Sociodemographic, Criminological and Clinical Determinants in Suicide After Release From Prison: A 23-Year National Cohort Study.

BACKGROUND

Suicide risk is elevated after prison release, but population-level evidence on temporal risk patterns and associated factors remains limited. We aimed to describe characteristics of individuals who die by suicide after release from Norwegian prisons, compare their suicide mortality with the general population, and examine risk factors over time.

MATERIAL AND

METHODS

Data from the Norwegian Prison Release Study (nPRIS), including all people in prison in Norway (2000-2022), were linked to the Norwegian Cause of Death Registry, the Norwegian Prison Registry, the Norwegian Patient Registry, and Statistics Norway. We calculated crude mortality rates (CMR) per 100,000 person-years, standardized mortality ratios (SMR), annual age-standardized years of life lost rate (ASYR), and Cox proportional hazards models.

RESULTS

From 2000 to 2022, 1183 suicides (9.1% of all deaths; CMR 81; 95% CI 76-85) occurred after release (90% male). The SMR was higher in women (SMR 8.64; 95% CI 7.17-10.34) than men (SMR 3.98; 95% CI 3.76-4.22). In multivariable models (2009-2022; n = 57,034; 516 suicides), strong independent associations with suicide 6 months post-release included self-harm (adjusted HR [aHR] 4.76; 95% CI 2.60-8.72), severe mental illness (aHR 1.95; 95% CI 1.16-3.27), release from high-security prisons (aHR 1.93; 95% CI 1.12-3.33), and pretrial detention (aHR 1.82; 95% CI 1.06-3.13).

CONCLUSIONS

Suicide risk is substantially and persistently elevated relative to the general population, peaks immediately after release, and is concentrated among people with prior self-harm, severe mental illness, and those released from high-security settings.