Suicide and Risk Behaviors in an Incarcerated American Indian Population in the Northern Plains [United States], 1999-2000 (ICPSR 3925)

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Study Purpose View help for Study Purpose

This study was initiated by the administrator of a county jail in the Northern Plains of the United States who was concerned about the incidence of suicide behaviors in that facility, particularly among the American Indian population. The county jail is situated within the center of the region in which the contemporary Plains Indian tribes reside. It houses persons arrested for misdemeanor and felony charges and, by contract, persons incarcerated under the jurisdiction of federal authorities. Approximately 45 percent of the yearly average intake bookings into the jail are American Indians. However, in 1996 there were 17 total suicide gestures in this facility and over 75 percent of them involved an American Indian. This study was a two-year project to evaluate the existing suicide screening protocol and improve it for use with the American Indian incarcerated population. Because the admission screening tool used in the county jail to interview inmates at their intake was developed in New York, one research objective was to determine if that instrument was culturally appropriate for use with the county jail population, particularly with the American Indian population. This endeavor involved exploring the connection between American Indian and non-Indian inmates' responses to suicide screening questions as they were asked within the jail setting. The specific objectives of the first year of this research project were: (1) to determine the prevalence rates of suicide ideation within and between American Indian and non-Indian jail populations, (2) to examine concordance of the current screening tool used in the county jail with other self-report measures of suicidal ideation and associated risk factors, (3) to examine the cultural relevance of the current suicide risk screening tool and of the intervention methods employed in response to suicidal behavior within this particular jail setting, (4) to develop measures of culturally-specific symptoms of suicide ideation that could be incorporated into a suicide screening protocol, and (5) to provide recommendations for culturally-sensitive suicide ideation detection and intervention or treatment policies in this detention setting. The principal objective of the second year of this research project was to determine whether the employment of different suicide screening protocols would make a difference in the responses of new detainees with regard to the likelihood of securing their honest reports of experiencing suicide ideation and its associated risk factors. In particular, the research goals of the second year were: (1) to identify, through the use of an experimental design, a suicide screening process that influenced Northern Plains detainees' comfort level in disclosure of suicidal ideation as well as future help-seeking behavior and depression management within the jail setting, and (2) to determine if the wording and format of screening questions and the type of screener made a difference in the detainees' comfort level for self-disclosure, management of depression, and future help seeking behavior.

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For the duration of this two-year research project, all male and female inmates aged 18 and older who were booked into the jail went through the customary booking procedure that included the administration of the New York Suicide Prevention Screening Guidelines (NYSPSG) questionnaire. Developed in New York and implemented in New York jails and lockups in 1986 in response to systemic problems thought to be contributing to a high rate of suicide in those facilities, the NYSPSG instrument was designed to assess two groups of risk variables: (1) factors enhancing the level of risk at the time of booking, and (2) demographic and personal characteristics correlated with suicide risk. This questionnaire was the suicide risk detection tool historically used in this detention center. Consistent with accepted jail practice and with the legal and correctional literature, these questionnaires were always completed prior to the inmate being asked to participate in the research. During the sampling periods, all new prisoners who gave their informed consent were given a self-report survey after they had been interviewed using the NYSPSG questionnaire. In Year One (Part 1, Year One Data) researchers administered a short self-report survey consisting of measures commonly associated with suicidal ideation. With the exception of the relatively few self-report surveys completed early in this project, which were completed just prior to the detainee being moved into his or her housing unit, all self-report surveys were completed in the booking area within approximately four hours of admission into the jail. The self-report survey measured stress, anxiety, suicide ideation, hopelessness, and the suicidal behavior history of both the inmate and his or her family. The protocols in the second year of the project (Part 2, Year Two Data) reflected efforts to test different screening conditions for four experimental groups and one control group of new detainees. Each group was assigned to a specific data collection period during which inmates admitted into the jail on a certain day and during a certain time period were considered potential participants. The control group consisted of inmates booked under normal procedures without any change to the assessment tool or process already in use in the jail. Additionally, for those subjects included in the control group, there were no changes made in the characteristics or credentials of the person doing the screening, nor was there a change in the type of setting in which the screening occurred. The use of this control group allowed for an accounting of the effects of each of the subsequent four experimental groups. The first experimental group consisted of new detainees screened in a private area of the booking section of the detention center by a uniformed officer. The second experimental group was comprised of all incoming inmates being screened by an American Indian officer in the more private area of the jail. The third experimental group had incoming inmates screened in private by someone with a credentialed mental health background. The fourth experimental group consisted of all incoming inmates being screened in private by a non-uniformed American Indian. The outcome variables were included in a short self-report survey consisting of measures of demographics, comfort experience during booking and the screening process, self-efficacy management of depression, knowledge of the mental health support available within the jail, and general well-being. All study participants were asked to complete this self-report survey after their booking and screening process was complete and just prior to either their release on bond or their transfer to housing units within the detention center. Part 2 of this data collection contains the quantitative responses to the Year Two questionnaire, while Part 3, Year Two Open-Ended Responses, contains the open-ended responses for the question asking the respondents' opinions about the Year Two questionnaire. The quantitative data collection was supplemented with qualitative data during both years of this project. The goal of the qualitative portion of the first year research endeavor was to develop the most straightforward assessment of suicide ideation criteria in this specific jail setting using semi-structured focus group interviews. The first three focus groups during Year One discussed the NYSPSG screening instrument, examining each item through probative questions. These focus groups were conducted with American Indian males (Part 4, Year One American Indian Male Focus Group Data on NYSPSG), American Indian females (Part 5, Year One American Indian Female Focus Group Data on NYSPSG), and non-American Indian males (Part 6, Year One Non-American Indian Male Focus Group Data on NYSPSG). The second set of focus groups in Year One reviewed the jail's suicide prevention policies and procedures. These focus groups were conducted with American Indian males (Part 7, Year One American Indian Male Focus Group Data on Jail Policies), American Indian females (Part 8, Year One American Indian Female Focus Group Data on Jail Policies), non-American Indian males (Part 9, Year One Non-American Indian Male Focus Group Data on Jail Policies), and non-American Indian females (Part 10, Year One Non-American Indian Female Focus Group Data on Jail Policies). Every inmate participant's informed consent was obtained prior to initiation of the group process and questioning. Focus group discussions generally lasted one to two hours. All focus group discussions were audiotaped and later transcribed and summarized. Lastly, a focus group comprised of officers having primary responsibilities in both the intake and housing areas of the jail was held (Part 11, Year Two Officer Focus Group Data). A semi-structured questioning method which allowed for the pursuit of emerging themes was utilized. The officers' focus group lasted nearly two hours and occurred after their evening shift, from approximately 11:00 p.m. to 1:00 a.m.

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For Part 1, all inmates brought into the jail were given an explanation of the research project and asked to sign the informed consent form and take the survey in a reasonably private but supervised space in the booking area. Rather than place a time limit on the sampling, the administrator and shift supervisors agreed to allow for ongoing sampling until a sufficient number of subjects was obtained. Except for a four week period between December 14, 1999, and January 13, 2000, detainees coming into the jail were asked to participate in the study. Exclusion criteria included those who were not proficient in reading and understanding the English language. The sampling period for the second year of research (Parts 2 and 3) was initiated in October 2000 and continued through May 31, 2001. Several sampling strategies were employed and these varied according to the intake protocol used by the booking officer after she or he received specific training in the nature and purpose of the study and the protocol to be used during the data collection period. In the initial months of the study period, using the jail's customary intake procedures, baseline data were collected by asking every inmate who was admitted into the jail to participate in the study by completing a Feedback and Satisfaction Survey after having been through the routine booking process. For Parts 4-11 a convenient, qualitative purposive sampling strategy was used. The jail mental health counselor approached detainees who she thought would be able to contribute to the focus group discussion. She described the study and asked for participation. Once the detainee agreed, their names were then added to a list that the officers used to "call out" when the focus groups where convened.

Universe View help for Universe

All inmates and officers in a county jail in the Northern Plains of the United States.

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Description of Variables View help for Description of Variables

Demographic variables in Part 1 include age, gender, ethnic identity, tribal affiliation, education level, income, marital status, number of children, religious beliefs, and official charges for arrest. Respondents were also asked about their previous arrest history, experience being jailed, and experience being hospitalized for emotional or substance abuse problems. Other items measured the severity of suicidal ideation, the extent of social support from significant others, and the types and amount of help received from resources other than family or friends for emotional support, substance abuse, domestic violence, anger control, or health problems. Additionally, respondents provided descriptions of anxiety symptoms, measures of loneliness, amount of stress from being in jail, and negative attitudes about the future. They also answered questions about their personal suicidal behaviors and those of their family members. Lastly, respondents provided information on traumatic life events and coping mechanisms. In Part 2, demographic information included age, gender, ethnic identity, tribal affiliation, and pending criminal charges. Additional questions inquired about the inmate's comfort and truthfulness response levels during the screening process. Other questions asked about the inmate's self-efficacy to perform self-management behaviors for depression.

Response Rates View help for Response Rates

Not Applicable.

Presence of Common Scales View help for Presence of Common Scales

Part 1 includes the Beck Scale for Suicide Ideation (SSI), Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS), Jail Stress Scale, a scale of spiritual or religious beliefs developed by the National Center for American Indian/Alaska Native Mental Health Research, Scale of Perceived Social Support, UCLA Loneliness Scale, Brief COPE Scale, and the Stressful Life Events Screening Questionnaire. Part 2 includes some questions from the Self-Efficacy Control/Manage Depression Scale of the Stanford Patient Education Research Center.

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Original Release Date View help for Original Release Date

2004-07-30

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