Forensic investigation of suicide cases in major Greek correctional facilities.

INTRODUCTION: According to Greek legislation the medico-legal investigation of deaths occurring in prisons is mandatory. Furthermore, in cases of suicide or of suspected suicide the contribution of medico-legal investigation is of grave importance. The current paper addresses the medico-legal investigation of suicide cases in Greek correctional facilities and aims to describe the current situation. MATERIALS & METHODS: Our study consists of the meticulous research in the data records of major Greek correctional facilities, for the time period 1999-2010. Official permission was obtained by the Hellenic Ministry of Justice, which provided us the access to the records. Data was also collected from the Piraeus Forensic Service, from the Department of Pathological Anatomy of the University of Athens and finally from our own records. Measures were taken to respect the anonymity of the cases. Data was collected for the social, penal, medical history as well as for the medico-legal investigation. RESULTS-CONCLUSIONS: It appears that 85.7% of suicide cases were transferred to the Prisoner's Hospital (p < 0.0001), the forensic pathologist who conducted the PME did not perform scene investigation in none of the 70 suicide cases. In a total of 70 cases, histopathological examination, was requested only in 30 cases (42.9%). Hanging was the preferred method for those who committed suicide, followed by the poisoning due to psychoactive substances. Understanding the mistakes made during the forensic investigation of suicide cases inside correctional facilities is necessary, in order to prevent them from occurring again in the future, by implementing appropriate new policies and guidelines.

The social profile of victims of suicide in major Greek correctional facilities.

INTRODUCTION: Suicide rates in correctional institutions have been increasing during the last decades. The reasons for this increase remain unclear, yet a lot of contradictory explanations were stated: the increase might be due to mass incarceration and overcrowding of small cells resulting in high psychosocial stress, changes in psychiatric health policy which might have transferred the care for patients from mental hospitals to custodial institutions, or legislation changes that might have led to a selection of offenders at higher risk (e.g. offenders who committed high violent offences or suffered from mental disorders without being referred to psychiatric hospitals). In Greece the situation is not described in details, at least during the last few years. By law, every death of prisoner is subject to medicolegal investigation. MATERIALS & METHODS: Our study consists of the meticulous research of the data records of major Greek correctional facilities, for the time period 1999-2010. An official permission was obtained from the Hellenic Ministry of Justice, which gave us access to these restricted records. Data was also collected from the Piraeus Forensic Service, from the Department of Pathological Anatomy of the University of Athens and finally from our own records. Measures were taken to respect the anonymity of the cases. Data was collected for the social, penal, medical history as well as for the medicolegal investigation. RESULTS - CONCLUSIONS: A total of 339 cases were collected, only 259 of which had available full data records, due to weaknesses in the prison records. From the 259 cases, 70 incidents of suicide were collected. Victims of suicide in major Greek correctional facilities, appear to fulfill the expected profile, as in the general population.

Self-injurious behavior among Greek male prisoners: prevalence and risk factors.

BACKGROUND: Self-harm among prisoners is a common phenomenon. This study aims to estimate the prevalence of self-injurious behavior (SIB) among Greek male prisoners, record their motives and determine independent risk factors. METHODS: A self-administered, anonymous questionnaire was administered to 173 male prisoners in the Chalkida prison, Greece. The questionnaire included items on self-harm/SIB, demographic parameters, childhood history, family history, physical and mental disease, lifestyle and smoking habits, alcohol dependence (CAGE questionnaire), illicit substance use, aggression (Buss-Perry Aggression Questionnaire [BPAQ] and Lifetime History of Aggression [LTHA]), impulsivity (Barrat Impulsivity Scale-11) and suicidal ideation (Spectrum of Suicidal Behavior Scale). Univariate nonparametric statistics and multivariate ordinal logistic regression were performed. RESULTS: Of all the participants, 49.4% (95% CI: 41.5-57.3%) disclosed self-harm (direct or indirect). The prevalence of SIB was equal to 34.8% (95% CI: 27.5-42.6%). Most frequently, SIB coexisted with indirect self-harm (80.7%). The most common underlying motives were to obtain emotional release (31.6%) and to release anger (21.1%). At the univariate analysis, SIB was positively associated with a host of closely related factors: low education, physical/sexual abuse in childhood, parental neglect, parental divorce, alcoholism in family, psychiatric condition in family, recidivism, age, sentence already served, impulsivity, aggression, alcohol dependence, self-reported diagnosed psychiatric condition and illicit substance use. Childhood variables were particularly associated with the presence of diagnosed psychiatric condition. At the multivariate analysis, however, only three parameters were proven independent risk factors: self-reported diagnosed psychiatric condition, illicit substance use and aggression (BPAQ scale). CONCLUSION: The prevalence of SIB is particularly high. Psychiatric condition, illicit substance use and aggression seem to be the most meaningful risk factors; childhood events seem only to act indirectly.

Health care provision in prisons: a review on European and international guidelines.

Health care provision in prisons is an area of increasing international concern. The spectrum of health problems which prisoners may bring to prison is wide and in many cases prevalence is greater than in the general population.The profound knowledge of delicate issues such as medical confidentiality and informed consent of the patient, with special refer to infectious disease, hunger strike and prison research is necessary in the prison working environment. In the following paragraphs the European and International conventions and guidelines on the matter are discussed.