Research Critique: Suicide Prevention

The suicide mortality rate is 3 times higher in prison populations than in the community, (Vera Institute, n.d.). Within the Arizona Department of Corrections in 2019 there have been 1807 self-injurious events that resulted in harm and 117 suicide attempts with 7 deaths, (“Inmate Assault Self Harm & Mortality Data,” 2019). All nursing professionals have the responsibility of protecting the health and safety of the inmate population. Not all suicides are preventable, but through a comprehensive suicide prevention program for nursing professionals a systematic reduction of these events can occur. This is why this nurse has based her PICOT on suicide prevention and recognition of those most at risk.

The purpose of this nurses PICOT Question was to identify those inmates within the Maricopa County jail system that are most at risk of suicide. The two Qualitative research articles used by this nurse were chosen to help identify those inmates most at risk. The first article this nurse identified was a study of. suicide ideation and attempts amongst incarcerated women in Israel. The background to this study showed that although suicide rates are higher amongst female inmates compared to male inmates, little is known about the predictors for suicide in these women, (Lifetime History of Suicide Ideation and Attempts Amongst Incarcerated Women In Israel, 2017). The study had the purpose of examining sociodemographic, criminological and psychological variables associated with suicide ideation and suicide attempts amongst incarcerated women, (Lifetime History of Suicide Ideation and Attempts Amongst Incarcerated Women In Israel, 2017). The research question posed by the study details inquiring about childhood abuse, symptoms of depression and mental health problems along with providing treatment for trauma exposure may reduce the risk suicidality in this population, (Lifetime History of Suicide Ideation and Attempts Amongst Incarcerated

Women In Israel, 2017). This study has great significance for nursing, by recognizing that female inmates’ previous experiences and traumas suffered increase the risk for suicide. Nurses can develop more robust screening questions to aid in recognizing these patients and assuring appropriate care is provided so the risk of suicide is identified early.

The second research article chosen involved active and passive suicide ideation in older prisoners. In fact, older prisoners are the fastest growing incarcerated population, but limited information is known on causes and risks of suicide making forming best practices for early risk detection and suicide prevention difficult. The study sought to determine current prevalence and factors associated with active suicide ideation (ASI) and passive suicide ideation (PSI). It also sought to determine if depression and lifetime suicide attempt were associated with ASI or PSI. The research question sought to determine the current prevalence and factors associated with ASI and PSI. This nurse has seen firsthand the increase in the elderly jail population. It is important to recognize the predictors for ASI and PSI in this population and again implement robust screening and treatment for this at group at risk of suicide, (Active and Passive Suicidal Ideation in Older Prisoners, 2016).

This nurse’s PICOT question identifies the patient problem as “Inmates within the Maricopa County jail system who are at risk of suicide.” Both research articles have helped this nurse identify specific populations are at increased risk of suicide and more in-depth training to help recognize those at-risk groups and their specific needs, with a trained mental health professional, is needed. This nurse’s PICOT has similarities to the first research article in that a questionnaire will be utilized, it will also involve the participants self-reporting on their experiences regarding the suicide prevention training provided. This nurse’s comparison group will also be a random sampling of a small group of nurses currently employed and those going through new employee orientation.

The method of study for the first article was a random sample of 46 Israeli women who were incarcerated in the Neve Tirza maximum security prison. Data was obtained through a series of questionnaires including on sociodemographic, addiction severity index, childhood trauma questionnaire The Renard Diagnostic Interview and the BDI-II, (Lifetime History of Suicide Ideation and Attempts Amongst Incarcerated Women In Israel, 2017). The second study took place in 3 prisons in the Connecticut Department of Corrections (CDOC) eligible participants were aged 50 and over and were required to be English speaking. 124 prisoners volunteered to participate, (50-83) face to face interviews took place during which time data was collected including demographics, The Geriatric Suicide Ideation scale and the the Physician Health Questionnaire (PHQ-9) were also utilized to determine ASI, PSI and major depressive episode. Chart reviews were also used to assess previous documentation of suicidal thoughts.

The differences between the two studies is the second used a much larger study over three prisons rather than just one. Also, the first study used a random sample of prisoners, the second study elicited participants through sending letters to eligible participants requesting they take part in the study. Lastly the first study used questionnaires whereas the second study used face to face interviews.

Both methods of research have benefits and limitations. The benefits of questionnaires are they are a useful survey tool and can allow large populations to be assessed with ease, (“quick guide to survey research,” n.d.). Questionnaires can also be inexpensive, practical and allow for easy analysis. However, the limitations include validity is dependent on response rate and discrepancy in recall rate. Interviews offer flexibility to the interviewers, also interviews have a better response rate than mailed questions and the interviewer can judge the nonverbal communication behavior of the respondent. Again, there are limitations, conducting interviews can be costly and time consuming and an interviewer can have bias toward the respondent, “Advantages and Disadvantages of Interview in Research,” 2019).

The key findings of the research article “Lifetime History of Suicidal Ideation and Attempts Amongst Incarcerated Women in Israel” were that a high prevalence of women who suffered child abuse had a high rate of suicide attempt (SA) or suicidal ideation (SI). They also found childhood abuse was strongly associated with past suicide attempts. Another finding was a strong association of SA SI in those with a history of substance abuse and those with a history of maternal mental health problems, (Lifetime History of Suicide Ideation and Attempts Amongst Incarcerated Women In Israel, 2017).

The study “Active and Passive Suicidal ideation in Older prisoners” findings suggest that “while SI is prevalent the majority of older prisoner don’t endorse SI,” (Active and Passive Suicidal Ideation in Older Prisoners, 2016). Factors that apply to other prisoners may be less relevant for older prisoners and PSI and ASI may be associated with depression and previous suicide attempt which are pre cursers for suicide, (Active and Passive Suicidal Ideation in Older Prisoners, 2016).

The nursing implications for both research articles are that little is known about these two large groups within the prison system and as correctional health nurses we should be undertaking research in the development of best practices for screening tools to assist in identifying the inmate population as a whole and their risk for SI or SA.

Ethics is essential to ensure research is useful and accurate information to the reader. Two considerations when ensuring research remains ethical are, Informed consent this means the person voluntarily, knowingly and intelligently in a clear way gives consent to participate in the research, (“What are the major ethical issues in conducting research? is there a conflict between the research ethics and the nature of nursing? | Insight Medical Publishing,” n.d.). The other consideration is beneficence or do no harm. Ultimately this goes back to the Hippocratic oath, that the study should be of benefit not harm the participant.

When reviewing the two chosen article it was noted that the first did not discuss any ethical considerations. It did, however, discuss the limitations of the study including the small sample size and that data was obtained based on retrospective self-reporting which is known to have limitations. In the second study it was noted the ethical concerns of obtaining informed consent and performing interviews in private areas to ensure confidentiality was maintained 

References

Advantages and Disadvantages of Interview in Research. (2019, December 7). Retrieved from https://www.sociologygroup.com/advantages-disadvantages-interview-research/

A quick guide to survey research. (n.d.). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964639/

Barry, L. C., Wakefield, D. B., Trestman, R. L., & Conwell, Y. (2016).

Active and Passive Suicidal Ideation in Older Prisoners. Crisis: The Journal of Crisis Intervention & Suicide Pretension, 37(2), 88–94. https://doi-org.lopes.idm.oclc.org/10.1027/0227-5910/a000350

Chen, G., & Gueta, K. (2017).

Lifetime history of suicidal ideation and attempts among incarcerated women in

Israel. Psychological Trauma: Theory, Research, Practice & Policy, 9(5), 596–604. https://doi-org.lopes.idm.oclc.org/10.1037/tra0000277

Inmate Assault, Self-Harm & Mortality Data. (2019, September 13). Retrieved from https://corrections.az.gov/reports-documents/reports/inmate-assault-self-harm-mortality-data

Vera Institute. (n.d.). Retrieved from https://www.vera.org/publications/culture-of-safety-sentinel-event-suicide-self-harm-correctional-facilities/culture-of-safety/overview

What are the major ethical issues in conducting research? is there a conflict between the research ethics and the nature of nursing? | Insight Medical Publishing. (n.d.). Retrieved from http://www.hsj.gr/medicine/what-are-the-major-ethical-issues-in-conducting-research-is-there-a-conflict-between-the-research-ethics-and-the-nature-of-nursing.php?aid=3485