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Prevention of Suicidal Behavior in Prisons : An Overview of Initiatives Based on a Systematic Review of Research on Near-Lethal Suicide Attempts

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      Worldwide, prisoners are at high risk of suicide. Research on near-lethal suicide attempts can provide important insights into risk and protective factors, and inform suicide prevention initiatives in prison.


      To synthesize findings of research on near-lethal attempts in prisons, and consider their implications for suicide prevention policies and practice, in the context of other research in custody and other settings.


      We searched two bibliographic indexes for studies in any language on near-lethal and severe self-harm in prisoners, supplemented by targeted searches over the period 2000–2014. We extracted information on risk factors descriptively. Data were not meta-analyzed owing to heterogeneity of samples and methods.


      We identified eight studies reporting associations between prisoner near-lethal attempts and specific factors. The latter included historical, prison-related, and clinical factors, including psychiatric morbidity and comorbidity, trauma, social isolation, and bullying. These factors were also identified as important in prisoners’ own accounts of what may have contributed to their attempts (presented in four studies).


      Factors associated with prisoners’ severe suicide attempts include a range of potentially modifiable clinical, psychosocial, and environmental factors. We make recommendations to address these factors in order to improve detection, management, and prevention of suicide risk in prisoners.

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      Most cited references 92

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      Suicide receives increasing attention worldwide, with many countries developing national strategies for prevention. Rates of suicide vary greatly between countries, with the greatest burdens in developing countries. Many more men than women die by suicide. Although suicide rates in elderly people have fallen in many countries, those in young people have risen. Rates also vary with ethnic origin, employment status, and occupation. Most people who die by suicide have psychiatric disorders, notably mood, substance-related, anxiety, psychotic, and personality disorders, with comorbidity being common. Previous self-harm is a major risk factor. Suicide is also associated with physical characteristics and disorders and smoking. Family history of suicidal behaviour is important, as are upbringing, exposure to suicidal behaviour by others and in the media, and availability of means. Approaches to suicide prevention include those targeting high-risk groups and population strategies. There are, however, many challenges to large-scale prevention, especially in developing countries.
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        Neurobiology of suicidal behaviour.

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          The health and health care of US prisoners: results of a nationwide survey.

          We analyzed the prevalence of chronic illnesses, including mental illness, and access to health care among US inmates. We used the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities to analyze disease prevalence and clinical measures of access to health care for inmates. Among inmates in federal prisons, state prisons, and local jails, 38.5% (SE = 2.2%), 42.8% (SE = 1.1%), and 38.7% (SE = 0.7%), respectively, suffered a chronic medical condition. Among inmates with a mental condition ever treated with a psychiatric medication, only 25.5% (SE = 7.5%) of federal, 29.6% (SE = 2.8%) of state, and 38.5% (SE = 1.5%) of local jail inmates were taking a psychiatric medication at the time of arrest, whereas 69.1% (SE = 4.8%), 68.6% (SE = 1.9%), and 45.5% (SE = 1.6%) were on a psychiatric medication after admission. Many inmates with a serious chronic physical illness fail to receive care while incarcerated. Among inmates with mental illness, most were off their treatments at the time of arrest. Improvements are needed both in correctional health care and in community mental health services that might prevent crime and incarceration.

            Author and article information

            [1 ]Department of Psychology, Middlesex University, London, UK
            [2 ]Centre for Suicide Research, University of Oxford, UK
            [3 ]Health and Justice, Health and Wellbeing Directorate, Public Health England, London, UK
            Author notes
            Seena Fazel, University Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK, Tel. +44 (0)1865 223-9041, Fax +44 (0)1865 79-3101, seena.fazel@
            13 June 2016
            9 June 2016
            September 2016
            23 November 2016
            : 37
            : 5
            : 323-334
            27278569 5120691 10.1027/0227-5910/a000394 EMS68819

            Distributed as a Hogrefe OpenMind article under the license CC BY 4.0 (


            Clinical Psychology & Psychiatry

            suicide, prison, prevention, jail, self-harm


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