Former New England Patriots tight end Aaron Hernandez killed himself by hanging at some point Tuesday night or Wednesday morning at the Souza Baranowski Correctional Center in Shirley, Mass., where he was serving a life sentence for the 2013 murder of Odin Lloyd. His death could serve to once again shine a spotlight on prison conditions in Massachusetts, where inmate suicides have been a recurring problem.

According to statistics released by the Bureau of Justice Statistics in December, federal and state prisoners in Massachusetts had an annual suicide rate of 32 per 100,000 prisoners from 2001 to 2014. Only three states — Rhode Island (45 per 100,000 prisoners), Utah (44 per 100,000 prisoners) and Montana (34 per 100,000 prisoners) — were worse.

Massachusetts’s prison suicide rate is more than twice the annual U.S. average: 13.26 per 100,000 individuals, according to the American Foundation for Suicide Prevention.

In all, 47 federal and state prisoners in Massachusetts killed themselves from 2001 to 2014, the BJS report states. Only disease killed more prisoners in the state. For comparison’s sake, only three Massachusetts prisoners were murdered by other prisoners over that span.

The problem hardly is new, according to a 2014 story in the Brockton Enterprise. Following a spike in Massachusetts prison suicides in 2006 and 2007, the state Department of Correction hired consultant Lindsay Hayes of the National Center on Institutions and Alternatives to produce a report. His first report, issued in 2007, found that the state’s prison staff needed more suicide-prevention training, at-risk prisoners weren’t checked often enough and inmates on suicide watch often became more isolated, increasing the risk of suicide. In a follow-up report four years later, Hayes said many of his recommendations had been implemented. Nevertheless, nine more prisoners killed themselves in Massachusetts from 2012 to 2014. There have been two prison suicides this year, according to the Boston Globe.

“It’s a really perplexing question for me, in large measure because this has been the story for quite some time, from the mid-’90s and probably earlier,” Bradley Brockmann, executive director of the Center for Prisoner Health and Human Rights at Miriam Hospital and Brown University Medical School, told the Enterprise.

In 2012, the Boston Globe reported that Souza-Baranowski Correctional Center had created a 19-bed secure treatment program for inmates with mental-health issues after a federally mandated settlement was brokered between the state Department of Correction and prisoner advocate groups. According to the Enterprise story, while federal prisoners are subject to a suicide-prevention program, the states alone decide the regulations in state-run facilities.

Though the specifics of his mental state at the time of his death are not known, Hernandez never was said to be suffering from mental illness during his murder trials and subsequent confinement. He reportedly had gotten into at least three fights in prison but also had taken up chess, led fellow prisoners in workouts and became an avid reader (Harry Potter, self-help and the like), according to people who had visited him. In announcing his death, the state Department of Correction said Hernandez was in a single cell in the general population unit and not in solitary confinement; such segregation has been found to exacerbate mental issues. Hernandez left no suicide note and was not under a suicide watch, according to a Department of Correction spokesman.

“It almost feels like the pressure on him is off, now that he is in jail,” Mark Ziogas, who coached Hernandez in Little League, told Sports Illustrated’s Michael Rosenberg for a story that ran last year. “He must have felt a lot of pressure. It makes you feel sad. Why didn’t he try to deal with it through counseling or something?”