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2013 25: 21 originally published online 1 June 2012Sex AbuseElizabeth L. Jeglic, Ashley Spada and Cynthia Calkins Mercado

An Examination of Suicide Attempts Among Incarcerated Sex Offenders  

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447201 SAX25110.1177/1079063212447201Jeglic et al.Sexual Abuse2013

1John Jay College, New York, NY, USA2City University of New York Graduate Center, New York, NY, USA

Corresponding Author:Elizabeth L. Jeglic, PhD, Department of Psychology, John Jay College of Criminal Justice, 445 West 59th Street, New York, NY 10019, USA Email: ejeglic@jjay.cuny.edu

An Examination of Suicide Attempts Among Incarcerated Sex Offenders

Elizabeth L. Jeglic1, Ashley Spada2, and Cynthia Calkins Mercado1

Abstract

Little is known about suicide attempts among sex offenders. This study examines the rates of nonfatal suicide attempts among a sample (N = 3,030) of incarcerated male sex offenders. Overall, the authors found that 14% of sex offenders in the study sample had made a suicide attempt at some point in their lives. Of those, 11% had reported a suicide attempt prior to incarceration, 0.5% had made a suicide attempt while incarcerated, and 2.5% made suicide attempts both prior to and during incarceration. Sex offenders who made suicide attempts were significantly more likely than those who did not make suicide attempts to have had an abusive childhood, a history of psychiatric problems, intellectual impairment, male victims, and related victims. Suicide attempters also scored higher on actuarial risk measures than nonattempters. No differences were found in attempter status between sex offenders who committed sex offenses against children and those who committed sex offenses against adults. A history of psychiatric problems and treatment as well as childhood abuse/neglect and perpetration against male victims predicted suicide attempter status. These findings are discussed as they pertain to suicide prevention, risk assessment, and the collateral consequences of sex offender legislation.

Keywords

suicide attempt, sex offender, risk

Article

22 Sexual Abuse 25(1)

Suicide is currently the third leading cause of death in American prisons behind natu-ral causes and AIDS (Mumola, 2005). On average, approximately 250 offenders in U.S. prisons die each year by suicide (Mumola, 2005). However, there is evidence that suicide prevention efforts have been effective and that overall suicide rates among prisoners have steadily declined since the early 1990s (Hayes, 1995; Mumola, 2005). Much of what has been published about prison suicide has focused on assessment and intervention techniques within the general prison population. However, few studies have focused on how suicide rates vary by offender type. One population that may be at particularly high risk for suicidal behavior is sex offenders.

Sex crimes are considered by society to be the most reviled type of offense, and there is little sympathy among the public for those accused of sex crimes. Even in prison, sex offenders are considered pariahs by other inmates (Samson, 1994). Furthermore, unlike other types of offenders, sex offenders may also be subject to numerous forms of legislation once they are released from prison, including postsen-tence civil commitment, residence restrictions, and registration and notification stat-utes. There is a growing body of evidence that suggests that these laws have unintended consequences, with offenders subject to such legislation reporting stigma, shame, iso-lation, and emotional difficulties (e.g., Levenson & Cotter, 2005; Tewksbury, 2005; Tewksbury & Lees, 2006). Indeed, Levenson and Cotter found that 60% of offenders in their Florida sample reported emotional distress related to their experiences with post-release legislation. Recently, Jeglic, Mercado, and Levenson (2011) found that 21% of sex offenders on the New Jersey public registry reported moderate (i.e., ele-vated) levels of depression and hopelessness, and a full 43% reported some degree of suicidal ideation. Furthermore, symptoms were more prominent among those offend-ers who reported more negative consequences as a result of sex offender legislation and among those deemed to be higher risk for reoffending (Jeglic et al., 2011). Factors such as chronic and acute stress, feelings of loneliness and isolation, and feelings of depression and hopelessness are all risk factors for suicide and suicide attempts (Beck, Brown, Berchick, Stewart, & Steer, 1990; Berman, 2009; Grover et al., 2009; Stravynski & Boyer, 2001). Furthermore, sex offenders may also have other risk fac-tors for suicide, including a history of sexual abuse and physical abuse or psychiatric conditions (Becker & Murphy, 1998; Langevin, Wright, & Handy, 1989).

Although the literature suggests that sex offenders have risk factors that may put them at higher risk than other types of offenders for engaging in suicidal behaviors, to date there has been very little research investigating suicidal behaviors specifically among sex offenders. One study compared completed suicide rates of child sex offend-ers (CSO) who had a history of (a) only criminal sexual offenses against a child (sex-only CSO), (b) both child sex offenses and nonsexual offenses (Multicriminal CSO), and (c) sexual crimes against children, nonsexual offenses, and a violent offense (Violent CSO; Pritchard & King, 2005). Using epidemiological data from two regions in the United Kingdom over a 6-year period, Pritchard and King found that whereas the “multicriminal CSOs” were 12 times more likely to commit suicide than the general population, the “sex-only CSOs” were 15 times more likely than the

Jeglic et al. 23

“multicriminal CSOs to commit suicide and 183 times more likely to commit suicide than the general population. There were no completed suicides among “violent CSOs” during the 6-year period. Similarly, Pritchard and Bagley (2000) found that 3% of the 374 CSOs they studied committed suicide during the 2-year study period and that these suicides occurred only among the nonviolent CSOs. Another Irish study examin-ing suicide risk among men under investigation for sex offenses found a risk ratio for suicide of 1/1644 for those accused of offending against an adult and 1/24 for those accused of offending against a child (Brophy, 2003). Thus, these rates were signifi-cantly higher than the population risk for suicide among Irish men for the same time period (1/5524; Brophy, 2003). Regardless of offense type, there is evidence that offenders in general are at increased risk for suicidal behavior. Using prisoner self-report, one study from the United Kingdom found that 20% of the sentenced male offenders had made a lifetime suicide attempt and that 6.6% had made a suicide attempt within the past year (Jenkins et al., 2005). Taken together, these findings sug-gest that not only may sex offenders be at increased risk for suicide generally but also that child molesters specifically may be at increased risk compared to other types of sex offenders.

What little research has been carried out so far has largely examined completed suicidal behavior and much less is known about offenders who make suicide attempts. Although it is useful to determine characteristics of those who eventually commit suicide, it can be difficult to assess psychological risk factors posthumously. One of the best predictors of a future suicide attempt is a past suicide attempt (Bostwick & Pankratz, 2000; Janis & Nock, 2008; Oquendo et al., 2004). Thus, understanding the characteristics of those who have made suicide attempts may be particularly useful in suicide prevention and intervention efforts. This could help identify individuals who may be at high risk for engaging in future suicidal behavior.

Many may question whether efforts and resources should be put forth to prevent suicide among sex offenders—a much reviled population. Along with a humanistic approach that might value the alleviation of distress and promotion of good lives, sui-cide prevention efforts may serve two other important ends. First, both attempted and completed suicides can result in enormous social, economic, and medical costs to the sex offender, their family, and the criminal justice system as a whole. A recent review by Hoffer, Shelton, Behnke, and Erdberg (2010) suggests that the suicide of CSOs may negatively affect the offender’s family, the victim, and law enforcement officers, as it results in many conflicted emotions such as anger, guilt, confusion, betrayal, and loss. Second, there is evidence that negative affective states associated with suicide—including depression, hopelessness, and suicidal ideation—precede sexual offending behavior (Hanson & Harris, 1998; Marshall, Anderson, & Fernandez, 1999; Pithers, Kashima, Cumming, Beal, & Buell, 1988). Consequently, identifying and treating those sex offenders who may be at risk for suicidal behavior may help decrease overall risk for recidivism.

Therefore, the overarching purpose of this study was to examine rates of nonfatal suicidal attempts among convicted sex offenders. To that end, we examined how

24 Sexual Abuse 25(1)

characteristics of offenders and their offending patterns related to suicidal behavior. We further examined whether rates of suicidal behavior differed with regard to risk level, given that negative mental states may be related to offending activity. Toward a prevention focus, we also analyzed whether those with preincarceration suicidal attempts were more likely to have attempted suicide while in prison and whether offenders who had child victims were more likely to attempt suicide than those with adult victims. Finally, using modeling analyses we examined whether certain vari-ables predict suicide attempts among sex offenders while in prison.

MethodParticipants

The sample of sex offenders was 41% White, 37% African American, 20% Latino, 1% Asian/Pacific Islander, and 0.1% Native American/Alaskan Native. Offenders ranged in age from 13 to 85 with a mean age of 39.2 (SD = 12.1) at the time of the record review. Approximately, 58% (n = 1,790) of the sex offenders had never been married, whereas 24% (n = 746) were married at the time of the data collection. The remaining 18% (n = 561) of the offenders were separated, divorced, or widowed from a significant other. The majority of offenders had children or stepchildren (66%, n = 2,029). Forty-five percent of the sample participants had less than a high school education, whereas 41% had a high school diploma or GED. Approximately 8% of the participants pursued some form of trade school, vocation, or college, whereas only 5% completed a 2- or 4-year college degree. With regard to occupa-tional status, 72% of offenders in the sample were employed prior to their incarcera-tion. Approximately 29.3% (n = 808) of the sample had a documented history of psychiatric symptoms, and 32.5% (n = 895) had received psychiatric treatment prior to incarceration.

ProcedureData were gathered from the archival records of male sex offenders (N = 3,167) who were housed at either a state sex offender treatment facility (n = 822) or the general population of a state prison system (n = 1,934) and who were released from custody between the years 1996 and 2007. Information pertaining to demographic character-istics, psychological functioning, institutional behavior, and risk level was coded from files by trained graduate-level research assistants.

MeasuresDemographic information. Data collected included demographic and personal char-

acteristics (e.g., age, ethnicity, and employment status prior to incarceration, reported history of physical or sexual abuse, whether they grew up in a two-parent home,

Jeglic et al. 25

removal from the home as a child), psychiatric history (e.g., past psychiatric treatment, neuropsychological impairment, diagnosis of mental retardation), offense history (e.g., type and number of past sexual and nonsexual offences), victim characteristics (e.g., age and gender), institutional behavior (such as suicide attempts while incarcer-ated), as well as static risk factors found to be associated with sexual offense recidi-vism as measured by the Static-99 (Hanson & Thornton, 2000) and the The Minnesota Sex Offender Screening Tool-Revised (MnSOST-R; Epperson et al., 2000).

Suicidal behavior. Suicidal behavior was assessed through the offender’s prison file. Suicidal behavior was defined as a nonfatal suicide attempt (intentional self-harm with the intent to die). As part of the intake procedure all offenders are routinely asked about their suicide attempt history. Thus, the majority of the noncustodial suicide attempts were based on offender self-reports. However, where possible, these attempts were corroborated with psychiatric or medical records located in the prison file. A his-tory of suicidal behavior in the institution was coded from the offender’s psychologi-cal records and based on documented nonfatal suicide attempts while incarcerated.

Static-99 (Hanson & Thornton, 2000). The Static-99 is a measure of actuarial risk for sexual recidivism for convicted sexual offenders. Hanson and Thornton found that the scale had moderate-to-high accuracy in predicting both sexual and violent recidivism. Other studies have found significant correlations between scores on the Static-99 and recidivism (Barbaree, Seto, Langton, & Peacock, 2001; Nunes, Firestone, Bradford, Greenberg, & Broom, 2002). Total scores range from 0 to 12, and these scores are then translated into risk levels ranging from 0 (lowest) to 6+ (highest).

The Minnesota Sex Offender Screening Tool-Revised (Epperson et al., 2000). The MnSOST-R is an actuarial risk assessment measure comprised of 16 items that pertain to the offender’s sex offending and institutional history. Total scores on the scale range from –14 to +30, and offenders are assigned to one of 6 risk levels based on this score. Epperson and his colleagues found that the MnSOST-R predicted sexual offense recidivism. Another study found the MnSOST-R to be successful in predicting in gen-eral recidivism (Barbaree et al., 2001).

ResultsOf the 3,030 sex offenders in the sample for whom data pertaining to suicide history were available, 406 (14%) offenders had made a suicide attempt at some time in their life. Specifically, 324 (11%) had made an attempt prior to their incarceration, 15 (0.5%) made attempts while incarcerated in a state facility only, and 56 (2%) offend-ers made both prior attempts and attempts while incarcerated. Of those who made a suicide attempt prior to their incarceration, the number of previous attempts ranged from 1 to 50, although the majority of offenders (57%) made only one attempt.

Chi-square analyses were used to compare suicide attempters (both prior and dur-ing incarceration) to those who did not make a suicide attempt in terms of demographic/personal information (see Table 1). Results indicated that offenders of Asian/Pacific Islander descent or White offenders were more likely to make an attempt than

26 Sexual Abuse 25(1)

Table 1. Comparison of Demographic Characteristics of Attempters and Nonattempters

Suicide Attempt No Attempt

n (%) n (%) χ2 df

Ethnicity 15.096* 5 White 158 (15) 898 (85) African American 89 (9.5) 850 (90.5) Latino 73 (13.1) 485 (86.9) Asian/Pacific Islander 4 (16) 21 (84) American Indian 0 (0) 2 (100) Other 1 (5.9) 16 (94.1 ) Two-parent home 12.688** 2 Yes 192 (11.9) 1416 (88.1) No 192 (16.4) 979 (83.6) Childhood abuse/neglect 162.536** 2 Reported 244 (25.2) 726 (74.8) Not reported 145 (8.1) 1648 (91.9) Removal from home 13.283** 2 Yes 26 (23.2) 86 (76.8) No 200 (11.9) 1474 (88.1) Family criminal justice system 8.411* 2 Yes 55 (19) 235 (81) No 203 (12.6) 1403 (87.4) Prior employment 37.578** 3 Yes 244 (11.4) 1896 (88.6) No 146 (19.6) 599 (80.4) Children/stepchildren 5.227 2 Yes 247 (12.8) 1685 (87.2) No 157 (15.5) 853 (84.5)

*p < .05. **p < .01.

offenders of African American, Latino, or American Indian descent (χ2 = 15.096, df = 5, p < .05). Furthermore, those who made suicide attempts were less likely to have grown up in a two-parent home (χ2 = 12.688, df = 2, p < .01) and to have been employed prior to their incarceration (χ2 = 37.578, df = 3, p < .001) than those who did not make an attempt. Those who made suicide attempts were more likely to have a reported his-tory of childhood abuse or neglect (χ2 = 162.536, df = 2, p < .001), a history of being removed from the home as a child (χ2 = 13.283 df = 2, p = .001), and to have had fam-ily members involved in the criminal justice system (χ2 = 8.411, df = 2, p < .05) than those who did not make a suicide attempt.

With regard to psychological characteristics, offenders who made a suicide attempt were more likely to have a history of psychiatric problems (χ2 = 400.940, df = 2, p < .001)

Jeglic et al. 27

and to have participated in psychiatric treatment prior to incarceration (χ2 = 370.007, df = 2, p < .001). Offenders who made a suicide attempt were also more likely to have a neuropsychological impairment (χ2 = 25.553, df = 2, p < .001), an intellectual impair-ment (χ2 = 38.323, df = 2, p < .001), or a diagnosis of mental retardation (χ2 = 15.677, df = 3, p < .01) than those who did not make a suicide attempt (see Table 2).

An examination of criminal characteristics found that a significantly greater pro-portion of sexual offenders with both male and female victims and those with exclu-sively male victims made suicide attempts compared to those who had exclusively female victims (χ2 = 22.076, df = 2, p < .001). Furthermore, a significantly greater proportion of sexual offenders whose victims were immediate family members made attempts during or prior to their incarceration than offenders whose victims were extended family, step family, acquaintances, or strangers (χ2 = 13.436, df = 5, p < .05). Suicide attempters were less likely to have denied their involvement in sexual offenses (χ2 = 10.710, df = 2, p < .01). Last, those with suicide attempts during or prior to their incarceration committed their first sexual offense 2.5 years earlier than those who did not make an attempt, t(501) = 3.878, p < .001 (see Table 3).

Finally, regarding actuarial risk, those who had ever made a suicide attempt had significantly higher total scores on both the Static-99 and MnSOST-R than offenders who did not make an attempt. On average, attempters scored higher on the Static-99 by 0.5 points, t(2232) = 4.215, p < .001, and higher on the MnSOST by 1.43 points,

Table 2. Comparison of Psychiatric Characteristics of Attempters and Nonattempters

Suicide Attempt

No Attempt

n (%) n (%) χ2 df

History of psychiatric problems 400.94** 2 Yes 308 (76) 660 (25.9) No 96 (23.7) 1888 (74) Psychiatric treatment 370.01** 2 Yes 267 (33.8) 522 (66.2) No 135 (6.3) 2010 (93.7) Neuropsychological deficit 25.55** 2 Yes 26 (28.9) 64 (2.2) No 344 (12.7) 264 (87.3) Intellectual impairment 38.32** 2 Yes 80 (23) 268 (77) No 286 (11.8) 2140 (88.2) Mental retardation diagnosis 15.68** 3 Yes 13 (35.1) 24 (64.9) No 118 (13.8) 738 (86.2)

*p < .05. **p < .01.

28 Sexual Abuse 25(1)

t(2283) = –5.086, p < .001, than nonattempters. There were no significant differences between those who made attempts and those who did not in terms of average ages of their victims, number of prior sexual offenses, or whether the nature of the index offense was child molestation or adult sexual assault.

To ascertain which variables were most likely to predict suicidal behavior, a hier-archical logistic regression was performed. Based on the suicide literature it was pre-dicted that variables related to psychological problems would contribute most to the predictive accuracy of the model, so psychological factors were entered into the first block of the model, followed by neuropsychological impairments/coping skills defi-cits, childhood and developmental variables, and finally, sex offender risk factors.

Results revealed improvement in the proportion of cases correctly classified by the model as each successive block was entered into the regression equation. In the initial model, including only the psychological factors, only 1.5% of those who made a sui-cide attempt were correctly classified by the model, which explained approximately 24% of the variance in whether or not an offender engaged in suicidal behavior (χ2 = 218.902, p = .000; see Table 4).

Neuropsychological factors were included in the model to determine whether they were associated with suicidal behavior, as it was predicted that these factors might inhibit the offenders’ ability to use coping skills when faced with stressors. Upon

Table 3. Comparison of Criminal Characteristics of Attempters and Nonattempters

Suicide Attempt No Attempt

M (SD) M (SD) t χ2 df

Age at first sex offense 27.74 (9.7) 29.74 (11.4) 3.878** 501Age of victim 12.9 (9.7) 13.09 (8.9) 0.589 455Number prior sex offenses 1.81 (1.3) 1.72 (1.2) 0.455 854 n (%) n (%) Victim gender 22.6** 4 Female only 293 (11.7) 2173 (87) Male only 74 (19.1) 305 (79) Male and female 18 (20.5) 69 (79) Relationship to victim 18.273* 10 Immediate family 51 (18.7) 218 (80) Extended/step family 95 (12.9) 631 (86) Familial combination 1 (3.8) 25 (96.2) Acquaintance 150 (11.5) 1139 (87.3) Stranger 57 (13.4) 362 (85) Other 32 (15.2) 173 (15.2) Deny Sexual Offenses 13.285** 4 Yes 47 (8.5) 498 (90.1) No 186 (14.7) 1066 (84)

*p < .05. **p < .01.

Jeglic et al. 29

adding the second block to include neuropsychological factors/coping skills deficits, the model improved, explaining 25% of the variance and correctly classifying 10% of the suicide attempters (χ2 = 231.347, p = .000). Within the model, psychiatric prob-lems and a history of psychiatric treatment remained significant predictors of suicidal behavior, and both intellectual impairment and diagnosis of mental retardation were also contributory (see Table 5).

Developmental variables were included in the model with the prediction that early developmental issues might lead to vulnerability for adult psychological problems

Table 4. Model 1: Effects of Psychiatric Variables on Suicidal Behavior

95% Confidence Interval

B SE Wald Exp(B) Lower Upper

History of psychiatric problems 1.60** .208 59.652 4.970 3.309 7.466History of psychiatric treatment 0.87** .192 20.385 2.383 1.635 3.474Constant –2.97 .140 448.499 0.051 χ2 218.902** –2 log likelihood 1030.139 Nagelkerke R2 0.238

Note: χ2 = 218.902, df = 2, p = .000.*p < .01.

Table 5. Model 2: Effect of Psychiatric and Coping Skills Variables on Suicidal Behavior

95% Confidence

Interval

B SE Wald Exp(B) Lower Upper

Psychiatric history factors History of psychiatric problems 1.62** .210 59.538 5.061 3.352 7.640 History of psychiatric treatment 0.82** .195 17.769 2.273 1.552 3.330Coping skills factors Neuropsychological deficit 0.04 .181 0.038 1.036 0.727 1.476 Intellectual impairment 0.35* .157 4.948 1.419 1.042 1.932 Mental retardation diagnosis 0.00* .000 5.096 1.000 0.999 1.000Constant –2.790 .185 227.201 0.061 χ2 231.347** –2 log likelihood 1017.694 Nagelkerke R2 0.251

Note: χ2 = 231.347, df = 5, p = .000.*p < .05. **p < .01.

30 Sexual Abuse 25(1)

and the potential for suicidal behavior. Block 3, which included childhood and devel-opmental factors, increased the predictive accuracy of the model to 26.5% but did not increase the classification accuracy for the attempters (χ2 = 243.924, p = .000). Both psychiatric variables remained predictive of suicidal behavior when the effects of childhood and developmental factors were also considered; however, neither intellec-tual impairment nor a diagnosis of mental retardation remained significant when the variability due to childhood/developmental factors were included in the model. Rather, a history of childhood abuse/neglect emerged as a significant predictor of suicidal behavior in the model (see Table 6).

The final model (see Table 7), which included sex offender risk factors in addition to the psychiatric variables, coping skills deficits, and developmental variables, was the most accurate of the four models in predicting suicidal behavior among our offender sample (χ2 = 259.344, p = .000; Nagelkerke R2 = .28). This suggests a small, significant effect, with the model accounting for approximately 28% of the variance in whether or not an offender made a suicide attempt. Overall, the predictive accuracy of the model was 86%. The model correctly classified 98% of nonattempters and 13.5% of those who engaged in suicidal behavior. In our final model, a history of psychiatric problems (odds ratio [OR] = 5.10) and a history of psychiatric treatment (OR = 2.12)

Table 6. Model 3: Effect of Psychiatric, Coping Skills, and Developmental Variables on Suicidal Behavior

95% Confidence Interval

B SE Wald Exp(B) Lower Upper

Psychiatric history factors History of psychiatric problems 1.60** .212 56.738 4.950 3.265 7.505 History of psychiatric treatment 0.76** .197 14.991 2.145 1.458 3.157Coping skills factors Neuropsychological deficit 0.01 .184 0.003 1.010 0.705 1.448 Intellectual impairment 0.31 .160 3.761 1.364 0.997 1.867 Mental retardation diagnosis 0.00 .000 2.095 1.000 0.999 1.000Developmental factors Two-parent home –0.17 .143 1.398 0.845 0.639 1.117 Childhood abuse/neglect 0.38** .138 7.571 1.461 1.115 1.914 Family criminal justice

involvement–0.10 .106 0.893 0.905 0.736 1.113

History of past employment –0.36 .173 3.785 0.715 0.510 1.002Constant –2.57 .261 97.498 0.076 χ2 243.924 –2 log likelihood 1005.117 Nagelkerke R2 0.264

Note: χ2 = 243.924, df = 9, p = .000.*p < .05. **p < .01.

Jeglic et al. 31

Table 7. Hierarchical Logistic Regression Analysis Final Model: Effect of Psychiatric Problems, Coping Skills Deficits, Developmental Factors, and Sex Offender Risk Factors on Suicidal Behavior

95% Confidence

Interval

B SE Wald Exp(B) Lower Upper

Psychiatric history factors History of psychiatric problems 1.625** .215 56.996 5.079 3.331 7.745 History of psychiatric treatment 0.750** .202 13.849 2.117 1.426 3.143Coping skills factors Neuropsychological deficit 0.001 .188 0.000 1.001 0.693 1.446 Intellectual impairment 0.308 .165 3.506 1.361 0.986 1.880 Diagnosis of mental retardation 0.000 .000 1.713 1.000 0.999 1.000Developmental factors Two-parent home –0.112 .146 0.594 0.894 0.672 1.189 Childhood abuse/neglect 0.343* .141 5.954 1.409 1.070 1.856 Family criminal justice involvement –0.111 .107 1.074 0.895 0.726 1.104 History of past employment –0.337 .175 3.710 0.714 0.506 1.006Sex offender risk factors Victim gender –0.652** .225 8.430 0.521 0.335 0.809 Relationship to victim –0.102 .067 2.341 0.903 0.792 1.029 Denied involvement 0.016 .095 0.030 1.017 0.843 1.225 New at first sex offense –0.015 .009 2.874 0.986 0.969 1.002 Static-99 total score –0.053 .062 0.719 0.949 0.840 1.072 MnSOST-R total score 0.027 .019 1.958 1.028 0.989 1.068Constant –0.491 .614 0.640 0.612 χ2 259.344** –2 log likelihood 989.697 Nagelkerke R2 0.279

Note: N = 1,541. χ2 = 259.344, df = 15, p = .000. MnSOST-R = Minnesota Sex Offender Screening Tool-Revised (Epperson, Kaul, Huot, Hesselton, & Alexander, 2000).*p < .05. **p < .01.

remained contributory to suicidal behavior. Specifically, those with a history of psychiatric problems were approximately 5 times more likely to engage in suicidal behavior than offenders without a history of psychiatric problems, and having a history of psychiatric treatment increased the odds of suicidal behavior more than doubled the odds of suicidal behavior.

With regard to the effects of developmental variables, experience of childhood abuse and/or neglect (OR = 1.41) increased the likelihood of suicidal behavior, such that childhood abuse/neglect increased the odds of suicidal behavior by 1.41 times. Results also indicated that victim gender had a significant additive effect on suicidal

32 Sexual Abuse 25(1)

behavior, such that those with male victims had an increased odds of engaging in sui-cidal behavior as compared to those without male victims (odds ratio [OR] = 0.52). No neuropsychological/coping skills variables remained significant in the final model, as their contribution to the predictive accuracy was better accounted for by other vari-ables in the model.

Finally, in an effort to examine whether there are variables that distinguish among sex offenders who made suicide attempts prior to their incarceration only, during their incarceration only, or both prior to and while incarcerated, comparisons of these three groups across our variables of interest were performed. The three groups differed sig-nificantly across several psychological and criminal factors as well as actuarial risk.

With regard to psychological variables, significant differences were found among the three groups in terms of psychiatric problems and treatment, neuropsychological impairment, and mental retardation. Among sex offenders for whom diagnostic infor-mation was available, those who made suicide attempts both prior to and during their incarceration were the most likely to have a history of psychiatric problems (85.7%), followed by those with attempts prior to incarceration only (75.2%) and those who made attempts only while incarcerated (53.3%; χ2 = 7.201, df = 2, p < .05). Similarly, those who made nonfatal suicide attempts both prior to and during incarceration were more likely to have had a history of psychiatric treatment than those who made an attempt exclusively prior to or exclusively during their incarceration (χ2 = 7.542, df = 2, p < .05). With regard to cognitive impairment, those who made attempts exclusively while incarcerated were significantly more likely to have an intellectual impairment (46%; χ2 = 8.433, df = 2, p < .05) and a diagnosis of mental retardation (40%; χ2 = 6.294, df = 2, p < .05) than those who made attempts both before and during their incarcera-tion or preincarceration only.

Significant differences were also found across variables related to criminal history. Those who made nonfatal suicide attempts both before their incarceration and while incarcerated (40%) were significantly more likely to have had family members involved in the criminal justice system than those who made attempts prior to their incarceration only (19.5%) or exclusively while incarcerated (0%; χ2 = 10.585, df = 2, p < .01). Conversely, those who made suicide attempts only while incarcerated were the most likely to have denied their involvement in the sexual offense (50%; χ2 = 6.101, df = 2, p < .05), compared to those who made an attempt both prior to and during their incarceration (28.6%) and those who made an attempt prior to their incarceration only (18.3%).

To examine potential differences among the three attempter groups in terms of our continuous variables of interest, one-way analyses of variance (ANOVAs) were con-ducted, utilizing the Bonferroni correction to compensate for multiple comparisons. The results revealed significant differences among the three attempter groups with regard to age of victim and number of prior sexual offenses. Post hoc analyses revealed a significant difference in victim age, specifically between those who attempted sui-cide only before their incarceration and those who attempted suicide both prior to and during their incarceration, F(1, 2) = 6.525, p < .01. Offenders who made attempts

Jeglic et al. 33

exclusively prior to their incarceration perpetrated against victims who were significantly younger (M = 12.23, SD = 7.52) than victims of offenders who made suicide attempts both prior to and during their incarceration (M = 17.49, SD = 17.89). With regard to sexual history, those who made suicide attempts prior to and during their incarceration had a significantly greater number of prior sexual offenses (M = 2.43, SD = 1.73) than those who made attempts exclusively prior to their incarceration (M = 1.67, SD = 1.15), F(1, 2) = 3.587, p < .05.

DiscussionThis study examined the rates of nonfatal suicidal behavior among convicted sex offenders both before and after their incarceration, as well as demographic, psychiat-ric, and criminal characteristics that differentiated sex offenders who made suicide attempts from those who did not. Overall, we found that 14% of sex offenders in our sample had made a suicide attempt at some point in their lives. Of those, 11% had reported a suicide attempt prior to incarceration only, whereas 0.5% had made a sui-cide attempt while incarcerated, and 2.5% made attempts both prior to and during incarceration. Sex offenders who had made a nonfatal suicide attempt (either prior to incarceration or while incarcerated) were significantly more likely than those who did not make suicide attempts to have an indication of abuse or neglect in their records, to have been removed from their home during childhood, to have grown up in a sin-gle-family household, and to have had family members involved with the criminal justice system. Suicide attempters were also more likely to have a history of psychi-atric problems and treatment or to be diagnosed with an intellectual or neuropsycho-logical impairment than those with no attempt history. Finally, an examination of offense characteristics revealed that those who engaged in suicidal behavior were less likely to have denied their sexual offenses, but were more likely to have used a weapon in the index offense, to have male only or both male and female victims (as opposed to female victims only), to have offended against family members, and to have committed their first sexual offense at an earlier age than those who did not engage in suicidal behavior. Suicide attempters also scored higher on actuarial risk measures than non-attempters. No differences were found in attempter status between sex offenders who committed offenses against children (child molesters) and those who committed sex offenses against adults (rapists).

In an effort to ascertain the potential contribution of the prison environment to the suicidal behavior, offenders who made suicide attempts prior to incarceration only, those who attempted both prior to and during incarceration, and those who attempted during incarceration only were compared. Those who exclusively made attempts prior to their incarceration and those who made attempts both prior to and during their incar-ceration were more likely to have a history of psychiatric problems and treatment, as well as family involvement in the criminal justice system, than those who made attempts only while incarcerated. Those who made attempts only while incarcerated, on the other hand, were more likely to have an intellectual impairment, have been

34 Sexual Abuse 25(1)

diagnosed with mental retardation, and deny their involvement in a sexual offense than those who attempted suicide prior to their incarceration and those with a history of suicide attempts prior to and during their incarceration. Furthermore, those who made attempts exclusively prior to their incarceration had significantly younger victims and perpetrated significantly fewer sex crimes than those who made suicide attempts both prior to and during their incarceration. These findings suggest that those who have a history of suicide attempts prior to incarceration may have more psychological prob-lems that may account for their suicidal behavior both prior to and during incarcera-tion. However, those who attempted exclusively in prison appear to have more cognitive impairments, which may suggest that they have more difficulty adjusting to the prison environment. More importantly, it should be noted that with such a small sample of offenders who engaged in suicidal behavior during their incarceration (n = 15), these findings are for future hypothesis generation only.

The regression model accounted for a small, yet significant, portion of the variance in whether or not an offender exhibited nonfatal suicidal behavior prior to or during incarceration. As is common in attempting to predict low base rate events such as suicide, the model accurately identified almost all of the nonattempters, but failed to identify the majority of the attempters. A history of psychiatric problems and psychi-atric treatment prior to incarceration prioir to incarceration were found to significantly predict sex offenders who made suicide attempts. This finding is somewhat expected as those who made serious suicide attempts would likely have received some sort of psychiatric treatment. It is unclear from the records whether the psychiatric treatment and problems were limited only to the circumstances surrounding the suicide attempt or whether they represented a more general pattern of mental instability. However, a recent study found that sex offenders were 6 times more likely to have a history of psychiatric hospitalization compared to the general population. Specifically, sex offenders were significantly more likely to have a diagnosis of schizophrenia or other psychotic disorders or bipolar disorders (Fazel, Sjostedt, Langstrom, & Grann, 2007). Furthermore, these disorders, along with depression, are the strongest psychiatric pre-dictors of a completed suicide (Tidemalm, Langstrom, Lichtenstein, & Runeson, 2008). Therefore, it appears that persistent mental illness may be linked to sexual offending and suicide behavior in this population.

In addition, a history of childhood abuse or neglect was found to significantly pre-dict sex offenders who made suicide attempts. This finding is consistent with the lit-erature, which identifies child physical and sexual abuse as factors related to suicidal behavior in the general population (Maniglio, 2011; Mironova et al., 2011). Furthermore, research has demonstrated an increased rate of physical and sexual abuse among sexual offenders, as compared to nonoffending populations (Seghorn, Prentky, & Boucher, 1987; Widom & Ames, 1994). Not only have researchers found that those who have been victims of abuse are at an increased risk for affective disorders but also that victimization in childhood increases the odds of future delinquency and adult criminality by 40% (Widom, 1992). Similarly, Lussier, Beauregard, Proulx, and Nicole (2005) found that a disruptive or violent home environment was associated with

Jeglic et al. 35

negative mood, which in turn was linked with the development of sexually abusive behavior in adulthood. Interestingly, those sex offenders who did make suicide attempts were in fact at higher risk for reoffending sexually as measured by the Static-99 and MnSOST-R. These findings are similar to those of Martin and Stermac (2010) who found that sex offenders with lower levels of hope (a variable that is highly correlated with suicide; Beck et al., 1990) seemed to be at higher risk of recidi-vism. Not only do these findings support the cycle of violence research, they also lend credence to the theory that negative affective states such as depression and hopeless-ness that generally accompany suicidal behavior may be related to sex offending behavior for certain sex offenders.

Last, having male victims was a predictor of suicide attempts among sexual offend-ers. One study investigating rates of sexual abuse among juvenile sex offenders found that 75% of offenders who assaulted a male were reportedly sexually abused as chil-dren, whereas only 25% of those who abused women were reported to have suffered from childhood sexual abuse (Worling, 1995). Since childhood sexual abuse is a risk factor for suicide (Becker & Murphy, 1998; Langevin et al., 1989), it is plausible that among sex offenders a history of childhood sexual abuse may influence both victim gender choice and likelihood of engaging in suicidal behavior.

We hypothesized that sex offenders would be at increased risk of suicidal behavior as compared to other types of offenders. However, we found that the overall lifetime incidence of suicide attempts (14%) among this sample of sex offenders was lower than a previous study of general offenders within the United Kingdom (20%; Jenkins et al., 2005). Furthermore, Jenkins et al. found that 6.6% of their general offender sample population made a suicide attempt in the past year, whereas only 2.5% of our sample population made an attempt while incarcerated (which was generally a much longer time frame than 1 year). One possible explanation for the difference is that in this study we used documented instances of suicide attempts, whereas Jenkins and colleagues relied on offender self-report. Many nonfatal suicide attempts are low in lethality and therefore often do not necessitate or warrant intervention and thus go unnoticed. It is plausible that the rate of suicide attempts is indeed much higher among the sex offender population. However, to assess this, offenders would need to be inter-viewed, and whenever possible, collateral information would need to be obtained from friends, loved ones, or medical personnel who may have been aware of the suicide attempt. In addition, the suicide attempt rate in this study was found to be higher than that of the general population, which has been estimated to range somewhere between 1% and 6% (Ramsay & Bagley, 1985; Welch, 2001). Although the results of this study suggest that sexual offenders may not be at a higher risk for suicidal behavior than other offender populations, there is evidence that offenders in general are at an increased lifetime risk of suicide compared to the general population. Thus, all those involved in the criminal justice system, including sex offenders, should be considered for suicide prevention and intervention efforts.

Unlike previous research that found that offenders who committed sex crimes exclusively against children were at heightened risk for completed suicide (e.g.,

36 Sexual Abuse 25(1)

Brophy, 2003; Pritchard & King, 2005), no differences in suicide attempter status (attempt/no attempt) were found in this sample between those who had child victims and those who had adult victims. However, McKibben, Proulx, and Lusignan (1994) found that negative affective states were related to deviant sexual behaviors in both rapists and pedophiles, which would support our findings. Although suicide attempts are one of the best proxies that we have for studying completed suicide, some key dif-ferences have been found between those who attempt suicide and those who commit suicide (DeJong, Overholser, & Stockmeier, 2010), and thus, conclusions drawn based on those who complete suicide may not always apply to those who attempt suicide.

Congruent with the general suicide literature, this study found that both childhood maltreatment and psychiatric disorders may place sex offenders at higher risk for engaging in suicidal behaviors; however, chronic and acute stressors unique to sex offenders may play an important role as well. Relative to other offenders, sex offend-ers are subject to increasingly strict legislation, with offenders reporting the collateral consequences of these laws to be heightened emotional distress, stigma, housing and employment difficulties, and problems in interpersonal relationships (Levenson, 2008; Tewksbury & Lees, 2006). Notification statutes, in particular, have been correlated with increased self-report of depression, hopelessness, and suicidal ideation (Jeglic et al., 2011). Furthermore, there is evidence to suggest that depression, hopelessness, and suicidal ideation are more prominent among sex offenders who report experienc-ing the most negative consequences as a result of sex offender legislation (Jeglic et al., 2011). Therefore, the heightened levels of suicidal ideation and suicidal behavior among the sex offender population, combined with evidence that the factors that cause emotional distress and suicidal ideation/behavior may be the same factors that lead to sexual recidivism, highlight a need for treatment interventions targeting this popula-tion both while incarcerated and once they return to the community. In addition, given the collateral consequences of sex offender legislation, including depression, suicidal ideation and behavior, and potential for increased recidivism risk, the evidence sug-gests that sex offender policies, particularly, registration/notification and residence restrictions, be reexamined in terms of their effectiveness (Jeglic et al., 2011; Levenson & Cotter, 2005; Tewksbury, 2005).

There were several limitations of the current study. First, this study employed archival data from inmate correctional records. Therefore, we were only able to ascer-tain whether or not an offender had made a suicide attempt and not the circumstances surrounding it. Furthermore, suicide attempt history was generally limited to offender self-report at intake or attempts that were documented in the file that took place while in custody. Many individuals make suicide attempts that do not require medical atten-tion and, thus, are never reported. Consequently, some offenders may not have dis-closed past suicide attempts; thus, the rates of suicide attempting that are reported are very likely an underestimate. Furthermore, information pertaining to suicide attempt status and other variables of interest were not located in all files. In addition, we found that a psychiatric history was predictive of suicide attempt status among sex offenders; however, as noted earlier, given that most offenders who made a documented suicide

Jeglic et al. 37

attempt likely received some sort of psychiatric care, it is unclear whether this variable accurately assessed psychiatric care prior to or as a consequence of the suicide attempt; thus, this variable should be interpreted with caution. Furthermore, given that we were using archival data we were only able to code information that was available in the files and, thus, we had missing data. The missing data problem multiplies as variables are added to the prediction mode; thus, power of our analyses to detect significance was reduced. Also contributing to decreased power to detect significance was the low base rate of suicidal attempts among our sample, particularly among those who attempted suicide while in prison. A low base rate can significantly decrease the over-all accuracy of detecting a phenomenon even if a model has a 100% accuracy rate. Finally, we were unable to ascertain the timeframes during which the suicide attempts that happened prior to incarceration took place. For example, a suicide attempt in childhood may have occurred for very different reasons than a suicide attempt in adulthood. Future research examining suicidal behavior among sex offenders should endeavor to include both offender self-report corroborating evidence. This would pro-vide more information about the context of the attempt.

In sum, these findings suggest an important public health concern, specifically, that sex offenders may be at heightened risk for suicide. Prevention efforts might focus on identifying those with previous suicide attempts, as well as those who have a history of psychiatric treatment or a history of neuropsychological or intellectual impairment, and providing targeted intervention services that aim to enhance coping strategies. Indeed, although sex offenders may be among the most vilified in our society—considered pariahs even by other criminals—a humanistic approach mandates that those within the criminal justice system provide intervention efforts that reduce sui-cide risk among sexual offenders. Furthermore, there is evidence to suggest that many of the risk factors associated with suicide attempts among sex offenders are precisely the same factors that contribute to risk of reoffending. Thus, early intervention efforts to bolster the coping skills of sex offenders may not only prevent potential suicides and increase sex offenders’ quality of life but also protect society by preventing poten-tial future offenses from occurring.

Acknowledgment

The authors wish to thank the New Jersey Department of Corrections and the New Jersey Department of Human Services for their support in providing access to offender records and the National Institute of Justice for their support of this work.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by Award No. 2007-IJ-CX-0037

38 Sexual Abuse 25(1)

awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this publica-tion are those of the authors and do not necessarily reflect those of the Department of Justice.

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