Facultad de Medicina, Universidad Diego Portales, Santiago, Chile; Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile.
Doctorado en Psicoterapia, Medical Faculties and Faculties of Social Sciences, Universidad de Chile and Pontificia Universidad Católica de Chile, Quetzaltenango, Guatemala; Dirección General del Sistema de Investigación, Centro Universitario de Occidente, Universidad de San Carlos de Guatemala, Quetzaltenango, Guatemala.
Lancet Psychiatry. 2024 Jul;11(7):536-544. doi: 10.1016/S2215-0366(24)00134-2. Epub 2024 May 29.
Suicide is a leading cause of death during imprisonment. This systematic review aimed to synthesise available evidence of prison suicide incidence worldwide.
We systematically searched the scientific literature, data repositories, and prison system reports, supplemented by correspondence with prison administrations. We included reports on people living in prison but excluded studies in preselected groups (by age or offence type). Absolute numbers and incidence rates of suicide mortality per 100 000 person-years by sex and country were extracted from 2000 to 2021. IQRs were used to describe the suicide incidence in different world regions. Incidence rate ratios comparing suicides of people living in prison with age-standardised general populations were calculated. We conducted meta-regression analyses on national-level and prison-level factors to examine heterogeneity. The study protocol was pre-registered with PROSPERO, CRD42021296819.
We included three scientific studies, 124 official reports, and 11 datasets from email correspondence. Between 2000 and 2021, there were 29 711 reported suicides during 91·2 million person-years of imprisonment in 82 jurisdictions worldwide (sex-specific data available for 13 289 individuals: 12 544 [94·4%] male and 745 [5·6%] female individuals). There were large variations between countries, with most studies reporting suicide rates in the range of 24-89 per 100 000 person-years in both sexes (22-86 in male individuals and 25-107 in female individuals). In meta-regression analyses, Europe (vs other regions), high-income countries (vs low-income and middle-income countries), and countries with lower incarceration rates (vs those with higher incarceration rates) had higher suicide rates. Incidence rate ratios between people who are incarcerated and age-standardised general populations in the same jurisdictions were typically in the range of 1·9-6·0 in male and 10·4-32·4 in female individuals.
Prison services worldwide, and particularly in Europe, should prioritise suicide prevention. Assessment and management of suicide risk in female individuals living in prison need particular attention due to excess mortality relative to community-based populations. Interpretation of synthesised data needs to be done with caution due to high heterogeneity between jurisdictions.
Agencia Nacional de Investigación y Desarrollo, Economic and Social Research Council, and Wellcome Trust.
自杀是监禁期间导致死亡的主要原因。本系统评价旨在综合全球监狱自杀发生率的现有证据。
我们系统地检索了科学文献、数据库和监狱系统报告，并通过与监狱管理部门的通信进行了补充。我们纳入了关于监禁中人员的报告，但排除了预先选定人群（按年龄或犯罪类型）的研究。从 2000 年至 2021 年，提取了每 10 万人年中按性别和国家划分的自杀死亡率的绝对数字和发生率。使用 IQR 描述不同世界区域的自杀发生率。计算了比较监禁中人员自杀与年龄标准化一般人群的自杀发生率比。我们对国家和监狱层面的因素进行了荟萃回归分析，以检查异质性。研究方案已在 PROSPERO 上预先注册，CRD42021296819。
我们纳入了三项科学研究、124 份官方报告和 11 份来自电子邮件通信的数据。在 2000 年至 2021 年期间，在全球 82 个司法管辖区的 91.2 百万人年监禁期间报告了 29711 起自杀事件（13289 人有性别特异性数据：12544[94.4%]为男性，745[5.6%]为女性）。各国之间存在很大差异，大多数研究报告的男女两性自杀率均在 24-89/10 万之间（男性为 22-86/10 万，女性为 25-107/10 万）。荟萃回归分析表明，欧洲（与其他地区相比）、高收入国家（与低收入和中等收入国家相比）以及监禁率较低的国家（与监禁率较高的国家相比）自杀率较高。同一司法管辖区内被监禁者与年龄标准化一般人群的发病率比值比通常在男性为 1.9-6.0，女性为 10.4-32.4。
全世界的监狱服务部门，特别是在欧洲，应优先考虑预防自杀。由于与基于社区的人群相比死亡率过高，因此需要特别注意对监禁女性自杀风险的评估和管理。由于司法管辖区之间存在很大的异质性，因此对综合数据的解释需要谨慎进行。
国家研究与发展局、经济和社会研究理事会以及惠康信托基金会。
