Statement of Purpose Suicide mortality has been increasing across the United States over the last several years. Formerly incarcerated persons (FIPs) often have high prevalence of mental health disorders and are especially vulnerable to self-harm. We estimated the burden of suicide mortality among persons released from North Carolina (NC) state prisons, as compared to the NC general population, and examined key characteristics of these fatal injuries.

Methods/Approach We conducted a retrospective cohort study of persons released from NC prisons during 2000–2015. Incarceration records were matched to death records from 2000–2016. Suicide deaths were categorized as firearm-involved or non-firearm-involved. We used indirect standardized mortality ratios (SMR) adjusted for year, gender, race, and age to compare suicide mortality among FIPs with the general NC population.

Results There were 228,556 individuals in NC who were released from incarceration 386,895 times during 2000–2015 and contributed 2,050,745 years of post-release person-time and 636 post-release suicide deaths (387 non-firearm-involved, 249 firearm-involved). Over the complete follow-up period, the suicide mortality rate among FIPs was 2.0 (95% CI=1.8, 2.1) times as high as the general NC population. When compared to the general population, the SMRs for non-firearm-involved and firearm-involved suicides among FIPs were 2.9 (95% CI=2.6, 3.0) and 1.3 (95% CI=1.1, 1.5), respectively.

Conclusions Formerly incarcerated persons have an increased rate of suicide death compared to the general population in NC, potentially attributable to high prevalence of mental health disorders among FIPs. While NC laws restrict persons with certain criminal histories from owning or purchasing firearms, firearm-involved suicide rates were higher among FIPs than the general NC population.

Significance and Contributions to Injury and Violence Prevention Science We highlight the need for suicide prevention efforts among this high-risk population. Prevention programs during incarceration and post-release, including lethal means restriction, should be explored.