TOPLINE:

A new study shows that extreme heat is associated with suicidality among incarcerated men, a finding that may have implications for legal interventions and advocacy to reduce heat-induced morbidity and mortality in prisons.

METHODOLOGY:

• Extreme heat poses a distinct risk to incarcerated people, many of whom have high rates of behavioral health conditions and are held in overcrowded prisons without air conditioning.

• People in solitary confinement are especially susceptible to the hazards of extreme heat because they’re less able to avoid or mitigate heat-related stress than those in general population units of prisons or in community settings.

• Researchers collected data on heat index (which combines relative humidity and air temperature) and suicide-watch incidents (an indicator of suicidality) in six prisons in Louisiana, a state with a densely populated prison system that’s engaged in litigation because of extreme heat, with an average of 35 days a year when heat exceeds dangerous levels. Researchers also determined the daily rate of solitary confinement.

• The longitudinal case series panel study included adult men incarcerated in one of the six Louisiana prisons between January 1, 2015, and December 31, 2017, and provided 6576 facility-incarceration days for the analysis.

TAKEAWAY:

• Except for one facility, all prisons had a similar percentage of days (9.8%) of extreme heat (exceeding the 90th percentile maximum daily heat index) during the observation period; the mean daily maximum heat index across all prisons was 84.5°F, with little variation between sites.

• Across all six prisons, the mean average percentage of people in solitary confinement was 21.2%, although it varied by facility.

• The mean daily number of suicide-watch events across all prisons was 0.79; the rate increased by 29% when the heat index reached 80°F – 89°F (incidence rate ratio [IRR], 1.29; 95% confidence interval [CI], 1.17 – 1.43; P < .001) and by 36% when reaching 90°F – 103°F (IRR, 1.36; 95% CI, 1.15 – 1.61; P < .001), after controlling for relevant facility-level covariates and potential seasonality effects.

IN PRACTICE:

In response to extreme heat, prisons are often provided access to fans, ice, and cold showers, but while these policies might avert heat-related conditions, they don’t address psychological and behavioral effects of extreme heat, the authors said. “Our results may help amplify the need for systematic changes,” they conclude.

STUDY DETAILS:

The study was conducted by David H. Cloud, PhD, JD, Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, and colleagues. It was published online August 11, 2023, in JAMA Network Open.

LIMITATIONS:

Using administrative data likely underestimated magnitudes of suicidality. The heat index inside prison cells likely exceeded outdoor exposures measured in the study because of the physical infrastructure. The generalizability of the study is limited because the sample included only incarcerated adult men. The authors didn’t have reliable data on race and ethnicity and were unable to determine whether anyone in the facility died by suicide.

DISCLOSURES:

The study received support from the Criminal Justice Research Training Program at Brown University and Miriam Hospital. Cloud reported having been formerly employed by the Vera Institute of Justice, which provided secondary data for the analysis; no other disclosures were reported.

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