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Suicide in custody

Case–control study

Division of Social Psychiatry, Department of Psychiatry, Medical University of Vienna, Vienna, Caritas St Poelten, St Poelten;

Teresa Matschnig, MD

Community Mental Health Services, Caritas St Poelten, St Poelten;

Franz Koenig and Peter Bauer, MD

Department of Medical Statistics, Medical University of Vienna, Vienna;

Patrick Frottier, MD

Justizanstalt Wien-Mittersteig, Vienna, Austria

Correspondence: Stefan Fruehwald, MD, Community Mental Health Services, Caritas St Poelten, Dr Karl Renner Promenade 12, A-3100 St Poelten, Austria. Tel: +43 699 1063 0808; fax: +43 2742 84139; e-mail: psd.fruehwald{at}stpoelten.caritas.at

Declaration of interest None.

Background Few risk factors and indicators of vulnerability for suicide in custody are known so far.

Aims A case–control study was conducted to investigate the relevance of criminal history, psychiatric morbidity and social integration to suicide in prison.

Method For every suicide that occurred in an Austrian correctional institution between 1975 and 1999, two controls matched for correctional institution, gender, nationality, age, custodial status and time of admission were selected. Psychiatric characteristics, previous suicidal behaviour, criminal history and indicators of social integration were compared.

Results Of 250 recorded suicides, 220 personal files were available and matched to 440 controls. The most important predictors for suicide in custody were a history of suicidality (status following attempted suicide and suicide threat), psychiatric diagnosis, psychotropic medication, a highly violent index offence and single- cell accommodation.

Conclusions A significant finding is the importance of suicidal behaviour as an indicator of risk of suicide in correctional institutions, which until now has been a matter of debate. This study demonstrates the need for staff to take suicidal behaviour as seriously in custodial settings as in any other circumstances.