BRIEF RESEARCH COMMUNICATION

Suicide behind bars: A 10‑year retrospective study

Rajesh V. Bardale, Pradeep G. Dixit
Department of Forensic Medicine, Government Medical College and Hospital, Nagpur, Maharashtra, India

ABSTRACT

Background: Studies conducted in several countries have found an increase in suicide rates in custody than the general
population.
Aims: The aim was to assess the trends of suicide in custody and to identify characteristics.
Materials and Methods: We examined all available files of the death of people in custody through 2001 to 2010.
Information collected included age, sex, type of custody, place of death, presence of any associated disease, history of
any psychiatric illness, substance abuse, and cause of death.
Results: A total 173 autopsies was performed out of which 14 cases were of suicide. The mean age was 31.71 years.
71.42% deaths were noted in police lock‑ups while 28.57% were recorded in prison. Hanging was the common method
of suicide followed by poisoning.
Conclusion: Suicide in custodial setting is preventable problem in India. Preventing suicide in custody needs cooperation
and coordination from various agencies.

Key words: Autopsy, custody, death, jail, police lock‑up, suicide

INTRODUCTION MATERIALS AND METHODS

Death while in custody is a sensitive issue and has potential
implications in the society. When such death is unnatural
one then the ramifications are wide and ranged from
violation of human rights to torture and causing death.
Suicide in custody is a well‑established problem. Studies
conducted in several countries have found an increase in
suicide rates in custody over the last five decades.[1] Few
studies have reported suicide rates are in excess than
the general population.[2‑5] Inmate suicide represents a
significant correctional health problem in the society
and specific interventions are required to prevent these
premature deaths. However, for this purpose updated data
of mortality pattern in custody are required. Considering
India, such data are lacking. The present study was
undertaken to assess the trends of suicide in custody and
to identify characteristics that can be utilized to prevent
such deaths.
Address for correspondence: Dr. Rajesh V. Bardale,
Department of Forensic Medicine, Government Medical
College and Hospital, Nagpur ‑ 440 003, Maharashtra, India.
E‑mail: bardalerv@yahoo.co.in
This is a postmortem examination based retrospective
study conducted at Department of Forensic Medicine,
Government Medical College and Hospital, Nagpur. We
examined all available files of inquest papers, autopsy
reports, toxicological analysis reports, histopathology
reports, and case papers into the death of people in
custody through 2001 to 2010. A standard proforma
was designed to collect the information to ensure
consistency for the whole sample. Only deaths due to
suicide, confirmed after investigation and evaluation of
circumstances, were included in the study. Information
collected included age, sex, type of custody (jail or police
lock‑up), place of death/incident, medical attention
received, presence of any associated disease, history of
any psychiatric illness, substance abuse, and cause of
death.
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How to cite this article: Bardale RV, Dixit PG. Suicide DOI:
behind bars: A 10-year retrospective study. Indian J Psychiatry
10.4103/0019-5545.148531
2015;57:81-4.

Indian Journal of Psychiatry 57(1), Jan-Mar 2015 81

 Bardale and Dixit: Suicide behind bars
RESULTS
A total 173 autopsies was performed during the 10 years
period from January 2001to December 2010 out of
which 14 (8.09%) cases were of suicide. The year‑wise
distribution of the custodial death and suicide is
presented in Figure 1.
Age and sex
The study consists of 14 incarcerated people consisting of 13
men and 1 woman. The mean age was 31.71 years [Table 1].
About 78.57% (n = 11) death were recorded in the age
group of 21–40 years [Figure 2] while one death was noted
at the age of 19 years.
Type of custody and timing
Ten deaths (71.42%) were noted in police lock‑ups while 4
deaths (28.57%) were recorded in prison [Table 1]. Mean age
of individuals who died in police custody was 32 years while
mean age of person died in jail was 31 years. Among the
people who were in police custody, 7 (70%) had committed
suicide within 24 h of the arrest. Among jail inmates, two
persons (50%) were convicted and 2 (50%) were temporary
prisoners. In case of temporary inmate, 1 had committed
suicide within 24 h of confinement.
Methods
Hanging was the common method of suicide (n = 6, 42.85%)
followed by insecticidal poisoning (n = 5, 35.71%) while
jumping from height was noted in two inmates (14.28%) and
self‑stabbing of abdomen in one individual (7.14%) [Table 1].
Place of death/incident
Analyzing the place of death, 7 (50%) died in police
lock‑ups, 3 (21.42%) died in prison cells, 2 (14.28%) died in
court premises and 2 (14.28%) died at other place. Among
those who died at other place 1 (7.14%) person flee from
police and consumed insecticide near jungle while other
stabbed himself while searching the stolen property at his
home.

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Figure 1: Distribution of deaths in custody
82
Moment of death/incident
About 50% (n = 7) of deaths/incident were recorded
in afternoon period while 42.85% were noted in night
hours (n = 6) and 7.14% in evening hours (n = 1).
History and circumstances
Analyzing the history and circumstances, 2 (14.28%)
persons had consumed alcohol (mean blood alcohol level
125.5 mg/100 ml), 1 person was in alcohol withdrawal state
while one had attempted suicide 2 weeks back in another
police lock‑up. While evaluating deaths due to hanging,
4 (66.66%) had used bars of cell while 1 (16.66%) each had
used window bar and half door of toilet, respectively, to
tie the ligature material. Two (33.33%) inmates had used
underwear, 2 (33.33%) had used piece of bed‑sheet (dari)
while 1 (16.66%) each had used lungi and blanket,
respectively, as a ligature material.
DISCUSSION
Suicide remains a major public and mental health problem
in India. Over 100,000 people die by suicide in India every
year. In the last two decades, the suicide rate has increased
from 6.4 in 1982 to 10.5 in 2002.[6] In comparison with
general population, people in custody have an increased
rate of suicide[5] and is of great concern as these people are
marginalized population. The data obtained from National
Crime Record Bureau, India for the year 2009–2011 regarding
inmate suicides in India are presented in Tables 2 and 3.
Over these year on an average about 27.48% custodial deaths
due to suicides in police lock‑ups are recorded. It means in
India about one‑fourth of the arrested population is at risk
and this is of great distress and worrying.
This study describes suicidal deaths within the custody in all
districts of Nagpur revenue division. Majority of deaths in
custody (92.85%) were of males. The less number of suicides
among female inmates might be explained by the fact that
they are less involved in crime and therefore represent
less in number of the inmate population. In the present
study, 78.57% deaths were recorded in the age group of
21–40 years. According to the Maryland study, prisoners







  
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Figure 2: Distribution of cases according to age‑groups
Indian Journal of Psychiatry 57(1), Jan-Mar 2015
 Bardale and Dixit: Suicide behind bars

Table 1: Characteristic of cases and cause of death sample size, it is difficult to comment what population has
Characteristics Cause of death greater risk in our setting. However, the fact that nearly
Hanging Poisoning Jump from Stab All 71.42% inmate suicides took place in police lock‑ups cannot
height wounds be ignored. It causes apprehension and raises concern
Sex (n) regarding the safety of these individuals from those people
Male 6 4 2 1 13 who are supposed to safeguard the society. About 35.71% of
Female ‑ 1 ‑ ‑ 1 individuals had committed suicide in police lock‑ups within
Age in years the first 24 h of incarceration. This is better understood
Range 23-40 27-43 24-45 19 19-45
Mean 32.16 32.6 34.5 ‑ 31.71
when one considers the sense of isolation, helplessness,
Number of cases and despair often experienced by new inmate.[9]
(and %) with
type of custody Hanging is the most common method of inmate suicide,
Police cell 5 (37.71) 2 (14.28) 2 (14.28) 1 (7.14) 10 (71.42) accounting for 42.85% of suicide in the present study.
Prison 1 (7.14) 3 (21.42) ‑ ‑ 4 (28.57)
Total number of 6 (42.85) 5 (37.71) 2 (14.28) 1 (7.14) 14 (100)
This method is followed by poisoning (35.71%). This has
cases (%) been seen in numerous prior studies.[2,8‑11] The pattern is
analogous to general population studies.[12‑14] As observed
in previous studies, suicidal hanging is facilitated by the
Table 2: Total number of deaths and suicides in police bar construction of cells (n = 4, 28.57%). These bars were
custody in india* utilized by the inmates to tie the ligature material. The
Year Death of Death of Total Number Percentage common articles such as underwear, bed‑sheet (dari), blanket
persons persons not deaths of suicides
and lungi were used as a ligature material. Elimination of
remanded remanded among
by the court by the court these deaths bar type of construction and redesigning of the cell would
further reduce the available means of suicide.[9] The vigilance
2009 25 59 84 21 25
2010 25 45 70 18 25.71 on greater suicidal risks is needed. The use of close‑circuit
2011 29 75 104 33 31.73 vigilance system may be of some use in such population and
*Source: National Crime Record Bureau India, Crime in India report 2011 installation of such gadgets should be considered. Similarly
the people with specializing police custody should be
Table 3: Total number of deaths and suicides in prison deployed to monitor the inmates and these policing staff
in india* should not be involved in other duties so they could carry
Year Total number Natural Unnatural Number of Percentage
out their duty with concentration and energy.
of death in deaths deaths suicides among
prison these deaths About 2 (14.28%) inmates had consumed alcohol and 1
2009 1430 1321 109 75 5.24 inmate (7.14%) was in withdrawal state. The depressant
2010 1436 1344 92 68 4.73 effects of alcohol and narcotics and their withdrawal are well
2011 1332 1244 88 68 5.10 recognized.[9] The lifetime risk of suicide in alcohol abusers
*Source: National Crime Record Bureau India, prison report 2009, 2010 and 2011 is estimated to be 7%. Similarly the acute intoxication may
increase impulsiveness and trigger suicidal acts.[6] For this
between ages 15 and 34 years are at twice the risk for suicide reason these persons should be recognized as greater
as the general population of the same age. Older inmates suicidal risks. Bizarre behavior and speech suggestive of
have a lower suicide rate relative to younger inmates and an underlying mental disorder and/or withdrawal state
the general population.[2] Social adversity is common in indicates the need for close observation or hospitalization.[9]
younger population. If such adversity is not recognized and The caretaker and policing staff should be sensitized and
properly addressed then it is often accompanied by early trained to recognize such behavior and early consultation
offending, psychiatric disorder, substance misuse, and should be sought from psychiatrist.
self‑harming behavior.[7]
There are few limitations to the study such as:
Type of custody may have an effect on the suicidal tendency. (1) Retrospective nature of study, (2) small sample size, (3) no
Few studies had noted increased mortality rate in long‑term socio‑cultural, economic and criminal background could be
incarceration while other studies had noted increased evaluated due to lack of information, and (4) not possible
suicide rate in short‑term custody and police custody.[2,8,9] to determine the crude suicide rate and compare them
In India, the prison houses temporary, under‑trial and with other population studies. It is difficult to determine
convicted persons as prisoners while police lock‑ups suicide rate because of rapid turnover of the population and
have person arrested for offences and for the purpose of therefore difficulty in getting the figure.
interrogation. Each population in these two institutes
differs and might have a separate set of risk factors for Corresponding with existing literature, our study identifies
suicide and have different suicide rate. Due to small some traits of custodial suicide. However, larger studies are

Indian Journal of Psychiatry 57(1), Jan-Mar 2015 83

 Bardale and Dixit: Suicide behind bars
required to analyze individual risk factors, precursors for
such act, environmental factors, and type of custody, period
of imprisonment, substance abuse and mental disorder,
and empirical significance and interactions of these factors
with suicidal behavior. Moreover, psychological studies of
such episode (psychological autopsy) might identify more
specific and relevant factors for suicidal causation. But for
this purpose, accurate and uniform data is required. There
is need to create national custody death database. This
database will allow for the analysis of multivariate models;
an analytical method by which the respective statistical
contribution of various factors may be identified. The
medical and related professional may utilize the database
and help to develop sound protocols so that the incidence
of such types of death can be reduced.[15]
CONCLUSION
Suicide in custodial setting is preventable but neglected
problem in India. Preventing suicide in prison or police
lock‑ups is not primarily a medical matter[16] but needs
cooperation and coordination from various agencies. There
is necessity for all policing staff to take suicidal behavior
as a serious but preventable disorder in custodial setting
as in any other circumstances. Screening the individuals
before putting them behind bars, identifying the important
risk factors such as drug and alcohol abuse or mental
illness and seeking appropriate medical aid in this regard
may reduce the number of such incidents in substantial
way. Similarly, the prison or police lock‑up environment
itself may increase suicide risk.[17] Many inmates feel that
84
an agonizing existence is worse than death. Therefore,
gradual change in environment may help the individual to
acclimatize with the condition and learn to cope with the
problems.
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Source of Support: Nil, Conflict of Interest: None declared
Indian Journal of Psychiatry 57(1), Jan-Mar 2015
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