SUICIDEASSESSMENT AND
PREVENTION INPRISONS
Prisoner suicide assessment and prevention is an area of
active research and clinical involvement. Indeed, it is an
important component of the forensic psychologist’s
clinical responsibilities due to the disproportionately
high incidence of prison suicide as compared with the
general population. This high incidence is a consistent
phenomenon across countries. In some countries, this
translates into suicide being a major cause of death
among prisoners. To address the topic of suicide assess-
ment and prevention, first the research challenges in
conducting prisoner suicide research and the relevant
theory in conceptualizing the process of prisoner suici-
dality are briefly summarized. A review of relevant risk
factors as evidenced by research are categorized into
several domains and described. These domains include
demographic factors, historical factors, criminality fac-
tors, and clinical factors. Following a review of risk fac-
tors, suicide prevention within the prison setting is
summarized.Research and Theory
In an effort to better understand and assess (i.e., predict)
prisoner suicide, a large body of research has investi-
gated the risk factors related to prisoner suicide.
However, there are some intrinsic challenges in the
prediction of suicide generally, and there are some
methodological weaknesses in prisoner suicide
research specifically. The major challenge in predicting
suicide is that it is a relatively rare event (i.e., has a low
base rate). Statistically, it is more difficult to predict a
rare event than a frequent event. This creates significant
challenges for researchers in designing good-quality
predictive studies. For example, because suicide is a
relatively infrequent event, a researcher would need to
have a very large number of subjects at the beginning of
a study for there to be a sufficient sample size of even-
tual suicides for analyses. For individual clinicians, this
difficulty in predicting rare events creates the higher
risk of false positives (i.e., predicting suicide where
none occurs). False negatives (a suicide occurs when it
was predicted that no suicide would occur) literally
have life and death implications and represent what
most clinicians and staff members want to avoid.
Some particular methodological weaknesses in pris-
oner suicide research include samples consisting of
mixed populations of prisoners (e.g., remanded andsentenced prisoners), lack of control or comparison
groups of nonsuicide or nonattempter prisoners, and
reliance on descriptive studies, which generates diffi-
culties in establishing a causal relationship between
risk factors and outcome. Of note is that, in recent
years, researchers have made efforts to address these
methodological problems. There have been efforts to
design more comparative studies, to use more sophisti-
cated statistical analyses (e.g., logistic regression), and
to even undertake matched control studies. This is a
welcome shift in the research approach to prisoner sui-
cide. Indeed, given the plethora of descriptive studies
generated over the last 25 to 30 years, there are limita-
tions in the value added by purely descriptive studies of
prisoner suicide at this time. Designing more method-
ologically sound studies will more meaningfully build
on current knowledge.
Overall, despite the challenges presented by
researching prisoner suicidality, identifying relevant
risk factors has facilitated the development of suicide
assessment protocols and scales. Prior to reviewing rel-
evant risk factors, it is important to note that, as useful
as individual risk factors are, there has been a major
contribution by researchers who have offered valuable
conceptualizations of the suicidal process as one that
occurs over time and is affected by multiple factors. In
particular, Marti Heikkinen and colleagues have pro-
vided one of the most well-developed models. Their
process model of suicide consists of risk factors, pre-
cipitating factors, vulnerability factors, and protective
factors that contribute to the process of suicidality. In
this model, the suicidal process is viewed as dynamic
and affected by several categories of risk factors (i.e.,
biological, psychological, social, cultural). At the same
time, the individual’s vulnerability and protective fac-
tors affect risk. For instance, a prisoner who has diffi-
culty in coping with various areas of his life will likely
experience greater risk. A prisoner with a strong social
support system would likely experience some protec-
tion against risk. Finally, the model includes precipitat-
ing factors such as stressors and external events that
contribute to triggering suicidality (e.g., loss of support,
negative decision regarding release).Risk Factors
Research on prisoner suicidality reveals several
domains of risk factors that are relevant to suicide
assessment. These general domains include demo-
graphic factors, historical factors, criminality factors,
and clinical factors.Suicide Assessment and Prevention in Prisons——— 781S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 781