Jailhouse Blues revisited.

BACKGROUND: Over the past decades a number of studies have appeared on suicide among persons in jail and prison remand settings, and sentenced prisoners. In these papers contradictory views concerning the relation between suicide risk and length of custody were published. METHODS: This article reports on a study that investigated all suicides (n=206) in all 29 Austrian jails and prisons between 1975 and 1996. The authors demonstrate the necessity to calculate the hazard that reflects the suicide risk in relation to time. RESULTS: The results suggest three different periods of high suicide risk: immediately after admission and 2 months thereafter for prisoners on remand; for long-term prisoners the suicide risk correlates with the length of the sentence and slightly increases with the time of custody. CONCLUSIONS: With this knowledge, suicide prevention programmes in prisons and jails could be made more effective and economic.

[Did suicidal behavior have relevance for prison suicide?]. / Welche Relevanz hat die dokumentierte Suizidalität in Gefangenensuiziden?

OBJECTIVE: Suicides in correctional institutions occur more frequently than in the general population. Inmate suicide rates have been increasing in many countries during the last decades, possibly reflecting a selection of highly endangered individuals with a high prevalence of mental disorders. This study investigates all suicides in all correctional institutions of Austria during the last 25 years. METHODS: All available personal files of inmates who had committed suicide in the 29 Austrian prisons between January 1st, 1975, and December 31st, 1999, were analysed. Beside personal characteristics and circumstances of custody, information concerning psychiatric disorders and the inmate's history of suicidal behavior was included. RESULTS: 220 personal files of 250 suicides were available and included. Half of all suicides had a history of attempted suicide and 37 % had expressed suicidality. Referral to psychiatric consultants was known in 48.6 % and about 37 % received psychopharmacological treatment. Based on these frequent signs of psychiatric illness and vulnerability, possible implications of these results for psychiatric services of the correctional system to improve suicide prevention are discussed. CONCLUSIONS: Obvious signs of suicidality play an important role in vulnerability profiles for jail and prison suicides. Any signs of suicidality (st. p. attempted suicide, verbal suicide threat, self-harm) should have the consequence of further psychiatric care.

[Deprivation versus importation: a model explaining the increase of suicide rates in custody]. / Deprivation versus Importation: ein Erklärungsmodell für die Zunahme von Suiziden in Haftanstalten.

High suicide rates in jail, lock-up or prison settings have given rise to a debate about whether suicides result chiefly from the type of people confined, or from the types of places they are confined in, the types of confinement. This is summarily framed by the terms of an associated debate in criminology, between importation and deprivation theory. This paper describes the importation versus deprivation theory, concerning the circumstances in Austrian prisons and jails. The article reports on all completed suicides over the period from 1947 to 1999 (n = 410). The increase of suicide rates in Austrian jails and prisons is significant over the last fifty years. While the rate was stable between 1947 and 1975, we have a significantly increasing rate since 1975. In 1975 there was an important legislational reform of the criminal law in Austria. The implications of this reform are discussed in the light of the importation/deprivation theory.

Fifty years of prison suicide in Austria: does legislation have an impact?

The absolute and relative frequency of suicides in jails and prisons in Austria over the 50 years from 1947 to 1996 is described. Important legislational changes regarding the criminal justice system are discussed with regard to possible consequences for the incidence of prisoners' suicides. Within the five decades a significant increase in the absolute numbers of jail and prison suicides was evident in spite of the considerable decrease in the total inmate population. Therefore, the suicide rate of inmates of correctional facilities increased significantly. Possible reasons for this phenomenon are discussed in relation to changes of the criminal law.

Prison suicides in Austria, 1975-1997.

Suicide prevention in custody is hampered by the lack of funds and professional staff. In order to evaluate the prison suicide phenomenon, a study was conducted evaluating all suicides that occurred in Austrian prisons between 1975 and 1997 (n = 220). In addition to evaluating the number of male versus female suicides, the preferred suicide methods were studied, as well as suicide risk of different circumstances of custody. Suicide rates of distinguishable, important subgroups of prisoners were calculated. The suicide rate for prisoners on remand was 236.0 per 100,000, and for offenders classified as mentally ill it was 205.4 per 100,000. That is about 8 times higher than the suicide rate in Austria's general population (1975-1997: 24.6 per 100,000). The suicide rate for sentenced offenders was 81.3 per 100,000, about twice the suicide rate in Austria's general male population. We recommend that psychologists or psychiatrists concentrate on the suicide prevention of high-risk offenders after screening the newly admitted offenders for their propensity to suicide.

[Assessment of custodial suicide risk--jail and prison suicides in Austria 1975-1996]. / Gefangenensuizide: Hinweise zur Abschätzung der Suizidgefahr- Suizide in Osterreichs Haftanstalten 1975-1996.

OBJECTIVE: Although incarceration is a high-risk situation for suicide all over the world, hardly any results have been published concerning the situation of custodial suicide in German-speaking countries. METHODS: We investigated the case notes of all suicides occuring in Austrian prisons between 1975 and 1996 (n= 207). Beside an evaluation of gender and preferred methods of suicide the suicide risk of different circumstances of custody was studied. Suicide rates of distinguishable, important subgroups of prisoners were calculated using the official statistical data of the Ministry of Justice. RESULTS: The suicide rate for people on remand and offenders classified as mentally ill was 231/100,000 vs. 191/100,000, that was about eight times higher than the suicide rate in Austria's general population. The suicide rate for sentenced offenders was 80/100,000, about three times as high as the suicide rate in Austria's general population (1980-1990: 26.4/100,000). The suicide risk increased with the length of the announced sentence. CONCLUSIONS: The suicide rate in custody was highest for prisoners on remand and mentally ill offenders. Female offenders had a high suicide risk, too. The common assumption that the suicide risk in jails and prisons is highest shortly after admission should be confirmed based on better methodology or be reconsidered.

Discriminating among incarcerated sexual offenders by their perception of interpersonal problems and experience-related anxiety.

Fifty-seven (57) incarcerated sex offenders were assessed for their capacity to perceive interpersonal difficulties and experience related anxiety. The findings suggest that the men who have sexually transgressed against minors view themselves as easily exploitable and nurturant, and those who have sexually aggressed against adult females demonstrated minimal regard for external negative views of them. These two groups did not differ significantly from each other along social avoidance and non assertiveness dimensions. Assertiveness was found to decrease as a consequence of multiple incarcerations in both groups. Furthermore, perception of interpersonal difficulties and experience related anxiety in our study correctly classified 72% of high and low violent sexual offenders.

The relevance of self-concepts discriminating in long-term incarcerated sex offenders.

Lack of self-esteem and assertiveness have been thought to play an important role in the etiology and maintenance of sex offending behavior and to be significantly related to the number of previous convictions or violence of the assault. We, therefore, analysed self-concepts of 53 long-term incarcerated sex offenders to research the correlation between concepts of self-esteem, assertiveness, feelings towards others and relationships and the degree of violence of the last offense and risk of reoffense. We also investigated the relationship of previous convictions and duration of incarceration with the offenders' self-concepts and the influence of psychotherapeutic intervention on the offenders' self-concepts.

[Successful intubation with the Combitube of two patients with bull neck]. / Erfolgreiche Intubation mit dem Combitube bei zwei Patienten mit Stiernacken.

Endotracheal intubation is without doubt the optimal method for emergency airway management. Rapid intubation and effective ventilation are the major aims during cardiopulmonary resuscitation. As an alternative, the Combitube can be used whenever endotracheal intubation is not immediately possible. We report the successful use of the Combitube during cardiopulmonary resuscitation in two patients with bull-neck. The patients could be oxygenated and ventilated adequately with the Combitube. This case report shows that the Combitube may be a valuable tool for emergency intubation in difficult situations.