PurposeThe purpose of this study was to assess the influence of multiple adverse life experiences (sexual abuse, homelessness, running away, and substance abuse in the family) on suicide ideation and suicide attempt among adolescents at an urban juvenile detention facility in the United States.Materials and MethodsThe study sample included a total of 3,156 adolescents processed at a juvenile detention facility in an urban area in Ohio between 2003 and 2007. The participants, interacting anonymously with a voice enabled computer, self-administered a questionnaire with 100 items related to health risk behaviors.ResultsOverall 19.0% reported ever having thought about suicide (suicide ideation) and 11.9% reported ever having attempted suicide (suicide attempt). In the multivariable logistic regression analysis those reporting sexual abuse (Odds Ratio = 2.75; 95% confidence interval = 2.08–3.63) and homelessness (1.51; 1.17–1.94) were associated with increased odds of suicide ideation, while sexual abuse (3.01; 2.22–4.08), homelessness (1.49; 1.12–1.98), and running away from home (1.38; 1.06–1.81) were associated with increased odds of a suicide attempt. Those experiencing all four adverse events were 7.81 times more likely (2.41–25.37) to report having ever attempted suicide than those who experienced none of the adverse events.ConclusionsConsidering the high prevalence of adverse life experiences and their association with suicidal behaviors in detained adolescents, these factors should not only be included in the suicide screening tools at the intake and during detention, but should also be used for the intervention programming for suicide prevention.
The authors describe a pilot medical education program that developed a new and ongoing correctional medicine curriculum for third- and fourth-year medical students at Nova Southeastern University College of Osteopathic Medicine. During the first two years of the pilot program (2000-02), a total of 53 students were placed in one-month rotations in prison health care settings. Students received orientations, directed readings, and prison clinic experience under the director of board-certified physician preceptors. An evaluation of the pilot experience was conducted by student survey. The findings indicate that students had positive experiences related to continuity of care, access to pathology, access to procedures, and exposure to a unique managed care model. Students requested more structured curriculum and more opportunities to develop content understanding of the unique clinical aspects of prison health care. The authors conclude that given the increasing U.S. prison population, the constitutional requirement to provide medical care to inmates, and demand for career-oriented correctional physicians, the favorable outcome of this pilot educational program provides support for implementing such programs in medical schools throughout the country. They also speculate that the program may encourage some students to practice in correctional institutions as a career.
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