An analysis of self-reported suicide attempts and ideation in a national sample of incarcerated individuals convicted of sexual crimes

ABSTRACT

Suicide is the leading cause of preventable death in US jails and prisons, with rates three to nine times higher than those of the general population. Although suicide in correctional settings has been recognised as a serious problem, the research on suicide among incarcerated individuals remains limited. Individuals who have committed sexual offenses may be at an elevated risk for suicide. Specifically, they have been found to report high rates of hopelessness and depressive mood, and approximately 14% of individuals convicted of sexual offenses have reported a suicide attempt at some point in their lives. Most of these data are based upon official reports and may represent an underreporting of the true prevalence of the problem. The current study provides an analysis of the prevalence and factors associated with self-reported suicidal thoughts and behaviours in a large national sample of individuals convicted of a sexually based crime. Overall, 17.9% of the offenders reported an attempted suicide in their lifetime, 15.1% reported experiencing suicidal ideation but never made an attempt. Risk factors for suicide attempts and ideation for this population are reported. The findings are discussed in the context of suicide prevention and intervention efforts among those who have committed sex offenses.     

Youth suicide in New Mexico: a 26-year retrospective review

Although suicidal behavior in children and adolescents is a major public health problem, large-scale research on suicide in this population is uncommon. In this study, we reviewed autopsy and field reports for all pediatric suicide cases referred to the New Mexico Office of the Medical Investigator from 1979 to 2005. The age-adjusted suicide rate was 4.8 per 100,000. Psychologic stressors and parasuicidal behavior were identified in some cases. Seventy-six percent of suicides occurred in the victim's home or yard, and 25% left a suicide note. In 26% of cases, alcohol or other drugs were detected in postmortem. Gunshot wound was the most common method overall (58%), followed by hanging (30%). Although the age-adjusted suicide rate is higher in New Mexico than nationally, the trends in the population are similar. With a solid understanding of the circumstances, it may be possible to predict, and hopefully prevent, future cases of child and adolescent death.     

Correlates of law enforcement suicide in the United States: a comparison with Army and Firefighter suicides using data from the National Violent Death Reporting System

Law Enforcement (LE) officers are considered to be at elevated risk of suicide. This study explored variables associated with LE suicide and the extent they differentiated LE suicides from those within similar occupations considered at risk – Army and Firefighters. Using a public health database of violent deaths, the US National Violent Death Reporting System (NVDRS), the prevalence of and association between seven suicide variables (treatment for a mental health condition, Post Traumatic Stress disorder diagnosis, alcohol and substance abuse, job problems, intimate partner problems) and suicide within LE, Army and Firefighters was computed. Method of suicide and demographic characteristics were also identified. All of the suicide variables were associated with suicide in the three occupation groups. LE suicides were differentiated from Army and Firefighter suicides by being more strongly associated with job problems and suicide by females was more common. Implications for suicide prevention strategies within LE are discussed.     

Study of an economic issue as a possible indicator of suicide risk: a discussion of stock prices and suicide

There were more than 30,000 suicides in 1998 in Japan, and since then, the numbers have remained high. In 2009, the number of suicides per a day was c. 90. This phenomenon constitutes a major social problem. One of the major reasons for the rapid increase in the number of suicides appears to be the worsening economic problems. It is therefore necessary to research the relationship between economic issues and suicide. In this study, we examined the relationship between the value of the Nikkei Stock Average and suicide rates in Japan. The value of the Nikkei Stock Average may be related to suicide among men. On the basis of the results, relevant researchers and organizations should understand the factors that relate to suicide to better carry out specific suicide prevention measures.     

An unusual case of a triple suicide pact at the time of the COVID-19 pandemic

In December 2020, the World Health Organization (WHO) declared SARS-CoV2 a global pandemic. Home confinement, low social contacts, and fear of virus transmission played a major role as risk factors for suicides during the following period. Suicide pacts, in particular, showed a different pattern. A rare case of a triple suicide pact among members of the same family nucleus is presented. The victims were an elderly, severely ill woman and her adult children (a son and daughter), linked by a morbid relationship. The last time the family was seen alive was 40 days before the discovery. All corpses presented decompositional changes. After a full autopsy, the cause of death was determined to be a lethal intake of morphine for the mother and acute blood loss due to self-stabbing at the neck for the siblings. The younger woman was under the effects of a large amount of heparin. Toxicological analysis was positive for opioids and alcohol in both siblings. Suicide pacts have rarely been described during the COVID-19 pandemic. In the few cases reported, the victims were more often relatives than people in a romantic relationship. The involvement of three people is unusual, as is the use of different suicide methods among the victims. In the presented case, the elderly mother's imminent death from terminal cancer, her concern over dying in a nondomestic environment, and the siblings' fear of being alone likely led to the conception of the suicide pact. Social isolation and economic difficulties also played a contributing role.     

Systematic Toxicological Analysis Revealing a Rare Case of Captan Ingestion

This article presents a case of suicide by intoxication with various pharmaceuticals, particularly anticonvulsants, combined with the fungicide captan. A cause of death could not be ascertained at autopsy. However, systematic toxicological analysis (STA) including a screening via solid‐phase microextraction (SPME) and gas chromatography‐mass spectrometry (GC‐MS) for (semi) volatile organic compounds revealed results suggesting a possible cause of death. The effects of captan on the human organism, its metabolism, and distribution will be discussed. Macroscopically, the cause of death was unascertained. STA revealed clonazepam, citalopram, and its metabolites, lamotrigine, levetiracetam, lacosamide, clonazepam, captan, and its metabolite tetrahydrophthalimide (THPI). For the first time, it was detected in human viscera. A quantification of THPI was performed to obtain distribution in the organs. The significance of a complete STA must be emphasized. The presence of THPI would have been missed without previous detection of captan. Consequently, this fatality would not have been investigated satisfactorily.     

Death certification of "suicide by cop"

Death certification of "suicide by cop" is controversial among some medical examiners and coroners. We present five such deaths that were certified as suicides and discuss the medico-legal issues involved with these certifications. To certify such a death as a suicide, certain criteria should be met. Suicide by cop is a circumstance that involves competing intentional acts that may result in dichotomous determinations of the manner of death. Despite the absence of direct self-infliction, there is overwhelming evidence that these five individuals intended to end their own lives. Their use of an unusual method to accomplish this goal may inappropriately result in a reflexive certification of homicide. All of the decedents possessed weapons or a facsimile of a weapon. We present five instances of suicide by cop and contend that these types of deaths are best certified as suicides.     

Schizophrenia and suicide: a 10-year review of Kentucky medical examiner cases

The risk of suicide is significantly increased in schizophrenics; it is estimated that 10-13% of individuals suffering from schizophrenia commit suicide. Schizophrenia is marked by psychotic exacerbations and remissions, with persistent deterioration in baseline functioning with each relapse. We present a 10-year (1993-2002) retrospective review of Medical Examiners' cases of suicide of schizophrenic victims. Twenty-nine cases were between the ages of 20 and 75 (mean age of 41.6 years). The majority of victims were male (62.1%) and Caucasian (86.2%). The leading method of suicide for both males and females was firearm injury (48.3%) mostly of the head, followed by overdose (20.7%), and hanging (13.8%). A comprehensive investigation of the biopsychosocial factors is warranted in cases of schizophrenics who commit suicide. This study offers an insightful analysis pertaining to the determination of intent in formulating the manner of death in this unique population.     

Correlates of hopelessness in the high suicide risk police occupation

Police officers are chronically exposed to work stress. We examined specific stressors that may be associated with hopelessness, a possible risk factor for suicide in this high suicide risk population. The study included 378 officers (276 men and 102 women) with complete data. Analysis of variance was used to estimate mean levels of hopelessness scores as associated with stress, adjusted for age, gender, and race/ethnicity. Posttraumatic symptoms were tested as a modifier of the association between stress and hopelessness. Increasing stress of administrative practices and lack of support were significantly associated with increasing hopelessness among officers (p < .006 – hopelessness range: 1.64–2.65; and p < .001 – hopelessness range 1.60–2.80, respectively). Posttraumatic stress disorder (PTSD) symptoms significantly modified the association between lack of organizational support and hopelessness (p < .010) with significant association only among individuals with higher PTSD symptoms (p < .001). Results suggest that hopelessness is associated with specific stressors in police work, and this is modified by posttraumatic symptomatology.     

Genetic analysis of suicide: a sample study in Tuscany (Central Italy)

Many studies have examined the genetic contribution to suicide. However, data on suicide in the Italian population are scarce. We therefore aimed to address this gap by investigating a cohort of 111 Italians for whom a verdict of suicide had been declared in court in Florence, Italy between 2007 and 2017. This cohort included 86 men and 25 women. DNA samples were obtained from tissues or blood, and 22 genes from multiple neurobiological pathways previously shown to be associated with the pathogenesis of suicide were analysed. Next-generation sequencing was used to compare these gene sequences with those from a large, normal population. In this study, we identified 19 gene variants that were present at significantly lower frequencies in our Italian cohort than in the general population. In addition, four missense mutations were identified in four different genes: Monoamine Oxidase A (MAOA), 5-Hydroxytryptamine Receptor 2 A (HTR2A), Sodium Voltage-Gated Channel Alpha Subunit 8 (SCN8A), and Nitric Oxide Synthase 3 (NOS3). Our study identified several potential genetic links with suicide in a cohort of Italians and supports a relationship between specific genetic variants and suicidal behaviour in this population.     

Suicidality in male prisoners: influence of childhood adversity mediated by dimensions of personality

This study aims to study the influence of childhood adversity on suicidal behavior in male prisoners. Including a random sample of 899 male prisoners (French National Mental Health Prison Survey, 2003), this paper studied suicidal ideations and suicide attempts using MINI criteria, and personality using Temperament and Character Inventory. Risk factors of suicidality were examined, and structural equations studied the influence of childhood trauma on suicidality, mediated by personality dimensions. The prisoners reported high levels of childhood adversity. More than a third reported recent suicidal ideations. Childhood adversity and dimensions of personality were associated with suicidality. Structural equations showed that childhood adversity was positively associated with suicidality, mediated by poor dimensions of character (affective stability, self-cooperativeness, and self-transcendence). In conclusion, these results confirm the importance of screening and treatment of childhood trauma among male prisoners. They suggest the importance to study dimensions of personality and tailor treatment to specific needs.     

Global functioning and suicide among Chinese rural population aged 15-34 years: a psychological autopsy case-control study

As the relationship between global functioning and young suicide remains unclear in rural China, this study was aimed to explore the relationship between them. Data of 391 rural suicides and 416 controls, all aged 15-34 years in three provinces in China were used for this study. The Global Assessment of Functioning (GAF) scale was adopted to assess global functioning of suicides and controls. The results showed that GAF score was stronger than mental illness in predicting suicide in China. Different correlates of GAF score were found between suicides and controls. Unsurprisingly, GAF score was significantly correlated with mental illness in both suicides and controls. Different characteristics were also found among three types of suicide which were classified using GAF score. Assessing global functioning is useful and GAF scale should be regularly used in suicide prevention practice.     

A Ten‐year Study of Suicides from a Rural/Suburban County

This study will discuss trends in suicide data compiled over 10 years in Dutchess County, NY, from 2004 to 2013. These data were based on reporting and examination standards recommended by the National Association of Medical Examiners and Department of Justice death investigation standards. Almost 300 cases were analyzed in terms of the deceased's gender, age, race, method of suicide, and weapon used. Results from this study agree with other reports showing significant differences for method of death both in terms of age and gender, with men more likely to choose firearms and women more likely to choose overdose. Furthermore, older persons were more likely to commit suicide by firearms, and the younger persons were more likely to commit suicide by overdose. However, other areas, such as method of suicide, differ from national statistics.     

Adolescent and young adult suicide: a 10-year retrospective review of Kentucky Medical Examiner cases

The compilation of all suicidal causes of death attained the third highest ranking of mortality between the ages of 15 and 24 following unintentional deaths and homicide in the United States, accounting for approximately 4000 deaths in 2002. A variety of biopsychosocial factors may contribute to adolescent suicidal behavior, including psychiatric disorders, risk-taking behaviors, and lack of a cohesive family unit. The authors conducted a 10-year (1993-2002) retrospective review of 108 Medical Examiner cases of suicide ages 11-17 and 358 cases ages 18-24 in Kentucky, which represents two thirds of the Coroner cases in the state. The majority of victims were male and Caucasian. The major causes of death were the same for the two age groups, specifically, firearm injury (72.2% and 70.7%), hanging (22.2% and 18.7%), and drug intoxication (2.8% and 5.3%). An integrated Coroner-Medical Examiner system profits in the public health arena by providing collaborative research data for policy decisions. The prevalence of youth suicide by firearm should prompt further discussion regarding ways to better identify high-risk adolescents and young adults and restrict pediatric access to unsecured household firearms.     

An exploration of attitudes and support needs of police officer negotiators involved in suicide negotiation

This study explored the attitudes and support needs of police officer negotiators involved in suicide negotiation. A qualitative approach was adopted, applying principles of grounded theory research. Purposive sampling was used and 16 semi-structured interviews conducted. Strategies and processes taught during training for the role constituted an important support mechanism. The lack of formal processes to support participants’ well-being was reported although effective peer support network amongst negotiators existed. Mental health awareness and suicide intervention training should be considered key for police officers, who are first responders. Robust procedures are needed to support the emotional well-being of police negotiators.     

自杀方式与性别和年龄关系548例分析

目的分析国内5个城市地区采取不同自杀方式人群的性别和年龄特征。方法收集上海、金华、武汉、娄底、都匀城市地区警方处理的548例自杀案例,根据自杀方法将案件进行分类,研究各种自杀方法的人群年龄和性别特征,结果在各种自杀方式的年龄分析中,高坠和自缢的自杀者平均年龄最大(约55岁),溺水、自缢次之(约49岁)、口服毒物较为年轻(约45岁),而CO中毒自杀者平均年龄最小(约37岁)。在自杀方式的性别差异中,男性更多地出现了锐器自杀(52:24),自缢(67:33)和高坠(55:45),女性则在溺水自杀中占据多数(58:42)。结论每种自杀方式涉及到的人群的性别和年龄特征差异明显,CO中毒自杀的自杀者最为年轻;男性更倾向于用机械性损伤的方式来自杀。     

重新界定《中华人民共和国海商法》的调整对象——以主体-关系规范模式为视角

《中华人民共和国海商法》（简称《海商法》）调整对象的准确界定是该法修改成功的基础之一。《海商法》第1条关于＂调整海上运输关系、船舶关系＂的规定,被认为是《海商法》调整对象的规范表述,但该表述存在概念指称不清、外延过于宽泛或不确定、主体缺失与规定错位及调整对象与调整目标之间缺乏合理的对应关系等问题。关于《海商法》调整对象的学理解释观点纷呈,但均过于表面化,未能反思立法不当问题。通过对《海商法》调整对象界定依据的分析,指出应当依据实践诉求、空间要素、主体法律地位及体系性诉求,将《海商法》调整对象界定为平等主体间的法律地位及因船舶运输、船舶停泊、船舶归属与利用而产生的社会关系及与之有关的社会关系。     

Understanding deliberate indifference to suicide in corrections facilities: A review of recent legal cases

The US corrections system is the largest provider of mental health care in the country. Suicide is a leading cause of death in corrections facilities with rates of inmate suicide being far higher than the national average. Suicide is an event that can lead to legal action against the facility, staff, and treating health-care providers. Some claims are based on medical malpractice. In this setting, claims may also be brought based on violations of the detainee's constitutional rights. Pretrial detainees and prisoners, alike, have a constitutional right to adequate medical and psychiatric care through the Fourteenth Amendment and Eighth Amendment, respectively. But, there is limited information on constitutional claims made against correctional health-care providers for cases of inmate suicide. To help bridge this gap, the authors conducted a search of federal legal case decisions involving claims against health-care providers for deliberate indifference to a detainee's serious illness or injury in the event of attempted suicide or death by suicide over a 5 year period from 2016 to 2021. Fifteen cases were identified. Five themes emerged from the cases, which could serve as bases for claims against health-care professionals: receiving screening, mental health assessment, treatment, documentation, and attention to facility policies. The cases and their clinical significance are summarized in this article. The materials provide an overview of the problems surrounding correctional suicides and can serve as practice pointers in the corporeal setting.