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Association of Overcrowding and Turnover with Self-Harm in a Swiss Pre-Trial Prison

Division of Prison Health, Geneva University Hospitals & University of Geneva, 1225 Geneva, Switzerland
Life Course and Inequality Research Centre, University of Lausanne, 1015 Lausanne, Switzerland
Australian Centre for Public Population Health Research, Faculty of Health, University of Technology, 2007 Sydney, Australia
Vulnerable Population Center, Department of Ambulatory Care and Community Medicine, Lausanne University Hospital & University of Lausanne, 1011 Lausanne, Switzerland
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(4), 601;
Received: 28 February 2018 / Revised: 22 March 2018 / Accepted: 22 March 2018 / Published: 27 March 2018
(This article belongs to the Special Issue Advances in Suicide Research)
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Self-harm is a common issue in detention and includes both suicidal and non-suicidal behaviours. Beyond well-known individual risk factors, institutional factors such as overcrowding (i.e., when the prison population exceeds its capacity) and turnover (i.e., the rate at which the prison population is renewed), may also increase the risk of self-harm. However, these factors are understudied or previous studies reported inconsistent findings. This study investigated the association of self-harm with overcrowding and turnover in the largest pre-trial Swiss prison in Geneva. Data were collected yearly between 2011 and 2017. Measures included self-harm (all kinds of self-injuring acts requiring medical attention, including self-strangulations and self-hangings). We performed meta-regressions to analyse the relationships between self-harm and institutional factors. Self-harm events were frequent, with a prevalence estimate of 26.4%. Overcrowding and turnover were high (average occupation rate of 177% and average turnover of 73%, respectively). Overcrowding and turnover were significantly associated with self-harm (respectively b = 0.068, p < 0.001 and (b = 1.257, p < 0.001). In both cases, self-harm was higher when overcrowding and turnover increased. Overcrowding and turnover raise important human rights concerns and have damaging effects on the health of people living in detention. Identification of and care for this vulnerable population at risk of self-harm are needed and institutional factors should be addressed. View Full-Text
Keywords: custody; health care; prevention; prisoners; suicide custody; health care; prevention; prisoners; suicide

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Baggio, S.; Gétaz, L.; Tran, N.T.; Peigné, N.; Chacowry Pala, K.; Golay, D.; Heller, P.; Bodenmann, P.; Wolff, H. Association of Overcrowding and Turnover with Self-Harm in a Swiss Pre-Trial Prison. Int. J. Environ. Res. Public Health 2018, 15, 601.

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