Epidemiology, Risk Factors, and Prevention of Suicidal Thoughts and Behaviour in Prisons: A Literature Review

Abstract

Suicide is a global public health concern that affects all echelons of society, albeit not equally so. Compared with adults in the general population, incarcerated offenders are at increased risk to consider, attempt, and die by suicide, which represents a substantial burden of morbidity and mortality in prisons worldwide. This review synthesises recent literature pertaining to the epidemiology, risk factors, and prevention of suicidal thoughts and behaviour among prisoners, and outlines a framework which emphasises the interplay between individuals (importation) and their surroundings (deprivation). The available evidence suggests that prison-specific stressors may exacerbate risk of suicide in an already vulnerable population characterised by complex health and social care needs. Emerging data point to differential mechanisms through which prisoners come to think about suicide and subsequently progress to suicidal behaviour. As risk of suicide is determined by a complex web of synergistically interacting factors, its management and prevention demands a cross-sectoral policy and service response that includes targeted interventions aimed at high-risk prisoners in combination with population strategies that promote the health and wellbeing of all people in prison.

Prevalence and risk factors for suicide attempts in prison

“…Solitary confinement, victimisation, poor social support, disciplinary infractions, and lack of purposeful activity were all prison-related factors that increased the likelihood of attempting suicide during incarceration. Together, these data lend support for a theoretical framework of suicidal behaviour in prisons that incorporates both imported vulnerabilities and environmental stressors (Favril, 2021).…”

“…Targeted strategies aimed at high-risk groups will rely on early identification of risk (Ryland et al, 2020) and should be supplemented by organisational and establishment-wide interventions as part of a whole population approach. These include measures aiming to promote purposeful activity and meaningful social support, as well as those to reduce victimisation in prison (Favril, 2021;Marzano et al, 2016). In view of the wide range of factors associated with risk of suicide in prisons, a multilevel approach that addresses both clinical vulnerabilities and prison-specific stressors is likely to have the largest potential to prevent suicidal behaviour (Barker et al, 2014;Stijelja & Mishara, 2022).…”

“…Prevention efforts should be integrated and joined-up, as no singular approach will likely be able to impact on a complex behaviour as (attempted) suicide. This will require a cross-sectoral policy and service response that involves health, social care, and criminal justice agencies (Favril, 2021).…”

“…Suicidal behaviour is a global public health concern that disproportionately affects the most vulnerable members of society, including people who experience incarceration (Favril, 2021).…”

“…Whilst this latter review was the first ever to quantitatively synthesise the overall evidence on risk factors among people in prison, it combined data for self-harm with and without suicidal intent. As there is evidence in the general population that suicidal and non-suicidal self-harm can be differentiated in terms of prevalence, predictors, and outcomes (Hamza et al, 2012;Mars et al, 2014aMars et al, , 2014bMuehlenkamp, 2014), in this review we specifically focus on suicide attempts (defined as non-fatal self-injurious behaviour with inferred or actual intent to die ;Favril, 2021). In addition, we aimed to examine the prevalence of suicide attempts during incarceration to map the scale of this health concern, which to our knowledge has not been done before.…”