Suicide risk among recently released prisoners in New South Wales, Australia

Azar Kariminia, Matthew G Law, Tony G Butler, Michael H Levy, Simon P Corben, John M Kaldor and Luke Grant
Med J Aust 2007; 187 (7): 387-390.


Objective: To determine the risk of suicide and drug overdose death among recently released prisoners.

Design, setting and participants: Retrospective cohort study of 85 203 adult offenders who had spent some time in full-time custody in prisons in New South Wales between 1 January 1988 and 31 December 2002.

Main outcome measures: Association between time after release and risk of suicide and overdose death.

Results: Of 844 suicides (795 men, 49 women), 724 (86%) occurred after release. Men had a higher rate of suicide than women both in prison (129 v 56 per 100 000 person-years) and after release (135 v 82 per 100 000 person-years). The suicide rate in men in the 2 weeks after release was 3.87 (95% CI, 2.26–6.65) times higher than the rate after 6 months. Male prisoners admitted to the prison psychiatric hospital had a threefold higher risk than non-admitted men both in prison and after release. No suicides among women were observed in the 2 weeks after release. No increased risk of suicide was observed among Aboriginal Australians in the first 2 weeks after release. Of 1674 deaths due to overdose, 1627 (97%) occurred after release. Drug-related mortality in men was 9.30 (95% CI, 7.80–11.10) times higher, and in women was 6.42 (95% CI, 3.88–10.62) times higher, in the 2 weeks after release than after 6 months.

Conclusions: Prisoners are at a heightened risk of suicide and overdose death in the immediate post-release period. After 6 months post-release, the suicide rate approaches the rate observed in custody.

  • Azar Kariminia1,2
  • Matthew G Law1
  • Tony G Butler3
  • Michael H Levy4,5
  • Simon P Corben6
  • John M Kaldor1
  • Luke Grant6

  • 1 National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW.
  • 2 Centre for Health Research in Criminal Justice, Justice Health, Sydney, NSW.
  • 3 National Drug Research Institute, Perth, WA.
  • 4 Corrections Health Program, Canberra, ACT.
  • 5 School of Public Health and Community Medicine, University of Sydney, Sydney, NSW.
  • 6 NSW Department of Corrective Services, Sydney, NSW.


This study is supported by National Health and Medical Research Council Research Grant No. 222849. We are grateful to Professor Gavin Andrews, University of New South Wales, for his comments. We also thank staff from the NSW Department of Corrective Services for their assistance in data collection.

Competing interests:

None identified.

  • 1. Harding-Pink D. Mortality following release from prison. Med Sci Law 1990; 30: 12-16.
  • 2. Joukamaa M. The mortality of released Finnish prisoners; a 7 year follow-up study of the WATTU project. Forensic Sci Int 1998; 96: 11-19.
  • 3. Verger P, Rotily M, Prudhomme J, Bird S. High mortality rates among inmates during the year following their discharge from a French prison. J Forensic Sci 2003; 48: 614-616.
  • 4. Stewart LM, Henderson CJ, Hobbs MS, et al. Risk of death in prisoners after release from jail. Aust N Z J Public Health 2004; 28: 32-36.
  • 5. Sattar G, Killias M. The death of offenders in Switzerland. Eur J Criminol 2005; 2: 317-340.
  • 6. Binswanger IA, Stern MF, Deyo RA, et al. Release from prison — a high risk of death for former inmates. N Engl J Med 2007; 356: 157-165.
  • 7. Pratt D, Piper M, Appleby L, et al. Suicide in recently released prisoners: a population-based cohort study. Lancet 2006; 368: 119-123.
  • 8. Kariminia A, Butler TG, Corben SP, et al. Extreme cause-specific mortality in a cohort of adult prisoners — 1988 to 2002: a data-linkage study. Int J Epidemiol 2007; 36: 310-316. doi: 10.1093/ije/dyl225.
  • 9. Australian Bureau of Statistics. Drug-induced deaths: a guide to ABS causes of death data, 2002. Canberra: ABS, 2002. (ABS Cat. No. 4809.0.55.001.)
  • 10. Australian Bureau of Statistics. Australian Standard Offence Classification, 1997. Canberra: ABS, 1997. (ABS Cat. No. 1234.0.)
  • 11. Seaman SR, Brettle RP, Gore SM. Mortality from overdose among injecting drug users recently released from prison: database linkage study. BMJ 1998; 316: 426-428.
  • 12. Seymour A, Oliver JS, Black M. Drug-related deaths among recently released prisoners in the Strathclyde Region of Scotland. J Forensic Sci 2000; 45: 649-654.
  • 13. Bird SM, Hutchinson SJ. Male drugs-related deaths in the fortnight after release from prison: Scotland, 1996-99. Addiction 2003; 98: 185-190.
  • 14. Farrell M, Marsden J. Drug-related mortality among newly-released offenders 1998 to 2000. Home Office Online Report 40/05. (accessed Apr 2005).
  • 15. Christensen PB, Hammerby E, Smith E, Bird SM. Mortality among Danish drug users released from prison. Int J Prisoner Health 2006; 2: 13-19.
  • 16. Bonner RL. Correctional suicide prevention in the year 2000 and beyond. Suicide Life Threat Behav 2000; 30: 370-376.
  • 17. Daniel AE. Preventing suicide in prison: a collaborative responsibility of administrative, custodial, and clinical staff. J Am Acad Psychiatry Law 2006; 34: 165-175.
  • 18. Maris RW, Berman A, Maltsberger J, Yufit RI, editors. Assessment and prediction of suicide. New York: The Guilford Press, 1992.
  • 19. Maris RW. Suicide. Lancet 2002; 360: 319-326.
  • 20. Fazel S, Bains P, Doll H. Substance abuse and dependence in prisoners: a systematic review. Addiction 2006; 101: 181-191.
  • 21. Hayes LM. Suicide prevention in correctional facilities: an overview. In: Puisis M, editor. Clinical practice in correctional medicine. St Louis: Mosby Publishing Company, 2006: 317-328.
  • 22. Kinner SA. The post-release experience of prisoners in Queensland. Trends and Issues in Crime and Criminal Justice No. 325. Canberra: Australian Institute of Criminology, 2006.
  • 23. Farr KA. Classification for female inmates: moving forward. Crime & Delinquency 2000; 46: 3-17.
  • 24. Klein SR, Bartholomew GS, Bahr SJ. Family education for adults in correctional settings: a conceptual framework. Int J Offender Therapy Comparative Criminology 1999; 43: 291-307.
  • 25. Thomson NJ, McDonald D. Australian deaths in custody, 1980-1989. 1. Relative risks of aborigines and non-aborigines. Med J Aust 1993; 159: 577-581.
  • 26. Henderson S. Mental illness and the criminal justice system. Sydney: Mental Health Co-ordinating Council, 2003. (accessed Mar 2007).
  • 27. White P, Whiteford H. Prisons: mental health institutions of the 21st century [editorial]? Med J Aust 2006; 185: 302-303. <MJA full text>
  • 28. Council of Australian Governments. Communique. Council of Australian Governments’ meeting, 14 July 2006. (accessed Aug 2007).
  • 29. Caplehorn JR, Dalton MS, Cluff MC, Petrenas AM. Retention in methadone maintenance and heroin addicts’ risk of death. Addiction 1994; 89: 203-209.
  • 30. Dolan KA, Shearer J, White B, et al. Four-year follow-up of imprisoned male heroin users and methadone treatment: mortality, re-incarceration and hepatitis C infection. Addiction 2005; 100: 820-828.
  • 31. Kariminia A, Butler T, Corben S, et al. Mortality among prisoners: how accurate is the Australian National Death Index? Aust N Z J Public Health 2005; 29: 572-575.
  • 32. O’Donnell I, Farmer R. The limitations of official suicide statistics. Br J Psychiatry 1995; 166: 458-461.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.