Suicide in prison and after release: a 17-year national cohort study

Anne Bukten,Marianne Riksheim Stavseth

doi:10.1007/s10654-021-00782-0

Anne Bukten, Marianne Riksheim Stavseth

Open Access

https://doi.org/10.1007/s10654-021-00782-0

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Abstract

BackgroundPeople in prison have an extremely high risk of suicide. The aim of this paper is to describe all suicides in the Norwegian prison population from 2000 to 2016, during and following imprisonment; to investigate the timing of suicides; and to investigate the associations between risk of suicide and types of crime.MethodsWe used data from the Norwegian Prison Release study (nPRIS) including complete national register data from the Norwegian Prison Register and the Norwegian Cause of Death Register in the period 1.1.2000 to 31.12.2016, consisting of 96,856 individuals. All suicides were classified according to ICD-10 codes X60-X84. We calculated crude mortality rates (CMRs) per 100,000 person-years and used a Cox Proportional-Hazards regression model to investigate factors associated with suicide during imprisonment and after release reported as hazard ratios (HRs).ResultsSuicide accounted for about 10% of all deaths in the Norwegian prison population and was the leading cause of death in prison (53% of in deaths in prison). The CMR per 100,000 person years for in-prison suicides was 133.8 (CI 100.5–167.1) and was ten times higher (CMR = 1535.0, CI 397.9–2672.2) on day one of incarceration. Suicides after release (overall CMR = 82.8, CI 100.5–167.1) also peaked on day one after release (CMR = 665.7, CI 0–1419.1). Suicide in prison was strongly associated with convictions of homicide (HR 18.2, CI 6.5–50.8) and high-security prison level (HR 15.4, CI 3.6–65.0). Suicide after release was associated with convictions of homicide (HR 3.1, CI 1.7–5.5).ConclusionThere is a high risk of suicide during the immediate first period of incarceration and after release. Convictions for severe violent crime, especially homicide, are associated with increased suicide risk, both in prison and after release.

Highlights

Suicide is a major public health concern
We considered only suicides with fatal outcome, coded X60 through X84 according to the ICD-10
Our study showed that the immediate period after imprisonment and after release impose a high risk of suicide, especially among people convicted of homicide

Summary

Introduction

Suicide is a major public health concern. Globally, nearly 800 000 people die each year due to suicide, and suicide is the second leading cause of death among 15–29-year-olds [1]. Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway is the single most common cause of death in prisons [3] and among the leading causes of death following release [4]. People in prison have an extremely high risk of suicide. The aim of this paper is to describe all suicides in the Norwegian prison population from 2000 to 2016, during and following imprisonment; to investigate the timing of suicides; and to investigate the associations between risk of suicide and types of crime. Suicide in prison was strongly associated with convictions of homicide (HR 18.2, CI 6.5–50.8) and high-security prison level (HR 15.4, CI 3.6–65.0). Conclusion There is a high risk of suicide during the immediate first period of incarceration and after release. Convictions for severe violent crime, especially homicide, are associated with increased suicide risk, both in prison and after release

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