عوامل پیش بینی کننده افکار خودکشی، اقدام به خودکشی و خودآسیبی و بدون قصد مرگبار در نمونه اصلاحات جامعه

Abstract 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.

Introduction The main objectives of the criminal justice system include deterrence, incapacitation, retribution and rehabilitation of criminal offenders (Yang, Kadouri, Revah-Levy, Mulvey, & Falissard, 2009). Yet, as government and private mental health institutions have faded from prominence, correctional facilities (i.e., jails, prisons, and community corrections) have increasingly become caregivers for people with acute and chronic mental illnesses ( Suto and Arnaut, 2010, Torrey et al., 2010 and Wortzel et al., 2009). Additional sociologic factors, such as the loss of traditional social networks and population migration, have also contributed to the increasing involvement of mentally ill individuals in the criminal justice system ( Harrison & Rogers, 2007). As the responsibility of caring for those with mental illness continues to shift from medical to correctional services, one would expect the associated risks of lethal and nonlethal self-harm behaviors to rise in correctional settings (Suto and Arnaut, 2010 and Wortzel et al., 2009). In fact, several researchers have noted that self-harm behaviors, attempted suicide, and suicide are higher among correctional populations than in the general population (Bjork and Lindqvist, 2005, Jeglic et al., 2005, Joukamaa, 1998, Kenny et al., 2008, Paanila et al., 1999 and Roe-Sepowitz, 2007). Given that the correctional system in the United States serves over 7.2 million offenders each year (Glaze, 2010), this population presents serious public health challenges. Although the vast majority of offenders are served in the community (5 million of the 7.2 million) (Glaze, Bonczar, & Zhang, 2010), most studies focus on self-injurious behavior, with and without suicidal intent, during incarceration. Few studies examine these behaviors in the context of community supervision of offenders (Wessely, Akhurst, Brown, & Moss, 1996) despite the previous finding that community offenders were at greater risk to die than prisoners (Pratt et al., 2006 and Sattar, 2003). Suicidal behavior The correctional population is skewed toward groups demographically at risk for addiction, mental illness, and healthcare disparities. Risk factors for suicide among the general population are also operant in correctional settings, including previous suicide attempt, mental health disorders (especially depressive disorders), substance abuse and dependence, impulsive aggressive personality style, significant social and occupational losses, social isolation, hopelessness, physical illness, family history of suicide, and exposure to suicide in the community (Baillargeon et al., 2009, Fagan et al., 2010, Miles, 1977, Sattar, 2003 and Wortzel et al., 2009). Offenders with mental disorders generally, and depression and personality disorders specifically, have a significantly higher standardized mortality than the general population (Kullgren, Tengstrom, & Grann, 1998). Systematic reviews indicate that recent suicidal ideation, prior suicide attempts, psychiatric illness, and alcohol abuse, have the strongest associations with suicide among incarcerated offenders (Fazel, Cartwright, Norman-Nott, & Hawton, 2008). Veteran status and post-traumatic stress disorder may confer an even greater risk of suicide in incarcerated persons than community dwellers (Wortzel et al., 2009). Prior victimization and childhood trauma also appear to increase risk for suicidal ideation and behavior (Daigle and Gilles, 2006, Sarchiapone, Carli, et al., 2009 and Sarchiapone, Jaussent, et al., 2009). Risk factors for suicide attempt following suicidal ideation include mood instability, hopelessness, clinical change in affective presentation, suicidal communication to significant others, anhedonia, panic attacks, and history of recent alcohol abuse (Fagan et al., 2010). In a New York State Department of Correctional Services study examining inmates who had some contact with mental health services during their incarceration, 84% of those who committed suicide received a mental health service within 3 days of the suicide and most had a substance abuse history, displayed agitation or anxiety, and many exhibited a behavioral change (Way, Miraglia, Sawyer, Beer, & Eddy, 2005). Additional risk factors are unique to the situation of incarceration (Sattar, 2003). Mumola (2005), for instance, found that the suicide rates in small jails were greater than those in large jails and prisons. Among prisoners, long sentence length, detention for violent offense, and placement in a single cell may confer some risk (Fazel et al., 2008). In other samples the early period of incarceration appears to be the time of greatest risk (Sattar, 2003 and Wortzel et al., 2009). Some interpersonal dynamic factors include contentious relationships with staff, over-controlled environment, and lack of contact with individuals not involved in the justice system (Suto & Arnaut, 2010). Other factors elevating suicide risk in incarcerated populations include difficult relationships with other inmates or staff, threats from other inmates, actual or anticipated segregation, bullying, violence, elevated emotional reactivity, and hypervigilance (Bonner, 2006 and Suto and Arnaut, 2010). Inmates who attempted suicide were more likely to have aggression during incarceration (Sarchiapone, Carli, et al., 2009 and Sarchiapone, Jaussent, et al., 2009). Common stressors preceding the suicide were adverse information such as loss of good time or disruption of family/friendship relationships in the community, inmate-to-inmate conflict, recent disciplinary action, physical illness, and fear (Way et al., 2005). However, good relationships with staff may be associated with suicide attempts of increased lethality in inmates with personality disorders owing to increased freedom (Magaletta, Patry, Wheat, & Bates, 2008).

Conclusions Our study provides evidence suggesting that multiple episodes of fracture and emotionally traumatic experience occurring before the age of 18 contributed to the prediction of suicidal ideation, suicide attempts, and volitional self-harm without lethal intent in this sample. In this sample in which most subjects met criteria for antisocial personality disorder, PCL:SV total scores contributed to the prediction of self-injury without lethal intent, while PCL:SV Factor 2 scores contributed to the prediction of suicidal ideation. Prior research has demonstrated that PCL-R Factor 2 scores were related to childhood adversity (Harpur, Hare, & Hakstian, 1989), so the finding of Factor 2 elevation in the prediction of suicidal ideation along with childhood trauma was not surprising. While depressive symptoms predicted suicidal ideation and attempts, it was symptoms of anxiety (specifically, panic in this sample) that predicted self-harm without lethal intent. Somewhat surprisingly, gender and age did not independently contribute to the prediction of any of the variables of interest, and race and drug dependence contributed only to the prediction of suicidal ideation. As the number of mentally ill persons entering the correctional system grows, jail, prison, and community corrections personnel will face increasing challenges in providing services to mitigate the risk of suicidal and self-injurious behavior in this population. Although at times the aims of supervision and mental health treatment may seem opposed, the common goals of minimizing both staff and offender injury provide valuable common ground in the assessment and supervision offenders with mental illness and increased risk of self-injurious and suicidal behavior (Fagan et al., 2010). It appears that assessing and treating the emotional impact of childhood trauma and inquiring about episodes of fracture, in addition to symptoms of depression and anxiety, among those served in correctional settings may play a role in assessing and mitigating the risk of self-injurious behaviors in these populations.