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Self-harm and suicidal behaviour among incarcerated adults in the Australian Capital Territory

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      Abstract

      BackgroundSuicide is the leading cause of death in prisons worldwide. Improved understanding of the factors associated with suicide is necessary to inform targeted suicide prevention and interventions. Here we aim to (a) document the prevalence of suicide attempts, suicidal ideation, self-harm, and mental disorder; and (b) identify demographic, mental health, and criminal justice correlates of suicidal ideation, in a sample of incarcerated adults in Australia.MethodsData were obtained from the 2016 Detainee Health and Wellbeing Survey conducted in the Alexander Maconochie Centre, the Australian Capital Territory’s only adult prison. Interviews with 98 incarcerated adults were conducted in October 2016. Descriptive statistics were calculated for all measures. Crude differences between participants who reported experiencing suicidal ideation in their lifetime and those who did not were compared using Fisher’s exact test.ResultsNearly half of the participants (48%, n = 47) reported lifetime suicidal ideation and 31% (n = 30) reported attempting suicide at some point in their lives. Eighteen participants (18%) reported a lifetime history of having engaged in self-harm. Factors significantly associated with suicidal ideation included lifetime history of mental disorder, self-harm, experiencing a drug overdose, and being hospitalized in the past 12 months.ConclusionThe burden of suicidal ideation and prior suicide attempts among people in prison is substantial. Incarceration is a pivotal opportunity to identify people with a history of mental health problems and target interventions aimed at reducing adverse outcomes including suicide mortality.

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      Fatal and non-fatal repetition of self-harm. Systematic review.

      Non-fatal self-harm frequently leads to non-fatal repetition and sometimes to suicide. We need to quantify these two outcomes of self-harm to help us to develop and test effective interventions. To estimate rates of fatal and non-fatal repetition of self-harm. A systematic review of published follow-up data, from observational and experimental studies. Four electronic databases were searched and 90 studies met the inclusion criteria. Eighty per cent of studies found were undertaken in Europe, over one-third in the UK. Median proportions for repetition 1 year later were: 16% non-fatal and 2% fatal; after more than 9 years, around 7% of patients had died by suicide. The UK studies found particularly low rates of subsequent suicide. After 1 year, non-fatal repetition rates are around 15%. The strong connection between self-harm and later suicide lies somewhere between 0.5% and 2% after 1 year and above 5% after 9 years. Suicide risk among self-harm patients is hundreds of times higher than in the general population.
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        Risk factors for suicide in individuals with depression: a systematic review.

        Depression is the most common psychiatric disorder in people who die by suicide. Awareness of risk factors for suicide in depression is important for clinicians. In a systematic review of the international literature we identified cohort and case-control studies of people with depression in which suicide was an outcome, and conducted meta-analyses of potential risk factors. Nineteen studies (28 publications) were included. Factors significantly associated with suicide were: male gender (OR=1.76, 95% CI=1.08-2.86), family history of psychiatric disorder (OR=1.41, 95% CI=1.00-1.97), previous attempted suicide (OR=4.84, 95% CI=3.26-7.20), more severe depression (OR=2.20, 95% CI=1.05-4.60), hopelessness (OR=2.20, 95% CI=1.49-3.23) and comorbid disorders, including anxiety (OR=1.59, 95% CI=1.03-2.45) and misuse of alcohol and drugs (OR=2.17, 95% CI=1.77-2.66). There were fewer studies than suspected. Interdependence between risk factors could not be examined. The factors identified should be included in clinical assessment of risk in depressed patients. Further large-scale studies are required to identify other relevant factors. Copyright © 2013 Elsevier B.V. All rights reserved.
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          Severe mental illness in 33,588 prisoners worldwide: systematic review and meta-regression analysis.

          High levels of psychiatric morbidity in prisoners have been documented in many countries, but it is not known whether rates of mental illness have been increasing over time or whether the prevalence differs between low-middle-income countries compared with high-income ones. To systematically review prevalence studies for psychotic illness and major depression in prisoners, provide summary estimates and investigate sources of heterogeneity between studies using meta-regression. Studies from 1966 to 2010 were identified using ten bibliographic indexes and reference lists. Inclusion criteria were unselected prison samples and that clinical examination or semi-structured instruments were used to make DSM or ICD diagnoses of the relevant disorders. We identified 109 samples including 33 588 prisoners in 24 countries. Data were meta-analysed using random-effects models, and we found a pooled prevalence of psychosis of 3.6% (95% CI 3.1-4.2) in male prisoners and 3.9% (95% CI 2.7-5.0) in female prisoners. There were high levels of heterogeneity, some of which was explained by studies in low-middle-income countries reporting higher prevalences of psychosis (5.5%, 95% CI 4.2-6.8; P = 0.035 on meta-regression). The pooled prevalence of major depression was 10.2% (95% CI 8.8-11.7) in male prisoners and 14.1% (95% CI 10.2-18.1) in female prisoners. The prevalence of these disorders did not appear to be increasing over time, apart from depression in the USA (P = 0.008). High levels of psychiatric morbidity are consistently reported in prisoners from many countries over four decades. Further research is needed to confirm whether higher rates of mental illness are found in low- and middle-income nations, and examine trends over time within nations with large prison populations.
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            Author and article information

            Affiliations
            [1 ]ISNI 0000 0004 1936 7494, GRID grid.61971.38, Faculty of Health Sciences, , Simon Fraser University, ; Vancouver, BC Canada
            [2 ]ISNI 0000 0001 2179 088X, GRID grid.1008.9, Melbourne School of Population and Global Health, , The University of Melbourne, ; Melbourne, Australia
            [3 ]ISNI 0000 0004 1936 7910, GRID grid.1012.2, School of Population and Global Health, , The University of Western Australia, ; Perth, Australia
            [4 ]ISNI 0000 0004 0375 4078, GRID grid.1032.0, National Drug Research Institute, , Curtin University, ; Perth, Australia
            [5 ]ISNI 0000 0000 9442 535X, GRID grid.1058.c, Centre for Adolescent Health, , Murdoch Children’s Research Institute, ; Melbourne, Australia
            [6 ]ISNI 0000 0004 0437 5432, GRID grid.1022.1, Griffith Criminology Institute, , Griffith University, ; Mt Gravatt, Australia
            [7 ]ISNI 0000 0000 9320 7537, GRID grid.1003.2, Mater Research Institute-UQ, , The University of Queensland, ; Brisbane, Australia
            [8 ]ISNI 0000 0004 1936 7857, GRID grid.1002.3, School of Public Health and Preventive Medicine, , Monash University, ; Melbourne, Australia
            [9 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, Health Service and Population Research Department; Institute of Psychiatry, Psychology & Neuroscience, , King’s College London, ; London, UK
            [10 ]ISNI 0000 0001 2179 088X, GRID grid.1008.9, Department of Psychiatry, , The University of Melbourne, ; Melbourne, Australia
            Contributors
            ORCID: http://orcid.org/0000-0002-9961-4306, albutler@sfu.ca
            jesse.young@unimelb.edu.au
            s.kinner@unimelb.edu.au
            rohan.borschmann@mcri.edu.au
            Journal
            Health Justice
            Health Justice
            Health & Justice
            Springer Berlin Heidelberg (Berlin/Heidelberg )
            2194-7899
            14 August 2018
            14 August 2018
            December 2018
            : 6
            30109499
            6091405
            71
            10.1186/s40352-018-0071-8
            © The Author(s). 2018

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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            © The Author(s) 2018

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