Dataset Information

Suicide in prisons: an international study of prevalence and contributory factors.

ABSTRACT: BACKGROUND:Prison suicide rates, rate ratios, and associations with prison-related factors need clarification and updating. We examined prison suicide rates in countries where reliable information was available, associations with a range of prison-service and health-service related factors, how these rates compared with the general population, and changes over the past decade. METHODS:We collected data for prison suicides in 24 high-income countries in Europe, Australasia, and North America from their prison administrations for 2011-14 to calculate suicide rates and rate ratios compared with the general population. We used meta-regression to test associations with general population suicide rates, incarceration rates, and prison-related factors (overcrowding, ratio of prisoners to prison officers or health-care staff or education staff, daily spend, turnover, and imprisonment duration). We also examined temporal trends. FINDINGS:3906 prison suicides occurred during 2011-14 in the 24 high-income countries we studied. Where there was breakdown by sex (n=2810), 2607 (93%) were in men and 203 (7%) were in women. Nordic countries had the highest prison suicide rates of more than 100 suicides per 100?000 prisoners apart from Denmark (where it was 91 per 100?000), followed by western Europe where prison suicide rates in France and Belgium were more than 100 per 100?000 prisoners. Australasian and North American countries had rates ranging from 23 to 67 suicides per 100?000 prisoners. Rate ratios, or rates compared with those in the general population of the same sex and similar age, were typically higher than 3 in men and 9 in women. Higher incarceration rates were associated with lower prison suicide rates (b?=?-0·504, p?=?0·014), which was attenuated when adjusting for prison-level variables. There were no associations between rates of prison suicide and general population suicide, any other tested prison-related factors, or differing criteria for defining suicide deaths. Changes in prison suicide rates over the past decade vary widely between countries. INTERPRETATION:Many countries in northern and western Europe have prison suicide rates of more than 100 per 100?000 prisoners per year. Individual-level information about prisoner health is required to understand the substantial variations reported and changes over time. FUNDING:Wellcome Trust and the UK National Institute for Health Research (NIHR).

SUBMITTER: Fazel S

PROVIDER: S-EPMC6066090 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Suicide in prisons: an international study of prevalence and contributory factors.

Fazel Seena S Ramesh Taanvi T Hawton Keith K

The lancet. Psychiatry 20171201 12

<h4>Background</h4>Prison suicide rates, rate ratios, and associations with prison-related factors need clarification and updating. We examined prison suicide rates in countries where reliable information was available, associations with a range of prison-service and health-service related factors, how these rates compared with the general population, and changes over the past decade.<h4>Methods</h4>We collected data for prison suicides in 24 high-income countries in Europe, Australasia, and Nor ...[more]

PMID: 29179937

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Project description:BackgroundSelf-harm and suicide are common in prisoners, yet robust information on the full extent and characteristics of people at risk of self-harm is scant. Furthermore, understanding how frequently self-harm is followed by suicide, and in which prisoners this progression is most likely to happen, is important. We did a case-control study of all prisoners in England and Wales to ascertain the prevalence of self-harm in this population, associated risk factors, clustering effects, and risk of subsequent suicide after self-harm.MethodsRecords of self-harm incidents in all prisons in England and Wales were gathered routinely between January, 2004, and December, 2009. We did a case-control comparison of prisoners who self-harmed and those who did not between January, 2006, and December, 2009. We also used a Bayesian approach to look at clustering of people who self-harmed. Prisoners who self-harmed and subsequently died by suicide in prison were compared with other inmates who self-harmed.Findings139,195 self-harm incidents were recorded in 26,510 individual prisoners between 2004 and 2009; 5-6% of male prisoners and 20-24% of female inmates self-harmed every year. Self-harm rates were more than ten times higher in female prisoners than in male inmates. Repetition of self-harm was common, particularly in women and teenage girls, in whom a subgroup of 102 prisoners accounted for 17,307 episodes. In both sexes, self-harm was associated with younger age, white ethnic origin, prison type, and a life sentence or being unsentenced; in female inmates, committing a violent offence against an individual was also a factor. Substantial evidence was noted of clustering in time and location of prisoners who self-harmed (adjusted intra-class correlation 0·15, 95% CI 0·11-0·18). 109 subsequent suicides in prison were reported in individuals who self-harmed; the risk was higher in those who self-harmed than in the general prison population, and more than half the deaths occurred within a month of self-harm. Risk factors for suicide after self-harm in male prisoners were older age and a previous self-harm incident of high or moderate lethality; in female inmates, a history of more than five self-harm incidents within a year was associated with subsequent suicide.InterpretationThe burden of self-harm in prisoners is substantial, particularly in women. Self-harm in prison is associated with subsequent suicide in this setting. Prevention and treatment of self-harm in prisoners is an essential component of suicide prevention in prisons.FundingWellcome Trust, National Institute for Health Research, National Offender Management Service, and Department of Health.

Project description:BackgroundRates 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.

Project description:BackgroundThere is mounting evidence that associates brain injury and offending behaviour, and there is a need to understand the epidemiology of head injury in prisoners in order to plan interventions to reduce associated disability and risk of reoffending. This is the first study to determine the lifetime prevalence of hospitalised head injury (HHI) in a national population of current prison inmates. In addition characteristics of prisoners with HHI and were compared to prisoners without HHI to discover whether those with HI differed demographically.MethodsWhole life hospital records of everyone aged 35 years or younger and resident in a prison in Scotland on a census date in 2015 were electronically linked via their unique NHS identifier and checked for ICD-9 and 10 codes for head injury. Using a case-control design, these data were compared with a sample from the general population matched 3:1 for age, gender and area-based social deprivation. Comparison of demographic variables was made between prisoners with and without HHI.ResultsHHI was found in 24.7% (1,080/4,374) of prisoners and was significantly more prevalent than found in the matched general population sample (18.2%; 2394/13122; OR 2.10; 95%CI 1.87, 2.16). The prevalence of HHI in prisoners and controls was similar with the exception of a higher risk of HHI in prisoners in lower deprivation quintiles. Having three or more HHI was more common in prisoners (OR 3.04; 95%CI 2.33, 3.97) as were HHI with ICD codes for intracranial injuries (OR 1.81; 95% CI 1.54, 2.11), suggesting that more severe HHI is more prevalent in prisoners than the general population. The distributions within demographic variables and the characteristics of HHI admissions in prisoners with and without a history of HHI were similar.ConclusionPrisoners in Scotland aged 35 years or younger have a higher lifetime prevalence of HHI than the general population and are more likely to have had repeated HI or intracranial injuries. Further work is required to elucidate the correspondence between self-report of HI and hospitalised records and to ascertain persisting effects of HI in prisoners and the need for services to reduce associated disability and risk of reoffending.

Dataset Information

Suicide in prisons: an international study of prevalence and contributory factors.

Publications

Suicide in prisons: an international study of prevalence and contributory factors.

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