Suicide
First case-control study to investigate the relevance of criminal history, psychiatric problems and social integration to suicide in prison
By Ashwin, UK Correspondent
Dec 5, 2004 - 6:15:00 AM

All staff should take suicidal behaviour seriously in custodial institutions, according to a new study published in the December issue of the British Journal of Psychiatry.

Suicide rates in prisons exceed the rates in the general population worldwide. Risk factors include long sentences after highly violent crimes, overcrowding, isolation, psychiatric disorders and alcohol and drug misuse. Evidence for suicidal behaviour as a predictor of suicide in prison has been conflicting until now.

This was the first case-control study to investigate the relevance of criminal history, psychiatric problems and social integration to suicide in prison.

For every suicide that occurred in an Austrian correctional institution between 1975 and 1999, two controls were selected, matched for correctional institution, gender, nationality, age, custodial status and time of admission.

Psychiatric characteristics, previous suicidal behaviour, criminal history and indicators of social integration were compared. Of 250 suicides, 220 personal files were available and matched with 440 controls.

The most important predictors of suicide in custody were a history of suicidality (status following attempted suicide and suicide threat), a psychiatric diagnosis, psychiatric medication, being in prison for a highly violent offence and single-cell accommodation (as a facilitating factor for suicide).

Professional education and working status before and during incarceration were significantly different between suicide cases and controls. The authors of the study believe that further studies are necessary to prove the relevance of social factors for suicide in custody.

Indicators of social integration could easily be asked about during admission proceedings; questions about working status before incarceration, or professional education, would be far less stigmatising than questions about psychiatric history and previous suicidal behaviour, they say.

The authors conclude that a significant finding of the study is the importance of suicidal behaviour as an indicator of risk of suicide in prison, which until now has been a matter for debate.

It is vital that all prison staff take suicidal behaviour seriously.

Paper reference
Fruehwald S, Matschnig T, Koenig F, Bauer P and Frottier P (2004) Suicide in custody. Case-control study. British Journal of Psychiatry, 185, 494-498.


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