Suicide-Related Outcomes Among Adults in Custody: An Umbrella Review of Systematic Literature Reviews

• Published date: 01 October 2024
• DOI: http://doi.org/10.1177/00938548241260806
• Author: Serena Bruno,Silvia Andreassi,Giulia Ballarotto,Valeria Carola,Silvia Cimino,Giacomo Ciocca,Barbara Cordella,Michela Di Trani,Federica Galli,Carlo Lai,Viviana Langher,Erika Limoncin,Manuela Tomai,Patrizia Velotti
• Date: 01 October 2024
• Subject Matter: Articles

CRIMINAL JUSTICE AND BEHAVIOR, 2024, Vol. 51, No. 10, October 2024, 1570 –1589.

DOI: https://doi.org/10.1177/00938548241260806

Article reuse guidelines: sagepub.com/journals-permissions

© 2024 International Association for Correctional and Forensic Psychology

1570

SUICIDE-RELATED OUTCOMES AMONG

ADULTS IN CUSTODY

An Umbrella Review of Systematic Literature Reviews

SERENA BRUNO

SILVIA ANDREASSI

GIULIA BALLAROTTO

VALERIA CAROLA

SILVIA CIMINO

GIACOMO CIOCCA

BARBARA CORDELLA

MICHELA DI TRANI

FEDERICA GALLI

CARLO LAI

VIVIANA LANGHER

ERIKA LIMONCIN

MANUELA TOMAI

PATRIZIA VELOTTI

Sapienza University of Rome, Italy

We conducted a comprehensive umbrella review including all published meta-analyses and systematic reviews on suicide-

related outcomes among adults in custody. Eligible studies were searched for in major scientific databases following the

PRISMA method up to February 2023. The quality of each study was assessed using the AMSTAR-2 protocol. Twenty stud-

ies were included, consisting of 11 meta-analyses and nine systematic reviews. Factors associated with suicide outcomes

among individuals in custody were categorized into five domains: clinical status, historical, custodial, criminological, and

prevention. However, all systematic studies reported considerable heterogeneity (I2 > 50%–85%). Most systematic literature

reviews and/or meta-analyses showed moderate quality based on AMSTAR-2. This umbrella review highlights individual

factors (in the clinical status and historical domain), contextual factors (in the custodial and criminological domains), and

protective factors (in the prevention domain) to provide a clearer understanding of the prison-related domains involved in the

development and maintenance of suicide-related outcomes.

Keywords: suicide-related outcomes; adults in custody; umbrella review; public health

AUTHORS’ NOTE: Correspondence concerning this article should be addressed to Patrizia Velotti,

Department of Dynamic & Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli

Apuli 1, Rome 00185, Italy. e-mail: patrizia.velotti@uniroma1.it.

1260806CJBXXX10.1177/00938548241260806Criminal Justice and BehaviorBruno et al. / Suicide-Related Outcomes Among Adults in Custody

review-article2024

Bruno et al. / SUICIDE-RELATED OUTCOMES AMONG ADULTS IN CUSTODY 1571

INTRODUCTION

Worldwide, it is estimated that more than 10.77 million people are held in correctional

institutions, either as persons in pretrial custody pretrial or as convicted felons (Fair &

Walmsley, 2021). The burden of social and health problems among individuals in detention

is significant. Indeed, this population commonly exhibits a higher prevalence of psychiatric

and substance use disorders (Wainwright & Dawson, 2022; Zavattini et al., 2017), as well

as somatic diseases (Tverborgvik et al., 2023). A history of incarceration also increases the

risk of death from internal causes such as cardiovascular disease, cancer, infectious disease,

and liver disease (Spittal et al., 2019). Increased alcohol, tobacco and drug use, homeless-

ness, higher levels of infections, and low socioeconomic status are possible explanations for

the elevated risk of death from internal causes among released prison populations

(Binswanger et al., 2007).

However, the most troubling and pervasive cause of nonnatural mortality within correc-

tional facilities is self-inflicted violent behavior (Fazel & Baillargeon, 2011), posing serious

social, economic, and public health problems. Suicide and self-harm, both suicidal and

nonsuicidal, rank among the most frequent causes of mortality risk among adults in custody

(Favril et al., 2022; Fazel et al., 2016). Specifically, suicide is defined as the death resulting

from intentional self-harm with the intent to die, while nonsuicidal self-injury is defined as

intentional self-harm without the intent to die. On the other hand, suicide attempt is defined

as intentional self-harm with the intent to die that did not result in death. In some cases, the

intent to die may not have been determined: undetermined suicide-related behavior.

The risk factors for the development of suicide-related outcomes in prison are multifac-

eted and attributable to various domains, including the individual’s life history, presence of

childhood trauma, clinical status, crime-related factors, and type of custody. Recent studies

(Perugino et al., 2023) have revealed a notably alarming rate of suicides in prisons, under-

scoring the urgent need for intervention in this phenomenon.

The most common forms of self-inflicted violence among incarcerated individuals are

nonsuicidal self-injury and suicide. Notably, self-injurious behavior often precedes suicide,

with approximately 50% of those who died by suicide in prison having a history of nonsui-

cidal self-injury, showing that for every suicide attempt, there was an 8.4 times greater

chance of having a suicide (Fazel et al., 2008).

A 5-year epidemiological study of adults in custody in prisons in England and Wales

(Hawton et al., 2014) found that cutting and scratching were the most frequent methods of

self-harm in both sexes. Moreover, concerning risk factors and triggering events for the

self-harm episode, this study found associations with life sentences or unsentences (e.g., for

individuals who are in the process of appealing their conviction or awaiting sentencing for

additional charges).

Regarding clinical status in relation to risk factors for suicide-related outcomes in prison,

studies have indicated that comorbidity with mental illness is associated with significantly

higher rates of suicidal ideation and behavior. Severe psychopathologies such as posttrau-

matic stress disorder and major depression (Barry et al., 2020; Gooding et al., 2017), as well

as borderline personality disorder (Favril, Indig, et al., 2020), and other psychiatric condi-

tions like psychosis, anxiety, and substance dependence, influence suicidality in the prison

population (Rivlin et al., 2010).