Elsevier

The Lancet

Volume 368, Issue 9530, 8–14 July 2006, Pages 119-123
The Lancet

Articles
Suicide in recently released prisoners: a population-based cohort study

https://doi.org/10.1016/S0140-6736(06)69002-8Get rights and content

Summary

Background

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.

Methods

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.

Findings

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.

Interpretation

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.

Introduction

Several studies have examined the risk factors for suicide in custody,1, 2, 3, 4, 5 but little is known about the risk of suicide after release from prison.6, 7, 8 A study in Finland7 showed that the suicide rate in people within 1 year of release from prison was almost three times the rate in the general population. A study in England and Wales8 showed that male offenders under criminal justice community supervision were at least ten times more likely to die by suicide than men in the general population. This study was a national study, but included only prisoners released under the supervision of probation, thus excluding more than half of all released prisoners. Here, we report data for a comprehensive 3-year national sample of self-inflicted death within 12 months of release from prison in England and Wales.

Section snippets

Study cohort

This study was approved by the multicentre research ethics committee of the Thames Valley National Health Service (NHS), Reading, UK. Information on suicides was taken from the database of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,9 which has records of individuals in England and Wales who receive a verdict of suicide or an open verdict at coroner's inquest. This information was obtained from the Office for National Statistics for England and

Results

In 244 988 released prisoners, we identified 382 suicides (34 women, 348 men) within 1 year of release. Suicides by recently released prisoners accounted for 3% of the 14 097 suicides occurring between 2000 and 2002, while released prisoners accounted for only 0·2% of the population (table). Figure 1 shows the distribution of these suicides, separated into 28-day periods over the year after release. 79 (21%) suicides took place in the first 28 days after release, and 195 (51%) within the first

Discussion

This study has shown that, during the first 12 months after release, prisoners in our analysis were at a much greater risk of suicide than the general population. Risk was particularly increased during the first 28 days, during which about a fifth of all suicides occurred. The risk was similar in men and women but, compared with the general population, the relative risk in women was substantially higher than in men. This result seems to support a previous finding that the rate of suicide for

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