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Article CommentaryAnalysis and Commentary

Preventing Prison Suicide With Life-Trajectory-Based Screening

Tyler S. Kaster, Michael S. Martin and Alexander I. F. Simpson
Journal of the American Academy of Psychiatry and the Law Online March 2017, 45 (1) 92-98;
Tyler S. Kaster
Dr. Kaster is a Psychiatry Resident, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Mr. Martin is a PhD Candidate, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Simpson is Chief of Forensic Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. No funding was provided for this research. T.S.K. was awarded the Isaac Sakinofsky Essay Prize in Suicidology from the Centre for Addiction and Mental Health for this work. M.S.M. is currently on unpaid educational leave from the Correctional Service of Canada.
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Michael S. Martin
Dr. Kaster is a Psychiatry Resident, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Mr. Martin is a PhD Candidate, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Simpson is Chief of Forensic Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. No funding was provided for this research. T.S.K. was awarded the Isaac Sakinofsky Essay Prize in Suicidology from the Centre for Addiction and Mental Health for this work. M.S.M. is currently on unpaid educational leave from the Correctional Service of Canada.
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Alexander I. F. Simpson
Dr. Kaster is a Psychiatry Resident, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Mr. Martin is a PhD Candidate, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Simpson is Chief of Forensic Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. No funding was provided for this research. T.S.K. was awarded the Isaac Sakinofsky Essay Prize in Suicidology from the Centre for Addiction and Mental Health for this work. M.S.M. is currently on unpaid educational leave from the Correctional Service of Canada.
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Article Figures & Data

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    Table 1

    Comparison of Life Trajectory Model and High Risk Clinical Profiles

    Acute Trajectory/PretrialChronic Trajectory/Incarcerated
    Age of suicide completionYounger (20–25 years)Older (>30 years
    Adversity burden++++++
    Length of adversity burdenShortLong
    Event inciting suicideMajor: incarceration itselfMinor: conflict of some sort
    Timing of suicide relative to incarcerationEarly during incarceration19Late in incarceration. Suicide risk increases with length of incarceration1
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    Table 2

    Hypothetical Adversity Burden Quantification in the Year Before Incarceration

    Life SphereIndividual With Low Adversity BurdenIndividual With High Adversity Burden
    Place of residence0, stably housed2, often homeless
    Parent–child relationship1, has not had any contact with parents1, has not had any contact with parents
    Emotional-romantic relationship1, infrequent, unstable relationships2, no romantic relationships
    Adult family life2, unstable, chaotic2, unstable, chaotic
    Episodes of personal difficulty0, no recent difficulties2, was recently assaulted
    Academic life1, completed high school with difficulty2, did not finish high school, has learning disability
    Professional life0, has had consistent employment2, has not maintained employment
    Social life1, has some friends2, does not endorse having any friends
    Dimensions of loss/separation/departures1, ended a romantic relationship1, loss of pet
    Other social adversity0, no significant social changes0, no significant social changes
    Protective factors−2, hopes to regain job & relationship0, does not have any goal for future
    Help seeking/services−2, sporadic substance use treatment0, not interested in any treatments
    Drug use1, uses marijuana weekly2, daily use of multiple substances
    Total adversity burden score418
    • View popup
    Table 3

    Intake Information at Correctional Services Canada and Relationship to Life-Trajectory Model

    ChildhoodAdolescenceAdultPeri-Arrest
    • Family violence (PR)• Less than high school diploma (AL)• Unstable job history (PL)• Social assistance previous years (PL)
    • Limited attachment to family unit (PR)• Less than grade 10 or equivalent (AL)• Absent employment history (PL)• Limited positive leisure activities (OSA)
    • Negative relationship with parents (PR)• Youth court appearances (EPD)• Financial instability (OSA)• Limited community attachment (SL)
    • Abuse (PR)• Victim of spousal abuse (AF)• Use of community resources (PF)
    • Adult court appearances (EPD)• Unemployed at arrest (PL)
    • Unstable housing past year (POR)
    • Life spheres measurable by data available from Correctional Services Canada: parent–child relationship (PR), place of residence (POR), adult family life (AF), episodes of personal difficulty (EPD), academic life (AL), professional life (PL), social life (SL), other social adversity (OSA), and protective factors (PF).

    • Unmeasurable life spheres: emotional–romantic relationships; dimensions of losses, separations, and departures; help-seeking/use of services, and drug use.

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Journal of the American Academy of Psychiatry and the Law Online: 45 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 45, Issue 1
1 Mar 2017
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Preventing Prison Suicide With Life-Trajectory-Based Screening
Tyler S. Kaster, Michael S. Martin, Alexander I. F. Simpson
Journal of the American Academy of Psychiatry and the Law Online Mar 2017, 45 (1) 92-98;

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Preventing Prison Suicide With Life-Trajectory-Based Screening
Tyler S. Kaster, Michael S. Martin, Alexander I. F. Simpson
Journal of the American Academy of Psychiatry and the Law Online Mar 2017, 45 (1) 92-98;
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  • Article
    • Abstract
    • Case Summaries
    • Efforts to Reduce Prison Suicide
    • A Life-Trajectory Model of Suicide
    • The Life-Trajectory Model Applied to Prison Suicide
    • Proposal for a Life-Trajectory–Based Suicide Screening Tool
    • Steps in Developing a Life-Trajectory Suicide-Screening Tool
    • Conclusion
    • Footnotes
    • References
  • Figures & Data
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