Prison Suicide Research Articles

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

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.

Suicide after reception into prison: A case-control study examining differences in early and late events.

ObjectivePrisoners constitute a high-risk group for suicide, with suicide rates about 5 to 8 times higher than in the general population. The first weeks of imprisonment are a particularly vulnerable time, but there is limited knowledge about the risk factors for either early or late suicide events.MethodsBased on a national total sample of prison suicides in Germany between 2005 and 2017, suicides within the first 2 (4 and 8) weeks after reception into prison were matched by age and penalty length with cases that occurred later. Factors that potentially influence the timing of suicide were investigated.ResultsThe study has shown that 16.7% (31.5%) of all 390 suicides in German prisons occurred within the first two weeks (two months) of imprisonment. Factors that facilitate adaptation to the prison environment (e.g. prior prison experience) were negatively associated with early suicide events. Factors that hindered the adaptation process (e.g. withdrawal from illicit drugs) were observed more frequently in early suicide events than in late ones. These factors are active at different times of imprisonment.ConclusionAt reception, particular attention should be paid to the following factors associated with early suicide events: widowed marital status, lack of prison experience, and drug dependency.

Exploring the Relationship Between Domestic Violence Perpetration and Suicidal Behavior in Male Prisoners

This study is the first to explore the relationship between domestic violence perpetration and suicidal behavior in prisoners in England and Wales. The nature of this relationship is unclear, however, understanding and reducing suicide in prisons is a critical issue for frontline staff and policy makers. Eight participants with a history of suicide attempts and domestic violence perpetration were interviewed. Five key themes were identified through thematic analysis; “Trauma, victimization and life struggles,” “Relationship ideals versus relationship reality”, “Explaining domestic violence”, “The impact of prison” and “Suicide as a coping strategy”. This study shows that the relationship between domestic violence and suicide risk in prisoners may be better understood through a pathway of experiences rather than individual risk factors. Further research is needed to test the replicability of this pathway in other samples.

Risk Factors for Suicide in Prison are Identified.

According to this study: Demographic, criminological, clinical, and institutional risk factors associated with suicide in prison have been identified.

The association between childhood trauma and lifetime suicide attempts among a sample of male prisoners: A pilot observational study

BackgroundPrisoners have higher rates of suicide attempts compared with general population. A history of childhood trauma (CT) is common among incarcerated subjects and it is a well-known risk factor for lifetime suicide attempts. Therefore, the purpose of the study was to investigate whether lifetime suicide attempts may be related to the exposition to CT among male prisoners. MethodWe conducted a cross sectional study recruiting newly arrived inmates in an Italian jail, between January 2017 and June 2018. Prisoners were interviewed to collect socio-demographic and clinical information. Moreover, inmates completed the Childhood Trauma Questionnaire. We excluded prisoners unable to speak or read Italian, with learning disabilities or current severe psychiatric symptoms. ResultsA total of 215 consecutive male inmates were included. Fifty-one prisoners (23.7%) had a history of attempted suicide. The most reported CT was physical neglect. Multivariate logistic regression analysis showed that a history of childhood sexual abuse, emotional neglect and psychiatric diagnosis significantly increased the likelihood of lifetime suicide attempt. ConclusionsA previous history of suicide attempt is highly prevalent among inmates. In agreement with previous findings, lifetime suicide attempts seem to be associated with the presence of CT and psychiatric diagnosis. Therefore, CT should be considered as a relevant variable to improve the programs for the prevention of suicide in prison.

Using Life Trajectories Analysis to Characterize Suicide Attempts in Prison.

Background: Suicide in prison is a major problem and several risk factors have been identified in the literature (e.g., period of incarceration, depressive disorders). Aims: The study examined the impact of several risk factors for suicide attempts before and during incarceration using life trajectory analysis of inmates by interviews with informants. Method: The lifetime of inmates with a history of suicide attempts (ISA; n = 20) or without (IWSA; n = 29) was recounted on a life chart according to four main domains (health, life events, relationships, and judiciary domain) organized in two different periods (predetention and current detention). Life charts were compared between the two groups and a predictive model of suicide risk was constructed using logistic regression and receiving operating characteristic curve analysis. Results: Before detention, more depressive experiences were observed in ISA than in IWSA, and ISA reported more behavioral disorders than IWSA during current detention. Moreover, the total burden for ISA was greater than that for IWSA. The predictive model identified three dimensions for differentiating ISA from IWSA: mood disorders before detention, behavioral disorders, and the quality of relationships with nuclear family during detention. Limitations: Interviews with inmates would have been informative. Conclusion: The accumulation of life events and behavioral manifestations should be incorporated in the developmental trajectory as a therapeutic model regarding suicide in prison.

Uncommon suicide methods in the detention regime in Milan (1993–2019): Forensic contribution on autopsy cases

We analysed the recorded cases of suicides committed other than by hanging in prison in Milan. A retrospective analysis was conducted on 25,512 autopsies performed from 1993 to 2019, selecting all the suicides in prison but our attention was focused solely on cases where an alternative mode to hanging was used. From a total of 97 suicide events in prison, 15 were consistent with the established search criteria: 6 victims died from plastic bag suffocation, 4 by direct inhalation of butane gas, 2 associated plastic bag suffocation to inhalation of butane gas, one committed suicide with an edged weapon, one by self-burning and, finally, one by voluntary ingestion of a food to which he was allergic, with the intent of inducing an anaphylactic shock. Our analysis has shown that the landscape of prison suicides is diverse, not limited solely to hanging. Therefore, it is necessary for the forensic scientific community to raise awareness of potentially unusual suicide methods in prisons and, in the same way, for the Penitentiary Administration to put adequate preventive measures and strategies in place.

Risk factors for suicide in prisons: a systematic review and meta-analysis

SummaryBackgroundRates of suicide among people in prison are elevated compared with people of similar age and sex who are living in the community. Improving assessments and interventions to reduce suicide risk requires updated evidence on risk factors. We aimed to examine risk factors associated with suicide in prisoners.MethodsWe did an updated systematic review and meta-analysis of risk factors for suicide among people in prison. We searched five biblographic databases for articles published between Jan 1, 2006, and Aug 13, 2020, and one database for articles published between Jan 1, 1973, and Aug 13, 2020. Eligible studies reported risk factors in individuals who died by suicide while in prison and in controls from the general prison population. Two reviewers independently extracted data for each study using a standardised form. We calculated random-effects pooled odds ratios (ORs) for the association of suicide with demographical, clinical, criminological, and institutional risk factors, and investigated heterogeneity using subgroup and meta-regression analyses. This systematic review is registered with PROSPERO, CRD42020137979.FindingsWe identified 8041 records through our searches, and used 77 eligible studies from 27 countries, including 35 351 suicides, in the main analysis. The strongest clinical factors associated with suicide were suicidal ideation during the current period in prison (OR 15·2, 95% CI 8·5–27·0), a history of attempted suicide (OR 8·2, 4·4–15·3), and current psychiatric diagnosis (OR 6·4, 3·6–11·1). Institutional factors associated with suicide included occupation of a single cell (OR 6·8, 2·3–19·8) and having no social visits (OR 1·9, 1·5–2·4). Criminological factors included remand status (OR 3·6, 3·1–4·1), serving a life sentence (OR 2·4, 1·3–4·6), and being convicted of a violent offence, in particular homicide (OR 3·1, 2·2–4·2).InterpretationSeveral modifiable risk factors, such as psychiatric diagnosis, suicidal ideation during the current period in prison, and single-cell occupancy, are associated with suicide among people in prison. Preventive interventions should target these risk factors and include improved access to evidence-based mental health care. Understanding other factors associated with suicide might improve risk stratification and resource allocation in prison services.FundingWellcome Trust, National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley.

Investigating prison suicides: The politics of independent oversight

This article examines the institutional arrangements in place to investigate prison suicides in England and Wales, focusing on inquiries by the Prisons & Probation Ombudsman and coroners’ inquests. The first half of the article is empirical, and draws on a set of elite interviews with Prisons & Probation Ombudsman investigators, senior coroners and other professionals involved in prison oversight. The latter half of the article is theoretical, and interprets prison suicide investigations as an example of broader trends of counter-democracy and depoliticisation. I provide a general theoretical overview of these concepts, and argue that Prisons & Probation Ombudsman investigations and coroners’ inquests operate according to a technocratic logic of independence, neutrality and rationality. The article concludes that prison suicide investigations are narrowly concerned with the factual details and administrative minutiae of individual cases, at the expense of more open ended, less manageable questions about the politics of punishment.

Reconceptualizing multisectoral prison regulation: Voluntary organizations and bereaved families as regulators

Prison health, prisoner safety and imprisonment rates matter: intrinsically and for health and safety outside. Existing prison regulation apparatuses (e.g. OPCAT) are extensive and hold unrealized potential to shape imprisonment. However, criminologists have not yet engaged much with this potential. In this article, I reconceptualize prison regulation by exploring the work of a broad range of multisectoral regulators who operate across stakeholder groups. I illustrate that voluntary organizations and families bereaved by prison suicide act as regulators, although their substantive actions have been erased from official narratives. Mobilizing (threats of) litigation, these actors have responsibilized the state and brought qualitative changes across the prison estate.

Suicide in Prisons: Active Deviation Profile

Suicide in Prisons: Active Deviation Profile

Lives saved: Correctional officers’ experiences in the prevention of prisoner death by suicide

Few researchers have empirically examined completed or attempted death by suicide in prison and, of the available research, most has been conducted in the United Kingdom. Our purpose in this article is to increase awareness and knowledge about “lives saved” in custody drawing on the voices of Canadian provincial and territorial correctional officers (COs; n = 43). We investigate their experiences with attempted and completed death by suicide to shed light on the commonality of such experiences, and their impact on officers over time. Based on an analysis of semi-structured interview transcripts, we explore the effects of exposure to these potentially psychologically traumatic events on COs, specifically their emotional responses, as well as the supports available, both informal and formal, as they navigate their work. We found that the roles of officers, which frequently overlap with the domains of mental health support and first response in a crisis situation, are often under-recognized and underappreciated. Ultimately, we highlight the need for increased dialogue surrounding workplace trauma and mental health in prison and explore the institutional barriers that arise when facilitating discussion about mental health. We show that although some lives are lost in prison, due to natural and nonnatural causes, many lives are saved by prison staff.

Prison staff’s views and understanding of the role of emotions in prisoner suicide and violence

ABSTRACT Suicide and violence are a major concern in prisons, and it has been suggested that alexithymia may be associated with these behaviours. Alexithymia can be defined as the inability to identify and describe emotions. This study aimed to explore staff’s understanding and attitudes about identifying and discussing emotions in prisoner suicide and violence. Twenty prison staff across departments were interviewed about their understanding of how emotional difficulties contribute towards prisoner suicide and violence. Interviews were transcribed verbatim and analysed using thematic analysis. Analysis revealed five main themes and nine subthemes. Staff felt that prisoners struggled to identify, understand and communicate their emotions which led to intense and sudden outbursts of emotion. In turn, prisoners responded to these outbursts using two main maladaptive coping strategies; drug and alcohol use and harming self or others. This process was placed in a broader context of both upbringing and the prison environment. These findings therefore suggest that a change to prison regime and culture is crucial to encouraging prisoners to overcome difficulties with identifying, understanding and communicating emotions which, in turn, could help to reduce rates of suicide and violence in prison.

1324 prison suicides in 10 countries in South America: incidence, relative risks, and ecological factors.

Although suicide rates of prison populations and incidence factors have been reported for high-income countries, data from low- and middle-income regions are lacking. The purpose of the study was to estimate suicide rates among prison populations in South America, to examine prison-related factors, and to compare suicide rates between prison and general populations. In this observational study, we collected the numbers of suicides in prison, rates of prison occupancy, and incarceration rates from primary sources in South America between 2000 and 2017. We compared suicide rates among prisoners with incidence rates in the general populations by calculating incidence rate ratios. We assessed the effect of gender, year, incarceration rates and occupancy on suicide rates in the prison populations using regression analyses. There were 1324 suicides reported during 4,437,591 person years of imprisonment between 2000 and 2017 in 10 South American countries. The mean suicide rate was 40 (95% CI 16-65) per 100,000 person years for male and female genders combined. The pooled incidence rate ratio of suicide between prison and general populations was 3.9 (95% CI 3.1-5.1) for both genders combined, 2.4 (95% CI 1.9-3.1) for men and a higher ratio in women (13.5, 95% CI 6.9-26.9). High occupancies of prisons were associated with lower incidence of suicide (β = - 58, 95% CI - 108.5 to - 7.1). Suicides during imprisonment in South America are an important public health problem. Suicide prevention strategies need to target prison populations.

Evaluating voluntary sector involvement in mass incarceration: The case of Samaritan prisoner volunteers

Mass incarceration and supervision operate through a mixed economy. Using the case study of Samaritans’ emotional support for prisoners in distress in England and Wales, we present an original framework of five normative criteria to facilitate nuanced assessment of voluntary sector criminal justice participation. This is an urgent, significant task for theory and practice: we need to find forms of public input that can deconstruct bloated penal systems. Whilst citizen involvement can be a positive form of ‘people power’, our assessment of Samaritans’ ostensibly welcome humanitarian intervention reveals how it deflects attention from severe shortcomings of the penal system. In the context of mass incarceration, we conclude that voluntary sector and citizen involvement in individualised service delivery alone risks obscuring deep problems and delaying much-needed change. This topic is particularly timely, given increasing non-state involvement in criminal justice and the global problem of prison suicide.

Do Institutional Investors Mitigate Social Costs of Privatization? Evidence from Prisons

This paper examines whether institutional investors mitigate social costs that arise when government services are outsourced to private enterprises. Using hand-collected data on U.S. prisons, I find that privatization is associated with an increase in prisoner suicides by up to 39%. However, institutional investors of public companies managing private prisons decrease suicide rates by one third. These effects are stronger for long-term institutional investors since failing to internalize social externalities negatively impacts the long-term success of portfolio firms. Evidence from a tax reform that exogenously increases institutional ownership of prison management companies suggests that the relationship between ownership and social outcomes is causal. To explain these results, I show that institutional investors have incentives to be socially responsible due to litigation and reputation risks.

Assessing vulnerability to risk of suicide and self-harm in prisoners: a Rasch analysis of the suicide concerns for offenders in the prison environment (SCOPE-2)

BackgroundWith increasing levels of suicide and self-harm behaviour in the criminal justice system professionals would benefit from a tool that can identify individuals who may be at risk of self-harm and/or suicidal behaviour.MethodThe Suicide Concerns for Offenders in the Prison Environment (SCOPE) tool was originally devised and validated in six UK prisons between 2003 and 2004. The goal of this study is to re-evaluate the SCOPE using Rasch methodology to produce a psychometrically robust instrument. Data were presented from 1051 SCOPE assessments of male and female offenders.ResultsThe analysis produced a revised SCOPE-2 tool reducing the tool from a 27 to a 19 items and simplifying the categorical six point scale to a four item scale.ConclusionsFurther validation of the new SCOPE-2 tool is required in samples of male and female prisoners to assess different cut-off points for clinical and policy use.

Dispositifs de prévention et de postvention du suicide en prison mis en place par l’Administration Pénitentiaire française

The French Prison Administration has been doing suicide prevention in prison for over 50 years. It is undoubtedly one of the administrations, which best takes these risks into account today. She even made it one of her priorities. On the one hand, by developing an initial and continuous training system on this subject, and on the other hand, by implementing preventive measures based on the assessment of the suicidal potential of anyone arriving in prison. It has thus set up prevention and postvention devices in the face of its own suicide risk. While all of these measures give encouraging signs in terms of results, the fact remains that a certain number of deaths by suicide in prison still occur each year. It is therefore necessary for the prison administration to also take postvention measures in order to minimize the psychological impact on prisoners and on personnel directly concerned by the discovery of a suicide prisoner. The prison staff has an obligation of means with regard to the medical care of detained persons. Several legal texts, European and French, legislate this obligation and lay down the broad outlines. The prevention of suicidal risks in the prison environment is based on the assessment of the suicidal potential of detained persons, upon their arrival in detention. Each inmate is assessed for the risk, urgency and suicidal dangerousness he presents during this incoming interview. Depending on the results, measures specific to the prison administration can be taken to limit, or even prevent, any risk of suicide. All personnel in initial training at the national school of prison administration (ENAP) are made aware of this evaluation method. There after, additional training, throughout their career, is offered to them in continuous training so that they develop their skills in this area. But when a suicide, or an attempt, occurs in detention, postvention measures are put in place for all those affected by this event, in particular prison staff, fellow prisoners and families. The prison administration has been working on suicide prevention in detention for over fifty years, making it one of the French administrations most involved in suicide prevention.

Feeling hopeful: can hope and social support protect prisoners from suicide ideation?

ABSTRACTSuicide is a major concern in custodial settings with prisoners identified as a high risk group. Much previous research is limited to focussing upon factors associated with increased likelihood of suicide. The current study investigates the potentially protective factors of hope and social support in a sample of 100 suicidal prisoners. Hope, especially the sub-component of agency thinking, and the perceived availability of social support were significantly related with lower levels of suicidal ideation. Prison suicide prevention efforts may benefit from incorporating hope focussed assessments and treatments. They should also consider an individual’s need for increased availability of social support.

Custody-related deaths in Maharashtra state of India - Analysis of autopsies performed at a medical Teaching Institute during the period 2000–2018

IntroductionCustody-related death is an internationally key sensitive issue with respect to Human Rights. The causes of death and associated factors in this vulnerable population vary according to country and region. The present study attempted to analyze the different causes of custody-related deaths and associated factors and identify the areas of intervention for prevention of such deaths. Material and methodsThis retrospective study was conducted using files of custody-related deaths in the Department of Forensic Medicine of Shri V. N. Government Medical College, Yavatmal, Maharashtra State (India). A total of 108 cases were autopsied by the Department during the period of 2000–2018. We used a pre-formed proforma to extract data from files of these cases; the data obtained tabulated and coded in to charts, following which they were analyzed in detail. ResultsMale preponderance (105) was observed, with there only being 3 female cases (Male: Female ratio 1:0.028). The most common age group among deaths in police custody/action was 31–40 years whereas; age group of 41–50 years was most common among prisoners. A majority of deaths occurred due to natural causes (69.44%); among these, 89.33% were prisoners, with cardiac causes being the most common. Many individuals died due to cardiac causes were brought dead at tertiary care hospital. Suicides were a common cause of unnatural deaths among individuals in police custody/action. The majority of victims committed suicide in police custody did so by hanging. All cases of suicide by insecticide poisoning were observed in police action, and hanging was the only cause of suicide in prison. Blunt force injuries were frequent cause of homicide in police custody, which were result of force used by police during interrogation. ConclusionLack of knowledge regarding the causes of death and careless attitude towards the suicidal behavior and, the health and welfare of detainees are avoidable reasons for custody-related deaths.