Etude sur le profil des patients en crise suicidaire dans le cadre de la détention avant jugement

Abstract

Introduction: Suicide is over-represented in the Swiss prison population. A better understanding of the profile of inmates in suicidal crisis is therefore essential in order to improve the identification of persons at risk and to propose a more adapted management. The aim of the present study is to analyze the clinical and sociodemographic profile of inmates in suicidal crisis and to compare it to that of non-suicidal inmates, with the hypothesis that it is different between the two groups. We also hypothesized that the majority of inmates in suicidal crisis presented elements indicative of such a crisis before their incarceration. Methods: This was an epidemiological, case-control, analytical study including 70 male patients between the ages of 18 and 67, incarcerated in pretrial detention but not convicted. The study was conducted between June 2011 and January 2012 in the Vaud pre-trial detention prisons. The “case” group included 34 inmates who presented a suicidal crisis during the first three months of incarceration, whereas the “control” group was composed of 36 inmates encountered during the same period, who did not present a suicidal crisis during the first 3 months of their detention. Data collection was done in the form of a semi-structured interview including an anamnestic record and a study of the medical file. Current psychiatric diagnoses were investigated using the Mini International Neuropsychiatric Interview (MINI) and the International Classification of Mental Disorders and Behavioral Disorders (ICD-10). The clinical assessment of suicidal behavior was carried out using the “RUD” (Risk, Urgency, Danger) scale and specific questionnaires on suicidal crisis. Life events were assessed using the Life Events Interview. Results: Results show that the profile of suicidal crisis patients in pretrial detention differed from that of the control group, primarily clinically, with significant associations for mood disorders, adjustment disorders, personal psychiatric history, and history of childhood sexual abuse. All patients in the crisis group had risk factors, but only one-third were already in suicidal crisis before incarceration. Social factors were similar in both groups. Conclusion: On the basis of these observations, we can only emphasize the importance of managing patients with risk factors from the beginning of incarceration, in order to prevent the occurrence of a suicidal crisis. This highlights the importance of re-evaluating the resources available in prisons, both for the initial assessment and for the implementation of appropriate management.