Increased Risk of Suicide Attempts and Unintended Death Among Those Transitioning From Prison to Community in Later Life.

OBJECTIVE

The number of individuals transitioning from correctional facilities to community in later life (age ≥50 ) is increasing. We sought to determine if later-life prison release is a risk factor for suicidal behavior and death by accidental injury, including drug overdose.

DESIGN

Retrospective cohort study.

SETTING

U.S. Department of Veterans Affairs and Medicare healthcare systems, 2012-2014.

PARTICIPANTS

Veterans age ≥50 released from correctional facilities (N = 7,671 re-entry veterans) and those never incarcerated (N = 7,671).

METHODS

Dates of suicide attempt and cause-specific mortality defined using the National Suicide Prevention Applications Network and the National Suicide Data Repository, respectively.

RESULTS

Later-life prison release was associated with increased risk of suicide attempt (599.7 versus 134.7 per 100,000 per year; adjusted hazard ratio [HR] 3.45; 95% confidence interval [CI] 2.24-5.32; p < 0.001, Wald χ2 = 31.58, degrees of freedom [df] = 1), death by drug overdose (121.7 versus 43.5; adjusted HR 3.45; 95% CI 1.37-8.73; p = 0.009, Wald χ2 = 6.86, df = 1), and other accidental injury (126.0 versus 39.1; adjusted HR 3.13; 95% CI 1.28-7.69; p = 0.013, Wald χ2 = 6.25, df = 1), adjusting for homelessness, traumatic brain injury, medical and psychiatric conditions, and accounting for competing risk of other deaths. Suicide mortality rates were observed as nonsignificant between re-entry veterans and those never incarcerated (30.4 versus 17.4, respectively; adjusted HR 2.40; 95% CI 0.51-11.24; p = 0.266, Wald χ2 = 1.23, df = 1).

CONCLUSION

Older re-entry veterans are at considerable risk of attempting suicide and dying by drug overdose or other accidental injury. This study highlights importance of prevention and intervention efforts targeting later-life prison-to-community care transitions.