Suicide risk among recently released prisoners in New South Wales, Australia

To determine the risk of suicide and drug overdose death among recently released prisoners.

Retrospective cohort study of 85 203 adult offenders who had spent some time in full-time custody in prisons in New South Wales between 1 January 1988 and 31 December 2002.

Association between time after release and risk of suicide and overdose death.

Of 844 suicides (795 men, 49 women), 724 (86%) occurred after release. Men had a higher rate of suicide than women both in prison (129 v 56 per 100,000 person-years) and after release (135 v 82 per 100,000 person-years). The suicide rate in men in the 2 weeks after release was 3.87 (95% CI, 2.26-6.65) times higher than the rate after 6 months. Male prisoners admitted to the prison psychiatric hospital had a threefold higher risk than non-admitted men both in prison and after release. No suicides among women were observed in the 2 weeks after release. No increased risk of suicide was observed among Aboriginal Australians in the first 2 weeks after release. Of 1674 deaths due to overdose, 1627 (97%) occurred after release. Drug-related mortality in men was 9.30 (95% CI, 7.80-11.10) times higher, and in women was 6.42 (95% CI, 3.88-10.62) times higher, in the 2 weeks after release than after 6 months.

Prisoners are at a heightened risk of suicide and overdose death in the immediate post-release period. After 6 months post-release, the suicide rate approaches the rate observed in custody.