Predicting self-harm in prisoners: risk factors and a prognostic model in a cohort of 542 prison entrants
Open accessAbstract
BACKGROUND: Self-harm is common in prisoners. There is an association between self-harm in prisoners and subsequent suicide, both within prison and on release. The aim of this study is to develop and evaluate a prediction model to identify male prisoners at high risk of self-harm. METHODS: We developed an 11-item screening model, based on risk factors identified from the literature. This screen was administered to 542 prisoners within 7 days of arrival in two male prisons in England. Participants were followed up for 6 months to identify those who subsequently self-harmed in prison. Analysis was conducted using Cox proportional hazard regression. Discrimination and calibration were determined for the model. The model was subsequently optimized using multivariable analysis, weighting variables, and dropping poorly performing items. RESULTS: Seventeen (3.1%) of the participants self-harmed during follow up (median 53 days). The strongest risk factors were previous self-harm in prison (adjusted hazard ratio [aHR] = 9.3 [95% CI: 3.3-16.6]) and current suicidal ideation (aHR = 7.6 [2.1-27.4]). As a continuous score, a one-point increase in the suicide screen was significantly associated with self-harm (HR = 1.4, 1.1-1.7). At the prespecified cut off score of 5, the screening model was associated with an area under the curve (AUC) of 0.66 (0.53-0.79), with poor calibration. The optimized model saw two items dropped from the original screening tool, weighting of risk factors based on a multivariable model, and an AUC of 0.84 (0.76-0.92). CONCLUSIONS: Further work is necessary to clarify the association between risk factors and self-harm in prison. Despite good face validity, current screening tools for self-harm need validation in new prison samples.
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Because prisoners are generally a population at high risk of self-harm, the identification of those at elevated risk of self-harm is a complex task and will probably require high-quality methods and external validation.
“Because prisoners are generally a population at high risk of self-harm, the identification of those at elevated risk of self-harm is a complex task,16 and will probably require high-quality methods and external validation.82”
From Risk factors for self-harm in prison: a systematic review and meta-analysis (2020) · cites this paper as [82]
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- Authors
- Ryland, H., Gould, C., McGeorge, T., Hawton, K., & Fazel, S.
- Affiliations
- University of Oxford (GB)
- Central and North West London NHS Foundation Trust (GB)
- North Middlesex University Hospital NHS Trust (GB)
- Corresponding author
- Fazel, Seena
- Venue
- European Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2020
- Volume
- 63
- Issue
- 1
- Pages
- e42-e42
- ISSN
- 0924-9338 (ISSN-L)
- 1778-3585
- PMC
- PMC7242092
- OpenAlex
- W3020662587
- Cited by
- 27
- References
- 32
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 8 · 2023: 4 · 2022: 4 · 2021: 1 · 2020: 2
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- European Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Wellcome Trust (202836/Z/16/Z, 202836)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Criminal Justice and Corrections Analysis
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Keywords
- self-harm, prisoners, suicide risk, risk prediction model, screening tool, suicidal ideation, incarcerated men, discrimination and calibration
- MeSH terms
- Adult, England, Follow-Up Studies, Humans, Male, Middle Aged, Prisoners, Prisons, Prognosis, Risk Factors, Reproducibility of Results, Cohort Studies, Self-Injurious Behavior, Young Adult, Suicidal Ideation
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