Young people who have contact with the youth criminal justice system (i.e. charged with a criminal offence and sentenced to a community order or youth detention) are among the most marginalised groups of young people in Australia. They commonly face multiple physical and mental comorbidities and have a markedly elevated risk of dying at a young age, especially from suicide. Multi-sectoral data linkage studies offer opportunities to understand and monitor their health and healthcare trajectories to prevent suicide in this disadvantaged group.
We analysed data from a data-linkage cohort study of all young people (aged 10-17 years) charged with a criminal offence in Queensland between 1993 and 2014, including their linked youth and adult correctional records, coronial reports, and death records (n=48,670). We calculated crude rates of suicide deaths among this cohort and compared these rates with the age- and sex-matched peers in the general Australian population using standardised mortality ratios. We used competing risks survival analysis to assess associations between time-varying risk factors and the risk of suicide, adjusted for time-varying and static covariates.
The majority of the cohort were males (75.6%) and had their first criminal charge after completing 14 years of age (86.5%); 27.2% were Indigenous. There were 495 deaths by suicide in this cohort of justice-involved young people. The rate of suicide was 75.7 (95% Confidence Interval [CI]: 69.3-82.7) per 100,000 person-years, which was 4.4 (95% CI: 4.1-4.8) times higher than the age- and sex-matched general population. In the competing risks analysis, we found that those young people who experienced at least one episode of youth detention had 2.1 (95% CI: 1.6-2.6) times higher rates of suicide compared to those who were charged but not sentenced.
Population health monitoring during and after exposure to the criminal justice system, which does not exist in Australia yet, could inform efforts to prevent youth suicide and address the profound health inequities faced by people with complex health needs. A better understanding of how young people exposed to the criminal justice system (in both youth and adult correctional settings) can be better cared for can lead to better addressing their critical life disadvantages. Our findings could inform policy change and the development of timely, scalable, culturally sensitive interventions to prevent cycles of health disadvantage and socioeconomic marginalisation that may lead to suicide. Input from young people with lived experience in youth justice will be critical to these efforts.