Environmental risk factors for self-harm during imprisonment: A pilot prospective cohort study
Introduction: Self-harm is a major public health issue in the imprisoned population. Limited high-quality evidence exists for the potential impact of prison environmental factors such as solitary confinement. This exploratory pilot prospective cohort study in a large male remand prison in England so...
| Main Authors: | , , , , , |
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| Format: | Journal article |
| Language: | English |
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Public Library of Science
2025
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| _version_ | 1824459286702456832 |
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| author | Stephenson, T Harris, I Armstrong, C Fazel, S Short, R Blackwood, N |
| author_facet | Stephenson, T Harris, I Armstrong, C Fazel, S Short, R Blackwood, N |
| author_sort | Stephenson, T |
| collection | OXFORD |
| description | Introduction: Self-harm is a major public health issue in the imprisoned population. Limited high-quality evidence exists for the potential impact of prison environmental factors such as solitary confinement. This exploratory pilot prospective cohort study in a large male remand prison in England sought to estimate effect sizes for a comprehensive range of prison environmental factors in relation to self-harming behaviours. Methods: A random sample of all prisoners (N = 149) starting a period of imprisonment at the study prison took part in a clinical research interview, which assessed a range of known risk factors for self-harm in prison. Information concerning environmental factors, including staff numbers, cell placement and movements, and engagement in work and activities were collected from prison records. Incidents of self-harm behaviour in the 3 months after entering prison were measured using medical records and self-report at end of follow-up. Multivariable logistic regression models were calculated individually for each predictor. Results: 55.7% of participants completed follow-up (83/149). Single cell placement (OR 4.31, 95% CI 1.06–18.24, p = 0.041) and more frequent changes of cellmate (OR 1.52, CI 1.14–2.17, p = 0.009) and cell (OR 1.83, 95% CI 1.28–2.86, p = 0.003) were associated with an increased risk of self-harming behaviour. Time spent in areas with a higher number of prisoners per member of prison staff was significantly associated with reduced self-harm behaviour in adjusted models (OR 0.89, CI 0.78–0.99, p = 0.039). Following sensitivity analyses, the associations between frequent cell changes and self-harm behaviour, and between single cell placement and self-harm ideation, remained statistically significant. Discussion: This exploratory pilot study provides prospective longitudinal data regarding relationships between prison environmental factors and self-harm behaviour. Findings regarding single cell accommodation and frequent cell changes are consistent with the prior evidence base largely derived from case-control study data. The finding regarding frequent cellmate changes predicting self-harm is novel. Findings regarding prisoner-staff ratio and self-harm most likely reflect a reverse causal relationship. Replication in larger cohort studies is required to address the limitations of this pilot study. |
| first_indexed | 2025-02-19T04:39:23Z |
| format | Journal article |
| id | oxford-uuid:57ee7cd9-23cd-4921-a139-b253815bec58 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2025-02-19T04:39:23Z |
| publishDate | 2025 |
| publisher | Public Library of Science |
| record_format | dspace |
| spelling | oxford-uuid:57ee7cd9-23cd-4921-a139-b253815bec582025-02-13T20:07:55ZEnvironmental risk factors for self-harm during imprisonment: A pilot prospective cohort studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:57ee7cd9-23cd-4921-a139-b253815bec58EnglishJisc Publications RouterPublic Library of Science2025Stephenson, THarris, IArmstrong, CFazel, SShort, RBlackwood, NIntroduction: Self-harm is a major public health issue in the imprisoned population. Limited high-quality evidence exists for the potential impact of prison environmental factors such as solitary confinement. This exploratory pilot prospective cohort study in a large male remand prison in England sought to estimate effect sizes for a comprehensive range of prison environmental factors in relation to self-harming behaviours. Methods: A random sample of all prisoners (N = 149) starting a period of imprisonment at the study prison took part in a clinical research interview, which assessed a range of known risk factors for self-harm in prison. Information concerning environmental factors, including staff numbers, cell placement and movements, and engagement in work and activities were collected from prison records. Incidents of self-harm behaviour in the 3 months after entering prison were measured using medical records and self-report at end of follow-up. Multivariable logistic regression models were calculated individually for each predictor. Results: 55.7% of participants completed follow-up (83/149). Single cell placement (OR 4.31, 95% CI 1.06–18.24, p = 0.041) and more frequent changes of cellmate (OR 1.52, CI 1.14–2.17, p = 0.009) and cell (OR 1.83, 95% CI 1.28–2.86, p = 0.003) were associated with an increased risk of self-harming behaviour. Time spent in areas with a higher number of prisoners per member of prison staff was significantly associated with reduced self-harm behaviour in adjusted models (OR 0.89, CI 0.78–0.99, p = 0.039). Following sensitivity analyses, the associations between frequent cell changes and self-harm behaviour, and between single cell placement and self-harm ideation, remained statistically significant. Discussion: This exploratory pilot study provides prospective longitudinal data regarding relationships between prison environmental factors and self-harm behaviour. Findings regarding single cell accommodation and frequent cell changes are consistent with the prior evidence base largely derived from case-control study data. The finding regarding frequent cellmate changes predicting self-harm is novel. Findings regarding prisoner-staff ratio and self-harm most likely reflect a reverse causal relationship. Replication in larger cohort studies is required to address the limitations of this pilot study. |
| spellingShingle | Stephenson, T Harris, I Armstrong, C Fazel, S Short, R Blackwood, N Environmental risk factors for self-harm during imprisonment: A pilot prospective cohort study |
| title | Environmental risk factors for self-harm during imprisonment: A pilot prospective cohort study |
| title_full | Environmental risk factors for self-harm during imprisonment: A pilot prospective cohort study |
| title_fullStr | Environmental risk factors for self-harm during imprisonment: A pilot prospective cohort study |
| title_full_unstemmed | Environmental risk factors for self-harm during imprisonment: A pilot prospective cohort study |
| title_short | Environmental risk factors for self-harm during imprisonment: A pilot prospective cohort study |
| title_sort | environmental risk factors for self harm during imprisonment a pilot prospective cohort study |
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