Skip to main content

Suicide in recently released prisoners: a case-control study

  • D. Pratt (a1), L. Appleby (a1), M. Piper (a1), R. Webb (a1) and J. Shaw (a1)...

Recently released prisoners are at markedly higher risk of suicide than the general population. The aim of this study was to identify key risk factors for suicide by offenders released from prisons in England and Wales.


All suicides committed by offenders within 12 months of their release from prison in England and Wales, between 2000 and 2002, were identified. One control matched on gender and date of release from prison was recruited for each case. Univariate and multivariate logistic regression modelling identified key independent risk factors for suicide.


Of 256 920 released prisoners, 384 suicides occurred within a year of release. Factors significantly associated with post-release suicide were increasing age over 25 years, released from a local prison, a history of alcohol misuse or self-harm, a psychiatric diagnosis, and requiring Community Mental Health Services (CMHS) follow-up after release from prison. Non-white ethnicity and a history of previous imprisonment were protective factors.


There is a need to improve the continuity of care for people who are released from prison and for community health, offender and social care agencies to coordinate care for these vulnerable individuals.

Corresponding author
*Address for correspondence: J. Shaw, F.R.C.Psych, Centre for Suicide Prevention, School of Community-Based Medicine, 2nd Floor, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. (Email:
Hide All
Appleby L, Shaw J, Sherratt J, Amos T, Robinson J, McDonnell R, McKann K, Parsons R, Hunt IM, Burns J, Bickley H, Kiernan K, Davies S, Harris C (2001). Safety First. A Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Department of Health: London.
Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, Koepsell TD (2007). Release from prison – a high risk of death for former inmates. New England Journal of Medicine 356, 157165.
Bogue J, Power K (1995). Suicide in Scottish prisons, 1976–1993. Journal of Forensic Psychiatry 6, 527540.
DoH (2002). National Suicide Prevention Strategy for England. Department of Health: London.
DoH (2003). Preventing Suicide: A Toolkit for Mental Health Services. Department of Health: London.
DoH (2005). Offender Mental Health Care Pathway. Department of Health: London.
DoH (2007). Improving Health, Supporting Justice: A Consultation Document. Department of Health: London.
DoH (2008). Independent Evaluation Report of ‘Improving Health, Supporting Justice: A Consultation Document’. Department of Health: London.
Dooley E (1990). Prison suicide in England and Wales 1972–87. British Journal of Psychiatry 156, 4045.
Freudenberg N, Daniels J, Crum M, Perkins T, Richie BE (2005). Coming home from jail: the social and health consequences of community reentry for women, male adolescents, and their families and communities. American Journal of Public Health 95, 17251736.
Fruehwald S, Frottier P, Matschnig T, König F, Bauer P (2004). Suicide in custody: a case-control study, British Journal of Psychiatry 185, 494498.
Goss JR, Peterson K, Smith LW, Kalb K, Brodey BB (2002). Characteristics of suicide attempts in a large urban jail system with an established suicide prevention program. Psychiatric Services 53, 574579.
Graham A (2003). Post-prison mortality: unnatural death among people released from Victorian prisons between January 1990 and December 1999. Australian and New Zealand Journal of Criminology 36, 94–108.
Harding-Pink D (1990). Mortality following release from prison. Medicine, Science, and the Law 30, 1216.
Harris EC, Barraclough B (1997). Suicide as an outcome for mental disorders; a meta-analysis. British Journal of Psychiatry 170, 205228.
HM Inspectorates of Prisons and Probation (2001). Through the Prison Gate: A Joint Thematic Review. Home Office: London.
HM Prison Service (2001). Prevention of Suicide and Self-Harm in the Prison Service. An Internal Review. HM Prison Service: London.
Home Office (2000). National Standards for the Supervision of Offenders in the Community. Home Office: London.
Home Office (2001). Prison Statistics: England and Wales 2000. Home Office: London.
Hosmer DW, Lemeshow S (2000). Applied Logistic Regression, 2nd edn. Wiley-Interscience: New York.
Joukamaa M (1998). The mortality of released Finnish prisoners: a 7 year follow-up study of the WATTU project. Forensic Sciences International 96, 1119.
King EA (2001). The Wessex suicide audit 1988–1993: a study of 1457 suicides with and without a recent psychiatric contact. International Journal of Psychiatry and Clinical Practice 5, 111118.
Lincoln T, Kennedy S, Tuthill R, Roberts C, Conklin TJ, Hammett TM (2006). Facilitators and barriers to continuing healthcare after jail: a community-integrated program. Journal of Ambulatory Care Management 29, 2–16.
Luoma JB, Martin CE, Pearson JL (2002). Contact with mental health and primary care providers before suicide: a review of the evidence. American Journal of Psychiatry 159, 909916.
National Probation Service (2004). Probation Circular 40/2004: Strategy for Preventing Sudden Deaths in Approved Premises. National Probation Service: London.
Neeleman J, Wessley S (1997). Changes in classification of suicide in England and Wales: time trends and association with coroners' professional background. Psychological Medicine 27, 467472.
Patient Information Advisory Group (2006). Guidance Notes: Section 60 of the Health and Social Care Act 2001 ( Accessed 2 March 2009.
Pratt D, Piper M, Appleby L, Webb R, Shaw J (2006). Suicide in recently released prisoners: a population-based cohort study. Lancet 368, 119123.
Shaw J, Appleby L, Baker D (2003). Safer Prisons. A National Study of Prison Suicides 1999–2000 by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Department of Health: London.
Shaw J, Baker D, Hunt IM, Moloney A, Appleby L (2004). Suicide by prisoners: a national clinical survey. British Journal of Psychiatry 184, 263267.
Shaw JJ (1997). The prevalence of serious mental illness in a court population. Ph.D. thesis, University of Manchester, UK.
Stewart LM, Henderson CJ, Hobbs MST, Ridout SC, Knuiman MW (2004). Risk of death in prisoners after release from jail. Australian and New Zealand Journal of Public Health 28, 3236.
Winter MM (2003). County jail suicides in a midwestern state: moving beyond the use of profiles. The Prison Journal 83, 130148.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 22
Total number of PDF views: 105 *
Loading metrics...

Abstract views

Total abstract views: 622 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th January 2018. This data will be updated every 24 hours.