Suicidal Ideation in a U.S. Jail: Demographic and Psychiatric Correlates and a Test of Baumeister's Escape Theory

Karen Schaefer

Major Professor: Christianne Esposito-Smythers, PhD, Department of Psychology

Committee Members: June Tangney, David Wilson

David King Hall, #2013
June 25, 2014, 11:00 AM to 08:00 AM

Abstract:

The purpose of this dissertation project was to examine socio-demographic and psychiatric correlates of suicidal ideation (SI) upon incarceration, and predictors of the development/maintenance of SI in a U.S. jail sample. First, given that only one paper has examined the rate of SI in a jail sample (and only with males), the first study examined the prevalence of SI in a U.S. jail sample that includes both sexes. Additionally, it examined socio-demographic and psychiatric risk factors (psychiatric diagnosis and suicide attempt history) found to be associated with SI in prison and community populations, but not yet examined in jail samples. Participants were 511 jail inmates (68% male, 43% Black , 36% White, 10% Latino, 3% Asian, 4% “Mixed,” 4% “Other”, range 18-72, M = 32.19 years, SD = 10.05) serving greater than a 4-month term or being held on a felony charge at a suburban jail. SI was assessed using the suicidality scale of the Personality Assessment Inventory. Socio-demographic variables were assessed via participant self-report. Psychiatric history was assessed using the Hare Psychopathy Checklist: Screening Version. Approximately 16% of participants reported clinically significant SI upon incarceration. Participants who were White (vs. Black), reported a prior psychiatric diagnosis, and/or endorsed a suicide attempt history reported greater SI. Degree of SI did not differ by sex or age. Overall, results indicate that: 1) rates of clinically significant SI in U.S. jails are lower than that found in prison samples; and 2) White inmates and those with a significant psychiatric history (psychiatric diagnosis and/or suicide attempt) may be more likely to report SI upon incarceration in a U.S. jail. Given that SI is one the strongest predictors of future suicide attempts, thorough mental health screenings upon incarceration may help to identify inmates at risk for suicidal behavior during incarceration.

The purpose of the second study was to test Baumeister’s escape theory of suicide as it applies to the development and/or maintenance of SI over the course of incarceration in a U.S. jail sample. According to this theory, suicide is motivated by an attempt to escape from negative self-awareness caused by stressors or setbacks that are attributed to oneself. Baumeister posits that suicidal individuals progress through six stages following negative life stress, which increasingly heighten a wish for permanent escape or death. These stages include shame and/or guilt, low self-esteem, anxiety and/or depression, hopelessness, disinhibition, and SI. This second study tests this theory in a sample of inmates recently exposed to the stress of arrest and incarceration, and also examines whether results vary by socio-demographics or psychiatric history. Participants were the same jail inmates described in the first study. All participants completed the well-validated Personality Assessment Inventory, Test of Self-Conscious Affect-Socially Deviant, Rosenberg Self-Esteem Scale, Values in Action scales, and the suicidality subscale of the Personality Assessment Inventory at the baseline assessment, which occurred shortly after incarceration. Two hundred thirty-one participants also completed the measure of SI again at pre-release/transfer (on average seven months after baseline assessment). Results indicated that each of the stages (or clinical risk factors) included in the escape theory of suicide, with the exception of guilt, were significantly correlated with SI over the course of incarceration. However, they did not fully mediate one another, as proposed in the escape model of suicide, resulting in poor model fit.

An exploratory model developed from theory, prior research, and model fit indices was then developed and tested. Guilt was removed from this model and nine paths were added (stress to depression, anxiety, and self-esteem; shame to depression, anxiety and hope; self-esteem to hope; and anxiety and depression to SI). This model provided excellent fit for the data. All pathways were significant except anxiety to hope, depression to hope, hope to SI, and depression to SI. Notably, this exploratory model fit equally well across race (White vs. Black), age, and the presence (versus absence) of a suicide attempt history. However, the model varied across sex and psychiatric treatment history. Specifically, while anxiety (but not hope and depression) was significantly related to SI in the overall sample model and for females, it was not significantly related to SI for males. Instead, depression was significantly related to lower hope and to SI for males. Among those with a history of psychiatric treatment, none of the paths directly leading to SI were significant. However, among those without a psychiatric treatment history, the paths from shame to hope and from depression to SI were significant. Study findings suggest that Baumeister’s fully meditational escape model of suicide may not explain the development and/or maintenance of SI in a U.S. jail sample. However, clinical risk factors for SI included in this theory are important to assess for upon incarceration. Inmates who experience high levels of these clinical risk factors upon incarceration may be at heightened risk for experiencing SI during incarceration.

Overall, results of both studies suggest that early screening for SI and clinical risk factors in jail samples is indicated. Those who are White and endorse a psychiatric diagnosis or attempt history may be most likely to report SI upon incarceration. Further, those who report heightened stress, shame (but not guilt), low self-esteem, depression, anxiety, and low hope may be at risk for developing and/or maintaining SI over the course of incarceration. Early assessment of these risk factors and clinical intervention as needed could help prevent future suicidal thoughts and behaviors in this population.