Exploring reasons and motivations for suicide attempts in prison before and during the SARS-CoV-2 pandemic.

Background
Suicide attempts represent a critical public health concern in prison settings, where rates are substantially higher than in the general population. The COVID-19 pandemic introduced additional stressors, yet little is known about its impact on suicide attempts among detained persons. This study aimed to identify the underlying reasons and motivations for suicide attempts in a Swiss pre-trial prison and to examine changes before and during the pandemic. We analyzed 205 suicide attempts by 125 detained persons between 2016 and 2021. Data were collected from clinical and prison records. Reasons and motivations were extracted using content analysis. Population-averaged logistic regression models were used to examine differences between periods.Results
Suicide attempts were associated with health-related and personal issues (85%), prison-related problems (76%), and interpersonal conflicts (61%). Psychological distress, juridical issues, and conflicts with correctional officers were the most common reasons. Motivations included protest against the institution (39%), desire to die (18%), escape (11%), and help-seeking (7%). There was an increase in health-related and personal problems during the pandemic, particularly dissatisfaction with medical care (+104%), physical pain (+181%), and psychological distress (+18%), while help-seeking motivations decreased (-72%). Psychiatric morbidity and self-harm history were associated with these outcomes. Sample characteristics remained largely stable across periods.Conclusions
This study highlights the multifaceted nature of suicide attempts in prison and the impact of the COVID-19 pandemic on health-related and personal issues. While preventive measures were essential for infection control, they may have increased psychological distress, and reduced medical resources likely exacerbated clinical needs. These findings underscore the importance of balancing public health measures with continuous access to care during public health emergencies.