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Risk factors of suicide in prisons: a comprehensive retrospective cohort study in France, 2017–2020

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Abstract

Purpose

Suicide is a leading cause of death in prison and the suicide rates are several times higher in the prison population than in the general population in most countries. Of the studies that have investigated risk factors for suicide in prison, few have controlled for possible confounding factors. The aim of this study is to identify risk factors of suicide among people in French prisons, over a four-year period.

Methods

All incarcerations that occurred in France during 2017–2020 were eligible. Sociodemographic, criminal and prison characteristics were collected for each incarceration from data of the National Prison Service. Survival univariate and multivariate analyses were performed with a Cox regression model.

Results

358,522 incarcerations were included, of which 449 ended in suicide during the follow-up. The median length of prison stay was 5.1 months. The median age at prison entry was 30 years and 95.8% of incarcerations involved men. The overall suicide rate was 173 [157–189] per 100,000 person-years. Factors associated with suicide in the multivariate model (p < 0.05) were the early stage of incarceration and in particular the first week (HR = 7.6 [5.4–10.8]), violent offences and in particular homicide (HR = 3.0 [2.1–4.2]), French (HR = 1.7 [1.2–2.4]) and other European nationalities (HR = 2.1 [1.4–3.3]), age above 40 (HR = 2.0 [1.5–2.6]), pre-trial incarceration (HR = 1.8 [1.4–2.3]), being separated (HR = 1.6 [1.1–2.3] and having a high school diploma (HR = 1.4 [1.0–1.8]).

Conclusions

Factors associated with suicide in prison are complex and involve individuals’ criminal history as well as conditions of incarceration. These characteristics may be relevant to focus suicide prevention efforts.

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Data availability

The data are not publicly available. The agreement signed between the Sorbonne Paris North University and the National Prison Service stipulates that the data collected for this specific study cannot be used for other purposes due to the sensitivity of individual data on people incarcerated.

Code availability

The code is available on request from the corresponding author.

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Acknowledgements

We are grateful to the National Prison Service, French Ministry of Justice, for allowing us to access their data, and in particular to the Data Office and the Social Policies and Partnerships Office of the National Prison Service for their help in data management. We thank Mathias Denjean, head of the Data Office of the National Prison Service, and François-Marie Tarasconi, deputy head of the Social Policies and Partnerships Office, for their review.

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  1. Maria Melchior and Thomas Lefevre have contributed equally to this work.

Authors and Affiliations

  1. Interdisciplinary Research Institute On Social Issues (IRIS), UFR SMBH, Sorbonne Paris North University, UMR 8156‑997, Aubervilliers, France

    Alexis Vanhaesebrouck & Thomas Lefevre

  2. Department of Legal and Social Medicine, Jean-Verdier Hospital (AP-HP), Bondy, France

    Alexis Vanhaesebrouck & Thomas Lefevre

  3. Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Sorbonne University, INSERM, Paris, France

    Alexis Vanhaesebrouck & Maria Melchior

  4. CHU Lille, U1172—Lille Neuroscience & Cognition, University Lille, INSERM, 59000 , Lille, France

    Thomas Fovet

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Contributions

Alexis Vanhaesebrouck formulated the research question and designed the study. Alexis Vanhaesebrouck carried out the study under the supervision of Thomas Lefèvre and Maria Melchior. Alexis Vanhaesebrouck analysed the data, under the supervision of Thomas Lefèvre and Maria Melchior. Alexis Vanhaesebrouck, Thomas Lefèvre, Maria Melchior and Thomas Fovet wrote the article. All authors read and approved the final manuscript.

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Correspondence to Alexis Vanhaesebrouck.

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All procedures performed were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the research ethics board of University Paris Centre (No 2022-86).

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Vanhaesebrouck, A., Fovet, T., Melchior, M. et al. Risk factors of suicide in prisons: a comprehensive retrospective cohort study in France, 2017–2020. Soc Psychiatry Psychiatr Epidemiol (2024). https://doi.org/10.1007/s00127-024-02661-x

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