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Cited by 357Suicide and Self-Harm StudiesCriminal Justice and Corrections AnalysisHomicide, Infanticide, and Child Abuse

Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide

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Hawton, Keith, Linsell, Louise, Adeniji, Tunde, Sariaslan, Amir, Fazel, Seena·2014·The Lancet
DOI 10.1016/s0140-6736(13)62118-2PMC PMC3978651
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Abstract

BACKGROUND: Self-harm and suicide are common in prisoners, yet robust information on the full extent and characteristics of people at risk of self-harm is scant. Furthermore, understanding how frequently self-harm is followed by suicide, and in which prisoners this progression is most likely to happen, is important. We did a case-control study of all prisoners in England and Wales to ascertain the prevalence of self-harm in this population, associated risk factors, clustering effects, and risk of subsequent suicide after self-harm. METHODS: Records of self-harm incidents in all prisons in England and Wales were gathered routinely between January, 2004, and December, 2009. We did a case-control comparison of prisoners who self-harmed and those who did not between January, 2006, and December, 2009. We also used a Bayesian approach to look at clustering of people who self-harmed. Prisoners who self-harmed and subsequently died by suicide in prison were compared with other inmates who self-harmed. FINDINGS: 139,195 self-harm incidents were recorded in 26,510 individual prisoners between 2004 and 2009; 5-6% of male prisoners and 20-24% of female inmates self-harmed every year. Self-harm rates were more than ten times higher in female prisoners than in male inmates. Repetition of self-harm was common, particularly in women and teenage girls, in whom a subgroup of 102 prisoners accounted for 17,307 episodes. In both sexes, self-harm was associated with younger age, white ethnic origin, prison type, and a life sentence or being unsentenced; in female inmates, committing a violent offence against an individual was also a factor. Substantial evidence was noted of clustering in time and location of prisoners who self-harmed (adjusted intra-class correlation 0·15, 95% CI 0·11-0·18). 109 subsequent suicides in prison were reported in individuals who self-harmed; the risk was higher in those who self-harmed than in the general prison population, and more than half the deaths occurred within a month of self-harm. Risk factors for suicide after self-harm in male prisoners were older age and a previous self-harm incident of high or moderate lethality; in female inmates, a history of more than five self-harm incidents within a year was associated with subsequent suicide. INTERPRETATION: The burden of self-harm in prisoners is substantial, particularly in women. Self-harm in prison is associated with subsequent suicide in this setting. Prevention and treatment of self-harm in prisoners is an essential component of suicide prevention in prisons. FUNDING: Wellcome Trust, National Institute for Health Research, National Offender Management Service, and Department of Health.

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  • The annual prevalence of self-harm in prison has been estimated to be 5-6% in men and 20-24% in women.

    “the annual prevalence of self-harm in prison has been estimated to be 5–6% in men and 20–24% in women,5”

    From Risk factors for self-harm in prison: a systematic review and meta-analysis (2020) · cites this paper as [5]

  • Self-harm is a leading cause of morbidity in prisoners.

    “Self-harm is a leading cause of morbidity in prisoners”

    From Risk factors for self-harm in prison: a systematic review and meta-analysis (2020) · cites this paper as [5]

  • The non-significance of female sex as a risk factor in this meta-analysis contrasts with findings in the general population, where female sex as a risk factor for self-harm is stronger, and with one high-quality population study of UK prisoners that reported that the odds of self-harm was four times higher in women than in men.

    “This non-significance contrasts with findings in the general population,74 in which female sex as a risk factor for self-harm is stronger, and one high-quality population study of UK prisoners5 that reported that the odds of self-harm was four times higher in women than in men.”

    From Risk factors for self-harm in prison: a systematic review and meta-analysis (2020) · cites this paper as [5]

  • Evidence on the clustering of self-harm and suicide in custody suggests that interventions after suicidal behaviour should extend beyond the individual prisoner to others in the same wing or prison who could be at risk.

    “This recommendation is supported by evidence on the clustering of self-harm5 and suicide78 in custody, which suggests that interventions after suicidal behaviour should extend beyond the individual prisoner to others in the same wing or prison who could be at risk.”

    From Risk factors for self-harm in prison: a systematic review and meta-analysis (2020) · cites this paper as [5]

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1 of the 44 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [28]Stockford SM Meta-analysis of intraclass correlation coefficients from multilevel models of educational achievement 2011 ProQuest (UMI Dissertation Publishing) Ann Arbor

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Authors
Hawton, K., Linsell, L., Adeniji, T., Sariaslan, A., & Fazel, S.
Affiliations
  • University of Oxford (GB)
  • Ministry of Justice (GB)
  • Karolinska Institutet (SE)
Corresponding author
Fazel, Seena
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2014-03
Volume
383
Issue
9923
Pages
1147-1154
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(13)62118-2
PMC
PMC3978651
OpenAlex
W2143818998
Cited by
357
References
44
Citations by year
2026: 14 · 2025: 26 · 2024: 32 · 2023: 26 · 2022: 46 · 2021: 35 · 2020: 27 · 2019: 30 · 2018: 29 · 2017: 26 · 2016: 34 · 2015: 17 · 2014: 12 · 2013: 1
FWCI
23.74
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
National Institute for Health Research (NIHR) Senior Investigator and to SF from the Wellcome Trust (095806)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Criminal Justice and Corrections Analysis
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
self-harm, suicide, prisoners, prison population, prevalence, risk factors, clustering, women prisoners, incarcerated men, violent offending, life imprisonment, adolescent girls, suicide prevention, England and Wales prisons, prison mental health, prison staff training
MeSH terms
Adolescent, Adult, Aged, Bayes Theorem, England, Female, Humans, Male, Middle Aged, Prisoners, Prisons, Risk Factors, Suicide, Wales, Prevalence, Case-Control Studies, Self-Injurious Behavior, Young Adult

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