Environmental risk factors for self-harm during imprisonment: a prospective cohort study
<p><strong>Introduction </strong></p>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 pilot prospective cohort study in a lar...
| Main Authors: | , , , , , |
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| Format: | Internet publication |
| Language: | English |
| Published: |
2024
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| _version_ | 1824459189990195200 |
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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 | <p><strong>Introduction </strong></p>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 pilot prospective cohort study in a large male remand prison in England sought to estimate effect sizes of a comprehensive range of prison environmental factors on self-harming behaviours.
<p><strong>
Methods </strong></p>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.
<p><strong>
Results </strong></p>Single cell placement (OR 4.31, 95% CI 1.06-18.24, p=0.041) and more frequent 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) changes were associated with an increased risk of self-harming behaviour. Unexpectedly, a lower staff-to-prisoner ratio (OR 0.89, CI 0.78-0.99, p=0.039) was also associated with an increased risk of self-harming behaviour. 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.
<p><strong>
Discussion </strong></p>This 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 staff-prisoner 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 | 2025-02-19T04:37:50Z |
| format | Internet publication |
| id | oxford-uuid:61f11a20-f83c-4076-b1b8-dca49a829bfd |
| institution | University of Oxford |
| language | English |
| last_indexed | 2025-02-19T04:37:50Z |
| publishDate | 2024 |
| record_format | dspace |
| spelling | oxford-uuid:61f11a20-f83c-4076-b1b8-dca49a829bfd2025-02-06T12:26:20ZEnvironmental risk factors for self-harm during imprisonment: a prospective cohort studyInternet publicationhttp://purl.org/coar/resource_type/c_7ad9uuid:61f11a20-f83c-4076-b1b8-dca49a829bfdEnglishSymplectic Elements2024Stephenson, THarris, IArmstrong, CFazel, SShort, RBlackwood, N<p><strong>Introduction </strong></p>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 pilot prospective cohort study in a large male remand prison in England sought to estimate effect sizes of a comprehensive range of prison environmental factors on self-harming behaviours. <p><strong> Methods </strong></p>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. <p><strong> Results </strong></p>Single cell placement (OR 4.31, 95% CI 1.06-18.24, p=0.041) and more frequent 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) changes were associated with an increased risk of self-harming behaviour. Unexpectedly, a lower staff-to-prisoner ratio (OR 0.89, CI 0.78-0.99, p=0.039) was also associated with an increased risk of self-harming behaviour. 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. <p><strong> Discussion </strong></p>This 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 staff-prisoner 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 prospective cohort study |
| title | Environmental risk factors for self-harm during imprisonment: a prospective cohort study |
| title_full | Environmental risk factors for self-harm during imprisonment: a prospective cohort study |
| title_fullStr | Environmental risk factors for self-harm during imprisonment: a prospective cohort study |
| title_full_unstemmed | Environmental risk factors for self-harm during imprisonment: a prospective cohort study |
| title_short | Environmental risk factors for self-harm during imprisonment: a prospective cohort study |
| title_sort | environmental risk factors for self harm during imprisonment a prospective cohort study |
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