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Psychosocial influences on prisoner suicide: A case-control study of near-lethal self-harm in women prisoners
Abstract
We examined the psychosocial influences on female prisoner suicide by carrying out a study of near-lethal self-harm. We interviewed 60 women prisoners who had recently engaged in near-lethal self-harm (cases) and 60 others who had never carried out near-lethal acts in prison (controls) from all closed female prison establishments in England and Wales, using mixed quantitative and qualitative methods. We gathered information on socio-demographic and criminological variables, life events and childhood trauma, exposure to suicidal behaviour, contributory and precipitating factors for near-lethal self-harm, social support and psychological characteristics. While socio-demographic factors were only modestly associated with near-lethal self-harm, being on remand, in single cell accommodation, and reporting negative experiences of imprisonment were strong correlates. Recent life events and past trauma, including different forms of childhood abuse, were also significantly associated with near-lethal self-harm, as were a family history of suicide and high scores on measures of depression, aggression, impulsivity and hostility, and low levels of self-esteem and social support. Our findings underline the importance of both individual and prison-related factors for suicide in custody, and hence the need for a comprehensive approach to suicide prevention in women's prisons. Given the multiple needs of female prisoners at-risk of self-harm and suicide, complex psychosocial interventions are likely to be required, including interventions for abused and bereaved women, and initiatives to improve staff-prisoner relationships and reduce bullying. The findings of this research may provide insights into factors leading to suicidal behaviour in other forensic and institutional settings, such as detention centres and psychiatric hospitals, and may assist in developing suicide prevention policies for prisoners and other at-risk populations.
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“Female prisoners are more likely to experience additional stressors around separation from family and children, higher rates of background abusive histories, and bereavement43 that might require interventions to be further tailored.”
From Risk factors for self-harm in prison: a systematic review and meta-analysis (2020) · cites this paper as [43]
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“However, in this report, the difference between cases and controls in self-reported rates of child sexual abuse did not reach statistical significance, in contrast to our parallel study of female prisoners [47] and other previous research [57].”
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“Prisoners' self-perceived social support was measured using the Social Support Scale (SSS); a 7-item instrument used in previous prison research (Jenkins et al., 2005;Marzano et al., 2011; Rivlin et al., 2013).”
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“Beyond a diagnosis of severe mental illness, the presence of comorbidity (19, 20), being placed in a single cell (33), the occurrence of life events (34) and previous suicide attempts (7), all risk factors for prison suicide, need to be considered.”
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“Disruption in interpersonal relationships and support systems often preceded suicide attempts in studies of inmates who attempted or died by suicide (Daniel, 2007; He et al., 2001; Marzano et al., 2011; Morgan & Hawton, 2004; Rivlin et al., 2013; Way, Miraglia, Sawyer, Beer, & Eddy, 2005).”
BackgroundNear-lethal self-harm in women prisoners: contributing factors and psychological processes
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“The results of this study underscore the considerable therapeutic needs many of these women have in terms of addressing their early experiences of abuse and violence (Marzano et al., 2011).”
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Self-citationFeeling hopeful: can hope and social support protect prisoners from suicide ideation?
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“Marzano et al. (2011) studied imprisoned male SSAs, comparing them with inmates who had not attempted suicide.”
ResultWittenborn, A. K., Natamba, B., Rainey, M., Zlotnick, C., & Johnson, J. E. (2020) · Journal of Community Psychology · doi:10.1002/jcop.22315 · Cited by 30
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Sánchez, F. C., Aizpurúa, E., Ricarte, J. J., & Barry, T. J. (2020) · Archives of Suicide Research · doi:10.1080/13811118.2020.1738293 · Cited by 28
“…social support and suicidal behavior have found that inmates who report near-lethal self-harm and suicide attempts also report significantly lower social support (using the Social Support Scale—7 items) than inmates who do not report such behavior (Marzano et al., 2011; Rivlin et al., 2013).”
BackgroundStoliker, B. E., Verdun‐Jones, S. N., & Vaughan, A. D. (2020) · Archives of Suicide Research · doi:10.1080/13811118.2020.1738294 · Cited by 23
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“Some authors report associations of suicide risk with aggression, impulsivity, hostility, childhood trauma, and hopelessness [18,19] or with low levels of social support and self-esteem [20,21].”
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“Literature highlights the important role that social support plays in supporting the health and wellbeing of prison populations (Biggam and Power, 1997; Cooper and Livingston, 1991; Marzano et al., 2011).”
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“demonstrated that female inmates on remand were more vulnerable to suicide when they had been isolated to a single cell [26].”
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Prison prescribing practice: practitioners’ perspectives on why prison is different
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“…whereas other research has clearly emphasized the importance of both individual and prison-related factors in female inmates’ suicidal behavior (Marzano et al., 2011), we focused exclusively on prisoners’ demographics, criminological characteristics, and clinical vulnerabilities as…”
BackgroundInfluentialUsing the CES-D-7 as a Screening Instrument to Detect Major Depression among the Inmate Population
Juarros‐Basterretxea, J., Escoda-Menéndez, P., Vázquez, M. V., Rodríguez‐Díaz, F. J., & Herrero, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18031361 · Cited by 14
“This is particularly important because of the comorbidity of depression with loss of psychological well-being and suicide rates [21,22], especially among prison inmates.”
BackgroundPainful lives: Understanding self-harm amongst care-experienced women in prison
Fitzpatrick, C., Hunter, K., Shaw, J., & Staines, J. (2022) · Criminology & Criminal Justice · doi:10.1177/17488958211067914 · Cited by 11
“Walker et al. (2020) found that 57% of those involved in their study of self-harm were care-experienced, although the latter issue was not specifically explored (see also Marzano et al., 2011).”
BackgroundInfluentialThe Link Between Adverse Childhood Experiences and Mental Health in Offenders: A Systematic Review
Pessoa, T. M. G., & Almeida, T. C. (2024) · Crime & Delinquency · doi:10.1177/00111287241242478 · Cited by 10
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Self-Esteem and Suicidal Thoughts and Behaviors: A Meta-Analytic Review
Buecker, S., Doll, J., Diaz, S. A., Haehner, P., Berg, F., Kaurin, A., & Teismann, T. (2025) · Clinical Psychological Science · doi:10.1177/21677026241308163 · Cited by 20
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A thematic analysis of how prisoners overcome suicidality
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“[22] reported a significant difference between female prisoners in terms of self-esteem and personal development.”
BackgroundPrisoner suicide: a multilevel problem
Larney, S., & Farrell, M. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30435-2 · Cited by 9
Abderhalden, F. P. (2022) · Corrections · doi:10.1080/23774657.2021.2023339 · Cited by 9
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Bailo, P., Gibelli, F., Celletti, A., Caraffa, A. M., Sirignano, A., & Ricci, G. (2023) · Criminal Behaviour and Mental Health · doi:10.1002/cbm.2319 · Cited by 10
Suicide Completion Among Incarcerated Women
Mennicke, A. M., Daniels, K., & Rizo, C. F. (2021) · Journal of Correctional Health Care · doi:10.1089/jchc.18.12.0070 · Cited by 8
“A study of women who were in-carcerated in England and Wales found key sociodemo-graphic factors of women who engaged in near-lethal self-harm to be White, single, and under the age of 30 (Marzano et al. , 2011).”
van Ginneken, E. F. J. C. (2022) · European Journal of Crime Criminal Law and Criminal Justice · doi:10.1163/15718174-bja10029 · Cited by 8
Personality and psychotic symptoms as predictors of self-harm and attempted suicide.
Bello, V. D., Verdolini, N., Pauselli, L., Attademo, L., Bernardini, F., Quartesan, R., & Moretti, P. (2015) · PubMed · Cited by 7
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“Deprivations related to security level, social isolation, and threats of violence/victimization from other inmates are related to increased feelings of suicide ideation and attempts (Bonner, 2006; Dye, 2010, 2011; Huey & McNulty, 2005; Kovasznay et al., 2004; Marzano et al., 2011).”
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“(2016) explican que los delitos violentos acrecientan la incidencia de la conducta suicida, siendo especialmente relevante entre la población reclusa femenina (Marzano et al., 2011; Opitz-Welke et al., 2019).”
BackgroundKurniati, D., Trapsilasiwi, D., As’ari, A. R., Basri, H., & Osman, S. B. (2022) · Tadris Jurnal Keguruan dan Ilmu Tarbiyah · doi:10.24042/tadris.v7i1.11263 · Cited by 6
“This statement follows the results of previous studies, which stated that controlling impulsivity in making decisions is the main characteristic of people with a critical thinking disposition (Marzano et al., 2011).”
ResultComparison of Mindfulness With and Without Practice Among Women in Custody
Song, X., Zhao, H., Lou, T., Wang, Y., & Zheng, M. (2020) · Criminal Justice and Behavior · doi:10.1177/0093854820974409 · Cited by 6
“In addition, the relatively small number and limited distribution of women’s prisons reduces the possibility of visits, making it more difficult for women to obtain family support while in custody (Marzano et al., 2011b).”
BackgroundKhatri, M. A., Al‐Huseini, S., Al-Maqbali, M., Cucchi, A., Saadi, A. A., Farsi, A. A., Jose, S., Al‐Sibani, N., & Al‐Adawi, S. (2023) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000726 · Cited by 5
Non-suicidal self-harm amongst incarcerated men: a qualitative study
Marzano, L., Ciclitira, K., & Adler, J. R. (2016) · Journal of Criminal Psychology · doi:10.1108/jcp-04-2016-0017 · Cited by 7
Vaisman, D. C., & Einat, T. (2021) · The Prison Journal · doi:10.1177/00328855211010412 · Cited by 7
“Marzano et al. (2011) conducted a quantitative and qualitative study of 120 women inmates in an English Prison to identify socio-demographic, psychological, societal, and criminological variables associated with the nearlethal self-harm incidents among women prisoners (i.e., life events, childhood…”
Comprehensive Histological and Immunochemical Forensic Studies in Deaths Occurring in Custody
NUGENT, K. M., Orellana-Barrios, M. A., & Buscemi, D. (2017) · International Scholarly Research Notices · doi:10.1155/2017/9793528 · Cited by 5
“This information was summarized into a narrative review.”
BackgroundCoping With Incarceration: How Women Adjust to Being Separated From Their Children
Koons‐Witt, B. A., Crittenden, C. A., & Crick, S. (2024) · Criminal Justice and Behavior · doi:10.1177/00938548231223172 · Cited by 4
“…reasons noted for women’s suicide attempts are mental health and substance abuse issues, traumatic histories, loss and/or separation from family, negative relationships within the prison, and a history of prior suicide attempts (Friestad et al., 2014; Marzano et al., 2010; Marzano et al., 2011).”
BackgroundSelf-Reports of Health before and during Imprisonment in Female Inmates
Alves, J., & Maia, Â. (2017) · Portuguese Journal of Public Health · doi:10.1159/000481967 · Cited by 4
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McDermott, D. (2017) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York) · Cited by 4
Rethinking pathways to completed suicide by female prisoners
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Iturri, F., Gale-Bentz, E., Reinhard, E. E., Hunter, T. B., McCann, C. N., Zaman, A., Chibueze, U., & Tellez, A. (2020) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000842 · Cited by 3
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“This framework opens possibilities for rethinking current, often ineffective, approaches to self-harm and suicide prevention in prisons (Marzano et al., 2011; Rivlin et al., 2013).”
Psychiatric Problems in Prisoners: Screening, Diagnosis, Treatment, and Prevention
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Penitentiary risk factors for suicide by inmates
Muskała, M. (2024) · Probacja · doi:10.5604/01.3001.0054.4144 · Cited by 2
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Psychiatrische Probleme im Justizvollzug
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Cezaevlerindeki İntihar Davranışlarında Bir Risk Faktörü Olarak Madde ve Alkol Bağımlılığı
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Metadata
- Authors
- Marzano, L., Hawton, K., Rivlin, A., & Fazel, S.
- Affiliations
- Warneford Hospital (GB)
- Corresponding author
- Hawton, Keith
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 72
- Issue
- 6
- Pages
- 874-883
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2102952146
- Cited by
- 139
- References
- 57
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 8 · 2023: 8 · 2022: 14 · 2021: 12 · 2020: 19 · 2019: 6 · 2018: 6 · 2017: 12 · 2016: 10 · 2015: 7 · 2014: 6 · 2013: 14 · 2012: 6
- FWCI
- 9.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Criminal Justice and Corrections Analysis
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- prison suicide, women prisoners, psychosocial risk factors, childhood trauma, childhood abuse, family history of suicide, depression, social support, pretrial detention, suicide prevention
- MeSH terms
- Adult, England, Female, Humans, Interviews as Topic, Prisoners, Social Environment, Social Support, Suicide, Wales, Case-Control Studies, Self-Injurious Behavior, Young Adult
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