Incarceration and subsequent risk of suicide: A statewide cohort study

Abstract

Introduction Increasing suicide rates across the United States are disproportionate among populations most impacted by mass incarceration. We sought to determine if incarceration is associated with risk of suicide and firearm suicide after release from prison. Methods Using a population‐based Washington cohort from Department of Corrections and vital statistics administrative records 1990–2017, individuals were compared to the sex‐, age‐, and race‐matched population of Washington using Poisson regression. Among previously incarcerated individuals, we included incarceration history characteristics to calculate sub‐hazard ratios using Cox proportional‐hazards models. Results Of 140,281 individuals released from prison, 484 died by suicide. Suicide risk was 62% higher among previously incarcerated individuals compared with the general population (RR: 1.62; 95% CI: 1.46–1.79). Suicide risk was higher among individuals convicted of firearm‐involved crimes (RR: 2.27; 95% CI: 1.79–2.89). Individuals released prior to age 18 had substantially higher risk of firearm suicide than those whose first release occurred between ages 18–24 (sHR: 11.91; 95% CI: 4.30–32.96). Conclusion Our findings highlight the need for improved mental health resources and lethal means safety in this population. Mental health and substance use treatment have been proposed as effective alternatives to incarceration—continuing to study their impacts may reveal additional benefits of reducing suicide.

Changes in self-harm and suicide in California from 2017-2021: a population-based study

“…50 It is likely the racial/ethnic disparities we identi ed are related, in part, to the pandemic-driven ampli cation of the structural inequities that shape population health in the U.S. 51 and the attrition of culturally-speci c factors protective of suicide. The communities most burdened by the health, economic, and social crises of 2020 and 2021 already faced disproportionate threats to their health as a result of systemic racism 8 and other systems of marginalization that concentrate greater risk factors associated with suicide (e.g., poverty, unemployment, and mass incarceration 34,35 ) and fewer protective factors (e.g., quality education, economic development, and culturally competent mental healthcare [36][37][38] ). Further, Black and Latino Americans, who attend church at higher rates than white Americans, 53 may have been disproportionately impacted by the restricted ability to gather for religious worship; and religiosity has been linked to reduction in suicide risk.…”

“…As in prior research, given the small number of cases coded as suicide among people under the age of 10, 30 we restricted both of our samples to people aged 10 years and older. We used race and Hispanic ancestry/origin (race/ethnicity) as proxies for sociocultural differences which may modify risk for self-harm 31,32 and for the effects of interpersonal and structural racism, including redlining, residential and social segregation, punitive immigration policy, mass incarceration, and the concentration and transmission of intergenerational trauma, 8, [33][34][35][36][37][38] which are risk factors for self-harm.…”

Changes in suicide in California from 2017 to 2021: a population-based study

“…It is likely the racial/ethnic disparities we identified are related, in part, to the pandemic-driven amplification of the structural inequities that shape population health in the USA (Gravlee 2020 ) and diminshment of culturally specific factors protective of suicide. The communities most burdened by the health, economic, and social crises of 2020 and 2021 already faced disproportionate threats to their health as a result of systemic racism (Bailey et al 2017 ) and other systems of marginalization that concentrate greater risk factors associated with suicide (e.g., poverty, unemployment, and mass incarceration (Gee and Ford 2011 ; Morgan et al 2022 )) and fewer protective factors (e.g., quality education, economic development, and culturally competent mental healthcare (Hawthorne et al 2012 ; Owens et al 2011 ; Primm et al 2010 )). Further, Black and Latino Americans, who attend church at higher rates than white Americans (Pew Research Center 2014 ), may have been disproportionately impacted by the restricted ability to gather for religious worship; and religiosity has been linked to reduction in suicide risk (Molock et al 2006 ; Lawrence et al 2016 ).…”

“…As in prior research, given the small number of cases coded as suicide among people under the age of 10 (Fatal Injury Reports, National, Regional, and States 2020 ), we restricted our sample to people aged 10 years and older. We used race and Hispanic ancestry/origin (race/ethnicity) as proxies for sociocultural differences which may modify risk for self-harm (Oquendo et al 2005 ; Molock et al 2006 ) and for the effects of interpersonal and structural racism, including historical redlining, residential and social segregation, punitive immigration policy, mass incarceration, and the concentration and transmission of intergenerational trauma (Bailey et al 2017 ; Gee and Ford 2011 ; Forster et al 2019 ; Morgan et al 2022 ; Hawthorne et al 2012 ; Owens et al 2011 ; Primm et al 2010 ), which are risk factors for self-harm.…”

Race, criminalization and urban mental health in the United States

“…Since 2020, incarceration has been one of the more frequently studied aspects of criminalization in regards to mental health, both in terms of the impact of first-hand experiences of incarceration [28–30,31 ▪ ,32 ▪ ,33–35,36,37 ▪▪ ,38–48], and the impact of having a family member incarcerated [49,50 ▪ ,51,52] (Table 1).…”