Mental disorders and risk of suicide attempt in prisoners
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ORIGINAL PAPER
Mental disorders and risk of suicide attempt in prisoners Louis Favril1 · Devon Indig2 · Craig Gear3 · Kay Wilhelm4,5 Received: 26 August 2019 / Accepted: 28 February 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 at some point (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. Keywords Psychiatric morbidity · Self-harm · Suicidal thoughts · Ideation-to-action · Offenders
Introduction
* Louis Favril [email protected] 1
Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, Gent, Belgium
2
School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
3
CGA Consulting, Sydney, Australia
4
Discipline of Psychiatry, University of Notre Dame, Notre Dame, Australia
5
School of Psychiatry, University of New South Wales, Sydney, Australia
Suicide is a global public health concern [1] occurring at higher rates in prisoners compared with non-incarcerated people in the community at large [2]. Like many other hea
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