Citation: Santoriello, C.; De Rosa, C.; Rufo, C.; Romano, F.; Termoli, G.; Fiorillo, G.; Caprio, L.; Vitolo, M.; Pagano, A.M. Suicide Risk Screening and Assessment before and after the COVID-19 Pandemic in New Inmates. Healthcare 2024, 12, 100. https:// doi.org/10.3390/healthcare12010100 Academic Editor: Stavroula Papadodima Received: 25 November 2023 Revised: 26 December 2023 Accepted: 31 December 2023 Published: 2 January 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). healthcare Article Suicide Risk Screening and Assessment before and after the COVID-19 Pandemic in New Inmates Carmen Santoriello * , Carmela De Rosa, Chiara Rufo, Francesca Romano, Gaetana Termoli, Giuseppina Fiorillo, Ludovica Caprio, Monica Vitolo and Antonio Maria Pagano * Unità Operativa Semplice Dipartimentale U.O.S.D. Department of Adults and Minors Healthcare, Criminal Area, Local Health Authority of Salerno, 84132 Salerno, Italy * Correspondence: carmensantoriello@blu.it (C.S.); a.pagano@aslsalerno.it (A.M.P.) Abstract: (1) Background: Suicide is the main cause of death in Italian prisons. The largest number of inmates who killed themselves was recorded during three years of the COVID-19 pandemic. This study aimed to explore psychosocial risk factors for suicide among inmates incarcerated before and after the onset of COVID-19. (2) Methods: At prison reception, inmates underwent clinical interviews and were assessed using the Blaauw Scale and Suicide Assessment Scale. Psychological distress, measured by the Symptom Checklist-90-R, was compared between inmates admitted before and after COVID-19. Regression analyses were run to examine psychosocial vulnerabilities associated with suicidal intent in newly incarcerated individuals at risk of suicide. (3) Results: Among the 2098 newly admitted inmates (93.7% male) aged 18 to 87 years (M = 39.93; SD = 12.04), 1347 met the criteria for suicide risk, and 98 exhibited high suicidal intent. Inmates who entered prison after the onset of COVID-19 were older and had fewer social relationships. They had a higher prevalence of recidivism and substance abuse, along with elevated levels of psychological distress. An increase in perceived loss of control, anergia, obsessive-compulsive symptoms, phobic anxiety, and paranoid ideation emerged as the factors most strongly associated with high suicidal intent. (4) Conclusions: These findings support the value of psychosocial screening in promptly identifying inmates at risk of suicide, enabling the implementation of targeted, multi-professional interventions. Future research should replicate these results, with a focus on longitudinal studies that monitor the same inmates throughout their incarceration period. Keywords: suicide prevention; prisoners; health; psychosocial distress; suicidal behavior 1. Introduction Suicide is self-directed, injurious behavior with the intent to die. A suicide attempt is when self-injurious behavior, planned and acted upon to achieve death, results in a non-fatal outcome [1–3]. Suicidal intent, defined as the intensity of the person’s wish to terminate his or her life, has been found to predict completed suicide [4–9]. Self-injurious behavior and suicide attempts are more common among inmates than non-inmates [10–13]. In 2007, the International Association for Suicide Prevention established the New Task Force on Suicide in Prisons, which updated the ‘Preventing Suicide’ guide [14], originally published by the World Health Organization’s Department of Mental Health. Konrad et al. [14] emphasized the importance of identifying and treating inmates’ vulnerability to suicidal behavior throughout their incarceration, with particular attention to the prison reception period [15–21]. The stress-vulnerability model describes suicidal behavior as a multidimensional process that evolves through the interaction of individual and environmental variables [22,23]. Inmates’ psychosocial vulnerabilities, such as social alienation, cognitive distortions, and deficient adaptive resources, along with poor coping skills to handle distress and prison stressors (e.g., uncertainty, separation from family, forced cohabitation with other inmates), may trigger suicidal ideation [22–24]. Healthcare 2024, 12, 100. https://doi.org/10.3390/healthcare12010100 https://www.mdpi.com/journal/healthcare