Investigating Suicidal Thinking in Men in Prison

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investigating-suicidal-thinking-in-men-in-prison_medium_smallThe Question
What factors contribute to suicidal thinking in men serving time in prison?

Background
The Interpersonal Theory of Suicide developed by Thomas Joiner and colleagues provides a framework for understanding suicidal behavior and developing interventions. This theory suggests that a person’s risk for suicidal behavior increases when three factors converge: one, their efforts to belong are unsuccessful; two, they feel they are a burden on others, and three, the person has developed a capability for suicide and pain tolerance after exposure to adversity, such as abuse.  A combination of contributors, such as mental health conditions, chronic pain, and genetics, can set the backdrop for these feelings. This theory and the three associated factors—thwarted belongingness, perceived burden, capability for suicidal behavior—have been tested in many groups and in many places, but until Dr. John Mandracchia’s work, the theory had yet to be studied in the prison population. Testing theories across multiple demographics and settings is critical to refining the theory and determining its applicability, and since suicide risk is high in prisoners, understanding the underlying dynamics could inform suicide interventions. For this study, Dr. Mandracchia earned AFSP’s Young Investigator Research Award.

The Study
The investigators surveyed inmates in a state prison and a regional facility in Mississippi. The questionnaires included the Acquired Capability for Suicide Scale (ACSS), the Interpersonal Needs Questionnaire (INQ), the Beck Scale for Suicidal Ideation (BSSI), the Center for Epidemiological Studies-Depression Scale (CES-D), the Depression, Hopelessness, and Suicide Screening Form – Hopelessness Scale (DHS-H), and the Painful and Provocative Life Events Scale (PPES).

Results

  • 399 men ages 19-69 responded. 55 percent of the participants were African American, 35 percent were Caucasian, and over 75 percent had a high school diploma, GED or above.
  • Over 12 percent reported a history of suicide attempts, and mild to moderate depression was often present.
  • In the Acquired Capability for Suicide Scale, three factors emerged that contribute to capability: General Fearlessness & Perceived Pain Tolerance, Fearlessness of Death, and Spectator Enjoyment of Violence.
  • Depression, suicidal ideation, and negative life events are all related to capability for suicide.
  • Past Attempt history was not associated with capability for suicide.
  • Depression and hopelessness was associated with current suicidal ideation.
  • For those who experienced thwarted belongingness, feeling like a burden was associated with suicidal ideation.

Takeaway
The investigators found that, in the context of depression and hopelessness, two of the three factors in the Interpersonal Theory of Suicide, thwarted belongingness and perceived burden, applied to suicidal thinking in men in prison. Acquired capability for suicide was found to be associated with depression, suicidal ideation and painful life experiences, though the role of acquired capability needs more investigation. Taken together this study highlights the complicated mix of feelings and experiences that relate to suicidal ideation and that family and friends may not always see what a suicidal person feels.

Publications from AFSP grant

  • Mandracchia, JT, Smith, PN. The Interpersonal Theory of Suicide Applied to Male Prisoners. Suicide and Life-Threatening Behavior,(2014),  DOI: 10.1111/sltb.12132
  • Smith PH, Wolford-Clevenger, C. Mandracchia, JT, Jahn, DR. An Exploratory Factor Analysis of the Acquired Capability for Suicide Scale in Male Prison Inmates. Psychological Services, 2013, Vol. 10, No. 1, 97–105 1541-1559/13/$12.00 DOI: 10.1037/a0030817

Dr. Mandracchia is an Assistant Professor at the University of Southern Mississippi. Click here to read about Dr. Mandracchia’s Young Investigator Grant.

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