Effectiveness of a psycho-educational intervention for people with suicidal conduct in the prison environment, N’viu project: a randomized control trial
Background: Suicide rates are higher in the prison environment than in the general population. Prevention involves strategies to promote mental health, early diagnosis, treatment and identification of precipitating factors. The aim of this study is to evaluate the effectiveness of a psychoeducational group intervention performed by rehabilitation professionals to decrease the number of suicidal behaviors in the penitentiary environment.
Methods: This study has been designed as a multicentric, randomized, two parallel-group, controlled trial. The study population will be male and female inmates of nine prisons of Catalonia (Spain). The primary outcome will be the total number of suicidal behaviours for 12 months of follow-up. Secondary outcomes will be suicide risk evaluated with the international neuropsychiatric interview (MINI); the severity of suicidal ideations assessed with the Columbia-suicide severity rating scale (C-SSRS), the presence of depressive and anxiety symptoms [Hamilton depression rating scale (HDRS) and Hamilton anxiety rating scale (HARS)] and health-related quality of life (EQ-5D). Other variables will be clinical and socio-demographic. Intervention will consist of 17 psychoeducation sessions for the intervention group and information on suicide for the control group.
Conclusions: This project aims to assess the effectiveness of a psycho-educational intervention on reducing the number of suicidal behaviours in the prison environment. If positive, the prison community will have a new tool to curb suicide in prisons.
Trial registration: The trial was registered on clinicalTrials.gov on 19 January 2022 (NCT05195554).
Suicide worldwide in 2019: global health estimates. Geneva: World Health Organization; 2021. Available at: https://www.who.int/teams/mental-health-and-substance-use/data-research/suicide-data. Accessed 10 December 2021.
Ministerio del Interior. Mortalidad en Instituciones Penitenciària s (II.PP.) Año 2017. Boletín epidemiológico de Instituciones Penitenciària. 2019;24(2).
Generalitat de Catalunya. Statistical Institute of Catalonia. Available at: https://www.idescat.cat. Accessed 10 December 2021.
Department of Justice. Penitentiary services. Statistics data 2018. Available at: http://justicia.gencat.cat/ca/departament/Estadistiques/serveis_penitenciaris. Accessed 10 December 2021.
Zhong S, Senior M, Yu R, Perry A, Hawton K, Shaw J, Fazel S. Risk factors for suicide in prisons: a systematic review and meta-analysis. Lancet Public Health. 2021;6(3):e164-74.
WHO. Preventing suicide in jails and prisons, 2007. Available at: https://apps.who.int/iris/handle/10665/. Accessed 10 December 2021.
Cramer RJ, Wechsler HJ, Miller SL, Yenne E. Suicide Prevention in Correctional settings: Current Standards and Recommendations for Research, Prevention, and Training. J Correct Health Care. 2017;23(3):313-28.
Chan A-W, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin J et al. SPIRIT 2013 Explanation and Elaboration: Guidance for protocols of clinical trials. BMJ. 2013;346:e7586.
Ferrando L, Bobes J, Gibert M, Soto M, Soto O. Mini International Neuropsychiatric Interview. Versión en español 5.0.0.DSM-IV. Instituto IAP, Madrid, 1998;1-28.
Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168(12):1266-77.
Al-Hálabí S, Sáiza PA, Burón P, Garrido M, Benabarre A, Jiménez E et al. Validation of a Spanish version of the Columbia-Suicide Severity Rating Scale (C-SSRS). Rev Psiquiatr Salud Ment (Barc). 2016;9(3):134-42.
Bobes J, Bulbena A, Luque A, Dal-Ré R, Ballesteros J, Ibarra N; Grupo de Validación en Español de Escalas Psicométricas. A comparative psychometric study of the Spanish versions with 6, 17, and 21 items of the Hamilton Depression Rating Scale. Med Clin (Barc). 2003;120(18):693-700.
Lobo, A, Chamorro L, Luque A, Dal-Ré R, Badia X, Baró E. Validation of the Spanish versions of the Montgomery-Asberg Depression and Hamilton Anxiety rating scales. Med Clin (Barc). 2002;118:493-9.
Badia X, Shiaffino A, Alonso A, Herdman M. Using the EuroQoL5-D in the Catalan general population: Feasibility and construct validity. Qual Life Res. 1998;7:311-22.
Pratt D, Tarrier N, Dunn G, Awenat Y, Shaw J, Ulph F, Gooding P. Cognitive- behavioural suicide prevention for male prisoners: a pilot randomized controlled trial. Psychol Med. 2015;45(16):3441-51.
Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care. 1989;27(S3):S178-89.
Leidenfrost CM, Schoelerman RM, Maher M, Antonius D. The development and efficacy of a group intervention program for individuals with serious mental illness in jail. Int J Law Psychiatry. 2017;54:98-106.
Winicov N. A systematic review of behavioral health interventions for suicidal and self-harming individuals in prisons and jails. Heliyon. 2019;5(9):e02379.
Johnson JE, Stout RL, Miller TR, Zlotnick C, Cerbo LA, Andrade JT et al. Randomized cost-effectiveness trial of group interpersonal psychotherapy (IPT) for prisoners with major depression. J Consult Clin Psychol. 2019;87(4):392-406.
Eck M, Scouflaire T, Debien C, Amad A, Sannier O, Chan Chee C et al. Suicide in prison: Epidemiology and prevention. Presse Medicale. 2019;48(1):46-54.