Recent Court Involvement and Risk of Suicide: A Population-based Study Utilizing a Comprehensive Criminal Justice Database

This study estimates the risk of suicide associated with recent court involvement (criminal, traffic, civil) and related court-related stressors using archived court data, a novel source of exposure data capturing a wide range of both minor and severe life stressors. By including all offenses, claims, appearances and court-related stressors and accurately measuring the timing and sequencing of events in relation to death, this study provides evidence regarding the most relevant period of heightened suicide risk surrounding severe life stressors and recent court involvement. The study utilizes a county-wide electronic archive of court-docket data linked to death certificates for all suicide victims and comparison causes of death in a large urban county of Ohio during the period of 2000-2005. For suicide deaths, medical examinerÕs notes were coded and matched to assess co-occurring risk factors, use of mental health and healthcare services, previous suicide attempts and behavioral markers relevant for developing court-based interventions. A matched case control design was used including all adult suicide deaths during the study period (N=315) frequency matched by sex, age, race and residential location to a control group of non-injury related deaths (N=615) and a second comparison group comprised of injury-related deaths (N=615). Nearly a third of all adult suicide victims had court involvement in the year prior to death, twice the proportion observed among non-injury deaths (OR = 2.0, 95% C.I. {1.44-2.75}, p <.001). Among younger men under 35, a majority of suicide victims had recent court contacts, a group with no recent contacts with either primary care or mental health. Involvement in criminal misdemeanors, car accidents and foreclosures each conferred a three-fold elevated risk of suicide. The risk of suicide peaks within three months of an offense or claim suggesting a short but measurable period of latency for targeted interventions. The dismantling of the public mental health system has led to an increase in the number of mentally ill appearing in courts and the criminal justice system. Archived court-data can serve as an evaluation tool to measure client outcomes and help expand and inform court-based suicide prevention strategies beyond reducing suicide within criminal justice facilities.