Suicide in prisons - Reflection of the communities served, or exacerbated risk?
Journal/Book: Brit J Psychiat. 1999; 175: British Journal of Psychiatry 17 Belgrave Square, London SW1X 8Pg, England. Royal College Of Psychiatrists. 50-55.
Abstract: Background A recent review showed that opioid users' deaths from suicide were 10 times as common as expected on the basis of age and gender. Surveys showing prisoners' high prevalence of injecting or opioid dependence have led to a new statistical approach to prison suicides. Aims To estimate the expected number of UK prison suicides annually, having taken account of inmates' age, gender and opioid dependence. Method By gender, estimate the effective number of individuals (in terms of community-equivalent suicide risk) For whom prisons have a duty of care as 10 times the number of opioid-dependent inmates plus the number of non-opioid user inmates. Apply the gender and age-appropriate national suicide rates to work out the expected number of prison suicides. Results The Scottish Prison Service can expect 7.1 suicides per annum, and annual totals up to 12 without exacerbation of suicides due to incarceration. For the Prison Service in England and Wales, 19.3 suicides per annum can be expected in prisons. And annual totals may range up to 28 without indicating incarceration; the total of self-inflicted deaths was 47 in 1993-94. Conclusions Prisons cannot prevent all suicides. An alert may be warranted if prison suicides exceed 12 per annum in Scotland, or 28 in England and Wales. Liebling (1996) has criticised naive statistical approaches to prison suicide which do not adequately account for the vulnerability profile of prisoners, including previous psychiatric contact, major drink or drug problems and unstable employment history; see also Lewis & Sloggett (1998), and Platt et al (1988) on the striking relationship between parasuicide and social class. Recently, and importantly, Harris & Barraclough (1998) have reviewed the age and gender-adjusted excess mortality of mental disorder, with one section devoted to the high excess mortality, including from suicide, associated with opioid use. Opioid users' deaths from suicide were 10 times as numerous as expected on the basis of age and gender (95% CI for standardised mortality ratio: 7.8 to 12.65). Prison surveys do not routinely ask about social class, but they do ask about drugs use; see Wozniak et al (1998), Gore & Bird (1998) and Singleton et al (1998). Statistical approaches to estimating the expected number of suicides in prison should account for the high prevalence of drug dependence among inmates, as we illustrate in assessing suicides in Scottish prisons, and in prisons in England and Wales. Declaration of interest None.
Note: Article Gore SM, MRC, Biostat Unit, Robinson Way, Cambridge CB2 2SR, ENGLAND
Keyword(s): ANONYMOUS HIV SURVEILLANCE; FACTOR ELICITATION; SCOTLAND