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

Social Psychiatry and Psychiatric Epidemiology volume 48, pages 1177–1185 (2013)Cite this article

An Erratum to this article was published on 28 March 2013

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.

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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.

Author information

Affiliations

  1. Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Second Floor, Oxford Road, Manchester, M13 9PL, UK

    Naomi Humber

  2. University of Manchester, Manchester, UK

    Roger Webb, Louis Appleby & Jenny Shaw

  3. Department of Health, Offender Health, London, UK

    Mary Piper

Authors
  1. Naomi Humber
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  2. Roger Webb
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  3. Mary Piper
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  4. Louis Appleby
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  5. Jenny Shaw
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Corresponding author

Correspondence to Naomi Humber.

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Humber, N., Webb, R., Piper, M. et al. A national case–control study of risk factors among prisoners in England and Wales. Soc Psychiatry Psychiatr Epidemiol 48, 1177–1185 (2013). https://doi.org/10.1007/s00127-012-0632-4

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  • DOI: https://doi.org/10.1007/s00127-012-0632-4

Keywords

  • Suicide
  • Prisoners
  • Epidemiology
  • Risk factors
  • Case–control studies