Psychiatric symptom severity, criminal risk, and suicidal ideation and attempts among not guilty by reason of insanity state hospital inpatients

Individuals forensically committed to a state hospital are at an increased risk of suicide; however, there is extremely limited research examining suicide risk estimates and risk factors among inpatients deemed not guilty by reason of insanity (NGRI). This study aimed to determine (a) rates of suicidal ideation history, suicide attempt history, and current distress due to suicidal ideation, and (b) the associations between psychiatric symptom severity, criminal risk factors, and suicide risk. NGRI inpatients (n = 207) from 2 state hospitals were administered assessments of psychiatric symptom severity and criminal risk factors (i.e., criminal tendencies and antisocial personality traits). Results indicated 46.4% of participants reported at least 1 previous suicide attempt, 58% reported previous suicidal ideation, and 10.1% reported some level of current distress due to suicidal ideation. Binary logistic regression results indicated psychiatric symptom severity, not criminal tendencies or antisocial personality traits, was associated with a greater likelihood of current distress due to suicidal ideation. There was a significant interaction between criminal tendencies and antisocial personality, which indicated that individuals higher in criminal tendencies and lower in antisocial personality traits are predicted to have the greatest probability of reporting current distress due to suicidal ideation. Additionally, psychiatric symptom severity and antisocial personality traits were associated with a greater likelihood of a suicide attempt history, whereas criminal tendencies were associated with a decreased likelihood. Clinical implications are discussed, particularly the need for suicide risk assessments and management to consider both psychiatric symptoms and criminal risk factors.