Suicidal Behaviors in Prisons: Exploring Racial and Gender Differences in Behaviors and Health Care Disparities in Prison Responses

Background/Purpose: The suicide rate for incarcerated adults is three times the suicide rate for adults in the community. Major limitations exist in research on prison-based suicidal behaviors, including most studies are conducted outside of the U.S. (thus, losing the context of over-representation of racial minorities), focus almost exclusively on men, look only at fatal suicide attempts, do not examine racial and gender differences in suicide-related behaviors, or center the experiences of racial minority prisoners. Thus, Black women’s suicidal behaviors in prison, for example, are highly understudied. In addition, there is a lack of research investigating health care disparities in the treatment prisoners receive post-suicide attempts. This study investigated racial differences in prisoners’ incidents of suicidal behaviors and health care disparities in treatment after suicide attempts.

Methods: This study used administrative data from five state prisons over a five year period. A total of 495 incidents occurred during this timeframe by 118 incarcerated men and 91 incarcerated women. With variables related to demographics, method, and context (e.g. placement in segregation), latent class analysis was conducted in order to understand race and gender differences in suicidal behaviors and treatment post-attempt.

Results: A latent class analysis revealed four classes for men and women. Among women, 25% were in a high-risk group (multiple attempts with multiple methods), and the remaining women were in groups categorized by method (30% cutting, 29% hanging/suffocation, and 16% drug overdose). Men showed the same four classes: 18% were in a high-risk group and groups categorized by method (29% cutting, 23% hanging/suffocation, and 30% drug overdose). Additionally, the high-risk and hanging/suffocation classes were more likely to attempt suicide while in segregation than the other two classes.

Next, race was examined as a predictor of class membership. Black men and women were at higher risk for the groups involving suicide attempt by hanging/suffocation (b = 1.43, b = 2.68, respectively) and the high-risk group (b = .91, b = 1.73, respectively) than the group involving suicide attempt by cutting.

Finally, class memberships were differentially associated with treatment outcomes following an attempted suicide. For women, the groups involving cutting (M = .40) and hanging/suffocation (M = .28) were less likely to have medical assistance requested by staff, in comparison to the high-risk group (M = .80) and the group involving drug overdose (M = .85). For men, the group involving hanging/suffocation (M = .43) had the lowest levels of treatment in comparison to the other classes (M = .68-.86).

Implications: Incarcerated Black men and women are rarely centered or highlighted within research on suicidal behaviors in prison. However, they are likely to be in a high-risk group or use hanging/suffocation for attempting suicide, are commonly in segregation when they attempt suicide, and are the least likely to receive health care post-attempt. Social work and public health efforts are needed to not only address health care disparities for Black incarcerated adults, but also to transform prison conditions and culture that promote, facilitate, and allow fatal and nonfatal suicidal behaviors.