Miller TR, Weinstock LM, Ahmedani BK, et al.
JAMA Network Open. 2024;7(5):e249965.
Key Points
Question What proportion of US adults who died by suicide spent at least 1 night in jail shortly before their death?
Findings In this cohort modeling study involving nearly 7.1 million US adults released from incarceration in 2019, nearly 20% of suicides occurred among those who were released from jail in the past year and 7% were by those in their second year of jail release.
Meaning Findings of this study suggest that focused suicide prevention efforts could reach a substantial number of adults who were formerly incarcerated within 2 years, when death by suicide is likely to occur.
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Abstract
Importance Although people released from jail have an elevated suicide risk, the potentially large proportion of this population in all adult suicides is unknown.
Objective To estimate what percentage of adults who died by suicide within 1 year or 2 years after jail release could be reached if the jail release triggered community suicide risk screening and prevention efforts.
Design, Setting, and Participants This cohort modeling study used estimates from meta-analyses and jail census counts instead of unit record data. The cohort included all adults who were released from US jails in 2019. Data analysis and calculations were performed between June 2021 and February 2024.
Main Outcomes and Measures The outcomes were percentage of total adult suicides within years 1 and 2 after jail release and associated crude mortality rates (CMRs), standardized mortality ratios (SMRs), and relative risks (RRs) of suicide in incarcerated vs not recently incarcerated adults. Taylor expansion formulas were used to calculate the variances of CMRs, SMRs, and other ratios. Random-effects restricted maximum likelihood meta-analyses were used to estimate suicide SMRs in postrelease years 1 and 2 from 10 jurisdictions. Alternate estimate was computed using the ratio of suicides after release to suicides while incarcerated.
Conclusions and Relevance This cohort modeling study found that adults who were released from incarceration at least once make up a large, concentrated population at greatly elevated risk for death by suicide; therefore, suicide prevention efforts focused on return to the community after jail release could reach many adults within 1 to 2 years of jail release, when suicide is likely to occur. Health systems could develop infrastructure to identify these high-risk adults and provide community-based suicide screening and prevention.
