Elevated Risk of Suicidal Behavior Among Incarcerated Adults While in Solitary Confinement

BACKGROUND AND PURPOSE: People who are incarcerated in the United States frequently describe solitary confinement as being highly psychologically distressing. However, empirical data on the mental health correlates of solitary confinement has been severely lacking. One longitudinal study found an elevated incidence of adjustment and depressive disorders corresponding to the period of solitary confinement. More recently, two studies have shown an elevated risk of suicide and self-harm among inmates placed special housing units in New York facilities. However, both of these studies used official health records rather than self-report, and therefore could not assess suicidal ideation, plans, or self-identified attempts that may not have triggered documentation as self-harm in the medical records (i.e., of insufficient severity to warrant medical attention, or self-harm not recorded as the cause of the injury). The aims of this study were to assess the association between placement in solitary confinement and suicidal ideation, plans, and attempts, among a sample of previously incarcerated adults.

METHODS: Formerly-incarcerated adults residing in the United States (N=201) were sampled using Qualtrics Panels, an internet-based survey administration service. Respondents were included if they self-reported a past history of incarceration greater than two weeks in duration. Participants self-reported sociodemographic factors, solitary confinement history, and suicidal thoughts, plans, and attempts. Respondents with a history of solitary confinement were asked to recall a two-week period during their solitary sentence and report whether they had experienced any of the suicide-related thoughts or behaviors during that time. Those without a history of solitary confinement were asked to consider a typical two-week period while incarcerated, and to report suicidal behaviors during that period. Separate logistic regression analyses were used to test for the association between solitary confinement history and each suicide-related outcome, with adjustment for potential demographic confounder variables.

RESULTS: Respondents with a history of incarceration in solitary confinement were significantly more likely to report suicidal ideation (49.4% vs. 19.3%), suicide plans (32.2% vs. 10.5%), and suicide attempts (26.4% vs. 4.4%), compared to those without a history of solitary confinement. All associations were significant in adjusted analyses. Specifically, solitary confinement was associated with increased odds of suicidal ideation, adjusted odds ratio=5.0 (95% CI=2.4-10.7), plans, adjusted odds ratio=5.0 (95% CI=2.2-11.0), and attempts, adjusted odds ratio= 9.7 (95% CI=3.3-28.8).

CONCLUSIONS AND IMPLICATIONS: Incarcerated adults in the U.S. are at drastically elevated risk for suicidal thoughts and behavior. The significant associations with attempts are particularly concerning, as this indicates that individuals are able to act on these thoughts and attempt suicide while in solitary units. It is unclear based on these cross-sectional data whether this is a causal relationship, particularly given that people may be placed in solitary confinement due to mental health reasons, including suicidal thoughts or behaviors. However, questions of causality do not detract from the clinical implications of this substantially increased risk for suicidal behavior, which suggest the need for greater suicide prevention efforts within this setting or, ideally, a reduction in the use solitary confinement or other punitive approaches that may contribute to suicidal thoughts.