Contact with the criminal justice system may be associated with suicide risk

Men and women who have had contact with the criminal justice system - even if they have never received a jail or prison sentence or a guilty verdict - appear to have a significantly higher rate of suicide than the general population, according to a report posted online today that will appear in the June print issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Most published research on suicide and the criminal justice system focuses on prisoners during their incarceration or soon after release, according to background information in the article. Few studies have investigated the risk of suicide among offenders who are not imprisoned. 'Some have suggested that community offenders could be even more vulnerable than prisoners,' the authors write.

Roger T. Webb, Ph.D., of the University of Manchester, England, and colleagues used national registries to identify 27,219 Danish individuals (18,063 men and 9,156 women) who died by suicide between 1981 and 2006. They also selected 524,899 controls matched by age, sex and time (in other words, the control patients were alive when their matched case died). They then linked this data to another national registry to determine which individuals had exposure to the criminal justice system after 1980.

More than one-third of men who died by suicide (34.8 percent) had a criminal justice history, compared with 24.6 percent of controls. For women, 12.8 percent who died by suicide and 5.1 percent of controls had exposure to the justice system.

The risk of suicide was highest among those who had received custodial sentencing (time detained in prison). However, compared with those who had never been exposed to the justice system, suicide risk was elevated even among those who had never received prison time or a guilty verdict. Suicide was most strongly associated with sentencing to psychiatric treatment and with charges conditionally withdrawn, proceedings in Denmark similar to suspended sentences.

The prevalence of psychiatric admission was high among individuals who had been exposed to the criminal justice system and then died by suicide, especially among women. The risk of suicide was especially high among those with a criminal history who were younger, who had been charged for violent offences and whose contact with the criminal justice system was recent or repeated.

'We believe that our findings of rising suicide risk with increasing recency and frequency of contact point toward a strong independent effect of criminal justice history,' the authors write. 'Thus, exposure to the criminal justice system in itself may contribute to elevating a person's suicide risk, rather than simply reflecting the traits and characteristics of people who come into contact with the system.'

'The need for developing more far-reaching national suicide prevention strategies is indicated,' the authors conclude. 'In particular, improved mental health service provision is needed for all people in contact with the criminal justice system, including those not found guilty and those not given custodial sentences. Our findings also suggest that public services should be better coordinated to tackle co-occurring health and social problems more effectively.'