Suicide is a national if not global crisis and according to the World Health Organization (WHO) close to 800,000 people die globally to suicide. It is also important to note that for each suicide there are more than suicide attempts, (“Suicide across the world (2016),” n.d.). For those incarcerated suicide is a major concern statistic from the US Department of Justice showed the
number of suicides in state prisons increased 30% from 2013-2014 and suicides represented 7% of all deaths in 2014. This was the largest percentage of deaths by suicide sine 2001, “Mortality in State Prisons-2001-2014-Statistical Tables,” n.d.). This information underlines the need for more robust suicide prevention programs not only in the community but also prisons where suicide rates are increasing rapidly.
As this nurse currently works within a correctional facility my PICOT has the purpose of determining if a more robust suicide prevention training reduces self-harm and suicides. The nurse chose two quantitative research articles to assist in preparing my PICOT question. The first article used is “National total Survey of German adolescents Suicide in Prison”. This was a ten year study of suicide rates (SR) and relative risk (RR). It details that incarcerated adolescents are a high-risk group for suicidal behavior, but data on completed suicide is scare in this area The study aimed at calculating RR and identifying age related factors. Data was compared of completed suicides in young detainees. The study showed that although in adults’ suicides were five-fold higher in pretrial detention, suicide rates were more balanced in adolescent detainees, ((2015). National total Survey of German adolescent Suicide in Prison. European Child & Adolescent.) The researcher posed the question that suicide is the second or third leading cause of death in people aged 15-20 years and prevention is challenging. Incarcerated adolescents constitute a high risk for suicide and that different reasons may contribute to the elevated suicide behavior, ((2015). National total Survey of German adolescent Suicide in Prison. European Child & Adolescent.). For this nurse the implications of the study will help improve the understanding of the important differences in the underlying mechanisms and motivations for suicide and self-harm.
The second study “Suicide Ideation and It’s Correlates in Prisoners” was based in four correctional facilities in the Zhe-jiang Province in China. The study noted that suicide is one of the leading causes of death in prisoners and have higher suicide rates that their community counterparts. The study also noted that the prevalence of suicidal ideation and suicide remain unknown amongst chines prisoners. Three types of prisoners were randomly selected and compared to a sample of college students with the aim of investigating the prevalence of suicidal ideation amongst incarcerated Chinese populations and protective factors. The researchers posed the question what are the rates of suicidal ideation in the prison population compared to the general population, (Suicidal ideation and its correlates in prisoners: a comparative study in China, 2010). Again, this research leads to the conclusion that suicide prevention programs are an essential nursing tool to help recognize suicidal ideation and suicide prevention.
The Maricopa County jail system not only houses male inmates like those in the Chinese study but also houses a small population of juveniles between the ages of 14-17 years within the main adult population. Juveniles are discussed in the German study and both study’s give predictors to suicidal ideation and help answer the nurses PICOT question that “All inmates are at risk of suicide”. Both studies offer recommendations of increased screening and suicide prevention programs which is the aim of my PICOT study. My PICOT question and form of study has comparisons with the Chinese study where there will be a control group that receive standard suicide prevention training and another group that will receive more robust suicide prevention training. Also, the interventions will be similar with the use of questionnaires and interviews.
The methods of study data collection for the Chinese study was a sample selection of four prisons in the Chinese Province of Zhe-jiang with the intention of being representative of the general population of all prisons in the Province. Random selection of three types of prisoners from four correctional facilities and a sample of college students from a police academy were used in the study. The German study was different in that the sample was a total national survey of completed suicide of young detainees (14-21) compared with adults 21 and above. Data was not collected through interviews or questionnaires but by analysis of statistical data and existing research.
A limitation of the Chinese study is that the use of interviews and questionnaires is the response of the respondent may be biased or under or over exaggerated therefore, limiting the validity of the study making generalizability difficult. Benefits are the randomization of subjects gives a good overview of the population in general. A benefit of the German study is statistical data is a proven independent variable by which to measure by. The limitations are there are no descriptive statistics that detail why the subjects are more at risk of suicide.
The key findings of the Chinese study were the prevalence of suicidal ideation were similar to those in the west and also in line with the prevalence of suicidal ideation in the general populations. It is also suggested that Chinese inmates have the same risk factors for suicidal ideation as the general public. Therefore, Chinese prisons can learn from and inform suicide prevention work from the general population, (Suicidal ideation and its correlates in prisoners: a comparative study in China, 2010).
In the German study the key finding s were that adolescents and young adults in Germany who were detained had a 23-fold greater risk of suicide than the general population. RR was three times higher in young prisoners than adults. Criminal rather than pretrial detention was strongly associated with suicide in young offenders compared to adults. It is important to take into account these aspects when developing guidelines and prevention strategies in order to reduce suicide in prison more effectively, ((2015). National total Survey of German adolescent Suicide in Prison. European Child & Adolescent.).
The anticipated outcome for this nurses PICOT question is that I will show nurses provided with enhanced suicide prevention training will not only feel better equipped to handle a suicidal patient but also be able to better recognize those inmates that may have a RR of suicide and appropriately coordinate care with the mental health team. I also hope for a lower rate of self-harm events or suicide attempts amongst those nurses with enhanced training. I believe my PICOT will align with the findings of my research articles which is that, better suicide prevention programs help prevent suicide amongst prison inmates
Mortality i State Prisons-2001-2014-Statistical Tables. (n.d.). Retrieved from https://www.bjs.gov/content/pub/pdf/msp0114st.pdf
Suicide across the world (2016). (n.d.). Retrieved from https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/
Zhang, J., Grabiner, V. E., Zhou, Y., & Li, N. (2010). Suicidal ideation and its correlates in prisoners: a comparative study in China. Crisis: The Journal of Crisis Intervention & Suicide Prevension, 31(2), 335–342. https://doi-org.lopes.idm.oclc.org/10.1027/0227-5910/a000055
Radeloff, D., Lempp, T., Herrmann, E., Kettner, M., Bennefeld-Kersten, K., & Freitag, C. (2015). National total Survey of German adolescent Suicide in Prison. European Child & Adolescent Psychiatry, 24(2), 219–225. https://doi-org.lopes.idm.oclc.org/10.1007/s00787-014-0568-1