Authors’ reply
In our paper,1 we presented information on rates of prison suicide during 2011–14 involving 3906 suicides from 24 countries, and risk ratios compared to general population rates of suicide. We also tested whether ten prison-level factors could explain the reported large variations in prison suicide rates and, apart from incarceration rate (which was attenuated when adjusted for other factors), there were no consistent findings.1 However, tackling prison suicide will need to include other parts of the criminal justice system and not just prison alone, and Stuart A Kinner and colleagues highlight the elevated rates of suicide after release.
In a systematic review,2 standardised mortality ratios for suicide in released prisoners have ranged from 2·6–13·5, and rates from 41–204 per 100 000 person-years, with increased suicide and external cause mortality risk in those with substance misuse disorders.3,4 Additionally, singling out one set of risk factors for suicide prevention and management, which our paper does not do, is not one of our recommendations. In fact, our concluding paragraph clearly states that prison suicide is probably due to complex interactions between individual-level and ecological factors, and that suicide prevention should address both individual and system-level risk factors. Furthermore, we propose research should be done on potentially more relevant ecological factors, and those that Annie Bartlett and colleagues list could be considered. We agree that solely focusing on individual factors should not be an implication of our study. As a secondary aim of our study was to explain variations in prison suicide rates, a research recommendation that follows is that individual factors should be examined (as tested prison-level factors did not explain observed heterogeneity). However, the clinical and service implications will need to consider how to address individual and prison-level factors that contribute to suicide risk.5
Footnotes
We declare no competing interests.
References
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