Predictors of suicidal ideation, suicide attempts, and self-harm without lethal intent in a community corrections sample

Purpose

Little published research data exist about suicidal ideation and self-harm behavior in community corrections and we seek to fill this void.

Aims

To examine the effects of drug dependence, depression, anxiety, psychopathy, fracture, and child trauma on suicidal ideation, suicide attempts, and self-harm without lethal intent in community corrections.

Methods

The Semi-Structured Assessment for the Genetics of Alcoholism Revised (SSAGA II) and the screening version of the Hare Psychopathy Checklist (PCL:SV) were administered. Separate binary logistic regression analyses were used to predict lifetime suicidal ideation, suicide attempt, and self-harm behavior.

Results

Prevalences of suicidal ideation, suicide attempt, and self-harm without lethal intent were 41%, 19%, and 14%. Suicidal ideation was predicted by drug dependence, elevated PCL:SV Factor 2 score, and Caucasian race. Suicidal ideation and attempt were both predicted by fractures, depression, and child trauma. Self-harm was predicted by fractures, panic, PCL:SV score, and child trauma.

Conclusions

Child trauma and multiple fractures are potent predictors for suicidal ideation, suicide attempts, and self-harm without lethal intent in this community corrections sample. Depression predicted suicidal ideation and attempts, while panic predicted self-harm without lethal intent. Psychopathy was also an important predictor of suicidal ideation and self-harm behaviors without lethal intent.     

The function of self-harm behavior in a forensic population

This article examines the functions of self-injurious behavior (SIB) in forensic populations. The cases of four individual offenders who have engaged in SIB are presented. These cases depict the four main functions of self-harm behaviors including (a) suicidal intent, (b) manipulation of the environment, (c) emotion regulation, and (d) a response to psychotic delusions or hallucinations. Assessment and treatment implications are discussed.     

Discriminating deliberate self-harm (DSH) in young prison inmates through personality disorder

This study investigated deliberate self-harm (DSH) in young inmates. The objectives are twofold: first, to identify the social and clinical characteristics of inmates who commit DSH; and secondly, to ascertain the types of personality who are vulnerable in order to be able to predict future inmates who may harm themselves. A cross-sectional design was used to study psychosocial correctional personality characteristics and clinical pictures in inmates with DSH versus a control group without DSH. The measures used to evaluate different variables were a standard protocol and a self-report questionnaire (MCMI-II). Although the two groups compared are homogeneous and similar in terms of different psychosocial variables, inmates with DSH presented a significant background of maltreatment. Borderline, passive-aggressive, and antisocial personality disorders best discriminated both groups. The detection of borderline, negativistic, and antisocial disorders may help the medical services of penitentiary centers to predict youths with a possible risk of DSH. Despite the results obtained, longitudinal studies are needed to help clarify other risk factors, as well as other risk factors leading to self-harm behavior.     

Self-harming behaviors in prison: a comparison of suicidal processes,self-injurious behaviors,and mixed events

Self-harming behaviors occurring in prison disproportionately consume resources and cause considerable disruption. To date, theoretical paradigms have explained self-injurious behaviors and suicidal processes either via a continuum or dichotomy of self-harm. This current study examines all documented acts of self-harm (n = 1,158) occurring in South Carolina’s 28 prisons over a 50-month period. We test and find support for a tripartite schema of self-harm; differentiated with regard to suicidal processes, self-injurious behaviors, and a ‘mixed group‘ of self-harming behaviors. These groups of behaviors were distinct with regard to situational variables (i.e. body part targeted, injury severity) as well as institutional responses (i.e., medical treatment needed, employment of suicide protocols). Findings indicate that self-injurious behaviors are likely to result in physical injury and/or hospitalizations.     

Aggressive behavior and measurement of psychopathy in female inmates of German prisons--a preliminary study

Studies concerning inmate psychopathy (as measured by Psychopathy-Checklist-Revised, PCL-R; Hare, 1991) have predominantly been concerned with male inmates. This study was the first to look into psychopathy using the PCL-R with the whole required procedure in German prisons with female inmates. The aims of the present study were to gain data about the prevalence of psychopathy in this sample and to examine potential relations between the types and motive of aggression, prosocial behavior and scores on the PCL-R. Sixty female inmates were examined. We obtained a prevalence rate of psychopathy of 17% (N=10, with a cut-off score of 25). Considering a wide range of subtypes of aggressive behaviors, we found that physical proactive, and relational reactive aggression as well as age predicted high scores of psychopathy. However, prosocial or helping behavior was not associated with psychopathy. Implications for diagnostic issues in forensics concerning female prisoners are discussed.     

Personality traits in suicidal and homicidal subjects with schizophrenia

Paranoid schizophrenia is characterised by an increased risk of suicide and homicide. Little is known about the influence of personality dimensions as determinants for suicidal and homicidal behaviour within this condition. We assessed the differences among suicidal, homicidal and non-aggressive adult male in-patients with ICD-10 paranoid schizophrenia. The clinical assessments included structured psychiatric interviews and reports on harmful alcohol use and suicide attempts. The personality dimensions were assessed with the Big Five Inventory-10. The study recruited 264 patients divided into three groups: suicide attempters (N = 62), homicide group (N = 70), and a comparative control group (N = 132). To examine how the clinical subgroups differed from the comparative sample in the studied variables, a multinomial regression was performed. Each subgroup was considered a nominal outcome variable and the log odds of the outcomes were modelled as a linear combination of the predictor variables. Neuroticism or emotional instability was the only personality dimension that was different among the study subgroups: a lower level of neuroticism was found in the homicide group. Other risk factors such as age, education, relationship status and history of self-aggressive behaviour could potentially distinguish these subgroups of paranoid schizophrenia patients.     

Trouble in Mayberry: A national analysis of suicides and attempts in small jails

Despite the fact that there are approximately 1,775 American jails of 99 beds or less, little is known about how these jails function, or the challenges that they confront. This study examined the problem of suicides and attempted suicides in small jails, finding that the prevalence of these incidents is two to five times greater than in their larger counterparts. Net of other factors, jails that had higher rates of admissions, as well as overcrowded facilities had a positive relationship with suicide attempts. We also found that jails that reported higher concentrations of special needs inmates were significantly associated with attempts. Specifically, facilities that had higher levels of long-term inmates were positively associated with suicide attempts. While almost one-fifth of small jails did not use formal suicide assessments at admission, and only slightly more than one-half of these facilities provided annual suicide training to jail officers, these factors were not significantly associated with suicide attempts in 2004. Implications for future research and practice are outlined.     

Suicidal ideation in a United States jail: demographic and psychiatric correlates

Suicidal behavior is a significant problem in United States jails. Suicidal ideation (SI) is an established precursor to suicidal behavior in incarcerated populations. No studies to date have examined the prevalence of SI or its correlates in a mixed-gender U.S. jail sample. The purpose of the present study was to document rates of SI in a mixed-gender jail sample and examine socio-demographic and psychiatric correlates. This study of 511 jail inmates found that approximately 16% of participants reported clinically significant SI upon incarceration. White participants, suicide attempters, and those with a psychiatric diagnosis history endorsed greater SI. Reported SI did not differ by sex and was not correlated with age. Clinically, results indicate that screening for SI in jail samples is necessary to identify high-risk individuals for intervention to prevent suicidal behavior.     

Clinical and forensic indicators of "suicide by cop"

This paper reviews the literature pertaining to the phenomenon of "suicide by cop"--any incident in which a suicidal individual attempts to get law enforcement to kill him. This article defines the term "suicide by cop," discusses the various motivations of individuals who engage in this type of behavior, presents the risk factors and indicators for suicide and violence, and describes specific indicators for suicide by cop. Proper recognition of these events, prior and subsequent to their occurrence, has important implications for prevention, officer safety, equivocal death analysis and psychological autopsy, civil litigation, criminal justice proceedings, and community stability. This paper presents seven case studies which demonstrate the clinical and forensic indicators of this phenomenon.     

Understanding the risk factors for violence and criminality in women: the concurrent validity of the PCL-R and HCR-20

This study explores the performance of 132 female maximum-security inmates on the Psychopathy Checklist-Revised (PCL-R) and the HCR-20 (Historical, Clinical, and Risk Management Scheme) to examine the concordance between these two risk assessment instruments, and to assess their potential usefulness in determining level of risk for violent behavior and other forms of criminality. The two instruments demonstrated consistent and highly significant correlations across total scores, factor scores, and subscale scores. When the two instruments were entered into a multiple regression analysis to predict violent and non-violent crime, the HCR-20 did not add to the variance explained by the PCL-R. These results confirm earlier research that suggests that there is little or no difference between these two risk assessment instruments in their relationship to community or institutional violence. Further, Receiver Operating Characteristics (ROC) analyses show that both instruments demonstrated an inverse ability to predict convictions for murder, a close to chance ability to predict violent crime, but a shared ability to predict property and minor crime. Broadly, these results suggest that psychopathic women are involved in chronic patterns of non-violent criminality, while women charged and convicted of murder generally do not have elevated scores on the PCL-R or HCR-20. The relevance of these findings to rehabilitation and treatment is discussed.     

PCL-R psychopathy predicts disruptive behavior among male offenders in a Dutch forensic psychiatric hospital

In this study, the relationship between psychopathy, according to the Dutch language version of Hare's Psychopathy Checklist-Revised (PCL-R), and various types of disruptive behavior during inpatient forensic psychiatric treatment is investigated. Ninety-two male participants were administered the PCL-R following admission to an inpatient forensic hospital. From daily hospital information bulletins, incidents of verbal abuse, verbal threat, physical violence, and violation of hospital rules were derived. Also, the number of seclusion episodes was recorded. As expected, significant correlations were found between PCL-R scores and verbal abuse, verbal threat, violation of rules, total number of incidents, and frequency of seclusion. Psychopaths (PCL-R > or = 30) were significantly more often involved in incidents than nonpsychopaths. Multiple regression analyses revealed that the PCL-R Factor 2 score in particular contributed uniquely to the prediction of the total number of incidents. The findings are discussed in terms of their clinical implications.     

Psychopathy, treatment change, and recidivism in high-risk, high-need sexual offenders

The present study investigated 154 consecutive admissions to the Regional Treatment Center (Ontario) Sex Offender Treatment Program with reference to psychopathy and outcome. Ratings of treatment behavior, as well as clinical judgments as to whether risk was reduced, were coded based on treatment reports. With reference to Psychopathy Checklist-revised (PCL-R) scores, survival analyses indicated that high scorers recidivated at significantly higher rates than low scorers. However, offenders who received high PCL-R scores and lower scores on measures of treatment behavior recidivated at the same rate as low scorers on the PCL-R. Furthermore, among high PCL-R offenders, those rated as lower risk at post treatment in fact reoffended at a lower rate than those whose risk was rated as unchanged, although this difference failed to reach significance. Findings are discussed in light of the clinical and research literature.     

The predictive validity of the Depression Hopelessness Suicide screening form for self-harm among prisoners

The Depression Hopelessness Suicide Screening Form (DHS) includes 12 ‘critical items’, which have not been validated for the prospective prediction of self-harm. We conducted a retrospective cohort study (N = 4196) to validate the ability of the DHS critical items to prospectively predict inmates with at least one incident of self-harm during the first six months of imprisonment. While the critical items were highly sensitive (89.5%) at predicting incidents of self-harm, 51.3% of the inmates endorsed at least one item. Five items reflecting more recent and specific risk factors reduced the referral rate to 17.7%, while maintaining high sensitivity (84.2%). While the DHS has high sensitivity to predict inmates at risk of self-harm, treating all items as equally critical results in excessive numbers of false positives that likely exceed the capacity of prison resources for professional assessment and intervention. Referral rules based on recency and specificity of risk factors are proposed.     

Behavior on the ward of personality-disordered inpatients and chronically psychotic inpatients during a three-year stay in a Dutch forensic psychiatric hospital

To gain insight into the behavior of a group of personality-disordered patients and a group of chronically psychotic patients during their stay in a Dutch forensic psychiatric hospital, data on these patients were collected biannually for seven years. Three aspects of the patients’ behavior were examined: the prediction of institutional behavior shortly after admission, changes in the patients’ behavior on the ward during their stay in hospital, and the prediction of these changes. In the personality-disordered patients, observed irritation/anger and aggressive behavior on the ward turned out to be positively related to psychopathy, the PCL-R lifestyle and antisocial facets, and the neuroticism domain. A positive relationship was also found between aggressive behavior on the ward and trait anger. In the chronically psychotic patients, a positive relationship was found between irritation/anger and the PCL-R interpersonal and lifestyle facet. During a stay of three years, the aggressive behavior of both patient subgroups, which was already low at the start, did not decrease further, but their prosocial behavior increased. In the personality-disordered patients, relatively high scores on the antisocial facet of the PCL-R indicated an increase in prosocial behavior, whereas in the chronically psychotic patients no relationship was found between any PCL-R facet and behavior change. Effect studies on treatment programs for forensic psychiatric inpatients have to contend with the problem of a low base rate of institutional aggression. Therefore, we advise that such studies focus not only on a decrease in negative behaviors but also on an increase in positive behaviors.     

A comparison of sexual coercion experiences reported by men and women in prison

Comparisons were made between self-reports from 382 men and 51 women who had experienced sexual coercion while incarcerated. Victim data were obtained from a sample of 1,788 male inmates and 263 female inmates who responded to an anonymous written survey distributed in 10 midwestern prisons. Men reported that their perpetrators in worst-case incidents were inmates (72%), staff (8%), or inmates and staff collaborating (12%). Women reported that their perpetrators were inmates (47%) and staff (41%). Greater percentages of men (70%) than women (29%) reported that their incident resulted in oral, vaginal, or anal sex. More men (54%) than women (28%) reported an incident that was classified as rape. Men and women were similar in feeling depression; however, more men (37%) than women (11%) reported suicidal thoughts and suicide attempts (19% for men, 4% for women). Implications of results for prevention of sexual coercion in prison are discussed.     

Too Close for Comfort: Exploring Gender Differences in Inmate Attitudes Toward Homosexuality in Prison

Since the inception of the Prison Rape Elimination Act in 2003, there has been increased interest in not only sexual victimization among incarcerated populations, but all aspects of prison sexuality. Correctional policies have focused on the homosexual population in attempts to protect these individuals from victimization and in attempts to decrease sexual relationships between inmates. While recent research has focused on the prevalence of homosexual behavior and the prevalence of sexual victimization among incarcerated populations, there has been little research on inmate attitudes toward homosexuality and same-sex sexual encounters in prison. The present study adds to the literature base by examining gender differences in attitudes toward inmate homosexuality among a sample of male and female inmates in a large Southern prison system. Findings revealed that male inmates, older inmates, and heterosexual inmates had significantly more negative attitudes toward homosexual inmates. Implications based on these findings are discussed.     

The Gender Paradox in Prison Suicide Rates

Few studies of prison suicide have focused on suicide among female inmates, and even fewer studies have provided comparisons of rates by gender. Using national data on U.S. prisons and suicide, this study examined the “gender paradox” in prison suicide rates by comparing suicide rates of female and male inmates and U.S. residents and then examined characteristics of prisons that reported suicides. Findings indicated that rates of suicide in prison were similar for female and male inmates, but rates were higher for female inmates and lower for male inmates compared to the respective rates for female and male U.S. residents. Prisons that reported female suicides evidenced significant differences in prison conditions, including higher assault rates and mental health service utilization, compared to prisons for males and female prisons without suicide. Implications of the findings for understanding the gender paradox and for prison suicide prevention are discussed.     

Psychopathy,intelligence, and impulsivity in German violent offenders

Previous studies have reported numerous correlations between psychopathy and various personality traits, behavioural tendencies or clinical characteristics. The present study examined in greater depth the relationships between the components of psychopathy as measured by the Psychopathy Checklist—Revised (PCL-R) and intelligence as well as impulsivity. A total of ninety male violent offenders were recruited from a prison and a forensic–psychiatric hospital in Germany. All of the subjects were assessed using the PCL-R, the Barratt Impulsiveness Scale (BIS-11), and a short version of the German Wechsler Adult Intelligence Scale (WIP). As expected, a canonical correlation analysis showed a negative association between spatial intelligence and the Factor 2 subtotal on the PCL-R (reckless lifestyle/antisociality). In addition, our results agreed with the assumption of an association between impulsivity and the subtotal for PCL-R Factor 2. The positive relationship between verbal intelligence and the subtotal for Factor 1 of the PCL-R (insincere, manipulative conduct/affective deficits) vanished after controlling for educational level. The results indicate that there is a relationship between the spatial components of intelligence and the concept of psychopathy as described by Hare. This result supports the spatial impairment aetiological model of antisocial behaviour.     

Questioning the psycho-socio-cultural factors that contribute to the cases of suicide attempts: an investigation

Suicide attempts can be described to include all actions taken by an individual to end their life as a result of acute desperation. In parallel with the changes in the make-up of human societies both globally and in this country in recent years, suicide attempts are receiving attention in ever increasing proportions. The current study is aimed at investigating the psycho-socio-cultural factors that contribute to the known cases of suicide attempts. The study included 116 cases admitted to the Emergency Internal Medicine and Surgery Units of the University of Istanbul, Faculty of Medicine Hospital between 1 December 1998 and 31 May 1999. In only 47 cases, a 30-point questionnaire was used in several face-to-face interviews with the patients following the preparation of a clinical case study. In establishing the socio-demographic, socio-cultural and socio-economic attributes of each individual case, a range of contributing effective factors is questioned. Including the specific reasons for each suicide attempt, the emotional state of the individual prior to the suicide attempt, the type of suicide action chosen and reasons for this selection, immediate family structure, personal psychiatric antecedent, substance abuse. The results of our investigations are compared with the existing literature in a multi-faceted discussion.     

Does Interrater (Dis)agreement on Psychopathy Checklist Scores in Sexually Violent Predator Trials Suggest Partisan Allegiance in Forensic Evaluations?

Many studies reveal strong interrater agreement for Hare's Psychopathy Checklist-Revised (PCL-R) when used by trained raters in research contexts. However, no systematic research has examined agreement between PCL-R scores from independent clinicians who are retained by opposing sides in adversarial legal proceedings. We reviewed all 43 sexual-offender civil-commitment trials in one state and identified 23 cases in which opposing evaluators reported PCL-R total scores for the same individual. Differences between scores from opposing evaluators were usually in a direction that supported the party who retained their services. These score differences were greater in size than would be expected based on the instrument's standard error of measurement or the rater agreement values reported in previous PCL-R research. The intraclass correlation for absolute agreement for the PCL-R Total score from a single rater (ICC 1,A = .39) was well below levels of agreement observed for the PCL-R in research contexts, and below published test-retest values for the PCL-R. Results raise concerns about the potential for a forensic evaluator's "partisan allegiance" to influence PCL-R scores in adversarial proceedings.