Gullotta Mathew, Greenberg David, Albalawi Olayan, Adily Armita, Karminia Azar, Knight Lee, Ellis Andrew, Butler Tony Gerard
School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia.
Justice Health and Forensic Mental Health Network, Sydney, NSW, 2036, Australia.
Health Justice. 2021 Jul 27;9(1):19. doi: 10.1186/s40352-021-00146-6.
Prisoners complete suicide and self-harm more frequently than members of the community. Sex offenders have been found to be at greater risk of engaging in these behaviours. This study examines the characteristics, prevalence, and predictors of self-harm and suicide attempts among: sex offenders that only victimise children (ChildSOs); adults (AdultSOs); or both (age-crossover polymorphous; PolySOs).
Data from three waves (1996, 2001, 2009) of the New South Wales (NSW) Inmate Health Survey was linked to the State's re-offending database to identify men with histories of sexual offending. The health surveys captured self-report data on self-harm and suicidality.
Non-sexual violent offenders (15%) and AdultSOs (14%) had the highest rate of self-harm, significantly more than ChildSOs (11%), non-sexual non-violent offenders (10%), and PolySOs (0%). Several factors significantly predicted self-harm at the bivariate level for both ChildSOs and AdultSOs, with unique predictors for each group. At the multivariate level, manic-depression trended towards significance for ChildSOs and any mental health condition remained a significant predictor for AdultSOs who self-harmed relative to AdultSOs who had not (aOR = 11.989, 95%CI [1.14, 126.66]). Approximately 23% of AdultSOs, 22% of PolySOs, and 19% of ChildSOs reported a suicide attempt throughout their lifetime, whereas only 15% of non-sexual non-violent offenders reported an attempt. At the bivariate level, few factors were significant for ChildSOs while several factors were significant for AdultSOs. At the multivariate level, a diagnosis of depression and treatment with psychiatric medication trended towards being significant predictors of suicide attempts for ChildSOs. In contrast, treatment with psychiatric medication (aOR = 25.732, 95%CI [1.91, 347.19])] remained a significant predictor for AdultSOs who attempted suicide relative to AdultSOs who had not, as well as historical psychiatric hospitalisation (aOR = 6.818, 95%CI [1.04, 44.82]) and self-harm (aOR = 5.825, 95%CI [1.31, 25.99]).
Sex offenders are at significantly higher risk of attempting and completing suicide relative to non-sexual non-violent offenders and warrant special attention. The prevalence rates and predictors of self-harm and suicidality suggest differences between sex offender subgroups may exist. These hold implications for the criminal justice and public health systems for addressing needs and identifying those most at risk of self-harm and suicide.
囚犯自杀和自我伤害的频率高于普通人群。已发现性犯罪者实施这些行为的风险更高。本研究调查了仅侵害儿童的性犯罪者（儿童性犯罪者）、成年性犯罪者或两者皆有的性犯罪者（年龄交叉多态性性犯罪者）自我伤害和自杀未遂的特征、发生率及预测因素。
新南威尔士州（NSW）囚犯健康调查的三轮数据（1996年、2001年、2009年）与该州的再犯罪数据库相关联，以识别有性犯罪史的男性。健康调查收集了关于自我伤害和自杀倾向的自我报告数据。
非性暴力罪犯（15%）和成年性犯罪者（14%）的自我伤害率最高，显著高于儿童性犯罪者（11%）、非性非暴力罪犯（10%）和年龄交叉多态性性犯罪者（0%）。在双变量水平上，有几个因素显著预测了儿童性犯罪者和成年性犯罪者的自我伤害，且每组有独特的预测因素。在多变量水平上, 躁郁症对儿童性犯罪者有显著预测趋势，而任何心理健康状况仍是成年性犯罪者自我伤害的显著预测因素，相对于未自我伤害的成年性犯罪者（调整后比值比[aOR]=11.989，95%置信区间[CI][1.14, 126.66]）。约23%的成年性犯罪者、22%的年龄交叉多态性性犯罪者和19%的儿童性犯罪者报告曾有过自杀未遂，而只有15%的非性非暴力罪犯报告有过自杀未遂。在双变量水平上，对儿童性犯罪者而言，几乎没有因素具有显著性，而对成年性犯罪者而言，有几个因素具有显著性。在多变量水平上，抑郁症诊断和精神科药物治疗对儿童性犯罪者自杀未遂有显著预测趋势。相比之下，精神科药物治疗（aOR=25.732，95%CI[1.91, 347.19]）仍是成年性犯罪者自杀未遂的显著预测因素，相对于未自杀未遂的成年性犯罪者，还有既往精神病住院史（aOR=6.818，95%CI[1.04, 44.82]）和自我伤害（aOR=5.825，95%CI[1.31, 25.99]）。
相对于非性非暴力罪犯，性犯罪者自杀未遂和自杀的风险显著更高，值得特别关注。自我伤害和自杀倾向的发生率及预测因素表明，性犯罪者亚组之间可能存在差异。这对刑事司法和公共卫生系统满足需求以及识别最易发生自我伤害和自杀的人群具有启示意义。
