Risk factors for suicide and self-harm among offenders are separated by offenders’ location within the criminal justice system and include demographic and psychosocial correlates of suicide and self-harm. This is a topic of importance within criminal psychology because offenders are at greater risk of experiencing suicide-related distress and self-harm than the general population. For example, in the United States, there are 13 deaths by suicide per 100,000 individuals; however, there are 36 deaths by suicide per 100,000 individuals in detention facilities. That is, inmates are 2.77 times more likely to die by suicide than individuals in the general population. Therefore, suicide and self-harm are problems that offenders and forensic professionals are more likely to encounter. There have been many studies examining risk factors for suicide and self-harm in corrections. However, given that there are more males involved in corrections than females, research about suicide and self-harm has primarily been conducted using males. In addition, there is a greater amount of research about suicide in prisons, followed by jails and community corrections (e.g., probation and parole). Furthermore, self-harm has received less empirical attention than suicide among correctional populations. This is important to keep in mind when considering risk factors for suicide and self-harm in corrections. This article provides an overview of risk factors for suicide and self-harm among offenders in prisons, jails, and community correction settings as well as a theoretical approach to suicide risk in corrections.
Suicide/death by suicide refers to death brought about by intentional self-injury with the intent to die as a result. Suicide attempt refers to nonfatal, intentional self-injury with the intent to die as a result. Suicide ideation refers to thoughts of ending one’s own life. Nonsuicidal self-injury (NSSI) refers to intentional self-inflicted damage to one’s body (e.g., cutting, burning, hitting) without intent to die. Self-harm is a broader term that does not specify intent to die during self-injury, and synonymous terms include self-injury, selfinjurious behaviors, parasuicide, undetermined suicide-related behaviors, among others. Suicide literature does not always delineate between selfinjurious behaviors with versus without an intent to die. This has produced a body of research that is unclear as to which risk factors are associated with suicide attempts versus NSSI. This is important to keep in mind when considering risk factors for suicide attempts versus NSSI.
The literature on prison suicide has focused on prisoner characteristics of individuals who die by suicide. For example, White prisoners are 3 times more likely to die by suicide than Black prisoners, and Hispanic prisoners are about 2 times more likely to die by suicide than Black prisoners. Contrary to findings that in the general population, males die by suicide at higher rates than females, and incarcerated males are no more likely to die by suicide than incarcerated females. Furthermore, prisoners charged with kidnapping have the highest suicide rate, followed by prisoners with murder charges, sexual assault charges, and assault charges. Violent prisoners are 2 times more likely to die by suicide than nonviolent prisoners. On the other hand, prisoners incarcerated for drug charges are the least likely to die by suicide. These characteristics may help identify those at elevated risk.
The prison environment may aid correction staff in identifying prisoners who may be more likely to die by suicide. Research suggests that 65% of deaths by suicide occur during the first year of incarceration; yet, time of day is not associated with death by suicide. Regarding housing location within prison, 80% occur when the prisoner is in their cell. Furthermore, 83% of suicides occur in maximum-security prisons and 23% occur in special housing units. However, prisoners who live in multiple occupancy cells (such as individuals at a lower security level) have lower rates of both suicide and homicide than those in single cells. The impact of segregation on mental health and suicide risk is a debated area in forensic psychology, such that some research suggests that segregation increases suicide risk, but other research shows no association between segregation and suicide risk. The association between housing location and suicide risk may be a function of the lack of positive social interactions, which also appears to increase suicide risk among prisoners. For example, prisoners who lack connections with the outside world are at greater risk of a suicide attempt than prisoners who are more connected with the outside world.
Research has also examined prisoners’ reasons for attempting suicide. Motivations for attempting suicide include inability to cope in prison, psychotic symptoms (i.e., hallucination and delusional thinking), an unexpected attempt (i.e., the prisoner did not expect to attempt), and attempts associated with withdrawal from drugs. Prison staff may have the perception that prisoners attempt or threaten suicide for a secondary gain (e.g., moving cells), which may lead to these attempts and threats not to be taken seriously. Despite the motivation, manipulative tendencies do not distinguish prisoners who made nonlethal attempts from those who made lethal attempts. Although perceived manipulative tendencies may play a role in inmates’ behavior, the lethality of the attempt does not appear to provide insight into motives behind prisoners’ suicide attempts. Therefore, all suicide-related behaviors should be treated seriously.
Risk Factors for Suicide in Jails
Research has provided demographic profiles of individuals who engage in suicidal behavior and self-harm; however, it is important to consider these demographic profiles within the context of demographic makeup of jails. The majority of prisoners who die by suicide are male, which may not be surprising given that there are many more males incarcerated than females. In addition, the majority of jailed suicide decedents are White and have an average age of 35 years (with approximately one third of these individuals falling between ages 33 and 42 years). Approximately 42% of suicide decedents are single, 19% are married, 9% are divorced, and the remaining individuals are separated, widowed, in common law marriages, or their relationship status is unidentified.
Furthermore, crime-related profiles may provide insight into suicide risk in jails. For example, approximately 43% of suicide decedents are charged with personal and/or violent offenses, 23% are charged with a minor crime (e.g., shoplifting, prostitution, traffic offences, violation of probation), 15% are charged with serious property crimes (e.g., burglary, grand theft auto, grand larceny), and 19% are charged with alcohol and/or drug-related offenses. Further, approximately two thirds of suicide decedents have a prior criminal charge.
In addition to basic demographic information and criminal history, mental health information may also guide determination of suicide risk in jails. In the general population, the vast majority of deaths by suicide are associated with a mental health disorder; however, within jails, only about 38% of jailed suicide decedents have a mental health disorder (data were not available for about 30% of decedents). Furthermore, about half of suicide decedents have a history of drug abuse and only 20% are intoxicated at the time of their deaths. Similarly, a suicide attempt history is one of the strongest predictors of future suicide attempts and deaths; however, only about one third of jailed suicide decedents have a previous suicide attempt (data were not available for approximately 24% of decedents).
The jail environment may also increase distress among inmates. About 23% of deaths by suicide occur within the first 24 hr of incarceration; however, 44.8% of suicide decedents in holding facilities die within the first 6 hr of incarceration, and the vast majority of deaths by suicide (95.1%) occur during the first year of incarceration. During the time of incarceration, suicides do not differ by month or vary by season or holidays. Approximately 38% of suicide decedents are in isolation or segregation at the time of death; therefore, the majority were not housed in segregation. This is likely associated with increased monitoring by correctional staff in segregation and decreased access to methods for suicide attempts.
Risk Factors for Suicide in Community Correction
Much less research has examined suicide and self-harm in community correction settings as compared to jails or prisons. After leaving prison, offenders continue to be at risk of suicide. Offenders involved in community corrections are more likely to have a previous suicide attempt if they are young, White, and female. In addition, if the individual is abusing drugs (e.g., cocaine, opioids, sedatives, and alcohol), he or she is at greater risk of a suicide attempt. Further, offenders on disability or retirement, with a history of abuse, or who are taking medications for mental health problems are at greater risk. When considering suicide ideation specifically, parolees are twice as likely to experience suicide ideation as nonparolees. Moreover, parolees who are married, older, and employed were not at lower risk of suicide ideation; however, among nonparolees, these characteristics are associated with decreased suicide ideation. Research also indicates that having health insurance is associated with less risk of suicide ideation. Furthermore, suicide attempts are more common among individuals who have a recent arrest when compared to the U.S. general population without a recent arrest, and individuals with multiple arrests or criminal charges are at even greater risk. Among individuals with multiple arrests, suicide attempts are more common among adults aged 25–34 years than other age groups; however, suicide attempts did not vary across gender and race/ethnicity. Notably, arrests prior to 1 year before the suicide attempt are not associated with increased risk.
Self-Harm in Corrections
Less research has specifically examined NSSI but more has focused on general self-harm (not indicating the intent to die from the self-harm). Offenders often engage in NSSI to regulate emotions and self-punish. Similarly, offenders who avoid their problem as a way to cope with them and have poorer problem-solving skills are more likely to engage in NSSI. Offenders who engage in NSSI also tend to be White, female, single, and have a lower level of education. Additionally, offenders with emotional, psychotic, and substance use disorders are at greater risk of NSSI. Furthermore, offenders with personality disorders (e.g., borderline personality disorder) are at increased risk of NSSI. Among offenders, aggression, impulsivity, and shame are associated with increased risk of NSSI; however, sadness (which is associated with NSSI among nonoffender groups) is not associated with NSSI among offenders. In addition, having a history of physical and sexual abuse during childhood and other childhood trauma is associated with NSSI among offenders. As with suicide risk, interpersonal conflict is associated with increased risk of NSSI.
A Theoretical Approach to Suicide Risk in Corrections
The corrections suicide literature is generally missing a theoretical conceptualization of suicide risk that goes beyond examining a long list of characteristics of offenders who experience suicide ideation, engage in NSSI or suicide attempts, and die by suicide. The interpersonal theory of suicide, put forward by Thomas Joiner, may provide a theoretical framework for suicide in corrections as well as other settings. This theory suggests that when individuals lack reciprocal caring relationships and are lonely (i.e., thwarted belongingness) and experience feelings of liability on others and self-hate (i.e., perceived burdensomeness), they are at increased risk of thoughts about death. When individuals experience thwarted belongingness and perceived burdensomeness concurrently, however, and are hopeless about these states changing, they are at greatest risk of suicide ideation. This theory also suggests that individuals must be capable of overcoming the pain and fear related to a suicide attempt (i.e., the capability for suicide) to be capable of a lethal or near-lethal suicide attempt.
This theory has shown promise among offenders. Research suggests that thwarted belongingness is significantly associated with suicide ideation after taking into account how depression and hopelessness are associated with suicide ideation among prisoners. In addition, prisoners experiencing higher thwarted belongingness and perceived burdensomeness report the greatest suicide ideation. Similarly, within community corrections, offenders experiencing higher thwarted belongingness and perceived burdensomeness also report the greatest suicide ideation. Thwarted belongingness is also associated with increased suicide ideation among jail inmates. Overall, these findings are consistent with the interpersonal theory of suicide. Continuing to identify theory-driven risk factors for suicide may provide a more parsimonious method of preventing suicide among individuals involved in the criminal justice system.
References:
- Dixon-Gordon, K., Harrison, N., & Roesch, R. (2012). Non-suicidal self-injury within offender populations: A systematic review. The International Journal of Forensic Mental Health, 11, 33–50. doi:10.1080/14999013.2012.667513
- Fazel, S., Cartwright, J., Norman-Nott, A., & Hawton, K. (2008). Suicide in prisoners: A systematic review of risk factors. Journal of Clinical Psychiatry, 69, 1721–1731. doi:10.4088/JCP.v69n1107
- Hayes, L. M. (2012). National study of jail suicide: 20 years later. Journal of Correctional Health Care, 18, 233–245. doi:10.1177/1078345812445457
- McCullumsmith, C. B., Clark, C. B., Perkins, A., Fife, J., & Cropsey, K. L. (2013). Gender and racial differences for suicide attempters and ideators in a high-risk community corrections population. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 34, 50–62. doi:10.1027/0227-5910/ a000160
- Mumola, C. J. (2005). Suicide and homicide in state prisons and local jails. Retrieved from https://www.bjs.gov/content/pub/pdf/shsplj.pdf