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Identifying inmates that will actually die by suicide
  1. Vladimir Carli
  1. Correspondence to Dr Vladimir Carli, Karolinska Instituet, National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Granits Vag 4 Stockholm 17177, Sweden; vladimir.carli{at}

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What is already known on this topic?

Suicide rates among prisoners are higher than in the general population.1 It has also been shown that specific risk factors, such as violent behaviour in prison, psychiatric diagnosis, substance abuse and previous suicide attempts are associated with self-harm in prison.2 Fifty per cent of prisoners who die by suicide have a history of self-harm3 and longitudinal studies are needed to understand which prisoners with self-harm are more likely to complete suicide.

What this paper adds

  • For the first time, a study reports a very large clustering effect of self-harm in prisoners (ICC=0.15).

  • The longitudinal observation provides an opportunity to identify risk factors associated with prisoners to be targeted by more intensive preventive programmes. Older age, a previous self-harm incident of moderate or high lethality for males, and a life sentence or more than five self-harm incidents in the previous year for females, are significantly associated with completed suicide among prisoners who self-harmed.

  • Self-harm repetition rates, stratified by gender, offer valuable information for health professionals who work in prison. Female prisoners who self-harm will have an …

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  • Competing interests None.

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