Suicidal thoughts and behaviour in prison : epidemiology, risk factors, and prevention

Preventing suicide in prisons is an international priority which necessitates a thorough evidence base. This dissertation reports on findings from a case file analysis, questionnaire survey, systematic review, meta-analysis, diagnostic interviews, and qualitative methods. Results indicate that suicidal thoughts and behaviour are four times more prevalent in prisoners than in the general population, contributing to substantial morbidity and mortality, with a range of modifiable risk factors. Specifically, data suggest that prison-specific stressors increase the likelihood of developing suicidal thoughts, whereas imported vulnerabilities characterised by behavioural disinhibition facilitate the transition towards suicidal behaviour. Given that risk of suicide is determined by a complex web of synergistically interacting factors, there is a need for a multi-level approach to suicide prevention that incorporates targeted strategies aimed at high-risk individuals in combination with population strategies that promote the health and wellbeing of all prisoners, with multi-agency collaboration having a key role