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首页> 外文期刊>The British journal of psychiatry : >Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case-control study.
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Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case-control study.

机译：从事近致命自我伤害的女性囚犯的精神疾病：病例对照研究。

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BACKGROUND: Female prisoners are 20 times more likely to die by suicide than women of the same age in the general population. However, risk factors and indicators of vulnerability for suicide in this group are not well-known. AIMS: We investigated prevalence of psychiatric disorders in women prisoners who had recently engaged in near-lethal self-harm (cases) and others who had never carried out near-lethal attempts in prison (controls). METHOD: We interviewed 60 cases and 60 controls from all closed female prison establishments in England and Wales. In addition to gathering details of sociodemographic, criminological and clinical history, we assessed participants' current and lifetime disorders using the Mini-International Neuropsychiatric Interview. Associations between near-lethal self-harm and psychiatric disorders were adjusted for age, educational qualifications (any v. none) and remand status (sentenced v. unsentenced). RESULTS: At the time of their near-lethal self-harm, 53 cases (88%) were on ACCT (Assessment, Care in Custody and Teamwork), the system for the care of prisoners at risk of suicide and self-harm in England and Wales. Cases had significantly greater levels of psychiatric morbidity than controls, and more comorbidity. The strongest associations with near-lethal self-harm were with current depression (age-adjusted odds ratio (OR) = 23.7, 95% CI 9.0-62.3), the presence of two or more diagnoses (age-adjusted OR = 18.3, 95% CI 5.9-56.9), a history of psychiatric in-patient treatment (OR = 25.4, 95% CI 5.7-113.5) and previous attempted suicide, especially in prison (OR = 129, 95% CI 27-611). The only tested diagnoses not associated with near-lethal self-harm were antisocial personality disorder, substance use and eating disorders. Adjusting for sociodemographic and criminological variables did not significantly alter any of these findings. CONCLUSIONS: This research underlines the importance of psychiatric risk factors for suicide in custody and in particular comorbidity. The finding that a formal care plan was in place for most cases at the time of their near-lethal act is indicative of good risk detection, but also suggests high levels of unmet need. Given the potential complexity of their mental health needs, interventions incorporating pharmacological and psychological treatments should be considered for at-risk prisoners.
机译：背景：女性囚犯自杀死亡的可能性是一般人口中相同年龄女性的20倍。然而，该组自杀的危险因素和指标并不为人所知。目的：我们调查了最近从事近致命自我伤害的女囚犯（案件）和从未在监狱进行过近致命企图的其他囚犯（对照）的精神疾病患病率。方法：我们采访了英格兰和威尔士所有封闭式女性监狱机构的60例病例和60例对照。除了收集社会人口统计学，犯罪学和临床病史的详细信息之外，我们还使用Mini-International Neuropsychiatric Interview对参与者的当前和终生疾病进行了评估。调整了近致死性自我伤害与精神疾病之间的关联，以适应年龄，学历（任何诉无）和还押状态（判刑与未判刑）之间的关系。结果：在他们接近致命的自我伤害时，有53例（88％）在接受ACCT（评估，羁押中的照料和团队合作）的案件中，该制度是英格兰有自杀和自残危险的囚犯护理系统和威尔士。病例的精神病发病率明显高于对照组，合并症更多。与近乎致命的自我伤害的最强关联是当前的抑郁（年龄调整后的优势比（OR）= 23.7，95％CI 9.0-62.3），存在两个或多个诊断（年龄调整后的OR = 18.3，95）百分比CI 5.9-56.9），有精神科住院治疗史（OR = 25.4，95％CI 5.7-113.5）和以前曾尝试自杀，尤其是在监狱中自杀（OR = 129，95％CI 27-611）。与致命致命性自我伤害无关的唯一经过测试的诊断是反社会人格障碍，物质使用和饮食失调。调整社会人口学和犯罪学变量不会明显改变任何这些发现。结论：这项研究强调了精神病危险因素对羁押期间自杀的重要性，尤其是合并症。大多数病例在接近致命行为时就已经制定了正式的护理计划，这一发现表明良好的风险检测能力，但也表明未满足需求的水平很高。考虑到他们心理健康需求的潜在复杂性，应考虑将高危囚犯纳入药物和心理治疗的干预措施。

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