County-level social determinants of health and suicide mortality trends among formerly incarcerated persons in North Carolina, 2010-2018.

IF 2.8 Q1 CRIMINOLOGY & PENOLOGY

Health and Justice Pub Date : 2026-04-10 DOI:10.1186/s40352-026-00409-0

Monica E Swilley-Martinez, Brian W Pence, Kate Vinita Fitch, Vanessa E Miller, Matthew M Turnure, Pasangi S Perera, Timothy S Carey, Shabbar I Ranapurwala

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引用次数: 0

Abstract

BACKGROUND: Suicide mortality represents a growing public health crisis in the United States, disproportionately affecting people with recent incarceration histories. The purpose of this study was to assess how county-level Social Determinants of Health—including educational attainment, unemployment, poverty, aging, racial composition, and rurality—are associated with suicide mortality among formerly incarcerated individuals in North Carolina in order to develop geographically focused, socially responsive suicide prevention resources. METHODS: We conducted a retrospective cohort study of people released from North Carolina prisons between 2010 and 2018 and compared suicide mortality with that of the North Carolina general population aged 18–69 years. Using linked administrative data, we calculated age-, sex-, and year-standardized suicide mortality rates and standardized mortality ratios (SMRs) by county-level social determinants of health, including educational attainment, unemployment, poverty, aging, racial composition, and rurality. RESULTS: Suicide mortality among formerly incarcerated individuals was consistently higher than in the general population, with the greatest disparities in counties that are urban (SMR: 2.04, 95% CI: 1.50, 2.58), have below average educational attainment (SMR: 2.53, 95% CI: 1.69,3.37), below average unemployment (SMR: 2.33, 95% CI: 1.66, 3.01), low poverty (SMR: 2.13, 95% CI: 1.56, 2.70), below-average racial diversity (SMR: 3.12, 95% CI: 2.20, 4.04), or an above-average proportion of older adults (SMR: 2.40, 95% CI: 1.22, 3.57). CONCLUSIONS: These findings suggest that suicide mortality disparities between formerly incarcerated individuals and the general population are greatest in more advantaged counties, where community-level protective factors appear to benefit the general population but do not extend to those returning from prison. Addressing these disparities will require investments in place-based mental health infrastructure and reentry support tailored to local community contexts.

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2010-2018年北卡罗来纳州前被监禁人员健康和自杀死亡率趋势的县级社会决定因素

背景：自杀死亡率是美国日益严重的公共卫生危机，对近期有监禁史的人影响尤为严重。本研究的目的是评估健康的县级社会决定因素（包括受教育程度、失业、贫困、老龄化、种族构成和乡村性）如何与北卡罗来纳州前被监禁者的自杀死亡率相关，以便开发地理上有重点的、社会反应性的自杀预防资源。方法：我们对2010年至2018年间从北卡罗来纳州监狱释放的人进行了一项回顾性队列研究，并将自杀死亡率与北卡罗来纳州18-69岁普通人群的自杀死亡率进行了比较。使用相关的行政数据，我们计算了年龄、性别和年份标准化自杀死亡率和标准化死亡率（smr），这些死亡率和标准化死亡率是由县级健康的社会决定因素决定的，包括受教育程度、失业、贫困、老龄化、种族构成和乡村性。结果：曾被监禁者的自杀死亡率始终高于一般人群，其中城市县（SMR: 2.04, 95% CI: 1.50, 2.58）、低于平均教育程度的县（SMR: 2.53, 95% CI: 1.69,3.37）、低于平均失业率的县（SMR: 2.33, 95% CI: 1.66, 3.01）、低贫困的县（SMR: 2.13, 95% CI: 1.56, 2.70）、低于平均种族多样性的县（SMR: 3.12, 95% CI: 3.12）差异最大。2.20, 4.04)，或高于平均水平的老年人比例（SMR: 2.40, 95% CI: 1.22, 3.57）。结论：这些研究结果表明，在更有利的县，以前被监禁的个人和一般人群之间的自杀死亡率差异最大，在这些县，社区层面的保护因素似乎有利于一般人群，但并不适用于从监狱返回的人。要解决这些差异，就需要投资于基于地方的精神卫生基础设施和适合当地社区情况的重返社会支助。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health and Justice Social Sciences-Law

CiteScore

4.10

自引率

8.60%

发文量

审稿时长

13 weeks

期刊介绍： Health & Justice is open to submissions from public health, criminology and criminal justice, medical science, psychology and clinical sciences, sociology, neuroscience, biology, anthropology and the social sciences, and covers a broad array of research types. It publishes original research, research notes (promising issues that are smaller in scope), commentaries, and translational notes (possible ways of introducing innovations in the justice system). Health & Justice aims to: Present original experimental research on the area of health and well-being of people involved in the adult or juvenile justice system, including people who work in the system; Present meta-analysis or systematic reviews in the area of health and justice for those involved in the justice system; Provide an arena to present new and upcoming scientific issues; Present translational science—the movement of scientific findings into practice including programs, procedures, or strategies; Present implementation science findings to advance the uptake and use of evidence-based practices; and, Present protocols and clinical practice guidelines. As an open access journal, Health & Justice aims for a broad reach, including researchers across many disciplines as well as justice practitioners (e.g. judges, prosecutors, defenders, probation officers, treatment providers, mental health and medical personnel working with justice-involved individuals, etc.). The sections of the journal devoted to translational and implementation sciences are primarily geared to practitioners and justice actors with special attention to the techniques used.