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Surveys of Suicides During Incarceration: A United States and International Comparison

A.R. Felthous. Suicide behind bars: Trends, inconsistencies, and practical implications. Journal of Forensic Sciences, 56(6), 1541-1555, 2011.

By Lori Whitten, Staff Writer, RTI International, Rockville, MD

Ever since researchers first began to study suicides at correctional facilities systematically, they have poThis photograph shows the flags of many different nations waving against the backdrop of a bright blue sky. ndered whether data from one country are relevant to another. To address this issue, Alan R. Felthous, M.D., at the Saint Louis University School of Medicine, compared two comprehensive studies—a nationwide survey of U.S. jail suicides with follow-up by Hayes1 and an international meta-analysis of suicides in jails and prisons by Fazel and colleagues2. Felthous also considered the results of other studies as well as theories to develop an overall picture of the common factors associated with suicide in jails or prisons.

Characteristics related to suicide in both major studies—and therefore considered highly generalizable between the United State and the international community—include white race and male gender. Although these factors are strongly associated with inmate suicides, they do not predict which prisoners are at high risk for suicide because of the high prevalence of white males in corrections facilities. But racial suicide patterns at correctional facilities that deviate from expected trends may signal problematic practices that particular institutions can address, Felthous stresses.

Other findings are consistent across both studies, and these, along with corroborating information from local and regional sources, may suggest preventive interventions. For example, both the American and international studies indicate that inmate suicides are more likely to occur soon after initial detainment (i.e., pre-trial), among individuals placed in a single cell or isolation, and among those with a history of substance abuse.

Felthous’s analysis also uncovered differences between American and international corrections facilities. For example, Hayes found a preponderance of youthful suicides in the United States, whereas Fazel reported a suicide rate that was evenly distributed by age in the international community. Hayes also found that most prisoners who committed suicide in the United States were incarcerated for minor, nonviolent offences, whereas Fazel reported that a higher percentage of prisoners who committed suicide in other countries had committed violent crimes.

Such differences between the results, however, were most likely caused by characteristics of the studies themselves. For example, Hayes examined only jail suicides, whereas Fazel also studied suicides that occurred in prisons. The profile of inmates in these types of facilities tend to differ—jails having a more transient population, including individuals who are dealing with a recent incarceration and facing sentencing, whereas many prisoners have had more time to adjust. Also, Hayes’ studies occurred at an earlier date, prior to widespread suicide screening, in contrast with Fazel’s more recent report, which spanned a period of 57 years. Hayes’ study pointed out the risk associated with initial detainment in jail and the critical importance of early screening of all new inmates, but more recent research suggests that offenders are also at risk around the time of trial.

Felthous notes that most research on suicides in correctional facilities is descriptive only; it lacks a coherent theoretical framework. He argues that the development of theoretical models on the formation of suicide intent and its influence on behavior may help improve suicide risk assessment and prevention.

He suggests that future research address how relationships, stress, psychological vulnerabilities, and factors associated with choosing suicide as a perceived “solution” to an “unbearable” existence influence this behavior. Such research, he notes, might consider an interpersonal psychological theory, which views suicide as a decision guided by a balance of perceived risks and benefits, in which inmates ask themselves: Is there reason enough to die that seems to outweigh any reason to go on living? Another theory, the stress-diathesis-vector model, emphasizes that chronic and acute stress, particularly the initial adjustment to incarceration, has a strong impact when an individual’s ego is weak and the idea of suicide dominates over alternative actions.

1 L.M. Hayes and B. Kajdan. The National Center on Institutions and Alternatives: And darkness closes in . . . final report to the National Institute on Corrections On the National Study Of Jail Suicides. Alexandria, VA: NCIA, 1981

L.M. Hayes. National study of jail suicides seven years later. Psychiatric Quarterly 60, 7–29, 1989.

2 S. Fazel, J. Cartwright, A. Norman-Nott, and K. Hawton. Suicide in prisoners: A systemic review of risk factors. Journal of Clinical Psychiatry 69(11), 1721–31, 2008.

For more information contact Alan R. Felthous, M.D., Department of Neurology and Psychiatry, Saint Louis University School of Medicine, Saint Louis, MO.

Posted Mon, Jul 16 2012 1:55 PM by Tracey Vessels


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