Investigating Chronic and Physical Conditions as a Risk Factor for Selfharm in Correctional Settings

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1 Investigating Chronic and Physical Conditions as a Risk Factor for Selfharm in Correctional Settings Asher Turney, MD, MBA, MSPH, CCHP 1, Kenneth Williams, MD, PhD 2, Michelle Staples-Horne, MD, MPH, MS 3, Robert Bradford, MHSA 1, Benjamin Ansa, MD 4 & Madison L Gates, PhD 4 1 Centurion, LLC; 2 Tennessee Department of Corrections; 3 Georgia Department of Juvenile Justice; 4 Augusta University

2 Introduction Suicide attempts greater in corrections compared to general population Risk of suicide attempts strongly associated with mental health disorders Association with chronic/physical conditions less established Aim: Identify chronic/physical conditions associated with suicide attempts

3 Methods Identified chronic/physical conditions potentially associated with suicide attempts (literature) Data source Kentucky Department of Corrections Included total population Analyses performed for men only (15 women attempted suicide) Created mutually exclusive groups: Chronic/physical health conditions, but no mental health disorders Patients with only one mental health disorder and no diagnosed chronic/physical conditions Identified health conditions significantly associated with suicide attempts (univariate analysis, logistic regression)

4 Percent Demographics Total population (N = 14769) African American White Men Women Minimum/ Medium Maximum Term limited Life Death Race * Gender * Class * Sentence * significant Total population Suicide attempts

5 Musculoskeletal Respiratory Total population (N = 14769) Arthritis Fractures Osteoporosis Allergy Asthma Respiratory diseases Tuberculosis

6 Neurological CVD Total population (N = 14769) Epilepsy Headache/migraine Pain Sleep disorders CVD Hypertension

7 Metabolic GI/Skin Total population (N = 14769) Diabetes Dyslipidemia Renal diseases Thyroid Gall bladder disorders GI Liver disorders Ulcer Skin disorders

8 Mental health disorders Total population (N = 14769) Anxiety Bipolar Depression Psychotic disorders

9 Percent Significant conditions entered into model Population: Men, 38.2 years old (N = 13463) Suicide attempt history No Yes

10 Suicide attempts (%) Suicide attempts Race Population: Men attempting suicide, 36.7 years old (n = 473) Age category > 65 (n= 54) (n= 3598) (n= 4302) (n= 3239) (n= 1608) (n= 337) (n= 325) Total population African American White

11 Suicide attempts (%) Suicide attempts security classification Population: Men attempting suicide (n = 473) Age category > 65 (n= 54) (n= 3598) (n= 4302) (n= 3239) (n= 1608) (n= 337) (n= 325) Total population Non-maximum Maximum

12 Odds ratios (logistic regression) Population: Men (N = 7076) Asthma CVD Dyslipidemia* Epilepsy* Fractures Pain* Skin disorders Ulcers < 20 vs < 30 s 20 s vs 30 s 40 s vs 30 s 50 s vs 30 s > 60 vs 30 s African American vs White Anxiety* Bipolar* Depression* Psychotic disorders* * significant

13 How discriminating is our model? Population: Men (N = 7076) Key: Sensitivity = true positives 1 Specificity = false positives

14 Implications & Next steps Evaluate suicide risk more broadly than mental health Examine screening practices Chronic diseases may provide red flags for managing suicide risk Risk factors and high risk groups may be different for our confined population compared to community Further investigations into maximum security classification Is impact of isolation age dependents (safer for younger, stressful for older or reverse)? What is relationship between sentence type and suicide attempts? Does association between pain and suicide attempts differ by acute or chronic?

15 Questions, comments, and suggestions Asher Turney, MD, MBA, MSPH, CCHP 1, Kenneth Williams, MD 2, Michelle Staples- Horne, MD, MPH, MS 3, Robert Bradford, MHSA 1, Benjamin Ansa, MD 4 & Madison L Gates, PhD 4 1 Centurion, LLC; 2 Tennessee Department of Corrections; 3 Georgia Department of Juvenile Justice; 4 Augusta University

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