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

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          Abstract

          Background

          Suicide 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.

          Methods

          Data 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.

          Results

          Nearly 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.

          Conclusion

          The 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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          Most cited references20

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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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            Self-harm.

            The term self-harm is commonly used to describe a wide range of behaviours and intentions including attempted hanging, impulsive self-poisoning, and superficial cutting in response to intolerable tension. As with suicide, rates of self-harm vary greatly between countries. 5-9% of adolescents in western countries report having self-harmed within the previous year. Risk factors include socioeconomic disadvantage, and psychiatric illness--particularly depression, substance abuse, and anxiety disorders. Cultural aspects of some societies may protect against suicide and self-harm and explain some of the international variation in rates of these events. Risk of repetition of self-harm and of later suicide is high. More than 5% of people who have been seen at a hospital after self-harm will have committed suicide within 9 years. Assessment after self-harm includes careful consideration of the patient's intent and beliefs about the lethality of the method used. Strong suicidal intent, high lethality, precautions against being discovered, and psychiatric illness are indicators of high suicide risk. Management after self-harm includes forming a trusting relationship with the patient, jointly identifying problems, ensuring support is available in a crisis, and treating psychiatric illness vigorously. Family and friends may also provide support. Large-scale studies of treatments for specific subgroups of people who self-harm might help to identify more effective treatments than are currently available. Although risk factors for self-harm are well established, aspects that protect people from engaging in self-harm need to be further explored.
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              Help-seeking behaviour and adolescent self-harm: a systematic review.

              Self-harm is common in adolescence, but most young people who self-harm do not seek professional help. The aim of this literature review was to determine (a) the sources of support adolescents who self-harm access if they seek help, and (b) the barriers and facilitators to help-seeking for adolescents who self-harm. Using a pre-defined search strategy we searched databases for terms related to self-harm, adolescents and help-seeking. Studies were included in the review if participants were aged 11-19 years. Twenty articles met criteria for inclusion. Between a third and one half of adolescents who self-harm do not seek help for this behaviour. Of those who seek help, results showed adolescents primarily turned to friends and family for support. The Internet may be more commonly used as a tool for self-disclosure rather than asking for help. Barriers to help-seeking included fear of negative reactions from others including stigmatisation, fear of confidentiality being breached and fear of being seen as 'attention-seeking'. Few facilitators of help-seeking were identified. Of the small proportion of adolescents who seek help for their self-harm, informal sources are the most likely support systems accessed. Interpersonal barriers and a lack of knowledge about where to go for help may impede help-seeking. Future research should address the lack of knowledge regarding the facilitators of help-seeking behaviour in order to improve the ability of services to engage with this vulnerable group of young people. © The Royal Australian and New Zealand College of Psychiatrists 2014.
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                Author and article information

                Contributors
                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
                : 13
                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
                Author information
                http://orcid.org/0000-0002-9961-4306
                Article
                71
                10.1186/s40352-018-0071-8
                6091405
                30109499
                887670e6-ae57-4d66-9a96-254963f28656
                © 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.

                History
                : 15 May 2018
                : 3 August 2018
                Categories
                Short Report
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                © The Author(s) 2018

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