Social Psychiatry and Psychiatric Epidemiology

, Volume 48, Issue 7, pp 1177–1185 | Cite as

A national case–control study of risk factors among prisoners in England and Wales

  • Naomi Humber
  • Roger Webb
  • Mary Piper
  • Louis Appleby
  • Jenny Shaw
Original Paper
First Online:
Received:
Accepted:

Abstract

Purpose

To examine risk factors for suicide among prisoners in a national population.

Methods

The Ministry of Justice identified all suicides occurring in prisons in England and Wales between 2005 and 2008. Two hundred and twenty suicides were matched to 220 living controls on age, gender, date of reception into prison and establishment type. Relative risks for clinical, custodial, service–response and socio-demographic characteristics were estimated using conditional logistic regression models.

Results

Having a history of violence and several indicators of past or current psychiatric illness were strong predictors at univariate level. Prisoners who died by suicide were over nine times more likely than controls to have been identified and managed as being at-risk of self-harm/suicide during the prison term. Multivariate analysis identified five mutually independent predictors: previous psychiatric service contact, history of self-harm, single cell occupation, remand status, and non-white ethnicity.

Conclusions

Suicide risk is elevated among certain types of prisoners, and targeted suicide prevention strategies should be developed for the monitoring, care and support of the high-risk groups that we identified. Further research is needed to determine the causal mechanisms that explain why some prisoners have a higher suicide risk than their peers.

Keywords

Suicide Prisoners Epidemiology Risk factors Case–control studies 
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Notes

Acknowledgments

The authors thank the Prison Service and NHS staff in establishments in England and Wales, Safer Custody and Offender Policy Group and Offender Management and Sentencing Analytical Service at the MOJ for their assistance. This study was funded by Offender Health at the Department of Health.

Conflict of interest

L. A. is National Clinical Director for Health and Criminal Justice, England and leads the National Suicide Prevention Strategy. M. P. is Senior Public Health Advisor, Offender Health, Department of Health, England.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Naomi Humber
    • 1
  • Roger Webb
    • 2
  • Mary Piper
    • 3
  • Louis Appleby
    • 2
  • Jenny Shaw
    • 2
  1. 1.Centre for Mental Health and RiskUniversity of ManchesterManchesterUK
  2. 2.University of ManchesterManchesterUK
  3. 3.Department of HealthOffender HealthLondonUK

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