Juvenile suicide in confinement--findings from the first national survey

Temporal trends in suicide ideation and attempt among youth in juvenile detention, 2016-2021

INTRODUCTION

Data from the general population of youth show increases in suicide ideation and attempt in recent years, with rates of increase differing across sex and racial/ethnic groups. This study assessed trends in suicide ideation and attempt from 2016 to 2021 in youth in juvenile detention, across sex, age, and racial/ethnic groups.

METHODS

We leveraged state-wide suicide screening data of all detained youth (n = 53,769) from 2016 to 2021. We analyzed data for periods defined by statistically significant changes in trends of lifetime suicide attempt, past 6-month suicide attempt, and current suicide ideation.

RESULTS

The prevalence of lifetime, but not past six-month, attempts increased, whereas the prevalence of current suicide ideation decreased annually from 2016 to 2021. Overall trends were qualified by distinct patterns among subgroups: rates of lifetime attempt increased among male, adolescent, and Black youth, while rates of current ideation decreased among male, adolescent, and White and Hispanic youth.

CONCLUSION

These data document increasing rates of lifetime suicide attempts in detained youth from 2016 to 2021, especially among male and Black adolescents, concomitant with decreasing rates of current suicide ideation. Suicide prevention approaches for detained youth may need to prioritize variables besides or in addition to suicide ideation.

A Statewide Evaluation of the Implementation of Evidence-Based Suicide Prevention Guidelines in Juvenile Detention Centers

This study aimed to explore suicide prevention in juvenile detention centers by conducting a case study of one state. Qualitative data from semistructured interviews were synthesized from 10 juvenile detention centers. Analytical techniques included thematic and content analysis and the integration of quantitative information and qualitative themes to illustrate key differences in suicide prevention practices and center characteristics among facilities with varying frequencies of crisis stabilization calls and critical incidents. Although the use of many suicide prevention practices was reported across the sample, the quality with which those practices were implemented was highly variable. The analysis suggests that facilities with higher-quality implementation of suicide prevention practices may have had leaders who acknowledged that their facility plays a role in suicide prevention. Moreover, preliminary evidence suggests that the quality of suicide prevention implementation may be associated with the number of crisis stabilization calls and critical incidents (i.e., variables related to suicidality) a facility experiences. Clear conceptualization of a juvenile detention center's role in suicide prevention may lead to better outcomes in suicide prevention implementation. High-quality implementation may reduce suicidality exhibited by youths in juvenile detention and save lives.

EARLY IDENTIFICATION OF SUICIDE RISK FACTORS AMONG JUSTICE-INVOLVED YOUTH

Suicidal thoughts and behaviors among juvenile justice populations are elevated. However, the characteristics of justice-involved youth who consider and attempt suicide are not well understood. This study examined suicidal ideation and attempt with first-time, preadjudicated diverted youth, and the relationship with commonly associated risk factors. The sample included 135 youth (50% male, M _age = 14.48) that provided complete responses to self-reported lifetime suicidal ideation and attempt items. Analyses examined relationships between suicidal ideation/attempt and mental health, child welfare involvement, delinquency, self-cutting, and substance use. First time, preadjudicated diverted youth reported high rates of lifetime suicidal ideation (27%) and attempt (17%). Suicidal ideation and attempt were associated with sexually minoritized status and self-cutting, while child welfare involvement was only associated with suicidal ideation. This high-risk population would benefit from refined suicide screening and prevention services not always available to justice-involved youth living in the community.

Suicide Screening Among Youth at First Court Contact

Youth involved in the juvenile justice system are at elevated risk for suicide and co-occurring mental health symptoms. This study aims to examine the suicide risk and treatment needs of court-involved, non-incarcerated (CINI) youth, and to understand the acceptability and effectiveness of implementing a mental health screening procedure at time of first court contact. By embedding a forensic mental health screening tool into the intake process of a family court diversionary program, a total of 891 youth (aged 12-18) were assessed using the Massachusetts Youth Screening Instrument-2 (MAYSI-2). Analysis of screening responses revealed 12.5% of youth indicated risk for suicide with risk levels differentiated by youth sex, race and ethnicity. Suicide ideation was also significantly associated with flagging, an indication of clinical risk, on all other scales of the MAYSI-2, as well as subsequent referrals to treatment. Screening for suicide at first point of court contact within an existing diversionary program may serve as a critical and effective point of intervention for youth in need.

Feasibility and acceptability of a brief suicide intervention for youth involved with the family court

As efforts to develop models for suicide prevention and intervention in the juvenile justice (JJ) system continue to grow, research to understand the feasibility and acceptability of implementing these models is critical. Examining organizational readiness for implementation, ensuring leadership and staff buy-in for delivering the intervention, and planning for sustainability of staff participation in implementation efforts is essential. The current study involved semi-structured formative evaluation interviews with key JJ stakeholders (n = 10) to determine perspectives on the acceptability (perceived need and fit of the intervention) and feasibility (organizational readiness for change) of a proposed brief safety planning intervention for youth with suicidal ideation delivered by nonclinical staff and integrated into the existing system. Qualitative data revealed stakeholders' perceived need for the intervention in the family court context and their agreement that the aims of the intervention were congruent with the goals of the family court. Some barriers to successful implementation were noted, which, addressed through selection of appropriate implementation strategies, can be overcome in a future test of the safety intervention.

Screening and Brief Intervention for Psychiatric and Suicide Risk in the Juvenile Justice System: Findings from an Open Trial

Court-involved non-incarcerated (CINI) youth endorse higher rates of lifetime suicide ideation (SI) and attempts than youth in the community. Brief intervention programs to address SI and related psychiatric symptoms upon entry into the juvenile justice system are rare. The current study reports the results of a pilot trial on a brief, coping intervention for CINI youth. Fifteen CINI youth (and caregivers) were eligible for participation based on youth report of SI or endorsing symptoms on a mental health screening tool. Youth completed a Coping Plan intervention with a master's-level counselor and received a 1-week follow-up call. Follow-up assessments were conducted at 1 and 3-months post-intervention. Participants were also interviewed about intervention acceptability. About half of the sample screened into the study based on SI and half screened in based on psychiatric symptoms on the Anxious/Depressed and Angry/Irritable subscales of the MAYSI-2. A reduction in SI and psychiatric symptoms was observed at 3-months post-intervention. Youth and caregivers reported the brief coping intervention was useful. This study highlights that intervening with youth with SI and psychiatric symptoms upon entry into the juvenile justice system can be successfully conducted with a population who historically has difficulty accessing mental health resources.

[Suicide and suicide tendencies in adolescent detainees]

Following accidents, suicide is the second leading cause of death in adolescence. This stage of life has the most suicide attempts of all age groups. In addition to mentally ill juveniles, adolescent delinquents represent a high-risk group for suicidal behavior and completed suicide. In particular, the population of detainees, an extreme form of juvenile delinquency, have a 16- to 18-fold higher risk of suicidal behavior and suicide compared to the general population. Because the composition of juvenile detainees differs greatly from that of detained adults, age-specific scientific approaches and prevention programs are needed. This task cannot be addressed by juvenile detention staff alone, but rather demands close cooperation between adolescent psychiatrists, psychologists, prison medical staff, legal experts and prison officers to use the opportunity for suicide prevention in juvenile detention facilities.

A Population-Based Study of the Prevalence and Correlates of Self-Harm in Juvenile Detention

Background

Suicide is the number one cause of death among incarcerated youth. We examined the demographic and forensic risk factors for self-harm in youth in juvenile detention using a Canadian provincial correctional database.

Method

We analyzed data from de-identified youth aged 12 to 18 at the time of their offense who were in custody in a Manitoba youth correctional facility between January 1, 2005 and December 30, 2010 (N = 5,102). Univariate and multivariate logistic regression analyses determined the association between staff-identified self-harm events in custody and demographic and custodial variables. Time to the event was examined based on the admission date and date of event.

Results

Demographic variables associated with self-harm included female sex, lower educational achievement, older age, and child welfare involvement. Custodial variables associated with self-harm included higher criminal severity profiles, younger age at first incarceration, longer sentence length, disruptive institutional behavior, and a history of attempting escape. Youth identified at entry as being at risk for suicide were more likely to self-harm. Events tended to occur earlier in the custodial admission.

Interpretation

Self-harm events tended to occur within the first 3 months of an admission stay. Youth with more serious offenses and disruptive behaviors were more likely to self-harm. Individuals with problematic custodial profiles were more likely to self-harm. Suicide screening identified youth at risk for self-harm. Strategies to identify and help youth at risk are needed.

National total survey of German adolescent suicide in prison

Incarcerated adolescents are a high-risk group for suicidal behaviour, but data on completed suicide are scarce in this population. The present study aimed at calculating relative risks (RR) of suicide in detention and identifying age-related risk factors. We compared data of a German national total survey of completed suicide of young detainees (14 to <21 years, N = 79) during the years 2000-2010 with age- and gender-adjusted suicide deaths in non-incarcerated adolescents (N = 3,484) and incarcerated adults (N = 781). Prison suicide accounted for 2.3% of all suicide deaths in adolescents, but only 0.1% of this age group was detained. The RR = 23.0 for adolescent suicide in detention exceeded the RR = 7.7 of adults by far. In adults, suicide rates in pre-trial detention was fivefold higher than in criminal detention; suicide rates were more balanced in adolescent detainees. Our results underline the need for age-specific suicide prevention strategies in detention.

Risk factors and study designs used in research of youths' suicide behaviour-an epidemiological discussion with focus on level of evidence

Abstract Introduction: Many different epidemiology study designs have been used to analyse risk factors for suicide behaviour. The purpose of this study was to obtain an insight into the current study design used in research on youths' risk factors for suicide behaviour and to rank the studies according to level of evidence (LoE).

METHODS

We searched PubMed and psycINFO in order to identify relevant individual studies.

RESULTS

We included 36 studies of children and youth on suicidal behaviour and ideation-many rank low on LoE. For suicide, cohort design was often used, and mental illness (depression, substance abuse and severity of mental illness) was the most common risk factor. Cohort studies are ranked 2b, which is high according to LoE. For suicide attempts, survey was often used, and psychopathology, substance abuse and being exposed to suicidal behaviour were the most common risk factors. For suicidal ideation, survey was the only design used, and substance abuse and psychopathology the most common risk factors. Surveys are ranked 4, which are low according to LoE. Many risk factors were broad and unspecific, and standard definitions of outcome and exposure were rarely used.

CONCLUSION

A good study of risk factors for suicidal behaviour would need a high LoE, as a high-powered longitudinal epidemiological study (cohort or case-control) of very specific risk factors. The factors would have high prevention potential, compared with more broad and unspecific risk factors, to which many people are exposed. We would recommend a cohort design (in high-risk populations) or a case-control design to identify risk factors, using clinical and/or register data instead of self-reported information, reporting adjusted estimates and using standard definition of suicidal outcome and risk factors.

Health care for youth involved with the correctional system

Adolescents with involvement in the correctional system have significant health risks and needs. Professional guidelines and policies related to health services in correctional settings can help health care providers who work in youth detention facilities and those who see youth for follow-up care after incarceration. Several challenges exist to providing care in detention facilities, but overcoming these barriers to optimally serve youth is critical. When youth are released to their homes, community providers must understand the extent of care offered in detention facilities, the unique considerations for youth on probation, and the aspects of follow-up care that should be addressed.

National study of jail suicide: 20 years later

Findings from a national study of jail suicide are provided, including the extent and distribution of suicides in holding and detention facilities, and descriptive data on demographic characteristics of each victim, incident, and facility. Among significant findings are that suicides were evenly distributed from first few days of confinement to over several months of confinement, many suicides occurred during waking hours, most inmates were not under the influence of drugs and/or alcohol at the time of death, and many suicides occurred in close proximity to a court hearing. Suicide prevention programming was found to be uneven in most facilities that experienced suicides. There has been a significant decrease in the rate of suicide in detention facilities.

Psychometric properties of a suicide screen for adjudicated youth in residential care

There is a need to efficiently and effectively screen adjudicated youth residing within the juvenile justice system for suicide proneness. Accordingly, in the current study, the psychometric properties of the Life Attitude Schedule: Short Form (LAS:S), a 24-item risk assessment for suicide proneness, were assessed using data from adjudicated youth residing in an alternative sentencing facility (n = 130). As predicted, statistically significant correlations were obtained between total LAS:S suicide proneness scores and reports of recent suicide ideation and hopelessness. Contrary to expectation, the previously reported 2-factor model for the LAS:S, with Factor 1 representing physical unhealthiness and Factor 2 representing psychological death, poorly fit the data. In adjudicated youth, we found that a single factor model derived from the 4 LAS:S subscales produced a better fit to the data than the 2-factor model. The death-related, self-related, injury-related, and negative health-related behaviors contained on the LAS:S shared common variance in these youth. A clinical implication is that practitioners can effectively use the total LAS:S score when screening adjudicated youth for suicide proneness.