The distillation of "VISCI": towards a better identification of suicidal inmates.

The "Viennese Instrument for Suicidality in Correctional Institutions" (VISCI) presented here is based on the results of a large case-control study and on research on literature examining suicide prevention in general and in the prison population in particular. The aim of this study was to validate the properties of the VISCI to differentiate between suicides and nonsuicides. The sensitivity and specificity of the VISCI was tested in the files of 55 correctional suicides, and 110 controls. VISCI differentiated well between suicides and nonsuicides. The routine administration of the VISCI may help to direct the existing professional attention to inmates with the highest need.

[At home in a home? Did de-hospitalisation mean de-institutionalisation?]. / Da-Heim im Heim!? Bedeutete Ent-Hospitalisierung auch Ent-Institutionalisierung?

OBJECTIVES: In the last decades, long-time patients were systematically discharged from psychiatric hospitals in order to integrate this disadvantaged population into the community. This procedures where adequately evaluated and are regarded to be completed in the western world today. However, few evidence has been presented regarding the further course of integration following discharge from mental hospitals: was integration into community really successful or were patients permanently placed in sheltered housing staffed 24 hours 7 days a week. This review focuses on the question whether papers describing large de-institutionalisation projects mention the level of institutional support in the years following discharge from hospital. Furthermore we tried to find out which parameters are dealt with when describing successful community integration. METHODS: "Pubmed" was searched for studies on de-institutionalisation projects published between 1997 and 2007. RESULTS: The discharge from the mental hospital wards was in all studies described as successful, positive effects like an increased quality of life were found. However, studies describing the years following discharge mentioned that patients continuously stayed in sheltered housing with care offered 24 hours a day. CONCLUSION: Reviewing the available data about the level of support regarding accommodation of former long time patients, the danger of "trans-institutionalisation" has to be pointed out. Evidence is lacking concerning support models tailored to the individual needs of the patients. Similarly, possible side effects of long-term stays in sheltered housing staffed 24 hours a day have not yet been established. Therefore, we see a need for further evaluation of different models of supported housing for former long-term hospitalised patients, as well as for new chronic mentally ill patients.

[Are there gender-specific differences between mothers and fathers caring for a schizophrenia patient?]. / Gibt es geschlechtsspezifische Unterschiede in der elterlichen Betreuung von Schizophrenie-Kranken?

OBJECTIVE: The purpose of this study was to investigate differences between mothers and fathers of patients with schizophrenia or schizoaffective disorders concerning the time spent with the patients as well as other aspects of caring. METHODS: 101 mothers and 101 fathers of the same patients suffering from schizophrenia or schizoaffective disorders according to ICD-10 were investigated. RESULTS: The mean time spent in personal (i.e. face-to-face) or telephone contact with patients was significantly higher for mothers than for fathers. About the half of the mothers spent more time with the patients than the fathers, while 12% of fathers spent more time than the mothers. Among 40% of patients, mothers and fathers spent an equal amount of time for personal or telephone contact with the patients. Concerning other aspects of caring (legal representative of the patient, payment for patient's costs, caring for the patient's household) we could not find any differences between mothers and fathers. CONCLUSIONS: Concerning several aspects we could not confirm that mothers are more involved into the patients' care than the fathers. These findings are in contrast to the usual assumptions about familial caregivers based on the traditional gender-specific role models.

Gender aspects of parents' needs of schizophrenia patients.

BACKGROUND: Most studies about the problems and needs of schizophrenia carers included only one care-giving relative, usually the patients' mothers. METHODS: 101 mothers and fathers of the same patients suffering from schizophrenia were included into this study. Their needs were assessed by means of the "Carers' Needs Assessment for Schizophrenia". RESULTS: Mothers reported significantly more often problems than fathers concerning stress due to earlier life events and burn-out. Mothers needed interventions such as individual psychoeducation or family counselling more than twice as often as fathers. Overall, mothers reported higher numbers of problems and needs for intervention than fathers. The number of mothers' problems was predicted by not living with a partner and by a shorter duration of the patients' illness. The number of mothers' needs was predicted by more psychiatric symptoms, not living with a partner and a shorter duration of the patients' illness. Among fathers we could not identify any predictors, neither for the number of problems nor for the number of needs. CONCLUSIONS: Fathers and mothers often report problems and frequently need professional support. Overall, mothers exhibited more problems and needs for interventions than fathers. The differences between mothers and fathers indicate the importance of considering the carer's gender in clinical work.

[Vocational rehabilitation for mentally ill persons--an overview of predictors for successful integration]. / Arbeitsrehabilitation psychisch kranker Menschen--ein Uberblick über Erfolgsprädiktoren.

OBJECTIVES: Unemployment has a strong negative impact on quality of life and on the further course of the disease of mentally disordered individuals. Therefore, vocational rehabilitation programmes are necessary to help people with mental disorders to obtain work. There is increasing scientific evidence concerning positive predictors for vocational integration. This paper intends to give an overview about established predictors for successful integration. METHODS: "Pubmed" was searched for studies on psychiatric vocational rehabilitation programmes published between 1997 and 2007, which had the focus on predictors of successful outcome. RESULTS: Some of the most important predictors are a better history of work integration and better work performance measured during psychiatric vocational rehabilitation. Successful vocational integration is harder if negative symptoms or cognitive deficits are present. The impact of sociodemographic factors, diagnosis, motivation to work and social skills is discussed controversially. CONCLUSION: Future research should be directed to design vocational rehabilitation programmes, which address the specific needs of psychiatric patients.

[VISCI--Viennese Instrument for Suicidality in Correctional Institutions]. / Das Wiener Instrument für Suizidgefahr in Haft.

OBJECTIVE: The assessment and estimation of suicidal risk constitutes a serious and difficult task for any mental health professional. If we add to this the challenges that may be presented by a specific population at higher risk with little possibilities for thorough psychiatric evaluation, the task appears even more complicated. METHOD: The "Viennese Instrument for Suicidality in Correctional Institutions" ("VISCI") presented here is based on the results of a case control study including all suicides in all Austrian jails and prisons between 1975 and 1999 and on research on literature examining suicide prevention in general and prison population in particular. RESULTS: Sensitivity and specificity of VISCI are presented. CONCLUSIONS: As suicide rates in custody are higher than in the general population, and these rates have been increasing within the last 20 years, the screening of offenders newly admitted to prison for their propensity to suicide is necessary to give a better estimation of the suicide risk and hopefully to stop further increase of suicide rates in jails and prisons.

[Suicide behind bars -- an international review]. / Suizide hinter Gittern im internationalen Vergleich.

OBJECTIVE: International surveys found an increase of mentally disordered individuals in correctional institutions. As a consequence, suicides and suicide rates in jails and prisons are increasing. Mental health services and criminal justice authorities have identified this problem, but there is a lack of knowledge concerning risk factors for inmate suicides and practicable prevention. METHOD: A literature research was conducted through "medline" searching for studies addressing the problem of jail and/or prison suicide. Subsequently, results of relevant surveys were compared and depicted in several tables. RESULTS: Suicide rates in correctional facilities significantly exceed those in the general male population. Suicide rates in custody have been increasing within the last decades. Pre-trial prisoners have the highest suicide risk within the total prison population. Long-term sentences, single-cell use, mental illness, substance abuse and a history of suicidality are associated with an increased suicide risk. DISCUSSION: The impact of suicide prevention strategies and future directions of research in this high-risk setting are highlighted.

Suicide in custody: case-control study.

BACKGROUND: Few risk factors and indicators of vulnerability for suicide in custody are known so far. AIMS: A case-control study was conducted to investigate the relevance of criminal history, psychiatric morbidity and social integration to suicide in prison. METHOD: For every suicide that occurred in an Austrian correctional institution between 1975 and 1999, two controls matched for correctional institution, gender, nationality, age, custodial status and time of admission were selected. Psychiatric characteristics, previous suicidal behaviour, criminal history and indicators of social integration were compared. RESULTS: Of 250 recorded suicides, 220 personal files were available and matched to 440 controls. The most important predictors for suicide in custody were a history of suicidality (status following attempted suicide and suicide threat), psychiatric diagnosis, psychotropic medication, a highly violent index offence and single- cell accommodation. CONCLUSIONS: A significant finding is the importance of suicidal behaviour as an indicator of risk of suicide in correctional institutions, which until now has been a matter of debate. This study demonstrates the need for staff to take suicidal behaviour as seriously in custodial settings as in any other circumstances.

Do monthly or seasonal variations exist in suicides in a high-risk setting?

An unequal distribution of suicides over months and seasons has been a consistent finding in epidemiological surveys on suicide. Jails and prisons are a high-risk setting for suicide all over the world. The high prevalence of both outward and self-directed violence in prison populations indicates dysfunctional central serotonin (5-HT) neurotransmission and, therefore, could account for an unequal distribution of suicides over months and seasons due to underlying bioclimatic factors. Within a total survey of suicides in the Austrian penitentiary system, the weekly, monthly and seasonal distribution of custodial suicides between 1947 and 1999 was studied. After an explorative comparison of suicide distribution over weekdays, months and seasons of the year by chi2-tests, a harmonic Poisson regression model was performed to detect seasonality of suicides. No unequal distribution of suicides was evident over the 53-year period. A limitation of this study was its sample size of 412, a low number compared with population-based samples, where a spring suicide peak was consistently found. An explanation for lacking seasonality could be that bioclimatic factors are less relevant in urban, industrialized areas, where jails and prisons usually are located. One of the core characteristics of penal institutions is the limited possibility for communication and social interaction. This social isolation is independent of seasonal changes. If the individual's possibilities for social interactions are limited, the influence of seasonal changes in social activities may be less relevant. This could explain the absence of seasonal changes in custodial suicide incidence.

The relevance of suicidal behaviour in jail and prison suicides.

PURPOSE: Suicide rates in correctional institutions have been increasing during the last decades. There has been little interest in whether suicidal ideation and intent has been documented by non-medical prison staff (reports of attempted suicide, suicide threats, self-harm), and whether these signs of suicidality had the consequence of adequate intervention efforts. METHODS: The personal files of inmates who committed suicide in the 29 Austrian jails and prisons during the last 25 years (1975-1999) were included. We analysed personal characteristics, criminological data, circumstances of custody and information about psychiatric disorders and treatment. RESULTS: Of a total of 250 suicides, 220 personal files were available and included. Suicide attempts were known in 50% of all suicides and 37% had expressed suicidality. In >20%, non-medical staff had documented signs of suicidality, but no further preventive action (e.g. referral to psychiatric care) had taken place. CONCLUSION: Signs of suicidality play an important role in vulnerability profiles for jail and prison suicides and should have the minimal consequence of further psychiatric care.

[Psychosocial characteristics of victims of suicide in prisons]. / Psychosoziale Charakteristika von Suizidopfern in Gefängnissen.

BACKGROUND: Besides some cases reported by the media in recent years about prison inmates who committed suicide, hardly anything is known concerning social, criminological and psychiatric characteristics of suicide victims in jails and prisons in Austria. It therefore seems necessary to evaluate jail and prison suicides in order to establish effective means of prevention. METHODS: A study was conducted evaluating all suicides in Austrian prisons between 1975 and 1999. In addition to nationality, education and working status, other indicators of social integration and psychiatric history of suicide victims were studied. RESULTS: 220 personal files of 250 suicides were available. During the observation period the suicide rate of imprisoned foreigners decreased slightly (mean 106.6/100,000), whereas the suicide rate of Austrian citizens increased significantly (mean 172.0/100,000). Of all suicide victims, 41% had neither finished school nor had they any professional education. 44% were unemployed before incarceration, 50% did not work while incarcerated. A high frequency of suicidal behavior amongst suicide victims before committing suicide (49% suicide attempts, 37% suicide threats), and a high prevalence of mental disorders (37% psychopharmacological treatment, 48.6% were assessed by a psychiatrist) could be detected. CONCLUSIONS: Screening instruments should be applied which are easy to handle for prison officers and indicate the appropriate management of inmates at a high suicide risk.