Racial Differences in Suicide Risk among Adults in Criminal-Legal Systems

Research shows that adults in the criminal-legal system have higher rates of suicide and behavioral health disorders than the general population. There are also documented racial differences in experiences of criminal processing and access to behavioral health care. However, few studies have looked at whether this population’s suicide risk varies by race. To fill that gap, researchers conducted a study to identify risk factors for suicide among adults involved in the criminal-legal system and to find out if there were differences in suicide risk based on race.

The sample for this study was 16,849 adults with recent criminal-legal involvement who were enrolled in a statewide behavioral health treatment program, Indiana Recovery Works, between October 2015 and March 2018. Participants only included those who identified as either White or Black. The group was predominantly White and male with an average age of 35. Suicide risk was determined by clinicians using the Adult Needs and Strengths Assessment (ANSA) tool. Researchers carried out analyses to model suicide risk overall and within each of the racial groups and to identify differences between them. 

The initial analyses revealed that one in five individuals had suicide risk, a majority had a primary diagnosis of substance use disorder and a primary mental health diagnosis, and a small percentage had a history of self-harm. Black participants were significantly older, had lower suicide risk and higher criminal behavior risk, and were more likely to have mental health or substance use diagnoses. White participants were more likely to have a co-occurring diagnosis, evidence of self-harm, and prior substance use episodes, and were more likely to be female and have worse scores on the domains of life functioning, strengths, and behavioral health needs. The secondary analyses found no evidence of differences in suicide risk between the groups based on race alone.

It is important to note that the study participants had already been identified as needing behavioral health treatment and therefore may have had higher suicide risk than the general population and others in the criminal-legal system. Without a behavioral health diagnosis or participation in treatment, additional or different risk factors may have been found, particularly since Black and White disparities have been found in both access to treatment and the likelihood of incarceration. All study participants were referred to treatment based on clinical diagnosis, which may have been influenced by implicit clinician bias (i.e., an association outside conscious awareness that lead to a negative evaluation of a person or group on the bias of irrelevant characteristics such as race or gender¹).

Nonetheless, these findings suggest that adults with behavioral health disorders and recent experience in the criminal-legal system experience risk factors for suicide similar to those in the general population. The association of substance use and co-occurring behavioral health disorders with suicide risk is particularly important given the current opioid epidemic. As the authors note, these findings highlight the need for more investigation on how criminal-legal involvement may worsen suicide risk.

Lawson, S. G., Lowder, E. M., & Ray, B. (2022). Correlates of suicide risk among Black and White adults with behavioral health disorders in criminal-legal systems. BMC Psychiatry, 22(163). doi: 10.1186/s12888-022-03803-8

1. Fitzgerald, C., & Hurst, S. (2017.) Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18(1). doi: 10.1186/s12910-017-0179-8