By Carolyn Crist

(Reuters Health) – Teens and young men in correctional facilities are at increased risk of dying by suicide, but they are otherwise fairly similar to unincarcerated youth who take their own lives, a U.S. study suggests.

Looking at a nationally-representative sample of all suicides by boys and men aged 10-24 years over a decade, one of the few differences researchers noted was that jailed youth were most likely to die within the first seven days of incarceration.

That suggests screening these youth for suicide risk factors at intake and monitoring them for signs of suicidal intent might reduce deaths, the authors conclude in the Journal of the American Academy of Child & Adolescent Psychiatry.

“Suicide prevention efforts for incarcerated youth should focus on timely and ongoing suicide risk assessment and safety planning,” said lead study author Donna Ruch of the Center for Suicide Prevention and Research at Nationwide Children’s Hospital in Columbus, Ohio.

From 2000 to 2014, suicide rates were two to three times higher for youth in custody than those in the general population, with more youth in confinement dying by suicide than any other reported cause of death, Ruch’s team notes.

In general, suicide is the second leading cause of death among youth ages 10-24, according to the Centers for Disease Control and Prevention.

“The National Action Alliance for Suicide Prevention has also identified youth in custody as high-risk individuals for suicide and established a strategic goal to reduce suicidal behavior in this population,” Ruch told Reuters Health by email.

The researchers analyzed the characteristics and circumstances around 10,000 suicides among young men ages 10-24 between 2003 and 2012, including 213 incarcerated youth who were in a short-term juvenile detention center, long-term juvenile correctional facility, adult jail or adult prison. The study team used the National Violent Death Reporting System, which captures and links violent death data from multiple reports by coroners, medical examiners and law enforcement.

Overall, the majority of suicides in and out of incarceration were white males, aged 20-24. But suicides among black youth were significantly more likely to take place in custody.

In addition, those who were incarcerated were more likely to die by hanging, strangulation or suffocation and less likely to die by firearms than those not incarcerated. The youth in custody were also more likely than unincarcerated peers to disclose their reason for suicide, leave a note, or show depressive symptoms leading up to the suicide.

About 37 percent of all youth who died by suicide had a documented mental health problem, the study also found. In general, risk factors for suicide, such as a history of suicide attempts, a history of mental health conditions and drug or alcohol use, were not significantly different between those who were in custody and not in custody.

This could mean unique aspects of the incarceration environment may be associated with a higher risk of suicide, the study authors note.

Based on a few case studies, they also found that one third of these suicides in custody occur within 24 hours of incarceration, and 76 percent within seven days of incarceration.

“This may be due to many factors, including the shock of the incarceration, aggravating the already fragile state of the youth,” said Madhav Bhatta of Kent State University in Ohio, who wasn’t involved in the study.

“Correctional facilities need better ways to screen youths in their custody for potential suicide risk, especially at intake and early incarceration,” Bhatta said in an email.

Ruch’s team is planning a follow-up study to identify the best screening tools to detect suicide risk in the criminal justice system and the most effective way to administer these assessments.

Correctional facilities may also consider computer adaptive testing for suicide assessments, which changes the questions based on the respondent’s prior answers and can adapt over time if given multiple times, said Karen Abram of Northwestern University Feinberg School of Medicine in Chicago, who also wasn’t involved in the study.

“Youth suicide is a preventable public health problem,” she said in an email. “Suicide prevention training for staff is critical, especially training to recognize warning signs for suicide.”

SOURCE: Journal of the American Academy of Child & Adolescent Psychiatry, online January 23, 2019.