People who have been in prison run a higher risk of committing suicide; 18 times that of the general population. By far the highest risk of suicide comes in the first months after release and among individuals with a history of substance abuse and previous suicide attempts. These are the findings of a register study conducted by researchers from Karolinska Institutet, being published in the Journal of Clinical Psychiatry.
It is previously known that persons in Swedish prisons and remand facilities run an increased risk of committing suicide. Studies from Australia, England and the United States have shown that there is also an elevated risk of suicide after being released when a prison sentence has been served. This matter has not been studied in Sweden, which in many ways differs from other countries with respect to prison stays. For example, a lower proportion of the population is sentenced to prison in Sweden than in Australia, England and the United States.
The study now being presented includes almost 27 000 persons who were released from Swedish prisons just under 40 000 times in a five-year period from 2005 to 2009. These persons were compared with 270 000 unconvicted control subjects, matched for sex and age, from the general population.
First four weeks
At the end of 2009, 920 of the released persons had died, and of these, 14 per cent, close to 130 persons, had taken their own life. Those who had been released from a prison sentence thus ran a higher risk of suicide; 18 times higher than in the general population. The risk was highest in the first four weeks after release.
"Our findings might be able to provide guidance in assessing suicide risk and for suicide prevention efforts by health care, probation services and social services for persons previously in prison care. Having been released from prison is an independent risk factor for suicide, even if the release is a few years in the past," says Axel Haglund, senior consultant in psychiatry and doctoral student at the Department of Clinical Neuroscience at Karolinska Institutet.
Age and sex did not affect the risk of suicide in the previously released persons. However, the existence of certain other psychiatric diagnoses and the country of birth did affect the risk. Past or present substance abuse, previous suicide attempts and being born in Sweden further increased the risk of suicide in persons released from a prison sentence. In contrast, the diagnosis of depression was less common in released persons who committed suicide than in the general population.
"One possible explanation is that those who have been in prison did not seek or receive treatment for their depression, which was thus under-treated. Another possible explanation is that it is primarily substance abuse and not depression that leads to suicide in individuals who have served a prison sentence. This is something that there is cause to look at further at in future studies," says Axel Haglund.
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"Suicide after release from prison: A population‐based cohort study from Sweden." Axel Haglund, Dag Tidemalm, Jussi Jokinen, Niklas Långström, Paul Lichtenstein, Seena Fazel, and Bo Runeson. Journal of Clinical Psychiatry, 2014;75(10):1047–1053, doi: 10.4088/JCP.13m08967