Rom J Leg Med 17 (1) 69 – 72 (2009) © 2009 Romanian Society of Legal Medicine ________________________ *) Corresponding author; 1) ER coordinator at St. John Clinical Emergency Hospital, Iaşi, e-mail: tudorciuhodaru@yahoo.co.uk; 2) Emergency surgery, Gr. T. Popa University of Medicine and Pharmacology, Iaşi, specialist in general surgery at St. John Clinical Emergency Hospital, Iaşi 3) ER, St. John Clinical Emergency Hospital, Iaşi; 4) Forensic Psychiatry Department, National Institute of Legal Medicine “Mina Minovici”, Sos. Vitan Birzesti 9, Sector 4, 04212 Bucharest. 69 Factors increasing mortality rates in suicide attempts in jail and prison T. Ciuhodaru 1* , S.N. Romedea 2 , T. Arhipescu 3 , O. Buda 4 Received: 29.10.2008/ Accepted in revised form: 9.01.2009 _____________________________________________________________________ Abstract: Suicide is a major cause of death in penitentiaries, having a higher rate than within other community groups. The purpose of this paper is to establish the risk factors which led to an increasing mortality rate among prisoners taken to St. John Clinical Emergency Hospital, Iaşi, who tried to commit suicide. There is a clear difference between patients who tried to commit suicide and those who succeeded it. Between January 1st, 2006, and December 31st, 2007, 205 cases of autolitic attempts were reported, committed by 129 prisoners. Three of them died. Personal and clinical data regarding all patients were registered in order to determine the diagnosis and establish the adequate treatment, as well as data regarding the number of autolitic relapses and their periodicity, frequency and the methods used. All those who died, belong to the 20 to 29 years old age group. They were not at their first suicide attempt and repeated it within 2-3 weeks. The act was committed at moments of scarce surveillance and the case was critical from the very beginning. Key words: suicide, suicide rates, suicide prevention, prison systems uicide is a complex phenomenon which, throughout centuries, drew the attention of philosophers, theologians, sociologists, artists, physicians and ordinary people. Each of these categories assigned a different meaning to this phenomenon. The suicide rate may be a test for a community’s psychological and relational health condition, a valuable indicator regarding society’s sanity. Penitentiaries may be considered to be a deviant type of society, where social rules are extremely strict, which means that, according to Durkheim’s classification, some of the suicides committed in penitentiary can be labelled as fatalistic [1]. However, most suicides committed in penitentiary are egotistic, reflecting a poor social integration. A special category is represented by prisoners on a death row. In their case, suicides can be both egotistical and fatalistic, because from their point of view, although they are socially isolated, the conditions are extremely strict and, at the same time, they are poorly socialized. Suicide is the third factor causing death in the United States prisons [2, 3]. Over the last thirty years, a high suicide rate was reported to exist in penitentiaries, ranging from 18 and 40 to 100.000 prisoners. The suicide rates were extremely high in crowded urban penitentiaries, such as those in New York, Atlanta and Miami, and relatively reduced in penitentiaries placed outside cities [3, 4]. As a group, prisoners present a suicide rate higher than other community groups, although risk factors like drug consumption, unemployment, personal conflicts and mental deseases, are equally encountered among common people and in prison. The circumstantial factors that would justify the higher suicide risk with prisoners, are the following: to deprive someone of his/her freedom, the loss of family and social support, fear of the unknown, fear of S