Suicides among prison inmates in Sri Lanka: prevalence and associated factors of suicidal behavior

Introduction: The suicidal rates in prison institutions are five times higher compared to the general population. Studies has found out that psychological distress among prison inmates has significant association with the suicidal behaviour. Aim: The objective of this study was to determine the prevalence and associated factors of suicidal bahaviour. Methods: An institutional based cross-sectional analytical study was carried out among 1730 study participants selected using multistage stratified cluster sampling in island-wide prison institutions. The prevalence of suicidal behaviour was assessed using the validated SBQ-R. Associated factors of suicidal behaviour was determined by multivariate analysis. Results: According to the SBQ-R the prevalence of suicidal behaviour among prison inmates was 22.7% (95% CI 20.7% – 24.7%). There was a significant association between psychological distress and suicidal behaviour among study participants identified in the multivariate analysis (AOR=1.58, 95% CI 1.20-2.10). Younger age (AOR=2.09, 95% CI 1.33-3.30), female sex (AOR=1.31, 95% CI 1.00-1.71), number of court cases (AOR=1.97, 95% CI 1.50-2.59), feeling of missing the family (AOR=0.52, 95% CI 0.35-0.76), violence at home during childhood (AOR=1.82, 95% CI 1.35-2.44), being neglected during childhood (AOR=1.61, 95% CI 1.11-2.33), witness a suicide (AOR=1.37, 95% CI 1.05-1.78), serious financial issue (AOR=1.35, 95% CI 1.05-1.74) recent change in prison (AOR= 0.73, 95% CI 0.56-0.94) and stigmatized for being imprisoned (AOR=1.82, 95% CI 1.37-2.42) were significantly associated with suicidal behviour in multivariate analysis. Conclusion: A structured screening programme to identify suicidal behaviour among prison inmates should be conducted with improved mental health facilities within prison institutions. A mandatory mental health module should be carried out for all prison inmates focusing on coping strategies on psychological distress and mental health promotion