Suicide in Prison: A Forensic Analysis of Sixteen Cases in Correctional Settings

Background/Objectives: Suicide in prison is a significant medico-legal and public health concern, with rates several times higher than in the general population. Vulnerability is heightened by psychiatric disorders, substance use, and custodial stressors such as isolation, overcrowding, and restricted healthcare access. This study examines custodial suicides to identify diagnostic complexities, systemic shortcomings, and possible prevention strategies, including technological innovations. Methods: We conducted a retrospective forensic investigation of sixteen confirmed custodial suicides between 2022 and 2024. Each underwent a standardized protocol comprising crime scene inspection, complete autopsy, histopathology, toxicology, and review of prison medical and psychiatric records. Data on suicide methods, psychiatric comorbidities, and substance use were analyzed. Results: Hanging was the predominant method (12/16), displaying classical forensic signs such as pale, oblique ligature marks and petechial hemorrhages. Four cases involved acute intoxication, often with non-prescribed drugs. Psychiatric disorders were identified in 14 cases, including major depressive disorder, bipolar disorder, and substance use disorder. Toxicological analyses revealed both prescribed and illicit substances, highlighting unauthorized exchanges within facilities. Autopsy findings consistently excluded homicide or natural causes, confirming the vitality of lesions and the mechanism of death. Conclusions: Custodial suicides are strongly associated with untreated or inadequately managed psychiatric conditions, compounded by restrictive prison environments. Comprehensive forensic autopsies are essential for accurate cause-of-death determination and institutional accountability. Preventive strategies should combine psychiatric care, architectural modifications to reduce ligature points, and ethical integration of AI-based surveillance for early detection of suicidal behavior. A multidisciplinary, rights-based approach is crucial to reduce suicide rates and safeguard the dignity and life of incarcerated individuals.