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15PSYCHOLOGICAL SCIENCES
SUICIDE RISK ASSESSMENT AMONG OLDER INMATES
Aliyeva G.
PhD student Baku State University Gender and applied psychology department ORCID number 0000-0001-9771-1156
Abstract
Globally, suicide and self-harm persist as a major public health concern, affecting people across the lifespan regardless of gender, culture or socioeconomic background. According to the World Health Organization, over 800000 people die by suicide each year. Experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour. Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and prisoners. Psychological well-being and mental health of elderly inmates are investigated by the international organizations, committees, and researchers. By far the strongest risk factor for suicide is a previous suicide attempt. Considering that the population of older prisoners in the world is increasing exponentially, they need psychological and social support to prevent future suicidal attempt.
A systematic review of research and policy papers, articles that published on self-harm among elderly inmates in correctional facilities, also effective programs outcomes were conducted. The main symptoms of the problem were measured with a special checklist and questionnaires. 200 elderly prisoners have been involved in the research from different prison regimes of Azerbaijan correctional facilities between 2019-2021.
A systematic approach in psychological work with elderly prisoners, also officers allows for the transition from a symptomatic to a personality-oriented level of psychological impact. Psychological emotional support can renew their hope on life, influence positive outcomes of the support program. According to the results of repeated psychological research, the patient's condition was characterized by positive dynamics: the level of psychological distress and the intensity of psychological distress significantly decreased, the general internality of the personality increased, as well as the subjective assessment of personal well-being.
It is necessary to focus the attention of specialists on the advisability of using psycho-educational programs in a prison environment, providing information about the aging dynamically. Such programs, used at the initial stages of work with patients, contribute to the creation of motivation for personal psychotherapy and significantly increase its effectiveness.
Keywords: self-harm, suicide, interpersonal relationship, elderly inmates, prison environment, depression symptoms.
Introduction. The demographic difference among the population also affects the prison population (1). Some evidence suggests that prisoners aged 50 and over typically suffer from "accelerated" ageing: a typical prisoner in their fifties has the physical health status of someone at least ten years older in the community, and this difference is due to health and /or lifestyle factors (e.g. prolonged drug use) which arise both before, and during imprisonment (1,2,3).
Mental health can be influenced by feelings of isolation in the prisons. Compared to younger prisoners, older inmates have fewer regular visitors and fewer connections and interpersonal relationships (4).
In this article, the self-harm problem among elderly inmates was examined. Firstly the problem was explored based on previous literature materials, then the survey questions were used by inmates. Based on statistics and figures those got from survey procedures, conclusion part of the paper was prepared, and concluded by discussing what kind of social-emotional support techniques officers can use to build effective relationships with older inmates.
Literature Review:
The authors of British Psychiatrists Council Report (5) identified consensus standards for assessment
following self-harm, and highlighted the specific risks associated with older adults. It is estimated that about 150000 cases present to accident and emergency departments in the UK annually (6). It is one of the five most frequent causes of acute medical admission for both men and women in the UK (University of York NHS Centre for Reviews and Dissemination, 1998). In the decade since the publication of Council Report CR32, The General Hospital Management of Adult Deliberate Self-Harm (Royal College of Psychiatrists, 1994), there have been a number of significant changes in the delivery of services for people who harm themselves. The average annual suicide rate for England and Wales is 10 per 100 000, with less than a quarter of those dying having been in contact with mental health services in the year prior to their death. Self-harm is a high risk factor for future suicide. Individuals who have deliberately harmed themselves have a 100-fold greater risk of suicide than the general population (6).
The College is concerned about the high rates of self-harm and suicide in the prison population. This population is particularly vulnerable because of high rates of mental illness, substance misuse and personality disorder. Prisoners are further disadvantaged by the
setting in which they live and the paucity of good health and psychological provision for them.
Mental Health Commission of New South Wales (NWS Government) focused suicide problem in Australia and highlighted that the largest number of suicides occurred in the 24-35 year age group. In 2017, 161 people lost their lives to suicide in NSW in this age group - 135 of these were men. Men aged 85 years and over also had the highest rate of suicide in Australia at 32.8 per 100,000 populations. They published strategic framework for suicide prevention in NSW 2018-2023 (7).
While concentrating risk factors for suicide and suicidal behaviors, we can determine demographic factors, groups at higher risk and current personal risk factors. The authors believe that people in prison or police custody are in groups who have higher suicidal risk, too. While suicide and self-harm are not exclusive to specific populations or groups, it is important to note that some groups of people are particularly vulnerable to suicide and self-harm. Many individuals fall into more than one of these groups.
Table 1.
People and groups at higher risk of suicide and suicidal behavior
Individuals Groups
Children in out of home care Aboriginal and Torres Strait Islander people
Care leavers (people who spent time in care as a child) Lesbian, gay, bisexual, transgender, and intersex people
Children and young people in the youth justice system Young people
People who have experienced bullying and victimisation People with severe mental health conditions
Survivors of abuse or violence including sexual abuse and domestic violence Certain occupational groups with increased knowledge of and ready access to the means to attempt suicide (e.g. doctors, nurses, farmers and other agricultural workers)
People who use or experience domestic violence Some male-dominated industries (e.g. construction and mining)
People living with long-term physical health conditions Some culturally and linguistically diverse (CALD) communities
People with untreated depression Asylum seekers and refugees
People who are socioeconomically disadvantaged Prisoners and others in contact with the criminal justice system
People who misuse drugs or alcohol Rough sleepers, the homeless and those at risk of homelessness
People bereaved or affected by suicide Older people, especially men
People who do not have strong connections to their culture or identity Residents of aged care facilities
In this framework authors are describing protective factors for suicidal behaviours: feelings of hopefulness, positive personal relations, strong and safe connection to family, community and culture, effective problem solving skills, ability to recognize and manage stressful or traumatic events, ability to adapt to change as possible, a sense of purpose, good physical and mental health and wellbeing and others.
Juvenile Justice NSW is working closely with the Justice Health and Forensic Mental Health Network to prevent suicidal behavior and self-harm among Juvenile Justice clients. Services include early screening for young people at risk of self-harm, trauma counseling for detainees who have been victims of crime, specialist assessment and referral, therapeutic care for clients with mental health issues and monitoring as required. However there is not special program for elderly inmates in prisons for preventing their future self-harm attempt.
In conclusion the NSW Government identify that sustained effort is required for a more localized, bottom-up approach that embeds improvement science principles and motivates future innovation and customization.
In the study "Suicide Risk Assessment" author Keith Hawton (Director of center for suicide research, professor of psychiatry in University of Oxford) focuses suicide and self-harm, studying their causes, and finding out what treatments and prevention measures are effective. He provides an excellent scale about assessment of suicide risk. A scale developed in 1983 by Patterson et al in Canada for teaching medical students about assessment of d suicide risk and it's called SADPERSONS Scale. Based on the 10 major risk factors for suicide:
- Sex (male)
- Age (<19 or >45)
- Depression
- Previous attempts
- Ethanol abuse
- Rational thinking loss
- Social support lacking
- Organized plan
- No spouse
- Sickness
The author attempted to answer a question "What is the best alternative to risk prediction?" and claims prediction model (a typical risk formulation approach) in this study. In conclusion, research has resulted in
specific treatments and prevention initiatives, some of which we have shown to have major benefits in reducing risk of further self-harm and preventing suicides (6).
Stavros P. Kiriakidis attempts a review of the evidence about the risk factors due to suicidality among the elderly, mainly depression, somatic illness, chronic pain and psychosocial factors, like social isolation, financial problems. In addition, author focuses on useful improvements of reducing suicide rates. While comparing different countries suicide rates, author suggests that there is significant variability of suicide rates between countries, mostly due to cultural factors. In sum, he believes that they should emphasize on the prevention and managing of the factors related with depression (8).
Peckel stressed lack of purposeful activity, medical and mental health issues, conditions of the specific prison environment, stress of adjusting to incarceration as a risk factors of suicide in prisons (8).
Lisa M. Brown concentrates on suicide facts in the USA, compares variables of younger adults and elderly population's suicidal behavior, presents implications for practice. Compared to younger suicidal adults, researcher notes that suicidal elderly individuals demonstrate significant differences in risk factors, precipitating events, and predisposing variables. In addressing different diagnoses of suicidal behavior, L.Brown stressed depression as one of the diagnoses. Author successfully presents that 83% of elderly suicides is associated with clinically depressed mood. In sum, she effectively presents development trajectory of suicide (9). Emotionally cool home environment, genetic and sociocultural factors were estimated as main reasons that influence future behavioral and interpersonal conflicts. Poor marital communication, workplace changes and conflicts in different environments lead to depression, and suicide and self-harm behavior can be observed in elderly years.
Methodology: The survey questionnaire and screening scale for depression were developed based on the review of available researches relevant to the study topic, to cover risk factors, addressing important variables. Elderly inmates in different prisons of Azerbaijan 2019-2021 years.
The survey is divided by 8 following components related to the prison life and relationships: the environmental factors in prisons, health conditions, level of interpersonal relationships with prison staff and other inmates, level of support and communication with family members, the type visits ( short and long visits), daily mood, depression level, hope for future.
Long-lasting and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide (WHO, 2018). Considering that it is short and easy for respondents, and can be applied in multiple patient populations, Patient Health Depression Questionnaire (PHQ-9) was used to determine depression level of inmates.
Ethics: The research was submitted to the Research Ethics Committee of the Baku State University, Faculty Social Science and Psychology, Department Gender and applied psychology, and approved under certificate number 07-2018/04/25. Informed consent was received from all patients in the study.
Results and conclusion: Across 3 prisons, a total 214 elderly male prisoners were approached to participate in the study, 200 of the survey results completed. All of them had Azeri nationality, and participants' mean age was 63 ±4,2 (range 55-84). 19 of them had been incarcerated life sentence (9,5%of participants), and mean duration imprisonment was 9,2±3,7 years in 181 of them (91,5% of participants).
Further details on respondents' characteristics are presented in Table 2.
Table 2.
Socio-demographic factors of inmates
Age 55-84 (63±4,2)
Nationality (Azeri) Religiousness (Islam) 200 200 100% 100%
Criminological factors
Previous incarceration 81 40,5%
First incarceration 119 59,5%
Offence against person 97 48,5%
Crimes Against property 34 17%
Drug related crimes 58 29%
others 11 5,5%
Life-sentence 19 9,5%
imprisonment 181 (9,2±3,7) 91,5%
Clinical factors
Previous illness 194 97%
No previous illness 6 3%
Patient Health Depression Questionnaire (PHQ-9) consists of 9 items which describe over 2 weeks problems and measured as minimal depression (1-4), mild depression (5-9), moderate depression (10-14), moderately severe depression (15-19), severe depression (20-
27). Depression score was 9,08±3,5 and this score fluctuate between mild depression and moderately severe depression (min:1, max:19, test of normality 0,129; df=200, p=0,00). Considering result of the survey and observation, elderly inmates suffer from feeling down,
hopeless, depressed, poor mood, falling or staying asleep, having little energy, trouble concentrating on things on several days and more than half the days.
minimal depression (9,5%)
mild depression(54%)
moderate depression(29,5%)
moderately severe depression(7%)
severe depression(0%)
Figure 1. Depression level of inmates
The age factors and depressed mood The importance of aging and its effect to daily mood was estimated during the research, so they divided two groups >60, and <60. There was 176 inmates who were elder than 60 years old, and their depression score fluctuated mild and moderate depression; 9,35±3,3. Inmates who weren't 60 yet, their depression level was lower than the elders' (7,12±4,8). That difference and positive correlation were significant (F=7,3; t=2,9; p=0,007; df=198; r=0,174*, p<0,05).
The imprisonment factors and depressed mood The sentence was checked as a first imprisonment factor. Thus the correlation between duration of imprisonment, and depression score was assessed, and the longer sentence was correlated higher level of depression (r=0,379**, p=0,000). When the elderly inmates sentence divided two groups (released till 3 years, and more than 3 years), the first groups' depression score was higher than the second one, 9,35±3.08; 7,37±3,08 respectively (F=0,00; t=-4,2; p=0,00; df=178).
While measuring depression level according to institutional factors, there weren't any significant difference, and scores were very close. Elderly inmates who satisfied with the attitude of officers (9,39±3,1) and other prisoners (9,07±3,4), and elderly inmates who aren't completely satisfied with the attitude of officers (8,58±4) and other prisoners' (9,11±3,8) depression levels similar to each other.
Moreover who was arrested in first time and didn't have previous imprisonment, there wasn't significant difference between two groups, 9±3,3 and 9,14±3,7 respectively (F=1,05; t=-0,2; p<0,7; df=198). When we divided them two groups based on considering age factor, and people attitude to their age, there wasn't significant contrast, 9,3±3,3 and 8,6±3,8 respectively (F=0,2; t=1,3; p<0,14; df=198).
During the interview with officers and chief of the prison, they stressed that, inmates who convicted crimes repeatedly, they could be adapted easily prison life, when others who didn't have previous crime had trouble in accepting that life. Process of adaptation in elderly inmates to prison life remains to be answered and can be main topic future research.
The family support and depression
The next step of the study is examine family support to elderly inmates and depression level. Prisoners who thought their family support them, their depression score fluctuated between 8,62±3,2; while others whose family and relatives sometimes visit and phone them their depression score was 10,34±4,0; people who said their family never support them, moderate depression level (14,5±0,7) dominated his mental health. These difference was significant and according to figures we can mention that whose family members and relatives visit to prisoners, they suffer depression less than whose relatives sometimes and never visit (%2= 12,5; df=2; p=0,002). When the correlation between family visit factor (regularly-1, sometimes-2, never-3) and depression score was checked, there was a significant positive correlation (r=0,246**, p=0,000).
Last item of the survey was directed their future plan and expectation. The elders whose family visit them, had exact plan more than others whose family seldom visit and the second groups' whose relatives sometimes visit their future plan fluctuated more than others. Consequently the family support has string impact on prisoners future plan, and this future plan and expectation let them survive. This gap was illustrated in chart below.
TC
7D 20 ■
1 R
1 n 10 ■ exact plan ■ fluctuating plan
c: ■ no expectation
0 - ■
i i i regularly visit sometime never
Figure 2. Family relationship's impact on the future plans.
The research goal is to analyze ageing prison population's psychological well-being, self-harm thoughts, preventing role of institutional and family factors. Chronic mental illness is potentiating risk factors, and depression symptoms are warning signs of self-harm and suicide.
Aging factor, imprisonment, sentence and duration were estimated as main factors, those affected prisoners daily mood, and depression level. This fact was mentioned in literature material, and survey results.
So, depression and preventing factors were measured during research. Interpersonal relationship in sentence divided two side: with staff and with inmates. Respondents didn't stress completely satisfied attitude to staff, and approximately 60% of them thought their ageing symptoms wasn't considering on daily routine. Moreover, elderly inmates highlighted their gratitude to other prisoners, and were pleased their respect. When some prisoners hesitated about personnel's behavior, no one was completely displeased prisoners.
Family support and their visits have important role on prisoners' psychology; it was proved in their results. Inmates whose family members visited them regularly, their depression level was lower than others whose relatives sometimes and never visited. The first group had exact future plan, while other expectations were fluctuated. Moreover, this fact let us say that family support is one of the preventing factor self-harm and encourage them to live.
Limitation: Since the attendance at the study was voluntary, not all the elderly prisoners made themselves available to participate in interviews. This is the first limitation, as more participation was expected.
Another limitation is due to variables, during the research limited numbers of variables were chosen and checked the correlation between these factors. Based on these data, in the future, the qualitative study could be realized related to the subjective attitude of participants. In addition, we could pay attention to socio-de-
mographic and professional information about participants to hypothesis correlations with the categories that are identified by this research.
The next limitation of this work's due to gender, so only male prisoners were involved, for future officers and female elderly inmates' attitude can be focused, too.
Considering this project as a first local experiment, in the future, we would like to expand this kind of survey to other prisons of regions with more participants
Ethics
The research was submitted to the Research Ethics Committee of the Baku State University, Faculty Social Science and Psychology, Department Gender and applied psychology, and approved under certificate number 07-2018/04/25.
Informed Consent: Informed consent was obtained from the participants.
Peer-review: Externally peer-reviewed.
Authorship Contributions
Supervision and advisor: Elmina Kazimzadeh., Concept: G.A.A., Design: G.A.A., Materials: G.A.A., Data Collection and/or Processing: G.A.A., Analysis and/or Interpretation: G.A.A., Literature Review: G.A.A.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study received no financial support.
Acknowledgements
My deepest gratitude is extended to my advisor, Associate Professor, Elmina Kazimzadeh who motivated, and supported me during these years. Without her support and enlightenment, it would not have been possible for me to complete not only this article, and previous works and future plans. I am extremely appreciative of her and my family ' s constant support over the years, both personal and academic.
Appendix 1.
N=200 frequency percent
age <60 32 16%
>60 168 84%
total 200 100%
Education level illiterate 9 4,5%
1-9 54 29%
10-11 78 39%
Diploma and above 59 29,5%
total 200 100%
Types of crime that commited murder 90 45%
Sexual assault 7 3%
Conflict 28 14%
robbery 5 2%
Drug traffic 58 29%
others 12 6%
total 200 100%
Duration of the improsenment Till 3 years 12 6,5%
3-5 years 14 7%
5-10 years 87 43%
10-15 years 60 30%
More than 15 years and life sentence 27 13,5%
total 200 100%
regime common 83 41,5%
strict 97 48,5%
severe 20 10%
total 200 100%
Appendix 2.
PATIENT HEALTH QUESTIONNAIRE (PHQ-9)
MAME:_ DATE
Over the last 2 weeks, how often have you beer bothered by any of the fallowing problems? (use^'to indicate your answer}
1. Little interest or pleasure in doing things o
2. Feeling down, depressed, irritable, or hopeless D
3. Trouble falling or staying asleep, or sleeping too much
4. Feeli ng tired or having little energy
5. Poor appetite, weight loss, or overeating
6. Feeling bad about yourself - orthatyou are a failure or have let yourself or your family down D
7. Trouble concentrating on things, such as sctiool work, reading, or watching television a
8. Moving or speaking so slowly that oltier people could have noticed. Or the opposite - being so fidgety or resdess that you have been moving around a lot more than usual o
9. Thoughts that you would be better off dead, or of hurting yourself in some way
add columns: t *
TOTAL:
10. If you checked of any problems, how Not difficult at all
difficult have these problems made it lor you to do your work, take care Somewhat difficult
of things at home, or get along with Very difficult
other people? Extremely difficult
PHQ-9 is adapted Torr PRIME MD TODAY developed by № Robert L. Sülze1 Janet B.W. Williams, Kurl Kranke, and colleagues, with an educational grant from Pfizer Inc For research information, oontact Dr Spitzer at rlsB® mlumbia.edu. Use of the PHQ-9 may Dniy be made in accordance with the Terms of Use available at http:tfwww.pfcBr.coni. Copyright «1905 Pfizer Inc. AI rights reserved. PRIME MD TODAY is a trademark of Pfizer Inc.
ZT2743BB
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ПОИСК СУПЕРМАМЫ (МАГИЧЕСКОГО РОДИТЕЛЯ) ДЛЯ ВНУТРЕННЕГО РЕБЁНКА В ПСИХОЛОГИЧЕСКОМ КОНСУЛЬТИРОВАНИИ
Веселкова Е.А.
Сибирский государственный университет путей и сообщения,
доцент, кандидат медицинских наук;
Бродская В.С. Клинический психолог, частной практики
SEARCH FOR A SUPERMAMA (MAGICAL PARENT) FOR THE INNER CHILD IN
PSYCHOLOGICAL COUNSELING
Veselkova E.,
Siberian State University of Railways and Communications, Associate Professor, Candidate of Medical Sciences;
Brodskaya V. Clinical psychologist, private practice
Аннотация
Статья посвящена клиническому опыту психологического консультирования сложных случаев. Во время поиска ресурса Внутреннего ребенка, могут возникнуть сложности из-за недостаточности выраженности Заботливого Родителя. Метод, который мы предлагаем связан с активизацией архетипического образа Магического Родителя. Данная психологическая последовательность поможет разрушить контаминации и восстановить структуру личности.
