Formerly incarcerated people have twice the risk of death by suicide, study finds

January 24, 2023

“Many of us love — or know someone who loves — a person who has been incarcerated. It might seem like being released is such a great joy that we don’t think they are at risk of dying by suicide afterward,” says Kate Vinita Fitch, a doctoral student in the Department of Epidemiology at the UNC Gillings School of Global Public Health. “But it’s important to know that formerly incarcerated people experience so many barriers to full participation in society after release, and this ongoing experience may contribute to an elevated risk of suicide even after they’ve been ‘out’ for a long time.”

Kate Vinita Fitch

A study published in the American Journal of Epidemiology by first author Fitch and co-authors is the first since 2007 to evaluate the suicide risk of North Carolinians who have been incarcerated compared to those who have not. On average, people who have been incarcerated are at twice the risk of death by suicide, even years after they are released.

The researchers also found that formerly incarcerated people more often turn to suicide methods other than guns, likely because many people leaving prison are barred from owning firearms. Fitch notes that since these methods of suicide are less often fatal, the rate of suicide attempts in this population is likely much higher than recorded data show.

Fitch worked with several Gillings School colleagues on the study, including Brian Wells Pence, PhD, professor of epidemiology; Bradley Gaynes, MD, adjunct professor of epidemiology; Monica Swilley-Martinez, MPH, doctoral student of epidemiology; and Shabbar Ranapurwala, PhD, assistant professor of epidemiology. These researchers and other study co-authors hold additional positions across the University of North Carolina at Chapel Hill — including at the Injury Research Prevention Center, the School of Medicine and the Cecil G. Sheps Center for Health Services Research — and at the North Carolina Department of Health and Human Services.

The study comes out of the larger INSPIRE (Innovations in Suicide Prevention Research) project, which studies suicide deaths in many different populations. Because INSPIRE has a data use agreement with the N.C. Department of Adult Correction (DAC), the research team had access to data on formerly incarcerated people in the state, which they analyzed with technical support from DAC staff. Fitch says earlier studies on the topic, which used data from 1980-2005 and then 2006-2007, relied largely on web queries for publicly available forms of data.

“Being able to tackle this topic again with more and better data was made possible through our cooperative relationship with DAC,” she says.

One surprising fact revealed by the expanded data sets is related to suicide patterns by age.

“Given what I know about how difficult it is to adjust to life outside of prison after many years inside, I expected suicide mortality ratios to increase with age,” Fitch shares. “However, we found that the rate of suicide death generally decreased with age. The youngest formerly incarcerated people (18 to 21 years old) had three times more suicide deaths of their non-incarcerated peers; those in their thirties and forties had less than twice the suicide mortality; and those in their fifties had a lower suicide rate than their peers. It was only in the oldest adults — in their sixties and up — that we saw an elevated suicide mortality rate again.”

Ultimately, the researchers completed the study with the goal of informing larger suicide prevention efforts. Fitch says these efforts must be rooted in recognition of the myriad ways that formerly incarcerated people are systemically disadvantaged in society.

“Post-release suicide prevention cannot and should not be the criminal legal system’s responsibility,” she states. “The efforts that I believe are next steps to address systemic disadvantages include: housing, education and employment support; civic empowerment of formerly incarcerated people through restoration of voting rights; improved access to health care through Medicaid expansion and post-release Medicaid enrollment programs; and primary prevention of incarceration itself.”

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.