This study aims to address a gap in the literature by systematically analyzing causes of death in the Portuguese prison population, an often-overlooked context, while comparing findings with international settings and presenting epidemiological and legal-institutional insights.
A systematic PubMed search (until December 31, 2024) identified 869 records; 21 were reviewed, and 11 met inclusion criteria using the population, concept and context framework. Due to limited and inconsistent literature, the review was supplemented by 14 institutional reports and legal documents. Portuguese data came from national statistics. Lack of standardized, complete data across countries precluded meta-analysis.
In Portugal, 60–70 deaths occur annually, mostly from disease, but suicide represents approximately 30% – one of the highest global rates. Homicides are rare. Some facilities face overcrowding. Compared to other nations, Portugal shows limited detail and transparency in public mortality data. Internationally, most prison deaths are from natural causes, but suicide and violent death rates vary widely.
This work highlights persistent structural and institutional shortcomings in the Portuguese prison system, including resource limitations, poor conditions, lack of transparency and potential non-compliance with international human rights standards. Although causality cannot be confirmed, overcrowding and identified risk factors may contribute to the high suicide rate. The absence of centralized, disaggregated data hinders effective monitoring and limits comparability with international benchmarks. New research lines is recommended to address the information gap on deaths in custody in Portugal, promoting systematic, standardized and internationally comparable data collection and analysis.
This review highlights significant inconsistencies in custodial mortality data and underscores the urgent need for standardized international protocols, such as the Minnesota and Istanbul Protocols, to ensure transparent investigations of deaths in custody. The notably high suicide rate in Portuguese prisons, surpassing 93% of countries reviewed, calls for immediate implementation of targeted mental health interventions and enhanced institutional oversight. These measures are essential to uphold human rights and improve the reliability of prison mortality reporting globally.
This study reveals the social invisibility of prison populations and the insufficient public discourse around deaths in custody. The high rate of suicides in Portuguese prisons reflects systemic neglect of mental health and human rights. Improving transparency and accountability in custodial death investigations can foster public trust in justice systems and promote societal engagement with prison reform. Addressing these issues is essential to reduce stigma, ensure dignity for incarcerated individuals and uphold democratic values within correctional institutions.
This review uniquely combines epidemiological data with legal-institutional analysis to examine custodial mortality, offering a comprehensive perspective rarely found in prior studies. By focusing on the Portuguese context within an international framework, it exposes significant data inconsistencies and raises critical questions about the implementation of global human rights protocols. The study provides original insights into the underexplored issue of prison suicide in Portugal and contributes valuable recommendations for improving transparency, accountability and policy development in custodial settings worldwide.
