Sex differences in suicide, suicidal ideation, and self-harm after release from incarceration: a systematic review and meta-analysis

Abstract

Purpose People released from incarceration are at increased risk of suicide compared to the general population. We aimed to synthesise evidence on the incidence of and sex differences in suicide, suicidal ideation, and self-harm after release from incarceration. Methods We searched MEDLINE, EMBASE, PsycINFO, Web of Science and PubMed between 1 January 1970 and 14 October 2021 for suicide, suicidal ideation, and self-harm after release from incarceration (PROSPERO registration: CRD42020208885). We calculated pooled crude mortality rates (CMRs) and standardised mortality ratios (SMRs) for suicide, overall and by sex, using random-effects models. We calculated a pooled incidence rate ratio (IRR) comparing rates of suicide by sex. Results Twenty-nine studies were included. The pooled suicide CMR per 100,000 person years was 114.5 (95%CI 97.0, 132.0, I2 = 99.2%) for non-sex stratified samples, 139.5 (95% CI 91.3, 187.8, I2 = 88.6%) for women, and 121.8 (95% CI 82.4, 161.2, I2 = 99.1%) for men. The suicide SMR was 7.4 (95% CI 5.4, 9.4, I2 = 98.3%) for non-sex stratified samples, 14.9 for women (95% CI 6.7, 23.1, I2 = 88.3%), and 4.6 for men (95% CI 1.3, 7.8, I2 = 98.8%). The pooled suicide IRR comparing women to men was 1.1 (95% CI 0.9, 1.4, I2 = 82.2%). No studies reporting self-harm or suicidal ideation after incarceration reported sex differences. Conclusion People released from incarceration are greater than seven times more likely to die by suicide than the general population. The rate of suicide is higher after release than during incarceration, with the elevation in suicide risk (compared with the general population) three times higher for women than for men. Greater effort to prevent suicide after incarceration, particularly among women, is urgently needed.

Share of Adult Suicides After Recent Jail Release

“…The number of postrelease suicides equaled the released person count times the CMR. The study sets comprised (1) our primary estimate; (2) a study from Ontario, Canada 17 ; (3) the SMR for releases in England and Wales 23 ; (4) a consolidated estimate from separate computations by sex; and (5) the meta-analysis by Janca et al 5 First, we estimated suicide SMRs in postrelease years 1 and 2 using meta-analytic RE-ML pooling of SMRs from 10 jurisdictions. Variance for CMRs and SMRs were computed using standard formulas.…”

“…3 Growing global literature suggests an even higher suicide rate in the year after release from incarceration; meaning that more suicides per day occur after release than during jail time. 4,5 Only 1 study with high-quality death registration, however, is specific to US jails: among Philadelphia Medicaid beneficiaries who died by suicide between 2003 and 2018, 25% had a history of Philadelphia county jail incarceration. 6 In the US, no data exist on suicide risk during an actionable period of 1 to 2 years after jail release.…”

“…People in jail have a high annualized suicide rate (48 per 100 000 people) and a standardized mortality ratio (SMR) of 2.2 compared with demographically similar US adults . Growing global literature suggests an even higher suicide rate in the year after release from incarceration; meaning that more suicides per day occur after release than during jail time . Only 1 study with high-quality death registration, however, is specific to US jails: among Philadelphia Medicaid beneficiaries who died by suicide between 2003 and 2018, 25% had a history of Philadelphia county jail incarceration …”

Suicide concerns among pretrial detainees: validation of the Portuguese version of the SCOPE-2

“…Besides, most research on suicide risk in prison is developed in male samples (Dye, 2011), even though previous literature has established that women present a higher number of risk factors (Spjeldnes et al , 2014). Indeed, a recent systematic review and meta-analysis showed that, even though the prevalence of suicide in general population tends to be higher in men, this difference does not exist between male and female prisoners (Janca et al , 2023). Taking into account the aspects mentioned above, we consider that the validation of such instrument is particularly relevant as it provides a reliable tool that allows a brief screening of both men and women who might report concerns that could predict future risk of suicide even though they do not show suicidal intention at that moment.…”

Несуицидальные Самопорезы Среди Убийц: Клинико-Социальные Закономерности

“…Так, членовредительство является основной причиной заболеваемости среди заключённых [2]. Люди, освобождённые из мест лишения свободы, подвержены повышенному (в семь раз выше) риску самоубийства [3], а шансы умереть от насилия у них в восемь раз больше, чем у населения в целом [4]. При этом особо высокие показатели различных самоповреждений наблюдается как раз среди убийц [5,6].…”