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Abstract
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Résumé
La problématique suicidaire en prison signe un enjeu important par le fait qu'il existe une sursuicidité carcérale, notamment lors des premiers temps d'incarcération. Quatre-vingt pour cent des sujets qui font un passage à l'acte expriment des idées suicidaires dans les mois qui précèdent. Ainsi l'expression des idées suicidaires est un facteur de risque du suicide et leur repérage est crucial. Au moyen d'outils d'évaluations tels que l'entretien semi-structuré et des échelles, nous avons évalué 100 détenus arrivant en maison d'arrêt : 11/100 personnes en prison présentent des idées suicidaires pour 4/100 personnes en milieu libre. Bien que les idées suicidaires ne soient pas liées de façon significative à l'incarcération, on trouve une corrélation significative entre les idées suicidaires et la sévérité des symptômes dépressifs, anxieux et psychotiques ainsi qu'avec les événements de vie (être marié, avoir des enfants, être âgé de plus de 35 ans, avoir une peine relative à un crime de sang ou délit sexuel, avoir déjà tenté de se suicider, avoir eu des troubles addictifs, manque de support familial). Le repérage des idéations suicidaires ainsi que des facteurs à risque dès le début de l'incarcération permettraient un dépistage précoce du risque suicidaire et une prévention adaptée de celui-ci.
Suicide in prison is in increase for several years and participates in a major problem of public health. The number of suicide in prison arises mainly during first moment of incarceration, in particular under fifteen days. Eighty percent of the subjects who attempt to commit suicide or commit suicide express such ideas months before. So the expression of suicidal ideations is a risk factor of suicide and their detection is crucial. This study has investigated suicidal risks in prisoners with the assessment of the rate of suicidal ideation as well as their link with risk factors such as depressive disorders, individual factors or life's event's life, etc. Participants were recruited from all-male adults, who just arrived in prison since one week in prison of Hauts-de-Seine, Nanterre, France. One hundred prisoners able to read and fill in the scales in autonomy way were evaluated from March to June 2007 using a structured interview, Beck Depression inventory (BDI), Scale of suicidal ideation by Beck (SSI) and a short version of Mini International Neuropsychiatric Interview (MINI). The SSI assesses precisely the presence of suicidal ideations and suicidal risk as well as its severity and the score gives some information on the severity of the suicidal risk. The BDI assesses the presence of depressive symptoms as well as the severity of depression according to a classification: Light, medium or severe depression. Eleven out of 100 prisoners have suicidal ideations in SSI. They are not connected significantly to the incarceration (χ2 = 3.52, P = 0.05). The scores go from 3 to 27 (the maximum score for this scale is 36) and the medium score is 8.81: four people have scores around the medium score, four people have a score smaller than 5, three people have a score higher than 9. The group of prisoners who have suicidal ideations (n = 11) was compared with the group of prisoners without suicidal ideations (n = 89). Suicidal ideations are in link with the severity of depression in BDI (χ2 = 12.53, P < 0.001) but not with its presence only: Prisoners who have suicidal ideations have a medium score of depression higher than prisoners who have not suicidal ideations (16.45 against 6.01, the maximum score for this scale is 39). Ninety-one percent of prisoners who have suicidal ideations suffer from medium or severe depression against 35 % of prisoners without suicidal ideations. Nevertheless, the difference is not significant if we compare the two groups with all types of depression-light, medium or severe (χ2 = 2.74, P < 0.05). Moreover anxious and psychotics symptoms, in particular hallucinations in MINI are linked significantly with suicidal ideation (anxiety: χ2 = 22.62, P = 0.00001; psychosis: χ2 = 6.639, P = 0.01; hallucinations: χ2 = 12.8, P = 0.001). Significant risk factors for suicidal ideation in prisoners are life's event such as personal suicidal attempt (χ2 = 25.58, P < 0.000001) and substance use history (χ2 = 7.76, P < 0.01) and the lack of family support (χ2 = 8.7, P < 0.01). It is not the case for suicidal attempt in family (χ2 = 1.663, P < 0.05) and a recent death (χ2 = 1.24, P < 0.015). Prisoners, who are more than 35 years old, are married, have children and are in prison for murder(s) or rape(s) have significantly more suicidal ideations. Some prisoners who have not suicidal ideation in the SSI have a suicidal risk in the MINI. So we can think these ideas are under-expressed in the SSI because prisoners can feel uncomfortable to express such ideas. Moreover there is more than the half of prisoners who present some signs of depression in BDI for less than one third of prisoners in MINI: Depression can be over-expressed in BDI, what explain it is the severity of depression which is in link with suicidal ideations and no only its presence because a lot of prisoners (with or without suicidal ideations) seem to have a depression with the assessment of BDI. The results must be used with care because the population of the study is quite small, in particular for prisoners who have suicidal ideations. Furthermore it is very heterogeneous and judging origins of the link between suicidal ideations and risk factors is very difficult. In conclusion, these results cannot be generalised to the whole prison; they are specifics to this place of research. Symptoms of depression, anxiety and psychosis as well as personal history of suicidal attempt, substance use and a lack of family support are risk factors for suicidal ideations in prisoners. The precocious detection of suicidal ideation and risk factors would prevent from suicide and reduce the risks.
Language: fr |