Psychological Medicine



Psychiatric and social aspects of suicidal behaviour in prisons


RACHEL JENKINS a1c1, DINESH BHUGRA a1, HOWARD MELTZER a1, NICOLA SINGLETON a1, PAUL BEBBINGTON a1, TRALOACH BRUGHA a1, JEREMY COID a1, MIKE FARRELL a1, GLYN LEWIS a1 and JO PATON a1
a1 WHO Collaborating Centre, David Goldberg Centre, Institute of Psychiatry, Denmark Hill, London; MRC Social and Psychiatry Unit, Institute of Psychiatry, Denmark Hill, London; Office of National Statistics, Social Survey Division, 1 Drummond Gate, London; Royal Free & University College London Medical School, UCL – Department of Mental Health Sciences, London; Department of Health Services, University of Leicester; Department of Forensic Psychiatry, William Harvey House, St Bartholomew's Hospital, West Smithfield, London; Division of Psychiatry, Cotham House, Cotham Hill, Bristol; HM Prison Service

Article author query
jenkins r   [PubMed][Google Scholar] 
bhugra d   [PubMed][Google Scholar] 
meltzer h   [PubMed][Google Scholar] 
singleton n   [PubMed][Google Scholar] 
bebbington p   [PubMed][Google Scholar] 
brugha t   [PubMed][Google Scholar] 
coid j   [PubMed][Google Scholar] 
farrell m   [PubMed][Google Scholar] 
lewis g   [PubMed][Google Scholar] 
paton j   [PubMed][Google Scholar] 

Abstract

Background. Suicidal behaviour and completed suicide are serious problems within British prisons, leading to significant morbidity and mortality, and are the focus of major efforts towards their prevention.

Aim. To explore the demographic, social and psychiatric correlates of suicidal behaviour in prisons in England and Wales and their relationship with health service use; and to develop a combined psychosocial model of risk.

Method. This report analyses the prevalence of suicidal ideation and suicide attempts in the ONS National Prison Survey, and their association with the presence of psychiatric disorders, personality disorder, substance abuse and social risk factors. These data were compared with data from the second national survey of psychiatric morbidity in adults living at home. In both surveys, a two-phase interviewing procedure was used, covering general health, health service use, assessment of psychiatric disorders, life events, social supports, suicidal behaviour, activities of daily living, sociodemographic data, substance abuse and intelligence.

Results. Suicidal thoughts and suicide attempts were commoner in prisons than in the general population and these were significantly associated with higher rates of psychosis, neurosis and personality disorder in prisons. In addition, demographic and factors such as being young, single, white, leaving school early and experiencing poor social support and significant social adversity were important risk factors for suicidal thoughts. Crucially, there was no separate category of people at suicidal risk who did not have psychiatric disorders.

Conclusions. The high rates of suicidal behaviour in prisons cannot be addressed without adequate attention to the high rates of psychiatric disorder and vulnerability factors in prisoners.


Correspondence:
c1 Dr Rachel Jekins, WHO Collaborating Centre, P.O. Box 35, David Goldberg Centre, Institute of Psychiatry, Denmark Hill, London. (Email: r.jenkins@iop.kcl.ac.uk)


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