Suicide in Prisoners

Being white, male, married and in a job makes you more likely to die by suicide on being sent to prison, an Oxford University study has found.

The strategies used by prisons to prevent suicides rely on identifying those who are most vulnerable. Oxford University researchers set out to determine the risk factors for suicide in prisons so that screening and prevention programmes can be improved. The results of their large-scale study are published in the Journal of Clinical Psychiatry.

To lower prison suicide rates, vulnerable prisoners should not be placed in single cells and intervening where mental illness and alcohol problems are evident should be a priority, say the researchers.

'Prison services should be aware of the risk factors we have found when screening those who come to prison,' says Dr Seena Fazel of the Department of Psychiatry, who led the work. 'It is important to realise that the associations with suicide in prisoners do not appear to be the same as the associations in the general population.'

Being married leads to an increased risk of suicide among prisoners. This is a surprise as marriage is associated with lower suicide risk in the general population. It may be that the loss of supportive social connections in prison leads to increased vulnerability to suicide. Similarly, being employed shows a trend for increased suicide in prison.

'This may be to do with the experience of loss on being incarcerated,' suggests Dr Fazel. 'If you have more to lose, you are more at risk of suicide.'

Prisoners who had had suicidal feelings, a history of previous suicide attempts, or had been diagnosed with a psychiatric illness were at higher risk of suicide. Those with alcohol problems also showed increased rates of suicide.

'These factors are potentially treatable,' says Dr Fazel. 'That's important because it may be possible to reduce that risk.'

'A lot of money has been spent on mental health services in prisons, and in England and Wales, this is currently being evaluated. This study underlines that the value of such care and highlights the importance of strategies to look out for danger signs,' says Dr Fazel.

Prisoners in a single cell, on remand, or on a life sentence were also more likely to die by suicide.

'One of the ways to make cells safe is not to put people at risk in single cells, even if they are being difficult or troublesome,' says Dr Fazel.

'Those on remand are facing uncertainty and have gone through a sudden change on going into custody. Not only is this a shock, but those on remand may be experiencing withdrawal effects from drugs and alcohol.'

The Oxford team performed a large-scale review of 34 studies including a total of 4780 suicide cases.

'Bringing all this data together can show new associations that were not apparent in the individual studies,' says Dr Fazel. 'The power of the review is that it can pull out trends in lots of smaller studies where there is no clear evidence and weigh up reports where there is uncertainty or conflicting results.'

'For example, nine of the pooled studies looked at the effect of marriage on suicide in prisons. Although eight out of the nine showed no clear association, by putting them all together a statistically significant correlation emerged.'

The group now intend to interview prisoners who have nearly died in suicide attempts to get much more information about the mental state of inmates and triggers that can lead to suicide.

For more information please contact the Press Office, University of Oxford on +44 (0)1865 280530 or press.office@admin.ox.ac.uk.

Suicide in Prisoners: A Systematic Review of Risk Factors

Seena Fazel, M.D.; Julia Cartwright, M.R.C.Psych.; Arabella Norman-Nott, M.R.Psych.; and Keith Hawton, D.Sc.

Marriage, single prison cells and mental illness associated with higher suicide risk in prisoners