Worldwide, incarcerated women are known to suffer adverse experiences that might increase the risk of suicide attempts during incarceration. The present investigation examines the prevalence of suicide attempts amongst incarcerated women in Spain and the factors associated with this. Between January and March of 2017 a total of 174 women, enrolled from two prisons in the southeast of Spain, completed anonymous self-report measures of demographic variables, penitentiary and sentence-related variables, mental distress (including depression, anxiety and stress), perceived social support, substance use (including alcohol, cannabis, cocaine, amphetamine, heroin and hallucinogens), prison victimization (property, verbal, physical and sexual victimization) and suicide attempts. Overall, 15.5 percent of women reported they had attempted suicide during their current incarceration. Compared with women who did not report suicide attempts, multivariate analysis showed that women reporting suicide attempts were more likely to report lower education levels, in-prison substance use, victimization and higher levels of mental distress. In order to prevent suicide amongst incarcerated women, victimization in all its forms, emotional distress and drug abuse in women with lower education levels should be considered highly targetable variables.
AntonyMMCoxBJEnnsMW, et al. (1998) Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment10(2): 176–181. DOI: 10.1037/1040-3590.10.2.176.
2.
BaborTHiggins-BiddleJCSaundersJBMonteiroMG (2001) AUDIT: The Alcohol Use Disorders Identification test: Guidelines for Use in Primary Care, Second Edition. Geneva: World Health Organization, Department of Mental Health and Substance Dependence. URL (accessed 21 June 2021): https://apps.who.int/iris/bitstream/handle/10665/67205/WHO_MSD_MSB_01.6a.pdf?sequence=1.
3.
BaranyiGSchollCFazelS, et al. (2019) Severe mental illness and substance use disorders in prisoners in low-income and middle-income countries: A systematic review and meta-analysis of prevalence studies. The Lancet Global Health7(4): 461–471. DOI: 10.1016/S2214-109X(18)30539-4.
BeckATResnikHLPLettieriDJ (1974) The Prediction of Suicide. Bowie, MD: Charles Press Publishers.
6.
BellCMRidleyJAOverholserJC, et al. (2018) The role of perceived burden and social support in suicide and depression. Suicide and Life-Threatening Behavior48(1): 87–94. DOI: 10.1111/sltb.12327.
7.
CallahanJLBorjaSEHerbertGL, et al. (2013) Test of the trauma outcome process assessment model: One model of individual and environmental factors to explain adjustment. Traumatology19(4): 268–279. DOI: 10.1177/1534765613476098.
8.
CallananVJDavisMS (2012) Gender differences in suicide methods. Social Psychiatry and Psychiatric Epidemiology47(6): 857–869. DOI: 10.1007/s00127-011-0393-5.
9.
Caravaca SánchezFWolffN (2016) Prevalence and predictors of sexual victimization among incarcerated men and women in Spanish prisons. Criminal Justice and Behavior43(8): 977–991. DOI: 10.1177/0093854816656895.
10.
Caravaca SánchezFWolffN (2020) Predictors of substance use among male prisoners in Spain: The role of childhood abuse and social support. Journal of the Society for Social Work and Research 11(2): 313–337. DOI: 10.1086/709752.
11.
Caravaca SánchezFAizpuruaERicarteJJ, et al. (2020) Personal, criminal and social predictors of suicide attempts in prison. Archives of Suicide Research. DOI: 10.1080/13811118.2020.1738293.
12.
CerezoAI (2017) Women in prison in Spain: The implementation of Bangkok rules to the Spanish prison legislation. European Journal on Criminal Policy and Research23(2): 133–151. DOI: 10.1007/s10610-016-9323-0.
13.
Clements-NolleKWoldenMBargmann-LoscheJ (2009) Childhood trauma and risk for past and future suicide attempts among women in prison. Women’s Health Issues19(3): 185–192. DOI: 10.1016/j.whi.2009.02.002.
DazaPNovyDMStanleyMA, et al. (2002) The depression anxiety stress scale-21: Spanish translation and validation with a Hispanic sample. Journal of Psychopathology and Behavioral Assessment24(3): 195–205. DOI: 10.1023/A:1016014818163.
16.
DeCouCRLynchSMColeTT (2017) Physical and sexual victimization predicts suicidality among women in prison: Understanding ethnic and trauma-specific domains of risk. Current Psychology36(4): 774–780. DOI: 10.1007/s12144-016-9465-8.
17.
DyeMH (2011) The gender paradox in prison suicide rates. Women and Criminal Justice21(4): 290–307. DOI: 10.1080/08974454.2011.609400.
18.
ElliottDEBjelajacPFallotRD, et al. (2005) Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women. Journal of Community Psychology33(4): 461–477. DOI: 10.1002/jcop.20063.
19.
FavrilLO’ConnorRC (2021) Distinguishing prisoners who think about suicide from those who attempt suicide. Psychological Medicine51(2): 228–235. DOI: 10.1017/s0033291719003118.
20.
FavrilLVander LaenenFVandeviverC, et al. (2017) Suicidal ideation while incarcerated: Prevalence and correlates in a large sample of male prisoners in Flanders, Belgium. International Journal of Law and Psychiatry55: 19–28. DOI: 10.1016/j.ijlp.2017.10.005.
21.
FavrilLYuRHawtonK, et al. (2020) Risk factors for self-harm in prison: A systematic review and meta-analysis. The Lancet Psychiatry7(8): 682–691. DOI: 10.1016/S2215-0366(20)30190-5.
22.
FazelSBenningR (2009) Suicides in female prisoners in England and Wales, 1978–2004. British Journal of Psychiatry194(2): 183–184. DOI: 10.1192/bjp.bp.107.046490.
23.
FazelSSeewaldK (2012) Severe mental illness in 33,588 prisoners worldwide: Systematic review and meta-regression analysis. British Journal of Psychiatry200(5): 364–373. DOI: 10.1192/bjp.bp.111.096370.
24.
FazelSRameshTHawtonK (2017a) Suicide in prisons: An international study of prevalence and contributory factors. The Lancet Psychiatry4(12): 946–952. DOI: 10.1016/S2215-0366(17)30430-3.
25.
FazelSYoonIAHayesAJ (2017b) Substance use disorders in prisoners: An updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction112(10): 1725–1739. DOI: 10.1111/add.13877.
26.
FazelSCartwrightJNorman-NottA, et al. (2008) Suicide in prisoners: A systematic review of risk factors. Journal of Clinical Psychiatry69(11): 1721–1731. DOI: 10.4088/JCP.v69n1107.
27.
FazelSHayesAJBartellasK, et al. (2016) Mental health of prisoners: Prevalence, adverse outcomes, and interventions. The Lancet Psychiatry3(9): 871–881. DOI: 10.1016/S2215-0366(16)30142-0.
28.
Federal Statistical Office of Germany (2020) International Statistics. Registered Deaths from Suicide. Wiesbaden (Germany).
29.
FreemanAMerglRKohlsE, et al. (2017) A cross-national study on gender differences in suicide intent. BMC Psychiatry17(1): 234–239. DOI: 10.1186/s12888-017-1398-8.
30.
FresánAGonzález-CastroTBPeralta-JiménezY, et al. (2015) Gender differences in socio-demographic, clinical characteristics and psychiatric diagnosis in/of suicide attempters in a Mexican population. Acta Neuropsychiatrica27(3): 182–188. DOI: 10.1017/neu.2015.6.
31.
FriestadCÅse-BenteRKjelsbergE (2014) Adverse childhood experiences among women prisoners: Relationships to suicide attempts and drug abuse. International Journal of Social Psychiatry60(1): 40–46. DOI: 10.1177/0020764012461235.
32.
García CarreteroMÁNovalbos RuizJPMartínez DelgadoJM, et al. (2016) Validation of the Alcohol Use Disorders Identification Test in university students: AUDIT and AUDIT-C. Adicciones28(4): 194–204. DOI: 10.20882/adicciones.775.
33.
GottfriedEDChristopherSC (2017) Mental disorders among criminal offenders: A review of the literature. Journal of Correctional Health Care23(3): 336–346. DOI: 10.1177/1078345817716180.
34.
GradusJLSuvakMKWiscoBE, et al. (2013) Treatment of posttraumatic stress disorder reduces suicidal ideation. Depression and Anxiety30(10): 1046–1053.
35.
GrennanSWoodhamsJ (2007) The impact of bullying and coping strategies on the psychological distress of young offenders. Psychology, Crime and Law13(5): 487–504. DOI: 10.1080/10683160601060598.
36.
HaglundATidemalmDJokinenJ, et al. (2014) Suicide after release from prison: A population-based cohort study from Sweden. Journal of Clinical Psychiatry75(10): 1047–1053. DOI: 10.4088/JCP.13m08967.
37.
HayesLM (2010) National Study of Jail Suicide. Washington, DC: U.S. Department of Justice, National Institute of Corrections. URL (accessed 21 June 2021): https://info.nicic.gov/nicrp/system/files/024308.pdf.
JenkinsRBhugraDMeltzerH, et al. (2005) Psychiatric and social aspects of suicidal behaviour in prisons. Psychological Medicine35(2): 257–269. DOI: 10.1017/S0033291704002958.
41.
JoinerT (2007) Why People Die by Suicide. Cambridge, MA: Harvard University Press.
42.
KresnowMIkedaRMMercyJA, et al. (2001) An unmatched case-control study of nearly lethal suicide attempts in Houston, Texas: Research methods and measurements. Suicide and Life-Threatening Behavior32: 7–20. DOI: 10.1521/suli.32.1.5.7.24210.
43.
KubiakSPBrennerHBybeeD, et al. (2018) Reporting sexual victimization during incarceration: Using ecological theory as a framework to inform and guide future research. Trauma, Violence, & Abuse19(1): 94–106. DOI: 10.1177/1524838016637078.
44.
LeeJJHGuilamo-RamosVMunõz-LaboyM, et al. (2016) Mechanisms of familial influence on reentry among formerly incarcerated Latino men. Social Work61(3): 199–207. DOI: 10.1093/sw/sww023.
45.
LeeseMThomasSSnowL (2006) An ecological study of factors associated with rates of self-inflicted death in prisons in England and Wales. International Journal of Law and Psychiatry29(5): 355–360. DOI: 10.1016/j.ijlp.2005.10.004.
46.
LieblingALudlowA (2016) Suicide, Distress and the Quality of Prison Life. Handbook on Prisons. London: Routledge.
47.
LovibondPFLovibondSH (1995) The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behaviour Research and Therapy33(3): 335–343. DOI: 10.1016/0005-7967(94)00075-U.
48.
MandracchiaJTSmithPN (2015) The Interpersonal Theory of Suicide applied to male prisoners. Suicide and Life-Threatening Behavior45(3): 293–301. DOI: 10.1111/sltb.12132.
49.
MarzanoLFazelSRivlinA, et al. (2010) Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: Case-control study. British Journal of Psychiatry197(3): 219–226. DOI: 10.1192/bjp.bp.109.075424.
50.
MarzanoLFazelSRivlinA, et al. (2011a) Near-lethal self-harm in women prisoners: Contributing factors and psychological processes. Journal of Forensic Psychiatry and Psychology22(6): 863–884. DOI: 10.1080/14789949.2011.617465.
51.
MarzanoLHawtonKRivlinA, et al. (2011b) Psychosocial influences on prisoner suicide: A case-control study of near-lethal self-harm in women prisoners. Social Science and Medicine72(6): 874–883. DOI: 10.1016/j.socscimed.2010.12.028.
52.
Mental Health Coordinating Council (MHCC ) (2013) Trauma-informed Care and Practice: Towards a Cultural Shift in Policy Reform Across Mental Health and Human Services in Australia, a National Strategic Direction. Position Paper and Recommendations of the National Trauma-Informed Care and Practice Advisory Working Group. Authors: Bateman J and Henderson C (MHCC), Kezelman C (Adults Surviving Child Abuse, ASCA).
53.
MillerNANajavitsLM (2012) Creating trauma-informed correctional care: A balance of goals and environment. European Journal of Psychotraumatology3(1): 17246. DOI: 10.3402/ejpt.v3i0.17246.
54.
MillerPBrookLStomskiNJ, et al. (2019) Suicide risk and social support in Australian resource sector employees: A cross-sectional study. Journal of Community Psychology47(3): 652–662. DOI: 10.1002/jcop.22145.
55.
Opitz-WelkeABennefeldt-KerstenKKonradN, et al. (2016) Prison suicide in female detainees in Germany 2000–2013. Journal of Forensic and Legal Medicine44: 68–71. DOI: 10.1016/j.jflm.2016.08.016.
56.
PrattDTarrierNDunnG, et al. (2015) Cognitive-behavioural suicide prevention for male prisoners: A pilot randomized controlled trial. Psychological Medicine45(16): 3441–3451. DOI: 10.1017/S0033291715001348.
57.
RabeK (2012) Prison structure, inmate mortality and suicide risk in Europe. International Journal of Law and Psychiatry35(3): 222–230. DOI: 10.1016/j.ijlp.2012.02.012.
58.
RequenaGCSalameroMGilF (2007) Validación del cuestionario MOS-SSS de apoyo social en pacientes con cáncer. Medicina Clinica128(18): 687–691. DOI: 10.1157/13102357.
59.
ReskoSMKruman MountainSBrowneS, et al. (2018) Suicidal ideation and suicide attempts among women seeking treatment for substance use and trauma symptoms. Health & Social Work43(2): 76–83. DOI: 10.1093/hsw/hly004.
60.
RichieFJBonnerJWittenbornA, et al. (2021) Social support and suicidal ideation among prisoners with major depressive disorder. Archives of Suicide Research25(1): 107–114. DOI: 10.1080/13811118.2019.1649773.
61.
RivlinAHawtonKMarzanoL, et al. (2013) Psychosocial characteristics and social networks of suicidal prisoners: Towards a model of suicidal. PLoS ONE8(7): e68944. DOI: 10.1371/journal.pone.0068944.
62.
Rodríguez-MartínezARuiz-RodríguezFAntón-BasantaJJ, et al. (2010) Do drug using inmates have social support? A case study in an Andalusian prison. Revista Española de Sanidad Penitenciaria12(1): 13–20. DOI: 10.4321/s1575-06202010000100002.
63.
SánchezFCFearnNVaughnMG (2018a) Prevalence and correlates of in-prison substance use among incarcerated women in Spain. Journal of Ethnicity in Substance Abuse17(3): 356–374. DOI: 10.1080/15332640.2016.1255579.
64.
SánchezFCFearnNVaughnMG (2018b) Risk factors associated with near-lethal suicide attempts during incarceration among men in the Spanish prison system. International Journal of Offender Therapy and Comparative Criminology62(6): 1452–1473. DOI: 10.1177/0306624X16689833.
65.
ShawJBakerDHuntIM, et al. (2004) Suicide by prisoners: National clinical survey. British Journal of Psychiatry184(3): 263–267. DOI: 10.1192/bjp.184.3.263.
66.
SherbourneCDStewartAL (1991) The MOS social support survey. Social Science and Medicine32(6): 705–714. DOI: 10.1016/0277-9536(91)90150-B.
Staton-TindallMRoyseDLeukfeldC (2007) Substance use, criminality, and social support: An exploratory analysis with incarcerated women. American Journal of Drug and Alcohol Abuse33(2): 237–243. DOI: 10.1080/00952990601174865.
69.
SteinerBEllisonJMButlerHD, et al. (2017) The impact of inmate and prison characteristics on prisoner victimization. Trauma, Violence, and Abuse18(1): 17–36. DOI: 10.1177/1524838015588503.
70.
TripodiSJPettus-DavisC (2013) Histories of childhood victimization and subsequent mental health problems, substance use, and sexual victimization for a sample of incarcerated women in the US. International Journal of Law and Psychiatry36(1): 30–40. DOI: 10.1016/j.ijlp.2012.11.005.
71.
TugnoliC (2016) Predictors of Internalizing Symptoms among a Sample of Female Ex-inmates with History of Trauma and Substance Use. ProQuest Dissertations and Theses.
72.
Van OrdenKAWitteTKCukrowiczKC, et al. (2010) The interpersonal theory of suicide. Psychological Review117(2): 575–600. DOI: 10.1037/a0018697.
73.
WalshKGonsalvesVMScaloraMJ, et al. (2012) Child maltreatment histories among female inmates reporting inmate on inmate sexual victimization in prison: The mediating role of emotion dysregulation. Journal of Interpersonal Violence27(3): 492–512. DOI: 10.1177/0886260511421670.
74.
WolffNShiJSiegelJA (2009) Patterns of victimization among male and female inmates: Evidence of an enduring legacy. Violence and Victims24(4): 469–484. DOI: 10.1891/0886-6708.24.4.469.
75.
ZhongSSeniorMYuR, et al. (2021) Risk factors for suicide in prisons: A systematic review and meta-analysis. The Lancet Public Health6(3): 164–174. DOI: 10.1016/S2468-2667(20)30233-4.
76.
ZlodreJFazelS (2012) All-cause and external mortality in released prisoners: Systematic review and meta-analysis. American Journal of Public Health102(12): 67–75. DOI: 10.2105/AJPH.2012.300764.
77.
ZweigJMYahnerJVisherCA, et al. (2015) Using general strain theory to explore the effects of prison victimization experiences on later offending and substance use. The Prison Journal95(1): 84–113. DOI: 10.1177/0032885514563283.
