Sex differences in suicide, suicidal ideation, and self-harm after release from incarceration: a systematic review and meta-analysis

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Abstract

Purpose

People released from incarceration are at increased risk of suicide compared to the general population. We aimed to synthesise evidence on the incidence of and sex differences in suicide, suicidal ideation, and self-harm after release from incarceration.

Methods

We searched MEDLINE, EMBASE, PsycINFO, Web of Science and PubMed between 1 January 1970 and 14 October 2021 for suicide, suicidal ideation, and self-harm after release from incarceration (PROSPERO registration: CRD42020208885). We calculated pooled crude mortality rates (CMRs) and standardised mortality ratios (SMRs) for suicide, overall and by sex, using random-effects models. We calculated a pooled incidence rate ratio (IRR) comparing rates of suicide by sex.

Results

Twenty-nine studies were included. The pooled suicide CMR per 100,000 person years was 114.5 (95%CI 97.0, 132.0, I ² = 99.2%) for non-sex stratified samples, 139.5 (95% CI 91.3, 187.8, I ² = 88.6%) for women, and 121.8 (95% CI 82.4, 161.2, I ² = 99.1%) for men. The suicide SMR was 7.4 (95% CI 5.4, 9.4, I ² = 98.3%) for non-sex stratified samples, 14.9 for women (95% CI 6.7, 23.1, I ² = 88.3%), and 4.6 for men (95% CI 1.3, 7.8, I ² = 98.8%). The pooled suicide IRR comparing women to men was 1.1 (95% CI 0.9, 1.4, I ² = 82.2%). No studies reporting self-harm or suicidal ideation after incarceration reported sex differences.

Conclusion

People released from incarceration are greater than seven times more likely to die by suicide than the general population. The rate of suicide is higher after release than during incarceration, with the elevation in suicide risk (compared with the general population) three times higher for women than for men. Greater effort to prevent suicide after incarceration, particularly among women, is urgently needed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00127-022-02390-z.

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Interrater reliability: the kappa statistic

Mary L McHugh (2012)

The kappa statistic is frequently used to test interrater reliability. The importance of rater reliability lies in the fact that it represents the extent to which the data collected in the study are correct representations of the variables measured. Measurement of the extent to which data collectors (raters) assign the same score to the same variable is called interrater reliability. While there have been a variety of methods to measure interrater reliability, traditionally it was measured as percent agreement, calculated as the number of agreement scores divided by the total number of scores. In 1960, Jacob Cohen critiqued use of percent agreement due to its inability to account for chance agreement. He introduced the Cohen’s kappa, developed to account for the possibility that raters actually guess on at least some variables due to uncertainty. Like most correlation statistics, the kappa can range from −1 to +1. While the kappa is one of the most commonly used statistics to test interrater reliability, it has limitations. Judgments about what level of kappa should be acceptable for health research are questioned. Cohen’s suggested interpretation may be too lenient for health related studies because it implies that a score as low as 0.41 might be acceptable. Kappa and percent agreement are compared, and levels for both kappa and percent agreement that should be demanded in healthcare studies are suggested.

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Improved tests for a random effects meta-regression with a single covariate.

Guido Knapp, Joachim Hartung (2003)

The explanation of heterogeneity plays an important role in meta-analysis. The random effects meta-regression model allows the inclusion of trial-specific covariates which may explain a part of the heterogeneity. We examine the commonly used tests on the parameters in the random effects meta-regression with one covariate and propose some new test statistics based on an improved estimator of the variance of the parameter estimates. The approximation of the distribution of the newly proposed tests is based on some theoretical considerations. Moreover, the newly proposed tests can easily be extended to the case of more than one covariate. In a simulation study, we compare the tests with regard to their actual significance level and we consider the log relative risk as the parameter of interest. Our simulation study reflects the meta-analysis of the efficacy of a vaccine for the prevention of tuberculosis originally discussed in Berkey et al. The simulation study shows that the newly proposed tests are superior to the commonly used test in holding the nominal significance level. Copyright 2003 John Wiley & Sons, Ltd.

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Author and article information

Contributors

Emilia Janca:

ORCID: http://orcid.org/0000-0001-9679-4893

emilia.janca@curtin.edu.au

Journal

Journal ID (nlm-ta): Soc Psychiatry Psychiatr Epidemiol

Journal ID (iso-abbrev): Soc Psychiatry Psychiatr Epidemiol

Title: Social Psychiatry and Psychiatric Epidemiology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0933-7954

ISSN (Electronic): 1433-9285

Publication date (Electronic): 3 December 2022

Publication date PMC-release: 3 December 2022

Publication date (Print): 2023

Volume: 58

Issue: 3

Pages: 355-371

Affiliations

[1 ]GRID grid.1032.0, ISNI 0000 0004 0375 4078, Curtin School of Population Health, Curtin University, ; 410 Koorliny Way, Bentley, WA 6102 Australia

[2 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Justice Health Unit, Melbourne School of Population and Global Health, , The University of Melbourne, ; 207 Bouverie Street, Carlton, VIC 3053 Australia

[3 ]GRID grid.1058.c, ISNI 0000 0000 9442 535X, Centre for Adolescent Health, , Murdoch Children’s Research Institute, ; 50 Flemington Road, Parkville, VIC 3052 Australia

[4 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, Department of Psychiatry, , University of Oxford, Warneford Hospital, ; Oxford, OX3 7JX UK

[5 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Melbourne School of Psychological Sciences, , The University of Melbourne, ; Grattan Street, Parkville, VIC Australia

[6 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Disability and Health Unit, Melbourne School of Population and Global Health, , The University of Melbourne, ; 207 Bouverie Street, Carlton, VIC 3053 Australia

[7 ]Mater Research Institute-UQ, University of Queensland, Mater Hospital, Raymond Terrace, South Brisbane, QLD 4101 Australia

[8 ]GRID grid.1022.1, ISNI 0000 0004 0437 5432, Griffith Criminology Institute, , Griffith University, ; 176 Messines Ridge Road, Mount Gravatt, QLD 4122 Australia

[9 ]GRID grid.1002.3, ISNI 0000 0004 1936 7857, School of Public Health and Preventive Medicine, , Monash University, ; 553 St Kilda Road, Melbourne, VIC 3004 Australia

Author information

Emilia Janca http://orcid.org/0000-0001-9679-4893

Article

Publisher ID: 2390

DOI: 10.1007/s00127-022-02390-z

PMC ID: 9971066

PubMed ID: 36462041

SO-VID: 6c35159f-34a3-47f1-964a-0583b3a0edf3

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 17 March 2022

Date accepted : 14 November 2022

Custom metadata

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: self-harm,suicide,suicidal ideation,sex differences,incarceration,systematic review

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ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: self-harm, suicide, suicidal ideation, sex differences, incarceration, systematic review

Sex differences in suicide, suicidal ideation, and self-harm after release from incarceration: a systematic review and meta-analysis

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Supplementary Information

Related collections

Hogrefe Medicine

Most cited references 94

Meta-analysis in clinical trials

Interrater reliability: the kappa statistic

Improved tests for a random effects meta-regression with a single covariate.

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