data analysis methods were used, which allowed us to provide clinically useful estimated probabilities. The BSI Item 9 has also been used as a categorical criterion variable in previous research and has been associated with suicide risk factors (i.e., Jahn et al, 2018; Mitchell et al, 2018; Mitchell et al, 2017). Previous research has also indicated that TB and PB were significantly associated with both suicide ideation distress and suicide ideation (Mitchell et al, 2017).…”

Hospital treatment of persons found not guilty by reason of insanity

“…Mitchell et al (2018) note that very little research exists on suicidal ideation (SI) in this population. In their study, 58% of acquittees experienced SI, which was statistically associated with psychiatric symptoms but not criminal tendencies.…”

“…It was more likely, however, for acquittees with high criminal tendencies and low antisocial traits to experience SI than those with moderate to high antisocial traits, perhaps mediated by feelings of guilt, shame, or loss that are less pronounced in those with more antisocial features. Therefore, these authors recommend addressing both psychiatric symptoms and criminogenic risk in treatment planning (Mitchell et al, 2018).…”

“…Because acquittees can be motivated to under-report their psychological and behavioral problems in hopes of being released, these authors highlight the value of this structured assessment approach (Tarescavage et al, 2016). Mitchell et al (2018) note that very little research exists on suicidal ideation (SI) in this population. In their study, 58% of acquittees experienced SI, which was statistically associated with psychiatric symptoms but not criminal tendencies.…”

Lifetime History of Suicide Attempts among Not Guilty by Reason of Insanity State Hospital Inpatients: The Roles of past Harmful Substance Use and Current Social Support

“…One study indicated a suicide rate of 101 suicides per 100,000 psychiatric hospital admissions among inpatients during hospitalization (Neuner et al, 2008). A recent study among inpatients found NGRI indicated that approximately 46% reported at least one previous suicide attempt, 58% reported previous suicidal thoughts, and 10% reported current suicide ideation distress (Mitchell et al, 2018a). Furthermore, the severity of psychiatric symptoms was associated with greater suicide ideation distress and suicide attempt history (Mitchell et al, 2018a).…”