title: Suicide among male prisoners in France: a prospective population-based study.
abstract: BACKGROUND
  Suicide rates are high among prisoners but little is known about the precise weight of each risk factor.
  
  
  METHODS
  We collected data on the periods of imprisonment of all adult males incarcerated in France between 1 January, 2006 and 15 July, 2009. We used survival analyses from the incarceration to its end, censored by the observation period. We calculated suicide rates and performed a Cox model to assess the link between prisoners' imprisonment characteristics and suicide risk.
  
  
  RESULTS
  Overall, 301,611 periods of imprisonment were observed and 353 suicides were recorded. The suicide rate was 17.9 suicides per 10,000 person-years (95% CI: 16.1-19.9). The hazard ratio (HR) of suicide risk was high for placements in a disciplinary cell (15.7, 95% CI: 10.6-23.5) and varied depending on the main offence (homicide: 7.6, 95% CI: 5.3-10.9, rape: 4.6, 95% CI: 3.2-6.6, other sexual assault: 2.9, 95% CI: 1.9-4.6, other violent offence: 2.1, 95% CI: 1.5-2.8, compared with other offences). HR was lower when visits from relatives were observed (0.4, 95% CI: 0.3-0.5) and higher if a hospitalization was observed (1.6, 95% CI: 1.3-2.0). After conviction, HR halved with respect to the remand period, but there was no difference by sentence length. HR was higher if incarceration occurred after age 30 (1.4, 95% CI: 1.1-1.7). Foreigners tended to have lower risks than French prisoners, with the exception of those incarcerated for rape.
  
  
  CONCLUSIONS
  The suicide rate in prison is generally much higher than in the general population. This study has replicated previous international findings, highlighting the impact of the type of offence on suicide risk. Suicide prevention programmes must consider the high risk associated with incarceration for a criminal offence against a person. With regard to the impact of visits from relatives and placements in a disciplinary cell, further work should be conducted from a psychological perspective to examine the effects of physical and social isolation.
authors: French Institute for Demographic Studies, INED, Paris, France. Electronic address: geraldine.duthe@ined.fr.
authors: Géraldine
authors: G
authors: Duthé
authors: Angélique
authors: A
authors: Hazard
authors: Annie
authors: A
authors: Kensey
authors: Jean-Louis Pan Ké
authors: JL
authors: Shon
mesh_terms: D000293:Adolescent; D000328:Adult; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005195:Family Relations; D005602:France; D006708:Homicide / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011329:Prisoners / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012742:Sex Offenses / Q000706:statistics & numerical data; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: France; Prison; Risk factor; Suicide; Survival analysis