Rethinking pathways to completed suicide by female prisoners [forthcoming]

Purpose: Explore the role of trauma experience in pathways to self-harm or attempted suicide in female prisoners who died through self-inflicted death in England and Wales. Design: Quantitative study using the Prison and Probation Ombudsmen’s independent reports on deaths in custody. 32 cases of female self-inflicted death in custody were coded on the presence of Direct or Interpersonal Trauma, presence of superficial self-harm, near-lethal self-harm, suicide attempts and recent significant life event. The number of previous suicide attempts and age at time of death was recorded. Findings: Direct trauma is linked with repeated suicide attempts but decreased the likelihood of superficial self-harm prior to suicide. Neither interpersonal trauma nor age increased likelihood of pre-suicide behaviours. Near-lethal self-harm was not predicted by either traumatic experience. Amongst these completed suicide cases, 56% were not reported as having experienced trauma, 46% had no recorded previous suicide attempts and 12% also had no previous self-harm reported. Research limitations/implications: The small sample limited statistical power and specificity of classifications. Provides support for direct trauma in developing capacity for repeated suicidal behaviour as indicated in theoretical models of suicide (Joiner, 2005; O’Connor, 2011). Practical implications: Different pathways to suicide likely to exist for female prisoners and importance of trauma intervention services. Originality/value: Using cases of completed suicide in female prisoners to investigate the pathway to suicide from trauma through previous self-harm and attempted suicide