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Marcel E. Salive, MD, MPH; Gordon S. Smith, MB, ChB, MPH; T. Fordham Brewer, MD, MPH

JAMA. 1989;262(3):365-369.

Abstract
Prisoners are reported to have a higher suicide rate than the community. We studied suicides in the Maryland prison system to determine the level of risk and risk factors for inmate suicide. There were 37 male inmate suicide deaths between 1979 and 1987 (39.6 suicides per 100 000 male inmates), which is significantly higher than the age- and race-adjusted male suicide rate in the general population of Maryland (22.0 per 100 000). Risk of male inmate suicide was increased for the following characteristics: white race (relative risk [RR], 2.0; 95% confidence interval [CI], 1.1 to 3.9), age 25 to 34 years (RR, 1.8%; 95% CI, 1.0 to 3.4), major crime committed against person (RR, 3.4; 95% CI, 1.7 to 6.7), life sentence (RR, 4.7; 95% CI, 2.2 to 10.0), and classification to the major maximum security institution in the prison system (RR, 5.1; 95% CI, 2.7 to 9.8). The methods of suicide chosen by inmates were hanging (86%), cutting wound (5%), antidepressant overdose (5%), and fall from height (3%), We conclude that inmate suicide represents a significant correctional health and public health problem. Specific implications for prevention of inmate suicide are examined.

(JAMA. 1989;262:365-369)

Author Affiliations
From the General Preventive Medicine Residency Program, Department of Health Policy and Management (Drs Salive and Brewer), and the Injury Prevention Center (Dr Smith), The Johns Hopkins University School of Hygiene and Public Health; and Maryland Division of Correction, Maryland Department of Public Safety and Correctional Services (Drs Salive and Brewer), Baltimore, Md. Dr Salive is now with the National Center for Health Services Research and Health Care Technology Assessment, Rockville, Md.

Footnotes
Reprint requests to National Center for Health Services Research, 5600 Fishers Ln, Room 18A19, Rockville, MD 20857 (Dr Salive).

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