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

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.