The Role of Relationships and the Search for Meaning in Suicide Ideation: An Exploratory Study of Incarcerated Women With Life Sentences

Background: Preventing suicide by incarcerated individuals is a concern for the fields of public health, social work, and criminal justice. A particular population in need of suicide prevention is women serving life sentences as they have significantly more suicide attempts in their lifetimes than men with life sentences and women with shorter sentences. Current theoretical models of suicide risk focus on the person in environment and assessing risk based vulnerability when responding to the dynamic interactions of biological, psychological, and situational factors. Incarcerated women with life sentences is a population that has been neglected in the suicide prevention research, and thus the research question underlying this exploratory work is: What factors related to place (i.e. prison), situations and events, individual characteristics and the perception of time (i.e. life in prison) are connected to suicide ideation for women with life sentences?

Methods: Semi-structured interviews were conducted with a sample of 33 women with life sentences in a state prison after their involvement in a pilot intervention for women with violent offenses. The mean age of the women was 42, and the average length of incarceration was 16 years with a range from 2 to 38 years. A majority of women (75%) had children, with approximately half as mothers to minor-age children. Unsolicited information about hopelessness/suicide was offered by several women.  Using principles of grounded theory, a thematic analysis was performed to identify themes related to suicide risk with an iterative process to develop codes for data interpretation. Within-case and cross-case analyses were conducted to identify and verify emerging themes. Coding was completed until inter-rater reliability was reached within the research team.

Results: Dominant themes emerged around the pivotal role of relationships in women’s lives. These relationships were described as based on loss (e.g. separation from children and family on the outside; grieving the inability to even have children), transition (e.g. other inmates entering and leaving the prison), and strain (e.g. struggling to sustain relationships under strict institutional policies). A meta-theme was the search for meaning and purpose while incarcerated for life. The need for supports to cope with these relationship factors and a lack of purpose were explained as driving feelings of hopelessness and the consideration of suicide as an option. Women reported seeking groups to address these needs as the current model of service provision within the prison prioritizes women facing re-entry into the community.

Conclusion/Implications: This study displays how incarcerated women with life sentences are a high risk and underserved population, as well as factors that are connected to feelings of hopelessness and suicide ideation. Given recent efforts led by SAMSHA, the World Health Organization, and other organizations to prevent suicide in prisons, social workers can gain insight about the possible needs and experiences of incarcerated women, especially those with long-term sentences, from this study. In consideration of the overwhelming spontaneous sharing of suicide ideation and feelings of hopelessness by the women, these results are a call to action for intervention development and testing with this population.