Solitary Confinement Tied to Greater Risk of Death After Prison Release

Prisoners who are held in restrictive housing (i.e., solitary confinement) face an increased risk of death after their release, according to a new study led by researchers from the University of North Carolina (UNC) at Chapel Hill.

The findings show that incarcerated individuals who were placed in restrictive housing in North Carolina from 2000 to 2015 were 24% more likely to die in the first year after their release, compared to those who were not held in restrictive housing.

In addition, those held in restrictive housing were 78% more likely to die from suicide, 54% more likely to die from homicide, and 127% more likely to die from an opioid overdose in the first two weeks after their release.

Further, the number of restrictive housing placements and spending more than 14 consecutive days in restrictive housing were associated with an even greater increase in the risk of death and reincarceration.

“For the first time ever, using data shared with us from our partners at the North Carolina Department of Public Safety, we’ve been able to demonstrate a connection between restrictive housing during incarceration and increased risk of death when people return to the community,” said lead author Lauren Brinkley-Rubinstein, PhD, an assistant professor of social medicine in the UNC School of Medicine.

“In addition, our study found that the more time people spent in restrictive housing the higher the risk of mortality after release. This study provides empirical evidence to support ongoing nationwide reforms that limit the use of restrictive housing.”

“North Carolina is a leader in this thinking as the Department of Public Safety has preemptively implemented multiple reforms that have resulted in the limited use of restrictive housing.”

“We appreciate this research collaboration and recognize the importance of these results in shaping policy and practice,” said Gary Junker, PhD, Director of Behavioral Health for the N.C. Department of Public Safety Adult Correction and Juvenile Justice.

“Since 2015, the department has initiated several programs to divert people from restrictive housing, including Therapeutic Diversion Units for those with mental illness. While safety and security must remain our top priority, we recognize that reduced use of restrictive housing will likely improve post-release outcome.”

These findings, published in the journal JAMA Network Open, are from a retrospective cohort study conducted by Brinkley-Rubinstein and co-authors from UNC, Emory University, the N.C. Department of Public Safety and the N.C. Department of Public Health.

Incarceration data for people who were confined in North Carolina between 2000 and 2015 were matched with death records from 2000 to 2016.

“We also found that non-white individuals were disproportionately more likely to be assigned to restrictive housing than their white counterparts,” said co-author Shabbar Ranapurwala, PhD, MPH, an assistant professor of epidemiology in the UNC Gillings School of Global Public Health and a core faculty member of the UNC Injury Prevention Research Center.

“In fact, the mortality and reincarceration outcomes after release were also quite different between these racial groups. The post-release opioid overdose and suicide death outcomes among those receiving restrictive housing were more pronounced among white individuals compared to non-whites, while the all-cause and homicide death and reincarceration outcomes were higher among non-white Americans compared to whites.”

Given the observational nature of the study, establishing cause and effect may be difficult, yet, the strength and consistency of the findings points to the fact that restrictive housing is an important marker of increased mortality risk among formerly incarcerated individuals.

Source: University of North Carolina Health Care

Study: Suicide Prevention in Less Well-Off Countries Needs Wider Approach

A new study suggests that the treatment and prevention of suicidal behavior in low- and middle-income countries (LMIC) should involve a wider range of approaches beyond just the treatment of psychiatric illness.

There are 800,000 suicide deaths annually, and the vast majority (76 percent) are from LMIC. However, current evidence into suicide prevention is largely based on high-income countries (HIC) and suggests more than 80 percent of suicidal behavior is linked to psychiatric disorders. Prevention initiatives in LMIC have been relatively neglected to date.

The study, published in the journal PLOS Medicine, is the first systematic review of the link between psychiatric disorders, such as depression, anxiety and schizophrenia, and suicidal behavior in LMIC.

“This is the first time we’ve really been able to take an overall look at what we already know about the association between psychiatric morbidity and suicidal behaviour in LMIC,” said Dr. Duleeka Knipe, Elizabeth Blackwell Institute (EBI) Vice Chancellor’s Research Fellow at the University of Bristol Medical School.

“Our analyses show there is a lot of variability between studies and countries, and this suggests there is no one answer, but does support our thinking that psychiatric disorder is perhaps not as important in these settings as in higher income countries.”

“Of course, the treatment of underlying psychiatric illness is important but prevention efforts should also incorporate a wider range of activities which aim to reduce access to lethal means, poverty, domestic violence and alcohol misuse. For example, population level solutions, such as banning highly toxic pesticides, have been shown to be effective in reducing the number of suicide deaths.”

An international research team, comprising experts from the universities of Manchester, Birmingham, Sheffield Hallam, Nottingham, Western Sydney and National Taiwan University, looked at data from 112 studies on 30,030 episodes of non-fatal suicidal behavior and 4,996 suicide deaths in 26 LMIC.

The study, which aimed to address the issue of suicide prevention in LMIC, found 58 percent of suicide deaths and 45 percent of non-fatal suicidal behaviors were linked to psychiatric disorders.

The researchers also found that the proportion of psychiatric disorders in suicidal behavior was highly variable, possibly reflecting between-country differences.

In HIC the treatment of psychiatric disorder is a key focus for suicide prevention, but this study suggests that a wider approach might be needed in LMIC.

“Despite the huge toll of deaths, suicide prevention in LMIC has been relatively neglected to date,” said Dr. Nav Kapur, professor of psychiatry and population health at the University of Manchester and the senior author on the paper. “Of course, we need more research — that much is clear. But we also need to get on and implement solutions based on what we already know.”

Source: University of Bristol

 

Brain Scans May Predict Suicide Risk

New research has identified brain circuitry differences that might be associated with suicidal behavior in individuals with mood disorders.

The study provides a promising lead toward tools that can predict which individuals are at the highest risk for suicide, according to researchers at the University of Utah Health and the University of Illinois at Chicago.

Suicide rates are rising steadily among young adults, especially those with mood disorders, such as depression. More than half of individuals who commit suicide saw a health professional within the past 30 days, but they did not necessarily seek care for mood problems, the researchers note.

“At present, we have very few tools to identify individuals who may be at high risk for suicide-related behavior,” said Dr. Scott Langenecker, a professor of psychiatry at the University of Utah Health and senior author on the study. “Right now, we go on self-report and clinician judgment. Those are good, but they’re not great.”

Previous studies identified brain circuits associated with mood disorders: The cognitive control network (CCN), which is involved in executive function, problem-solving and impulsivity; the salience and emotional network (SEN), which is involved in emotion processing and regulation; and the default mode network (DMN), which is active when individuals are engaged in self-focused thought.

However, these studies focused primarily on depression, according to the researchers.

“This is one of the first studies to try to understand brain mechanisms that may be relevant to suicide risk,” said Dr. Jonathan Stange, an assistant professor of psychiatry at the University of Illinois at Chicago and first author on the study.

The study used resting-state functional MRI (fMRI), which captured brain images while participants were rested and calm, to assess the connectivity of these circuits in 212 young adults at the University of Illinois at Chicago and the University of Michigan.

“For risk factors involved in suicide, the tasks we have to measure are pretty nonspecific and inexact,” Langenecker said. “If we go to the level of the resting-state networks, we’re actually asking the brain to tell us which brain networks and connections are most relevant.”

The study included individuals with mood disorders and a history of suicide attempts, those with mood disorders and a history of suicidal thoughts, those with mood disorders and no history of suicidal behavior or thoughts, and healthy controls. All study participants with mood disorders were in remission, the researchers noted.

Compared with other study participants — even those with mood disorders and a history of suicidal thoughts — people with a history of suicide attempts showed less connectivity in the CCN and between the CCN and DMN, neural circuitry associated with cognitive control and impulsivity, according to the study’s findings.

These differences could present a target for treatment, according to the researchers.

“If we could figure out how to improve connectivity within this brain circuit, we might be able to reduce suicide risk in the future,” Stange said.

Stange and Langenecker emphasize the research is still in its early stages. This was a small study, with only 18 participants with mood disorders and a history of suicide attempts. It will have to be replicated in a larger number of participants, they said.

In addition, the researchers note it is not yet clear whether individuals with mood disorders and at risk for suicide have a different disease from those without such risk, or whether all individuals with mood disorders are at varying degrees of risk for suicide.

The study was published in Psychological Medicine.

Source: The University of Illinois at Chicago

Common Household Drugs Often Used By Youth in Suicide Attempts

A new study finds that adolescent suicide attempts by self-poisoning often involve common household medications, such as ibuprofen or antidepressants.

The findings, published online in the journal Clinical Toxicology, also reveal that self-poisoning suicide attempts are more common in rural communities, particularly during the academic school year.

The study expands on previous research that looked at the incidence and outcomes from intentional suspected-suicide self-poisoning in children and young adults ages 10 to 24 years old from 2000-2018.

In that 19-year time frame, there were more than 1.6 million intentional suspected-suicide self-poisoning cases in youth and young adults reported to U.S. poison centers. The majority of cases were female (71%), and involved a pharmaceutical (92%).

“While most of these cases involved medications, with adolescents, any available medication can be a potential hazard,” said Henry Spiller, M.S., D.ABAT, director of the Central Ohio Poison Center at Nationwide Children’s Hospital, and co-author of the study.

“It’s not so much a matter of substance type, but rather a matter of access to the substance. Any type of medication can be misused and abused in ways that can unfortunately lead to very severe outcomes, including death.”

The two most common substance groups in all age groups were over-the-counter (OTC) painkillers such as acetaminophen, ibuprofen and aspirin, followed by antidepressants. In youth (ages 10-12) and adolescents (ages 13-15), ADHD medications were common, and had the highest risk of serious medical outcomes. Opiates only accounted for 7% of cases with serious medical outcomes.

“Because medications are so readily available in homes, many families do not take precautions to store them safely. Our findings suggest this is a big problem,” said John Ackerman, Ph.D., clinical psychologist and suicide prevention coordinator for the Center for Suicide Prevention and Research at Nationwide Children’s, and co-author of the study.

“Medications can be part of effective treatment, but they require an extra layer of care. The answer is not to stop prescribing medications to those who stand to benefit, but rather to emphasize the practice of safe storage and vigilance when administering any kind of medicine, especially when children and teens live in the home.”

The findings also show that states with a lower population per square mile (rural areas) had a greater number of reported cases with all outcomes and serious medical outcomes.

Results also revealed there was a significant decrease in the number of cases in school-aged individuals during non-school months of June through August (27.5% decrease in 10-12-year-olds; 27.3% decrease in 13-15-year-olds; and 18.3% decrease in 16-18-year-olds), compared with school months September through May.

Nationwide Children’s Big Lots Behavioral Health experts recommend that parents check in with their children regularly, and ask them directly how they are doing and if they have ever had thoughts about ending their life. These direct questions are even more critical if warning signs of suicide are observed.

Medications should be stored up, away and out of sight, preferably in a locked cabinet. Administration of medicine should always be supervised.

“It should concern us that youth in rural areas are about twice as likely as those living in urban areas to die by suicide. Although we are in dire need of more research to help us understand what places some people at more risk than others, available evidence indicates that include increased social isolation, stigma, access to lethal means and lack of appropriate mental health resources may play a role in this disparity,” said Ackerman.

His suicide prevention team provides comprehensive training to more than 140 central and southeast Ohio schools with the SOS Signs of Suicide program.

“It is vital that parents, teachers and other trusted adults start conversations about mental health early, and pay even closer attention during the school year, as rates of anxiety and depression are shown to increase during that time. Warning signs can often be detected and support is available for young people in crisis.”

Source: Nationwide Children’s Hospital

Restless Legs Syndrome Tied to Triple the Risk of Suicide, Self-Harm

A new study has found that restless legs syndrome is associated with a nearly tripled risk of suicide and self-harm.

Researchers at Penn State found that people with restless legs syndrome (RLS) had a 2.7-fold higher risk of suicide or self-harm, even when the researchers controlled for other conditions such as depression, insomnia, diabetes, and more.

“Our study suggests that restless legs syndrome isn’t just connected to physical conditions, but to mental health, as well,” said Dr. Xiang Gao, associate professor of nutritional sciences and director of the Nutritional Epidemiology Lab at Penn State.

“And, with RLS being under-diagnosed and suicide rates rising, this connection is going to be more and more important. Clinicians may want to be careful when they’re screening patients both for RLS and suicide risk.”

According to the researchers, RLS affects approximately 5 percent of the U.S. population, causing an uncomfortable feeling in a person’s legs, resulting in the urge to move them, often during the night. While the exact cause of RLS is unknown, previous research has found an association between RLS and iron deficiency, as well as low levels of dopamine in the brain.

“I’ve wanted to explore a potential connection between RLS and suicide for more than 10 years, but because both RLS and suicide rates are low from a data perspective, it wasn’t possible,” Gao said. “But, when I moved here to Penn State, I gained access to a data set with more than 200 million people, so it gave us power to finally test this hypothesis.”

The researchers used data from the Truven Health MarketScan national claims from 2006 to 2014, including 24,179 people who had been diagnosed with RLS and 145,194 people who did not have RLS. All participants were free of suicide and self-harm at the baseline of the study, the researchers report.

After analyzing the data, the researchers found that people who had restless leg syndrome had a 270 percent higher chance of suicide or self-harm than people who did not. The risk did not decrease even when the researchers controlled for such factors as depression, sleep disorders and common chronic diseases, according to the researchers.

“After controlling for these factors, we still didn’t see the association decrease, meaning RLS could still be an independent variable contributing to suicide and self-harm,” said Dr. Muzi Na, Broadhurst Career Development Professor for the Study of Health Promotion and Disease Prevention at Penn State. “We still don’t know the exact reason, but our results can help shape future research to learn more about the mechanism.”

The study was published in the Journal of the American Medical Association (JAMA) Network Open.

Source: Penn State