Predicting self-harm in prisoners: Risk factors and a prognostic model in a cohort of 542 prison entrants
AbstractBackground.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 d...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2020-01-01
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| Series: | European Psychiatry |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933820000401/type/journal_article |
| _version_ | 1811156307062816768 |
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| author | Howard Ryland Charlotte Gould Tristan McGeorge Keith Hawton Seena Fazel |
| author_facet | Howard Ryland Charlotte Gould Tristan McGeorge Keith Hawton Seena Fazel |
| author_sort | Howard Ryland |
| collection | DOAJ |
| description | AbstractBackground.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. |
| first_indexed | 2024-04-10T04:49:22Z |
| format | Article |
| id | doaj.art-7118e71b3d244a478f6ca1ed0a14144c |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-04-10T04:49:22Z |
| publishDate | 2020-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-7118e71b3d244a478f6ca1ed0a14144c2023-03-09T12:33:57ZengCambridge University PressEuropean Psychiatry0924-93381778-35852020-01-016310.1192/j.eurpsy.2020.40Predicting self-harm in prisoners: Risk factors and a prognostic model in a cohort of 542 prison entrantsHoward Ryland0https://orcid.org/0000-0002-5287-555XCharlotte Gould1Tristan McGeorge2Keith Hawton3https://orcid.org/0000-0003-4985-5715Seena Fazel4https://orcid.org/0000-0002-5383-5365Department of Psychiatry, University of Oxford, Oxford, United KingdomCentral and North West London NHS Foundation TrustNorth Middlesex University Hospital NHS TrustDepartment of Psychiatry, University of Oxford, Oxford, United KingdomDepartment of Psychiatry, University of Oxford, Oxford, United KingdomAbstractBackground.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.https://www.cambridge.org/core/product/identifier/S0924933820000401/type/journal_articlePredictionprisonrisk factorsscreeningself-harmprediction model |
| spellingShingle | Howard Ryland Charlotte Gould Tristan McGeorge Keith Hawton Seena Fazel Predicting self-harm in prisoners: Risk factors and a prognostic model in a cohort of 542 prison entrants European Psychiatry Prediction prison risk factors screening self-harm prediction model |
| title | Predicting self-harm in prisoners: Risk factors and a prognostic model in a cohort of 542 prison entrants |
| title_full | Predicting self-harm in prisoners: Risk factors and a prognostic model in a cohort of 542 prison entrants |
| title_fullStr | Predicting self-harm in prisoners: Risk factors and a prognostic model in a cohort of 542 prison entrants |
| title_full_unstemmed | Predicting self-harm in prisoners: Risk factors and a prognostic model in a cohort of 542 prison entrants |
| title_short | Predicting self-harm in prisoners: Risk factors and a prognostic model in a cohort of 542 prison entrants |
| title_sort | predicting self harm in prisoners risk factors and a prognostic model in a cohort of 542 prison entrants |
| topic | Prediction prison risk factors screening self-harm prediction model |
| url | https://www.cambridge.org/core/product/identifier/S0924933820000401/type/journal_article |
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