Childhood maltreatment and suicide attempts in prisoners: a systematic meta-analytic review.

Ioannis Angelakis,Jennifer L Austin,Patricia Gooding

doi:10.1017/s0033291719002848

Abstract

In the past decade, the links between core types of childhood maltreatment and suicidal acts have become an increasingly important area of investigation. However, no meta-analytic review has examined this relationship in prisoners. We undertook the first systematic meta-analytic review examining the link between childhood maltreatment and suicide attempts in prisoners to redress this important gap. We searched Medline, PsychINFO, Embase, Web of Science and CINAHL from inception until August 2019. Meta-analyses using random effect models were applied, and heterogeneity was quantified using the I2 statistic. Publication bias and risk of bias across studies were assessed. We identified 24 studies comprising 16 586 prisoners. The rates of different types of childhood maltreatment ranged between 29% and 68% [95% confidence interval (CI) 18-81%]. The rate of suicide attempts in prisoners was 23% (95% CI 18-27%). Main results demonstrated that sexual abuse [odds ratio (OR) 2.68, 95% CI 1.86-3.86], physical abuse (OR 2.16, 95% CI 1.60-2.91), emotional abuse (OR 2.70, 95% CI 1.92-3.79), emotional neglect (OR 2.29, 95% CI 1.69-3.10), physical neglect (OR 1.57, 95% CI 1.27-1.94) and combined abuse (OR 3.09, 95% CI 2.14-4.45) were strongly associated with suicide attempts in prisoners. There was an indication of publication bias. Duval and Tweedie's trim-and-fill method was applied, which increased the odds for suicide attempts. Given the high rates of prison suicide deaths and suicide attempts, our findings suggest an urgent need for targeted suicide prevention priorities for prisoners, with a particular focus on ameliorating the effects of childhood traumatic experiences on suicidal prisoners.

Highlights

Suicide fatalities are a major problem facing prisons, with male and female prisoners dying by suicide at a rate that is three- to nine-times higher than that found in the general population (Fazel et al, 2011, 2017)
Previous research has established that prisoners reliably report more childhood traumatic events than those in the general community (Jordan et al, 1996) and that these experiences are strongly linked to suicidal acts (Angelakis et al, 2019)
We demonstrated that suicide attempts were strongly linked, cross-sectionally, with experiences of childhood abuse and/or neglect in prisoners, which remained unaffected by methodological variations

Summary

Introduction

Suicide fatalities are a major problem facing prisons, with male and female prisoners dying by suicide at a rate that is three- to nine-times higher than that found in the general population (Fazel et al, 2011, 2017). A meta-analytic review which examined this association in clinical and non-clinical populations demonstrated a strong link between key types of childhood maltreatment (i.e. sexual, physical and emotional abuse, and emotional neglect) and both suicide attempts and ideation (Angelakis et al, 2019). These results were unaffected by key methodological variations (e.g. screening tools and/or research designs employed) and individual-level characteristics (e.g. age and gender) across studies.

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Discussion

Conclusion