The impact of trauma, substance abuse, and psychiatric illness on suicidal and self-harm behaviours in a cohort of migrant detainees: An observational, prospective study

Abstract

Background: According to the WHO, detainees attempt suicide ten times more than the general population. Aims: To investigate the impact of migration trauma on Suicidal and Self-Harm Behaviours (SSHB) of migrants in jail and to explore how substance use and other psychiatric features affect this relationship. Methods: Prospective cohort study, conducted at the ‘Sant’Anna’ jail in Modena (Italy) between February 2017 and September 2019. Socio-demographic, psychiatric features and records of previous SSHB were collected. Experience of migration-related trauma was assessed with the LiMEs (List of Migration Experiences) checklist. Participants were followed-up for the occurrence of further SSHB. Survival analysis was performed and Cox’s Hazard Ratios (HR) were used as a measure of association of comparisons. Results: Amongst the 112 subjects (96% male, median age 33), the prevalence of any mental disorder was 26% and of substance abuse 59%. History of SSHB was present in 36% of the sample. Median follow-up time was 80 days. During follow-up, 11 events were observed (of which three were suicide attempts). Cumulative survival probability was 85%. Having experienced trauma related to war and violence was significantly associated with SSHB, HR: 7.05. No SSHB were recorded amongst subjects without substance abuse. Conclusions: Migrants in custody who experienced trauma in the post-migration period, attempt SSHB seven times more frequently than those without traumas at any time. War trauma and post-migration trauma due to exposure to violence seem to be more strongly associated with SSHB, also controlling for psychiatric diagnosis, ongoing psychopharmacological therapy and substance abuse. Further research and possible intervention programs should focus on addressing post-migration living-difficulties.

Post-traumatic stress disorder among LGBTQ people: a systematic review and meta-analysis

“…, 2021 ; Marchi et al. , 2022b , 2020 ). In this perspective, the association between the sexual variant status and experiences of traumatization may be relevant also for other forms of psychopathology.…”

Suicide risk and suicide risk factors among immigrants in Italy: A bi-center matched sample study

“…The first result of this study was that there were no differences between immigrant and Italian patients in terms of either suicidal ideation (previous or current) or suicide attempts (previous or current). Only a few papers have addressed suicidal ideation and suicide attempts in immigrants in Italy (Iliceto et al, 2013; Marchi et al, 2020). A multicenter study on 237 non-clinical Italians and 234 immigrants did not find differences in suicide risk or psychopathology between the two groups (Iliceto et al, 2013).…”

“…High growth rates were recorded in both northern and central Italy and, in 2010, the provinces of Milan (north) and Rome (center) combined contained 18% of all immigrants in the country (Bratti & Conti, 2018). Although Italy has the third-largest immigrant population of European Union countries, only a few papers have examined suicide risk in immigrants (Iliceto et al, 2013; Kõlves et al, 2011; Marchi et al, 2020) and in immigrant psychiatric patients in Italy.…”