Background Suicidal behaviour is a global public health concern that disproportionately affects the most vulnerable members of society, including prisoners.
Aim To map the epidemiology and risk factors for suicidal behaviour in Belgian prisons, and make recommendations to improve its management and prevention.
Method A national case file analysis of all suicides in Belgian prisons over a 20-year period (2000-2019) and a large-scale survey study covering 13% of the prison population nationwide (n = 1326).
Results Suicide accounts for one-third (33%) of all deaths in Belgian prisons. One in five (22%) prisoners in Belgium have attempted suicide in their lifetime, half of whom (10%) did so while incarcerated. Female prisoners have a higher prevalence of suicidal thoughts and attempts than their male counterparts. Risk factors for suicidal behaviour in prison include recent suicidal ideation, previous self-harm, psychiatric morbidity, environmental stressors, and aspects of the prison climate.
Conclusion In Belgium, suicidal behaviour is five times more common in prisoners compared to the general population. We propose an integrated prevention model that incorporates targeted interventions aimed at high-risk individuals in combination with population strategies that promote the health and wellbeing of all people in prison.