Abstract
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. 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. 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). 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.
Highlights
Self-harm represents a substantial burden of morbidity in prisons
Repetition of self-harm is common in prison, with male prisoners who self-harm doing so on average around twice per year, while female prisoners repeat self-harm around eight times per year [2]
We found that the strongest associations with self-harm in the first 6 months of prison entry were previous self-harm inside prison and current thoughts of self-harm
Summary
Self-harm represents a substantial burden of morbidity in prisons. In England and Wales, rates of self-harm have increased sharply in recent years from 264 per 1,000 prisoners in 2004 to 629 per 1,000 prisoners in 2018, equivalent to 52,814 incidents [1]. An estimated 5–6% of male prisoners selfharm every year, with annual rates of 20–24% observed in female prisoners [2]. In England and Wales, the mean annual rate for suicides in male prisoners who had self-harmed was 334 per 100,000, compared with 95 per 100,000 for those who had not selfharmed [2]. 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. 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). Current screening tools for self-harm need validation in new prison samples
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