Background

Few risk factors and indicators of vulnerability for suicide in custody are known so far. Within a large epidemiological investigation, a case-control-study was conducted to investigate the relevance of criminal history, psychiatric morbidity and social integration for suicide in prison.

Methods

All suicides in all Austrian correctional institutions between January 1st, 1975, and December 31st, 1999 were investigated. Suicide rates were calculated and compared to the rates in the general population. All available personal files of inmates who had committed suicide in any of the 29 Austrian jails and prisons during these 25 years were analyzed. For every suicide, two controls matched for correctional institution, sex, nationality, age, custodial status, and time of admission were selected. Psychiatric characteristics, previous suicidal behavior, criminal history, and indicators of social integration were compared.

Results

Out of 250 recorded suicides, 220 personal files were available. The suicide rate in custody exceeded the rates in the general population, and significantly increased during the study period. The most important predictors for suicide in custody were a history of suicidality (status post attempted suicide and suicide threat), psychiatric diagnosis, psychotropic medication, a high violent index offense and single-cell accommodation.

Conclusion

A significant finding is the importance of suicidal behavior for suicides in correctional institutions, which had been contradictorily discussed so far. This CCS demonstrates the necessity for correctional staff to take suicidal behavior as seriously in custodial settings as in any other circumstances. Possible strategies for suicide prevention in this high-risk setting are discussed.