Incarceration and subsequent risk of suicide: A statewide cohort study

Increasing suicide rates across the United States are disproportionate among populations most impacted by mass incarceration. We sought to determine if incarceration is associated with risk of suicide and firearm suicide after release from prison.

Using a population-based Washington cohort from Department of Corrections and vital statistics administrative records 1990-2017, individuals were compared to the sex-, age-, and race-matched population of Washington using Poisson regression. Among previously incarcerated individuals, we included incarceration history characteristics to calculate sub-hazard ratios using Cox proportional-hazards models.

Of 140,281 individuals released from prison, 484 died by suicide. Suicide risk was 62% higher among previously incarcerated individuals compared with the general population (RR: 1.62; 95% CI: 1.46-1.79). Suicide risk was higher among individuals convicted of firearm-involved crimes (RR: 2.27; 95% CI: 1.79-2.89). Individuals released prior to age 18 had substantially higher risk of firearm suicide than those whose first release occurred between ages 18-24 (sHR: 11.91; 95% CI: 4.30-32.96).

Our findings highlight the need for improved mental health resources and lethal means safety in this population. Mental health and substance use treatment have been proposed as effective alternatives to incarceration-continuing to study their impacts may reveal additional benefits of reducing suicide.