What Differentiates Prisoners Who Attempt Suicide from Those Who Experience Suicidal Ideation? A Nationally Representative Study

Abstract

Many people who think about suicide do not engage in suicidal behavior. Identifying risk factors implicated in the process of behavioral enaction is crucial for suicide prevention, particularly in high-risk groups such as prisoners. Method: Cross-sectional data were drawn from a nationally representative sample of 17,891 prisoners (79% men) in the United States. We compared prisoners who attempted suicide (attempters; n = 2,496) with those who thought about suicide but never made an attempt (ideators; n = 1,716) on a range of established risk factors. Results: More than half (59%) of participants who experienced suicidal ideation had also attempted suicide. Violent offending, trauma, brain injury, alcohol abuse, and certain mental disorders distinguished attempters from ideators. Conclusion: Our results fit within recent ideation-to-action theories that emphasize the role of a capability for suicide in the transition from thoughts to acts of suicide. Suicide is a global public health concern (Turecki et al., 2019) which disproportionally impacts on the most vulnerable members of society, including people exposed to the criminal justice system (Webb et al., 2011). Specifically, suicide is a leading cause of death in prisoners (Favril, Wittouck, Audenaert, & Vander Laenen, 2019), with rates at least three times higher than in age-equivalent peers outside prison (Fazel, Ramesh, & Hawton, 2017). Prisoners who die by suicide only represent the tip of the iceberg; many more consider or attempt suicide without a fatal outcome. Large-scale studies from Australia

The relationship between age and suicidal thoughts and attempted suicide among prisoners

“…Despite a growing body of literature focused on suicide among older and aging adults, along with the trend toward an aging prison population, there is a marked lack of empirical research on the nature of suicidal thoughts and behavior among older prisoners (e.g., see Barry et al, 2017;Opitz-Welke et al, 2019). Studies have, in some capacity, considered the relationship between age and suicidal thoughts/behavior among prisoners (e.g., see Blaauw, Winkel, & Kerkhof, 2001;Dye, 2010;Favril, Stoliker, & Vander Laenen, 2020;Marzano, Hawton, Rivlin, & Fazel, 2011;Stoliker, 2018), but this research has produced mixed findings. Some evidence suggests that prisoners who engage in suicidal behavior tend to be younger (Blaauw et al, 2001;Daniel & Fleming, 2006;Liebling, 1999;Marzano et al, 2011) and that an increase in age corresponds to decreased odds of reporting a previous suicide attempt compared to no attempt (Stoliker, 2018) and suicidal ideation only (Favril et al, 2020).…”

Factors associated with the transition from suicidal ideation to suicide attempt in prison

“…This was deemed ignorable missingness, and listwise deletion was used to handle missing cases for all analyses. 7,9 All analyses were done in SPSS version 26, and statistical significance was set at p < 0.05.…”

“…The wording of the question and choice of a self-report measure of lifetime psychiatric diagnoses is consistent with previous research in prisoners. 9,19 Following the New South Wales Inmate Health Survey, 20 participants were also asked about in-prison use of illicit drugs (excluding alcohol) and currently prescribed psychotropic medication.…”

“…Identifying what factors may precipitate the transition from thought to enactment could elucidate points at which to disrupt this trajectory of risk. In light of this, recent work [6][7][8][9] suggests that brain injury, interpersonal violence, non-suicidal self-injury, trauma, and substance abuse increase the risk of suicide attempt among prisoners with suicidal ideation. These risk factors largely mirror those found for behavioural enaction in the general population, [10][11][12][13][14][15] albeit their background prevalence is much higher among prisoners.…”

“…These risk factors largely mirror those found for behavioural enaction in the general population, [10][11][12][13][14][15] albeit their background prevalence is much higher among prisoners. A central limitation of these studies, however, relates to the assessment of prisoners' suicidal outcomes on a lifetime basis, [6][7][8][9] hence providing limited information concerning what factors are associated with behavioural enaction while incarcerated. Consequently, the potential role of prison-specific influences (e.g.…”