Suicidality in the Criminal Justice System: The Role of Cumulative Adversity and Protective Factors

Background: Incarcerated men experience disproportionately high levels of health inequities shaped by social determinants, including poverty, violence, family adversity, trauma, and limited access to healthcare. These long-standing disadvantages, added to the adverse conditions experienced in prisons, may be associated with elevated rates of suicidality in this population. This study examined the prevalence of suicidal ideation and lifetime suicide attempts among men deprived of liberty in Southern Brazil and investigated the role of cumulative adversities and current protective factors in these outcomes. Methods: A cross-sectional study was conducted with 496 incarcerated men. Participants completed a sociodemographic and background questionnaire assessing lifetime adversity (e.g., hunger, homelessness, sexual abuse, domestic violence, family substance dependence) and current protective factors in prison (e.g., family visits, education, leisure, physical activity, religion, positive self-perception). Cumulative adversity and protective factors were operationalized as composite indices. Logistic regression models tested whether cumulative adversities and protective factors were independently associated with suicidal ideation and suicide attempts. Results: Lifetime prevalence was 9.6% for suicidal ideation and 10.8% for suicide attempts. Cumulative adversities were associated with higher odds of both suicidal ideation (OR = 1.43; 95% CI = 1.11-1.84; p = 0.006) and suicide attempts (OR = 1.94; 95% CI = 1.50-2.52; p < 0.001). Protective factors were associated with lower likelihood of suicidal ideation (OR = 0.74; 95% CI = 0.58-0.96; p = 0.020) but were not significantly associated with suicide attempts. No significant interaction effects were observed, indicating that protective factors did not moderate the impact of adversity. Conclusions: Suicidal tendencies among incarcerated men were associated with cumulative structural and psychosocial adversities. Protective factors in prison were associated with lower odds of ideation but not attempts. These associations may inform person-centered and equity-oriented approaches and are consistent with the relevance of social determinants to mental health, although causal inferences are not supported by this project.