Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK.
Br J Psychiatry. 2010 Sep;197(3):219-26. doi: 10.1192/bjp.bp.109.075424.
Female prisoners are 20 times more likely to die by suicide than women of the same age in the general population. However, risk factors and indicators of vulnerability for suicide in this group are not well-known.
We investigated prevalence of psychiatric disorders in women prisoners who had recently engaged in near-lethal self-harm (cases) and others who had never carried out near-lethal attempts in prison (controls).
We interviewed 60 cases and 60 controls from all closed female prison establishments in England and Wales. In addition to gathering details of sociodemographic, criminological and clinical history, we assessed participants' current and lifetime disorders using the Mini-International Neuropsychiatric Interview. Associations between near-lethal self-harm and psychiatric disorders were adjusted for age, educational qualifications (any v. none) and remand status (sentenced v. unsentenced).
At the time of their near-lethal self-harm, 53 cases (88%) were on ACCT (Assessment, Care in Custody and Teamwork), the system for the care of prisoners at risk of suicide and self-harm in England and Wales. Cases had significantly greater levels of psychiatric morbidity than controls, and more comorbidity. The strongest associations with near-lethal self-harm were with current depression (age-adjusted odds ratio (OR) = 23.7, 95% CI 9.0-62.3), the presence of two or more diagnoses (age-adjusted OR = 18.3, 95% CI 5.9-56.9), a history of psychiatric in-patient treatment (OR = 25.4, 95% CI 5.7-113.5) and previous attempted suicide, especially in prison (OR = 129, 95% CI 27-611). The only tested diagnoses not associated with near-lethal self-harm were antisocial personality disorder, substance use and eating disorders. Adjusting for sociodemographic and criminological variables did not significantly alter any of these findings.
This research underlines the importance of psychiatric risk factors for suicide in custody and in particular comorbidity. The finding that a formal care plan was in place for most cases at the time of their near-lethal act is indicative of good risk detection, but also suggests high levels of unmet need. Given the potential complexity of their mental health needs, interventions incorporating pharmacological and psychological treatments should be considered for at-risk prisoners.
女性囚犯自杀的可能性是同龄普通女性的 20 倍。然而，该群体中自杀的风险因素和脆弱性指标并不为人所知。
我们调查了最近在狱中进行过接近致命性自伤的女性囚犯（病例）和从未在狱中进行过接近致命性尝试的女性囚犯（对照）的精神障碍患病率。
我们对英格兰和威尔士所有封闭式女性监狱的 60 名病例和 60 名对照进行了访谈。除了收集社会人口统计学、犯罪学和临床病史的详细信息外，我们还使用迷你国际神经精神访谈评估了参与者当前和终身的障碍。在调整年龄、教育程度（有 v. 无）和还押身份（已判刑 v. 未判刑）后，将接近致命性自伤与精神障碍之间的关联进行了调整。
在进行接近致命性自伤时，53 名病例（88%）正在接受 ACCT（评估、羁押中的护理和团队合作），这是英格兰和威尔士对有自杀和自伤风险的囚犯进行护理的系统。病例的精神疾病发病率明显高于对照，且合并症更多。与接近致命性自伤最强相关的是当前抑郁（年龄调整优势比（OR）=23.7，95%置信区间（CI）9.0-62.3）、存在两种或两种以上诊断（年龄调整 OR=18.3，95% CI 5.9-56.9）、精神科住院治疗史（OR=25.4，95% CI 5.7-113.5）和以前的自杀企图，尤其是在狱中（OR=129，95% CI 27-611）。唯一经过测试的与接近致命性自伤无关的诊断是反社会人格障碍、物质使用和饮食障碍。调整社会人口统计学和犯罪学变量并没有显著改变这些发现。
这项研究强调了在羁押期间，特别是在合并症方面，精神风险因素对自杀的重要性。在接近致命行为发生时，大多数病例都有正式的护理计划，这表明风险检测良好，但也表明存在高度的未满足需求。鉴于他们的心理健康需求可能很复杂，应该考虑为高危囚犯提供包含药理学和心理治疗的干预措施。
