Date Published: April 3, 2019
Publisher: Public Library of Science
Author(s): Daniel Radeloff, Franziska Stoeber, Thomas Lempp, Mattias Kettner, Katharina Bennefeld-Kersten, Michael Kaess.
Prisoners have a higher risk of suicide compared to non-incarcerated individuals. One aim of suicide prevention for prisoners is to identify risk factors in order to put stronger support mechanisms in place for the more vulnerable detainees. This study investigates the suicide risk (SR) in offence-related sub-populations in a representative German sample and differentiates between SR for adolescent and adult prisoners.
Conducting a national study with data from public German records on the entire prison population from 2000 to 2016 and suicide numbers in German prisons in the same period, SR was calculated for the total male prison population as well as for both subgroups, adolescent and adult male prisoners.
In the study period, male prisoners spent 959.584 life years (LY) in German criminal detention. Among those, 524 prisoners died of suicide. SR was higher for detainees imprisoned for an offence resulting in extensive physical harm for another person, e.g. homicide (suicide rate = 134,8 suicides per 100.000 LY; OR = 2,47; CI95%: 1,98–3,08), bodily injury (suicide rate = 87,3; OR = 1,60; CI95%: 1,29–1,99), and sexual offences (suicide rate = 84,2; OR = 1,54; CI95%: 1,18–2,01) compared with the SR of the total prison population (suicide rate = 54.6). Age differences between offence-related SR were found for theft, with adolescents (suicide rate = 69,3; OR = 1,25; CI95%: 0,85–1,84) showing higher SR than adults (suicide rate = 38,2; OR = 0,7; CI95%: 0,54–0,92).
The index offence of detainees is associated with SR and age-related differences exist. Suicide prevention in prisons should take both into account to determine populations at risk.
Suicide prevention is a public health imperative  and according to WHO guidelines, it is crucial that in the course of public health suicide prevention approaches high-risk groups are identified and psychiatric support is provided .
Suicide prevention in prisons is a multilevel approach, including key components like training and awareness programs of the prison staff, intake screening and on-going observation of suicide intent, improvement of architecture, and management following screening i.e. mental health treatment . The aim of this study was to provide some evidence for risk assessment procedures in prisons. Since a large amount of suicides take place during the first weeks after intake, guidelines emphasize the need for risk assessment immediately after imprisonment .
Some limitations apply to this study. First, due to data structure, results were not corrected for possibly confounding variables (e.g. length of sentence or prison conditions). Second, small case numbers of suicides among adolescents limited statistical power further, so that wide confidence intervals impede the interpretation of differences between offence-related SR in age groups, especially in offence groups with a small number of detainees.
In this total national study, we found that SR is not stratified homogeneously across offence types. Significantly higher SR were found in prisoners detained for an offence resulting in extensive physical harm for another person. To our knowledge, this is the first study that analysed differences in offence-related SR between adolescent and adult prisoners. Based on the results of this study, we propose that age- and offence-related risk factors should be assessed consistently in multidimensional suicide risk screenings in prisons.