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Rempel AML, Persons JE, Bengtson K, Nashelsky MB. Causes of Death in the Presence of Law Enforcement in Johnson County, Iowa, 2011-2020. Am J Public Health 2024; 114:642-650. [PMID: 38574318 PMCID: PMC11079845 DOI: 10.2105/ajph.2024.307616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Objectives. To examine sudden and unexpected or trauma-related deaths that occurred in the presence of law enforcement in Johnson County, Iowa, between 2011 and 2020. Methods. We identified deaths in the presence of law enforcement using definitions from the National Association of Medical Examiners. We obtained data, including demographics, cause and manner of death, toxicology results, and circumstances and location of event leading to death, from comprehensive medical examiner investigative reports. Results. There were 165 deaths that occurred in the presence of law enforcement: 114 were from a known disease, and 51 were either trauma related or the sudden, unexpected initial presentation of a previously unrecognized disease. Three deaths occurred in the context of physical restraint by law enforcement. Suicide was the leading manner of death among trauma-related deaths; the means of suicide was predictable based on in-custody (hanging) or precustody (firearm) circumstances. Conclusions. Our findings highlight the potential role of medical examiners and coroners in improving completeness of data on reporting death in the presence of law enforcement to public health agencies. (Am J Public Health. 2024;114(6):642-650. https://doi.org/10.2105/AJPH.2024.307616).
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Affiliation(s)
- Anne M L Rempel
- Anne M. L. Rempel, Jane E. Persons, and Marcus B. Nashelsky are with the Department of Pathology, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City. Anne M. L. Rempel is also with the University of California, San Francisco, Department of Emergency Medicine, Fresno, CA. Kate Bengtson and Marcus B. Nashelsky are also with the Johnson County, Iowa Medical Examiner Department, Iowa City
| | - Jane E Persons
- Anne M. L. Rempel, Jane E. Persons, and Marcus B. Nashelsky are with the Department of Pathology, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City. Anne M. L. Rempel is also with the University of California, San Francisco, Department of Emergency Medicine, Fresno, CA. Kate Bengtson and Marcus B. Nashelsky are also with the Johnson County, Iowa Medical Examiner Department, Iowa City
| | - Kate Bengtson
- Anne M. L. Rempel, Jane E. Persons, and Marcus B. Nashelsky are with the Department of Pathology, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City. Anne M. L. Rempel is also with the University of California, San Francisco, Department of Emergency Medicine, Fresno, CA. Kate Bengtson and Marcus B. Nashelsky are also with the Johnson County, Iowa Medical Examiner Department, Iowa City
| | - Marcus B Nashelsky
- Anne M. L. Rempel, Jane E. Persons, and Marcus B. Nashelsky are with the Department of Pathology, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City. Anne M. L. Rempel is also with the University of California, San Francisco, Department of Emergency Medicine, Fresno, CA. Kate Bengtson and Marcus B. Nashelsky are also with the Johnson County, Iowa Medical Examiner Department, Iowa City
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Aon M, Levinsen AKG, Abtal T, Regragui M, Ngwa CH, Leth-Sørensen DB, Bouharras M, Azzouzi M, Benjelloun A, Riffai N, Brasholt M. Suicide, suicide attempts and self-harm in Moroccan prisons. INTERNATIONAL JOURNAL OF PRISON HEALTH 2024; 20:88-101. [PMID: 38984559 DOI: 10.1108/ijoph-12-2022-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
PURPOSE High rates of suicide and self-harm are reported in prisons in Western countries, while fewer studies exist from a non-Western context. This study aims to identify rates of suicide, non-fatal suicide attempts and self-harm in Moroccan prisons and to better understand the context, methods, tools, predictors and profile of persons engaged in the acts. DESIGN/METHODOLOGY/APPROACH The authors report findings from a mixed-methods study carried out before an intervention project. The study consists of a systematic literature review, an analysis of suicide case files, a quantitative survey on suicide attempts and self-harm, as well as interviews and focus group discussions. The authors calculate suicide, suicide attempt and self-harm rates and present descriptive data on the incidents. The authors use regression models to explore the association between the number of incidents per individual and selected predictors, adjusting for clustering by institution. FINDINGS Over a four-year period, 29 detained persons in Morocco died by suicide (average annual suicide rate 8.7 per 100,000). Most were men under the age of 30. Hanging accounted for all but one case. In one year, 230 suicide attempts were reported. Over a three-months period, 110 self-harm cases were reported from 18 institutions, cutting being the most common method. Self-harm was significantly more prevalent among persons with a life sentence or repeated incarcerations. RESEARCH LIMITATIONS/IMPLICATIONS To make the study manageable as part of an intervention project, the authors collected data on suicides and suicide attempts from all prisons, while data on self-harm were collected from fewer prisons and over a shorter time period. The authors did not collect comparable information from detained persons who did not die by suicide, attempt suicide or self-harm. This prevented comparative analyses. Further, it is possible that self-harm cases were not reported if they did not result in serious physical injury. Data were collected by prison staff; thus, the voice of incarcerated persons is absent. PRACTICAL IMPLICATIONS This study provided a solid basis for designing an intervention project including the development of a national prison policy and guidelines on suicides, suicide attempts and self-harm and a country-wide training program for prison staff. It also led to a better surveillance system, allowing for trend analysis and better-informed policymaking. The qualitative results helped create an understanding of how staff may trivialize self-harm. This was integrated into the training package for staff, resulting in the creation of prison staff trainers who became the strongest advocates against the notion that self-harm was best ignored. ORIGINALITY/VALUE To the best of the authors' knowledge, this is the first published data on suicide and self-harm in Moroccan prisons. It underscores the necessity for the intervention project and gives valuable insights into suicide and self-harm in a non-Western prison context. Further research is needed to assess whether the findings are typical of the region.
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Affiliation(s)
- Maha Aon
- Department of Health, DIGNITY, Danish Institute against Torture, Copenhagen, Denmark and Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Taoufiq Abtal
- Division d'Action Sanitaire, La Délégation Générale à l'Administration Pénitentiaire et à la Reinsertion (DGAPR), Rabat, Morocco
| | - Mouna Regragui
- Division d'Action Sanitaire, La Délégation Générale à l'Administration Pénitentiaire et à la Reinsertion (DGAPR), Rabat, Morocco
| | - Che Henry Ngwa
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Mohamed Bouharras
- Division d'Action Sanitaire, La Délégation Générale à l'Administration Pénitentiaire et à la Reinsertion (DGAPR), Rabat, Morocco
| | - Majda Azzouzi
- Division d'Action Sanitaire, La Délégation Générale à l'Administration Pénitentiaire et à la Reinsertion (DGAPR), Rabat, Morocco
| | - Adil Benjelloun
- Division d'Action Sanitaire, La Délégation Générale à l'Administration Pénitentiaire et à la Reinsertion (DGAPR), Rabat, Morocco
| | - Nisrine Riffai
- Division d'Action Sanitaire, La Délégation Générale à l'Administration Pénitentiaire et à la Reinsertion (DGAPR), Rabat, Morocco
| | - Marie Brasholt
- Department of Health, DIGNITY, Danish Institute against Torture, Copenhagen, Denmark
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Vanhaesebrouck A, Tostivint A, Lefèvre T, Melchior M, Khireddine-Medouni I, Chee CC. Characteristics of persons who died by suicide in prison in France: 2017-2018. BMC Psychiatry 2022; 22:11. [PMID: 34983453 PMCID: PMC8729083 DOI: 10.1186/s12888-021-03653-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In northern countries, suicide rates among prisoners are at least three times higher for men and nine times higher for women than in the general population. The objective of this study is to describe the sociodemographic, penal, health characteristics and circumstances of suicide of French prisoners who died by suicide. METHODS This study is an intermediate analysis of the French epidemiological surveillance program of suicides in prison. All suicides in prison in 2017-2018 in France were included in the study. Archival sociodemographic and penal data and specific data on the circumstances of the suicidal act were provided by the National Prison Service. Health data was provided by physicians working in prison using a standardized questionnaire. RESULTS In 2017-2018, 235 prisoners died by suicide. The suicide rate was 16.8/10 000 person-years. Among suicide cases, 94.9% were male, 27.2% were under 30, 25.1% were aged 30 to 39, 27.7% were aged 40 to 49 and 20.0% were 50 or older. At the time of suicide, 48.5% were on custodial remand. Incarceration is associated with a threefold increase in the frequency of anxio-depressive disorders (24.6% in prison versus 8.2% before prison). The week before the suicidal act, 60% of prisoners visited the health unit and a significant event was detected for 61% of all cases. Suicide was less than 1 week after prison entry for 11.9% of prisoners, corresponding to a suicide rate 6.4 (CI95% [4.3 - 9.5]) times higher than for the remaining time in prison, and was more than 1 year after entry for 33.7% of them. CONCLUSIONS The high frequency of events the week before suicide in our study suggests that events in prison could play a role in the occurrence of suicides. Comparative studies are needed to further explore the time association between events and suicide in prison. As most of prisoners who died by suicide visited the health unit the week before suicide, the identification of triggering factors could help psychiatrists and other health professionals to assess the short-term risk of suicide and to implement preventive measures.
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Affiliation(s)
- Alexis Vanhaesebrouck
- Interdisciplinary Research Institute On Social Issues (IRIS), UFR SMBH, Université Sorbonne Paris Nord, UMR 8156-997, Paris, France. .,Department of Legal and Social Medicine, Hôpital Jean-Verdier (AP-HP), 93140, Bondy, France. .,Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Sorbonne Université, INSERM, Paris, France.
| | - Amélie Tostivint
- grid.494228.10000 0004 0639 9788Health division of the National Prison Service, Ministry of Justice, Paris, France
| | - Thomas Lefèvre
- grid.462844.80000 0001 2308 1657Interdisciplinary Research Institute On Social Issues (IRIS), UFR SMBH, Université Sorbonne Paris Nord, UMR 8156-997 Paris, France ,grid.414153.60000 0000 8897 490XDepartment of Legal and Social Medicine, Hôpital Jean-Verdier (AP-HP), 93140 Bondy, France
| | - Maria Melchior
- grid.418241.a0000 0000 9373 1902Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Sorbonne Université, INSERM, Paris, France
| | | | - Christine Chan Chee
- grid.457361.2National Agency of Public Health (Santé Publique France), Saint-Maurice, France
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Favril L. Epidemiology, Risk Factors, and Prevention of Suicidal Thoughts and Behaviour in Prisons: A Literature Review. Psychol Belg 2021; 61:341-355. [PMID: 34900324 PMCID: PMC8622377 DOI: 10.5334/pb.1072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/19/2021] [Indexed: 12/21/2022] Open
Abstract
Suicide is a global public health concern that affects all echelons of society, albeit not equally so. Compared with adults in the general population, incarcerated offenders are at increased risk to consider, attempt, and die by suicide, which represents a substantial burden of morbidity and mortality in prisons worldwide. This review synthesises recent literature pertaining to the epidemiology, risk factors, and prevention of suicidal thoughts and behaviour among prisoners, and outlines a framework which emphasises the interplay between individuals (importation) and their surroundings (deprivation). The available evidence suggests that prison-specific stressors may exacerbate risk of suicide in an already vulnerable population characterised by complex health and social care needs. Emerging data point to differential mechanisms through which prisoners come to think about suicide and subsequently progress to suicidal behaviour. As risk of suicide is determined by a complex web of synergistically interacting factors, its management and prevention demands a cross-sectoral policy and service response that includes targeted interventions aimed at high-risk prisoners in combination with population strategies that promote the health and wellbeing of all people in prison.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, BE
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Pfeifer P, Nigg-Trawally N, Bartsch C, Reisch T. Characteristics of Suicides and Toxicology in a Cohort of Individuals With Opioid Use Disorder. Arch Suicide Res 2021; 25:287-296. [PMID: 32281522 DOI: 10.1080/13811118.2020.1746941] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Suicide in patients with opioid use disorder (OUD) is a complex issue. In addition to accidental intoxications, a higher prevalence of fatal suicides in patients with OUD can be found compared to the general population. In this study, suicides with a diagnosis of OUD documented in the project "Suicides, A National Survey" were extracted from our data bank. Individuals with a diagnosis of OUD in their medical history were compared to other suicides. The analyses included clinical and demographic factors as well as an investigation of suicide methods and toxicology of psychotropic drugs. For the statistical analyses, we applied chi-square tests and calculated odds ratios. Out of 6,495 suicide cases in Switzerland between 2000 and 2010, 215 individuals with a medical history of OUD could be identified. Persons in OUD cases were significantly younger than in other suicide cases (p < .001) and had more frequently a positive history for suicide attempts (p = .02). In addition, persons in OUD cases were more often female (p = .076). Intentional self-poisoning with medication was applied more often in individuals with OUD compared to other suicide methods (p < .001). When self-poisoning with drugs was compared to violent suicide methods, a combination of benzodiazepines with antidepressants was predominantly found. Our study yielded significant characteristics and risk factors for suicides in individuals with OUD. The predominant method of suicide in individuals with OUD was intended self-poisoning by medication. This knowledge is of clinical importance for the monitoring of at-risk individuals with OUD as well as for suicide prevention in this patient group.
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Zhong S, Senior M, Yu R, Perry A, Hawton K, Shaw J, Fazel S. Risk factors for suicide in prisons: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e164-e174. [PMID: 33577780 PMCID: PMC7907684 DOI: 10.1016/s2468-2667(20)30233-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Rates of suicide among people in prison are elevated compared with people of similar age and sex who are living in the community. Improving assessments and interventions to reduce suicide risk requires updated evidence on risk factors. We aimed to examine risk factors associated with suicide in prisoners. METHODS We did an updated systematic review and meta-analysis of risk factors for suicide among people in prison. We searched five biblographic databases for articles published between Jan 1, 2006, and Aug 13, 2020, and one database for articles published between Jan 1, 1973, and Aug 13, 2020. Eligible studies reported risk factors in individuals who died by suicide while in prison and in controls from the general prison population. Two reviewers independently extracted data for each study using a standardised form. We calculated random-effects pooled odds ratios (ORs) for the association of suicide with demographical, clinical, criminological, and institutional risk factors, and investigated heterogeneity using subgroup and meta-regression analyses. This systematic review is registered with PROSPERO, CRD42020137979. FINDINGS We identified 8041 records through our searches, and used 77 eligible studies from 27 countries, including 35 351 suicides, in the main analysis. The strongest clinical factors associated with suicide were suicidal ideation during the current period in prison (OR 15·2, 95% CI 8·5-27·0), a history of attempted suicide (OR 8·2, 4·4-15·3), and current psychiatric diagnosis (OR 6·4, 3·6-11·1). Institutional factors associated with suicide included occupation of a single cell (OR 6·8, 2·3-19·8) and having no social visits (OR 1·9, 1·5-2·4). Criminological factors included remand status (OR 3·6, 3·1-4·1), serving a life sentence (OR 2·4, 1·3-4·6), and being convicted of a violent offence, in particular homicide (OR 3·1, 2·2-4·2). INTERPRETATION Several modifiable risk factors, such as psychiatric diagnosis, suicidal ideation during the current period in prison, and single-cell occupancy, are associated with suicide among people in prison. Preventive interventions should target these risk factors and include improved access to evidence-based mental health care. Understanding other factors associated with suicide might improve risk stratification and resource allocation in prison services. FUNDING Wellcome Trust, National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley.
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Affiliation(s)
- Shaoling Zhong
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | | | - Rongqin Yu
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amanda Perry
- Department of Health Sciences, University of York, York, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Jenny Shaw
- University of Manchester, Greater Manchester Mental Health Trust, Manchester, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
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Reisch T, Hartmann C, Hemmer A, Bartsch C. Suicide by hanging: Results from a national survey in Switzerland and its implications for suicide prevention. PLoS One 2019; 14:e0220508. [PMID: 31532773 PMCID: PMC6750587 DOI: 10.1371/journal.pone.0220508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hanging is a frequent suicide method, but developing measures to prevent suicide by this method is particularly challenging. The aim of this study is to gain new knowledge that would enable the design of effective of measures that would help prevent suicide by hanging. METHODS A total of 6,497 suicides registered across the eight Swiss Forensic Institutes (IRM) were analysed. Of these, 1,282 (19.7%) persons hung themselves. T-test and chi-square tests. and chi-square tests were used to analyse …(or determine, or investigate) …group differences regarding sociodemographic variables and triggers. FINDINGS Men and women who hung themselves showed no significant differences in sociodemographic variables. However, women were significantly more likely to have a psychiatric illness history, whereas men were more likely to have somatic diagnoses. In controlled environments, people used shelves, plumbing and windows more often than beams, pipes, bars and hooks to hang themselves. Compared with other suicide methods, hanging was more likely to have been triggered by partner and financial problems. CONCLUSIONS Suicide by hanging can be best prevented in institutions (e.g. psychiatric hospitals, somatic hospitals, prisons). These institutions should be structurally evaluated and modified with a primary focus on sanitary areas, windows and shelves. Otherwise, it is important to use general suicide prevention measures, such as awareness raising and staff training in medical settings, low-threshold treatment options and regular suicide risk assessment for people at risk.
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Affiliation(s)
- Thomas Reisch
- Hospital of Psychiatry Muensingen, Department of Psychiatry, Muensingen, Switzerland
- Hospital of Psychiatry, Department of Psychiatry, University of Bern, Bern, Switzerland
| | - Chantal Hartmann
- Hospital of Psychiatry Muensingen, Department of Psychiatry, Muensingen, Switzerland
| | - Alexander Hemmer
- Hospital of Psychiatry Muensingen, Department of Psychiatry, Muensingen, Switzerland
| | - Christine Bartsch
- Alfred Wegener Institute, Helmholtz Association, Department of Infrastructure/Administration / Operations and Research Platforms, Bremerhaven, Germany
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Favril L, Wittouck C, Audenaert K, Vander Laenen F. A 17-Year National Study of Prison Suicides in Belgium. CRISIS 2018; 40:42-53. [PMID: 30052079 DOI: 10.1027/0227-5910/a000531] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Suicide is a leading cause of mortality in prisoners worldwide, yet empirical data on this matter are lacking in Belgium. AIMS This study sought to describe characteristics associated with a consecutive series of suicides in Belgian prisons from 2000 to 2016 inclusive, in order to inform suicide prevention strategies. METHOD All documented cases of suicide ( N = 262) were reviewed using a standardized assessment checklist. Official records were abstracted for prisoners' sociodemographic, criminological, and clinical information, as well as for suicide-related characteristics. RESULTS Over the 17-year study period, suicides accounted for one third of all deaths in Belgian prisons. The average annual suicide rate in Belgium from 2000 to 2016 was 156.2 per 100,000 prisoners. Examination of all cases highlights both individual (psychiatric disorders and a history of suicide attempt) and situational (the early period of incarceration, interfacility transfers, and placement in solitary confinement) factors common in many prison suicides; some of them amenable to (clinical) management, which presents several potential avenues for suicide prevention. LIMITATIONS Given the absence of a matched control group, no conclusions could be ascertained regarding risk factors. CONCLUSION Suicide is a common, preventable cause of death among prisoners in Belgium. The results underscore the timely need for national standards and guidelines for suicide prevention in Belgian prisons.
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Affiliation(s)
- Louis Favril
- 1 Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Belgium
| | - Ciska Wittouck
- 2 Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Kurt Audenaert
- 2 Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Freya Vander Laenen
- 1 Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Belgium
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