Suicide in recently released prisoners: A population-based cohort study

Centre for Suicide Prevention, University of Manchester, Manchester M13 9PL, UK.
The Lancet (Impact Factor: 45.22). 08/2006; 368(9530):119-23. DOI: 10.1016/S0140-6736(06)69002-8
Source: PubMed

ABSTRACT Several studies have been undertaken on suicide in custody, but few on suicide after the release from prison. We undertook a population-based cohort study to investigate suicide rates in recently released prisoners in England and Wales.
We used the database of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness for England and Wales to identify all individuals who died by suicide or who received an open verdict at the coroner's inquest between 2000 and 2002. These records were linked to a Home Office register to identify all such deaths in people within 1 year of release from prison in England and Wales. We compared suicide rates per 100,000 person-years in these released prisoners with rates in the general population by using the indirectly age-standardised mortality ratio.
We identified 382 suicides occurring in 244 988 individuals within 1 year of release from prison; a suicide rate of 156 per 100 000 person-years. 79 (21%) suicides occurred within the first 28 days after release. In all age groups, suicide rates were higher in recently released prisoners than in the general population. The overall age-standardised mortality ratio for recently released prisoners was 8.3 (95% CI 7.5-9.3) for men and 35.8 (25.4-50.2) for women.
Recently released prisoners are at a much greater risk of suicide than the general population, especially in the first few weeks after release. The risk of suicide in recently released prisoners is approaching that seen in discharged psychiatric patients. A shared responsibility lies with the prison, probation, health, and social services to develop more collaborative practices in providing services for this high-risk group.

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Available from: Daniel Pratt, Apr 04, 2014
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    • "The prevalence of non-communicable diseases is also elevated, although this issue is under-recognised (Herbert et al. 2012; Binswanger et al. 2009). Following release, ex-prisoners are at increased risk of mortality associated with suicide (Pratt et al. 2006), drug overdose (Merrall et al. 2010) and injury (van Dooren et al. 2013), as well as death from natural causes (Spaulding et al. 2011). Despite this, in most countries the health needs of prisoners receive relatively little policy attention (Lines 2006) and remarkably little is known about broader health outcomes after release from prison, or how these may shape future offending trajectories. "
    12/2015; 3(1). DOI:10.1186/s40352-015-0022-6
    • "The perspectives explored here, however, are illustrative of churners, who are frequently in and out of the prison system. It has been suggested that this group is at higher risk of suicide and self-harm than long-term prisoners because their short sentences mean that, when released, they do not fall under the supervision of the probation services and, therefore, do not benefit from post-release support (Pratt et al. 2006). We also recognise that the data represent respondents' constructions of past events and may have been influenced by many factors, including being interviewed shortly before release and the fact that respondents (male offenders) may have sought to present themselves in a particular light to the (female) researcher (Mills 1940). "
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    ABSTRACT: Suicide is common among offenders, who are at increased risk of homelessness, unemployment and mental illness and are prone to impulsivity. Release from prison is a particularly vulnerable time. This qualitative study investigated the views of 35 offenders in South-West England prior to and after release from prison, enquiring into their previous suicide attempts and how they saw their future. Semi-structured interviews were analysed thematically, comparing individuals who had made one, more than one, and no suicide attempts. Multiple attempters were often in despair and enmeshed in substance misuse, with little control over their lives. Most of those with one-off or no previous attempts portrayed themselves as having more mastery. One-off attempters described using particularly violent means. The role of different types of agency in pathways to and from suicide is discussed. Iterational agency, the selective reactivation of past patterns of behaviour, appeared to dominate in individuals who were choosing between further suicide attempts and substance use. Projective agency, having a more future orientation, appeared more prominent in some single attempters and in those individuals with plans to escape crime and social exclusion. © 2015 Foundation for the Sociology of Health & Illness.
    Sociology of Health & Illness 07/2015; 37(6). DOI:10.1111/1467-9566.12259 · 1.88 Impact Factor
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    • "Rates of death due to homicide, liver disease, suicide and motor vehicle accidents were more than three times that of the comparison group. The finding of increased risk of death by suicide and drug overdose has supported by multiple studies [13-19]. Each of these outcomes is plausibly associated with mental health and/or substance use disorders. "
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    ABSTRACT: The population of ex-prisoners returning to their communities is large. Morbidity and mortality is increased during the period following release. Understanding utilization of emergency services by this population may inform interventions to reduce adverse outcomes. We examined Emergency Department utilization among a cohort of recently released prisoners. We linked Rhode Island Department of Corrections records with electronic health record data from a large hospital system from 2007 to 2009 to analyze emergency department utilization for mental health disorders, substance use disorders and ambulatory care sensitive conditions by ex-prisoners in the year after release from prison in comparison to the general population, controlling for patient- and community-level factors. There were 333,369 total ED visits with 5,145 visits by a cohort of 1,434 ex-prisoners. In this group, 455 ex-prisoners had 3 or more visits within 1 year of release and 354 had a first ED visit within 1 month of release. ED visits by ex-prisoners were more likely to be made by men (85% vs. 48%, p < 0.001) and by blacks (26% vs. 16%, p < 0.001) compared to the Rhode Island general population. Ex-prisoners were more likely to have an ED visit for a mental health disorder (6% vs. 4%, p < 0.001) or substance use disorder (16%vs. 4%, p < 0.001). After controlling for patient- and community-level factors, ex-prisoner visits were significantly more likely to be for mental health disorders (OR 1.43; 95% CI 1.27-1.61), substance use disorders (OR 1.93; 95% CI 1.77-2.11) and ambulatory care sensitive conditions (OR 1.09; 95% CI 1.00-1.18). ED visits by ex-prisoners were significantly more likely due to three conditions optimally managed in outpatient settings. Future work should determine whether greater access to outpatient services after release from prison reduces ex-prisoners' utilization of emergency services.
    BMC Emergency Medicine 11/2013; 13(1):16. DOI:10.1186/1471-227X-13-16
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