title: Suicide in adults released from prison in Queensland, Australia: a cohort study.
abstract: BACKGROUND
  Previous research has demonstrated elevated mortality following release from prison. We contrasted the risk of opioid overdose death with the risk of suicide in a cohort of adults released from prison in Queensland, Australia over a 14-year-period. We examine risk factors for suicide in the cohort, and make comparisons with the general population.
  
  
  METHODS
  We constructed a retrospective cohort of all adults released from prison between 1994 and 2007 and linked this to the National Death Index for deaths up to 31 December 2007.
  
  
  RESULTS
  We identified 41 970 individuals released from prison. Of the 2158 deaths in the community, 371 were suicides (crude mortality rate (CMR) 13.7/10 000 person-years) and 396 were due to drug-related causes (CMR 14.6/10 000 person-years). We observed a spike in drug-related deaths in the first 2 weeks after release from prison but no such pattern was observed for suicide. Being married (HR 0.40) and number of prior imprisonments (HR 3.1 for ≥5 prior incarcerations compared with none) independently predicted suicide. Age, sex, Indigenous status, length of incarceration and offence history were not associated with suicide. The standardised mortality ratios indicated that released women were 14.2 times and released men 4.8 times more likely to die from suicide than would be expected in the population.
  
  
  CONCLUSIONS
  This study demonstrates that the rate of suicide in adults released from prison is similar to the rate of drug-related deaths. Strategies that provide support to vulnerable people after release may reduce suicide in this population.
authors.affiliation: Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Spittal
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Forsyth
authors.affiliation: Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Pirkis
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Australia Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia.
authors.forename: Rosa
authors.initials: R
authors.lastname: Alati
authors.affiliation: Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia School of Medicine, University of Queensland, Brisbane, Australia School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia Murdoch Children Research Institute, Melbourne, Australia.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Kinner
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002423:Cause of Death; D015331:Cohort Studies; D062787:Drug Overdose / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D011329:Prisoners / Q000706:statistics & numerical data*; D065840:Protective Factors; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Cohort studies; MORTALITY; SUBSTANCE ABUSE; SUICIDE