Early Childhood Adversity, Sex Offender Status, and Other Related Predictors of Suicidality in a Forensic Mental Health Sample

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Individuals in the forensic mental health system who have experienced adverse childhood experiences (ACEs) are more likely to display suicidal ideation and engage in suicidal or non-suicidal self-injurious behavior. Additionally, prior research suggests that sex offender status may be disproportionately associated with increased suicidality. The current study explores risk correlates in those at heightened risk of suicidality and self-harm due to involvement with the criminal justice system, the presence of serious mental illness, and exposure to ACEs.

Initial ACEs research explored the impact of self-reported physical, sexual, and emotional abuse, emotional and physical neglect, and household dysfunction on long term adult mental and physical health outcomes. While the ACE survey is a strong determinant of possible later adulthood adversity in samples with a range of exposure to adversity, it may be less helpful in criminal justice and forensic populations who experience disproportionate exposure to ACEs. Other risk correlates above and beyond those identified in the ACE survey may influence suicidality and self-harm and are yet to be explored. Here, outcomes included history of suicide attempts, age at first suicide attempt, and if 1st psychiatric hospitalization resulted from attempting suicide. Predictors included gender, total ACE score, out of home placements, status as a violent or sexual offender, mental health diagnoses, multiple sexual perpetrators against female participants, and cause of parental incarceration.

Participants were 182 forensic inpatients in a maximum and intermediate security state hospital. The majority were male (81%; n = 147), with ethnicity nearly evenly distributed between Caucasian (56%; n = 101) and African-American (40%; n = 73), with few of Hispanic (2%; n = 4) or mixed ethnic (2%; n = 4) origins. Participants were, on average, 32.5 years of age (SD = 11.6, range 10-61). Most presented with a psychotic disorder (59.90%, n = 109), while other most frequent diagnoses included intellectual disability/cognitive developmental disorders (57.70%, n =1 05), a mood disorder (45.60%, n = 83), and impulse control disorders (22.5%, n = 41). Thirty-seven participants reported an ACE score of 0 (20.6%), 36 an ACE score of 1 (20. %), 32 an ACE score of 2 (17.8%), and 17 an ACE score of 3 (9.4%). Fifty-eight patients presented with an ACE score of 4+ (33%). Mean gender differences were significant (χ2 = 25.9, df = 8, p < .001), with the modal ACE score among female participants at 7, at a rate of nearly 23%. Of note, 29 (15.9%) had previous arrests for sexual offenses, and 79 (42.7%) were arrested for non-sexual violent offenses. Those remaining had engaged in these behaviors but were not arrested.

In order to evaluate the impact of our predictor variables on the relationship between ACE score and likelihood of an individual making a suicide attempt, a single predictor logistic model will be fitted to the data. History of suicide attempts included 96 participants (52.7%) having made an attempt. Because it is likely that ACE score alone will not explain the relationship between suicide attempts in a sample with such elevated ACE scores, additional predictors will be included in a multiple predictor logistic model, including status as a sexual offender. Similar analyses will examine the impact of ACEs, sex offender status, and other related variables on the likelihood that first psychiatric hospitalization resulted from suicidality. A one-way between subjects ANOVA will be conducted to compare the effect of an ACE score of four or more on the age at first suicide attempt. We will additionally examine the impact of sex offender vs. violent vs. other offense status on age at first suicide attempt.


Atlanta, GA

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