Washington State prisoners on parole are 3.5 times more likely to die than other residents and almost 13 times more likely in their first two weeks of release, reported a study conducted by a former UW student.

"Release from Prison — A High Risk of Death for Former Inmates," was recently published in the New England Journal of Medicine and theorizes that prisoners may have difficulty re-adjusting to society.

"Our motivation to do this was we didn't know if there was risk during the transition from prison to community," said lead researcher Ingrid Binswanger, who began the study at UW. "We've identified that vulnerable time."

Drug overdose is the leading cause of death, followed by heart disease and homicide. This shows that many ex-convicts may be returning to unsafe situations, said Thomas Koepsell, epidemiology professor and research mentor.

"I was struck by the marked increase in risk of dying within the first one to two weeks after release from prison, and that so many of those early deaths were drug related," he said in an e-mail. "Overall, many of the excess deaths in former inmates were due to homicide, suicide or other injuries, suggesting that many inmates soon return to dangerous environments."

The researchers studied prisoner-release cases of a four-year period.

"We obtained records from the department of corrections for people who were incarcerated between 1999 and 2003," Binswanger said. "We were able to determine through data linkage how many people died in Washington state during that period and then were able to calculate death rates."

Of the 30,237 ex-convicts studied, 443 died within about two years of release, the study reported.

Though less than 3 percent of those studied were over age 55, heart disease, the most common cause of death in the U.S., killed 56 of the 443, making it twice as likely to kill former inmates than others.

Eighty-seven percent of the former inmates were men, while 13 percent were women.

Yet females are 5.5 times more likely to die than women of the general public.

Comparable research has been conducted in Europe and Australia that also shows elevated death risk after release from prison. Binswanger's publication, however, is the first major study of the issue in the U.S.

Binswanger, now an assistant professor and public health researcher at the University of Colorado at Denver, began her research while a UW post-doctorate fellow for the Robert Wood Johnson Clinical Scholars Program.

Her long-term interest in research on vulnerable populations led her to begin studying the health concerns of prison inmates.

"Both in my medical work and volunteer work, I've noticed the large impact of the criminal-justice system and wondered ... how we could work better with patients who interact with the criminal justice system," Binswanger said.

The next step is to research the topic in other places around the country and alter or create programs to aid released inmates in transitioning to society.

"Replication of the study in other states or venues would be informative, but an even bigger challenge is to try to find ways to reduce the excess deaths among former inmates," Koepsell said. "This may involve designing preventive interventions prior to release, so that former inmates are better able to avoid dangerous environments and cope better with readjustment to life outside."

Currently, prisoners are released to one of three situations: their own recognizance without any jurisdiction from the Department of Corrections (DOC); their home with the supervision of a community corrections officer; or a work-release program where they work in the community during the day and remain in the home the remainder of the time, said Marc Stern, Washington State DOC Health Services director, in an e-mail.

"While under community supervision or in work-release, we make a number of services available to them, [including] vocational counseling, facilitate access to education, group therapy to improve function in the community, chemical dependency treatment," he said. "The governor's budget requests additional monies from the legislature to expand the services offered in these venues."

The DOC is attempting to improve and further develop these programs.

"One of our major expansions, if approved by the legislature, would be a pilot of the addition of licensed mental health professionals working in our community supervision center to improve the linkages to community mental health services, provide individual counseling, and especially provide cognitive-behavioral therapy as offenders are transitioning back to their communities," Stern said.

Reach reporter Meghan Peters at news@thedaily.washington.edu.