‘I don’t want to be alive’: Suicidal ideation and attempted suicide among prison inmates

Suicide is a serious public health concern and prisoners represent a particularly high-risk group. Though research on the suicidality of prison inmates has gained considerable momentum in recent decades, there are several underexplored areas of inquiry. The purpose of this dissertation was to add knowledge to three underexplored avenues of research. First, very limited research has used a multi-level methodological approach to investigate how both micro-level prisoner and macro-level prison characteristics contribute to suicidal thoughts and behaviour among prison inmates. Second, rates of suicide are highest among middle-aged and older adults; yet, little is known about the nature of suicidal thoughts and attempted suicide among older prison inmates, especially with respect to how they compare to younger counterparts. Third, suicide attempters represent a heterogenous group, whereby repeat-suicide attempters are clinically distinct from single-suicide attempters; however, most prison-based research has examined suicide attempters as a homogenous group, with a paucity of research which has aimed to identify factors that distinguish repeat-suicide attempters from single-suicide attempters. This dissertation used the 2004 Survey of Inmates in State and Federal Correctional Facilities, a cross-sectional survey which collected data on a nationally representative sample of 18,185 prison inmates in the U.S. Results from the first study (Chapter 2) highlight that both micro-level prisoner and macro-level prison characteristics are important to consider as correlates of suicidal thoughts and attempted suicide. This study also highlights variations in predictive patterns for suicidal thoughts versus attempted suicide, as well as gendered patterns with respect to predicting suicidal thoughts/attempts. Results from the second study (Chapter 3) suggest that suicidal thoughts/attempts may manifest differently for younger and older prisoners, with differing patterns of risk. Results from the third study (Chapter 4) emphasize the importance of acknowledging the heterogeneity of suicide attempters, as repeat-suicide attempters potentially possess a differing risk profile as compared to single-suicide attempters. The collective results from this work may be of great use for prison administrators and mental health professionals working in prison settings who want to reduce suicide-related issues or otherwise improve the well-being of at-risk prisoners.