Predicting self-harm in prisoners: Risk factors and a prognostic model in a cohort of 542 prison entrants.
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ABSTRACT: 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.
SUBMITTER: Ryland H
PROVIDER: S-EPMC7242092 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundSocial problem-solving is one technique used to help reduce incidence of self-harm. Our study evaluated the feasibility and acceptability of the adaptation and implementation of a brief Problem-Solving Training (PST) intervention to reduce self-harm in prisons.MethodsThe process involved i) adaptation of the training materials using focus groups with prison staff and prisoners, ii) training frontline prison staff to use the skills, and iii) implementation of the skills with prisoners at risk of self-harm. Qualitative interviews were conducted with prison staff, prisoners and field researchers and were analysed using a thematic framework to produce a model of the barriers and facilitators to the process.ResultsWe conducted 43 interviews across three prison sites. The interviews included 19 prison staff, 18 prisoners and six field researcher meetings. The adaptation to the training and intervention materials were well received. The findings identified the need to support training using a collaborative and flexible approach. Prisoner engagement was affected by their own personal circumstances and by a range of contextual issues relating to the prison environment. Implementation of the skills by prison staff were hindered by resource constraints, the prison environment and staff attitudes.ConclusionsWe found that it was feasible to adapt an existing intervention and contextualise it within the prison environment. Although we could train large numbers of staff it was deemed unfeasible for staff to implement the problem-solving skills to prisoners at risk of self-harm. Prisoners who engaged with the intervention reported a range of benefits. Alternative implementation mechanisms to tackle the contextual barriers proposed by staff and prisoners included delivery of the intervention using an educational setting and/or use of a prisoner peer-led scheme.
| S-EPMC6717963 | biostudies-literature
Project description:BACKGROUND:Self-harm is a leading cause of morbidity in prisoners. Although a wide range of risk factors for self-harm in prisoners has been identified, the strength and consistency of effect sizes is uncertain. We aimed to synthesise evidence and assess the risk factors associated with self-harm inside prison. METHODS:In this systematic review and meta-analysis, we searched four electronic databases (PubMed, Embase, Web of Science, and PsycINFO) for observational studies on risk factors for self-harm in prisoners published from database inception to Oct 31, 2019, supplemented through correspondence with authors of studies. We included primary studies involving adults sampled from general prison populations who self-harmed in prison and a comparison group without self-harm in prison. We excluded studies with qualitative or ecological designs, those that reported on lifetime measures of self-harm or on selected samples of prisoners, and those with a comparison group that was not appropriate or not based on general prison populations. Data were extracted from the articles and requested from study authors. Our primary outcome was the risk of self-harm for risk factors in prisoners. We pooled effect sizes as odds ratios (OR) using random effects models for each risk factor examined in at least three distinct samples. We assessed study quality on the basis of the Newcastle-Ottawa Scale and examined between-study heterogeneity. The study protocol was registered with PROSPERO, CRD42018087915. FINDINGS:We identified 35 independent studies from 20 countries comprising a total of 663?735 prisoners, of whom 24?978 (3·8%) had self-harmed in prison. Across the 40 risk factors examined, the strongest associations with self-harm in prison were found for suicide-related antecedents, including current or recent suicidal ideation (OR 13·8, 95% CI 8·6-22·1; I2=49%), lifetime history of suicidal ideation (8·9, 6·1-13·0; I2=56%), and previous self-harm (6·6, 5·3-8·3; I2=55%). Any current psychiatric diagnosis was also strongly associated with self-harm (8·1, 7·0-9·4; I2=0%), particularly major depression (9·3, 2·9-29·5; I2=91%) and borderline personality disorder (9·2, 3·7-22·5; I2=81%). Prison-specific environmental risk factors for self-harm included solitary confinement (5·6, 2·7-11·6; I2=98%), disciplinary infractions (3·5, 1·2-9·7; I2=99%), and experiencing sexual or physical victimisation while in prison (3·2, 2·1-4·8; I2=44%). Sociodemographic (OR range 1·5-2·5) and criminological (1·8-2·3) factors were only modestly associated with self-harm in prison. We did not find clear evidence of publication bias. INTERPRETATION:The wide range of risk factors across clinical and custody-related domains underscores the need for a comprehensive, prison-wide approach towards preventing self-harm in prison. This approach should incorporate both population and targeted strategies, with multiagency collaboration between the services for mental health, social care, and criminal justice having a key role. FUNDING:Wellcome Trust.
| S-EPMC7606912 | biostudies-literature
Project description:BackgroundSelf-harm, including suicide, is common among prisoners. Staff attitudes and perceptions regarding self-harm may affect quality of care and patient safety.AimsTo systematically review the experiences, perceptions and attitudes of staff in adult prisons regarding self-harm.MethodSystematic searches of EMBASE, Medline, PsycINFO and CINAHL databases were conducted, and supplemented by hand-searching and grey literature review, to identify relevant English-language articles published since the year 2000. Articles were screened by two authors and evaluated with standardised quality appraisal tools. Qualitative data were analysed thematically, whereas quantitative data were narratively synthesised because of high study heterogeneity.ResultsTwo thousand articles were identified, of which 32 were included, involving 6389 participants from five countries. Most studies were moderate (n = 15) or poor (n = 10) quality, and seven were rated as good quality. Staff frequently witnessed self-harm and described multiple perceived risk factors and causes of this. Perceptions that self-harm is 'manipulative' or 'attention-seeking' were associated with hostility toward prisoners and lower quality of care. Perceived barriers to preventing and managing self-harm included low staffing levels, prison environments and culture, poor staff confidence and insufficient training. The importance of multidisciplinary teamwork and building staff-prisoner relationships were highlighted. Staff occasionally experienced intense psychological reactions to self-harm, which resulted in adaptive or maladaptive coping that influenced their capacity to care.ConclusionsThere are mixed attitudes and perceptions toward self-harm among prison staff. Further training, support and resources are required to protect staff's well-being and improve self-harm prevention and management in prisons.
| S-EPMC9230562 | biostudies-literature
Project description:A better understanding of the functioning of the brain, particularly executive functions, of the prison population could aid in reducing crime rates through the reduction of recidivism rates. Indeed, reoffending appears to be related to executive dysfunction and it is known that executive functions are crucial for self-regulation. In the current paper, studies to executive functions in regular adult prisoners compared to non-offender controls were reviewed. Seven studies were found. Specific executive functions were found to be impaired in the general prison population, i.e., attention and set-shifting, as well as in separate subgroups of violent (i.e., set-shifting and working memory) and non-violent offenders (i.e., inhibition, working memory and problem solving). We conclude that the limited number of studies is remarkable, considering the high impact of this population on society and elaborate on the implications of these specific impairments that were found. Further empirical research is suggested, measuring executive functioning within subjects over time for a group of detainees as well as a control group.
| S-EPMC4311616 | biostudies-literature
Project description:BACKGROUND:Depression is a common mental disorder among prisoners characterized by a mood change involving a feeling of sadness, lack of interest, or hopelessness that lasts for weeks, months, or even longer. Besides imprisonment, depression is the primary factor leading to suicidal attempts. However, little is known about the depressive status of prisoners in Ethiopia. Therefore, this study aimed at assessing the magnitude and associated factors of depressive symptoms among prisoners of Debre Berhan prison. METHODS:We conducted an institution-based cross-sectional study. We collected data from 336 randomly selected prisoners using interviewer-administered Patient Health Questionnaire-9 (PHQ-9). We collected the data from May 3 to 28, 2015, and performed binary logistic regression to identify independent predictors of depressive disorder. RESULT:Out of the total of 336 prisoners, 98% (n = 330) were males. Using PHQ-9 at the cut-off point of ≥5, we found the prevalence of depression to be 44% (n = 148). Being widowed (AOR = 6.30; CI: 1.09-36.67), having a college or university level educational status (AOR = 5.34; CI:1.59-17.94), having a history of suicide attempt (AOR = 2.76 CI: 1.04-7.31), having faced severe stressful life events (AOR = 2.57; CI: 1.41-4.67), being sentenced for 5 to 10 years (AOR = 2.51; CI:1.32-4.79), and having a history of chronic medical illness (AOR = 3.32 CI: 1.26-8.75) were found to be independently associated with depressive symptoms. CONCLUSION:There is a high prevalence of depression among prisoners of Debre Berhan prison. Hence, designing strategies for early screening and treatment of depression at prisons is crucial.
| S-EPMC7067449 | biostudies-literature
Project description:BackgroundGlobally, ocular morbidity has emerged as a major public concern with at least 2.2 billion people having vision impairment or blindness. Prisoners (inmates) tend to have limited access to health care especially eye health, and as a result some conditions may go undiagnosed or mismanaged. With the increasing prison population in Uganda and in the face of limited facilities, little is known about the prevalence and factors associated with ocular morbidity amongst inmates of Luzira prison.MethodThis was a descriptive cross-sectional study conducted on inmates of Luzira prison. The study included both male (334) and female (33) inmates using the proportionate stratified random sampling. Data on social demographic characteristics, medical, imprisonment factors and ocular assessment was collected using a questionnaire. All complete data was entered using an Epidata version 3.1 entry template, and logistic regression was used to determine associated factors.ResultsOverall, a total of 367 inmates were examined consisting of 334 (91%) males and 33(8.9%) females. The male-to-female ratio was 10:1 with ages ranging from 18 to 76 years. The mean age being 39 years (SD + 13.4) and the overall ocular morbidity was found to be 49%. The most common ocular morbidity included; presbyopia (27.4%), allergic conjunctivitis (19.6%) and cataracts (11.4%). Other disorders included; refractive errors, pterygia, optic atrophy and vitamin A deficiency. There was a statistically significant relationship between ocular morbidity and age (OR 11.96, CI 0.85-2.74), trauma (OR 5.21, CI 1.52-17.87), non-prison food (OR 0.45, CI 0.26-0.79).ConclusionThe prevalence of ocular morbidity among inmates was found to be high and significantly associated with age, trauma and having meals besides prison food. A fully functional eye unit established within the prison, and timely referral of complicated cases would help in offering quality eye services to the inmates.
| S-EPMC8278745 | biostudies-literature
Project description:BackgroundWith increasing levels of suicide and self-harm behaviour in the criminal justice system professionals would benefit from a tool that can identify individuals who may be at risk of self-harm and/or suicidal behaviour.MethodThe Suicide Concerns for Offenders in the Prison Environment (SCOPE) tool was originally devised and validated in six UK prisons between 2003 and 2004. The goal of this study is to re-evaluate the SCOPE using Rasch methodology to produce a psychometrically robust instrument. Data were presented from 1051 SCOPE assessments of male and female offenders.ResultsThe analysis produced a revised SCOPE-2 tool reducing the tool from a 27 to a 19 items and simplifying the categorical six point scale to a four item scale.ConclusionsFurther validation of the new SCOPE-2 tool is required in samples of male and female prisoners to assess different cut-off points for clinical and policy use.
| S-EPMC7161173 | biostudies-literature
Project description:ObjectivesProblem-solving skills training is adaptable, inexpensive and simple to deliver. However, its application with prisoners who self-harm is unknown. The study assessed the feasibility and acceptability of a problem-solving training (PST) intervention for prison staff and prisoners who self-harm, to inform the design of a large-scale study.Design and settingA mixed-methods design used routinely collected data, individual outcome measures, an economic protocol and qualitative interviews at four prisons in Yorkshire and Humber, UK.Participants(i) Front-line prison staff, (ii) male and female prisoners with an episode of self-harm in the previous 2 weeks.InterventionThe intervention comprised a 1 hour staff training session and a 30 min prisoner session using adapted workbooks and case studies.OutcomesWe assessed the study processes-coverage of training; recruitment and retention rates and adequacy of intervention delivery-and available data (completeness of outcome data, integrity of routinely collected data and access to the National Health Service (NHS) resource information). Prisoner outcomes assessed incidence of self-harm, quality of life and depression at baseline and at follow-up. Qualitative findings are presented elsewhere.ResultsRecruitment was higher than anticipated for staff n=280, but lower for prisoners, n=48. Retention was good with 43/48 (89%) prisoners completing the intervention, at follow-up we collected individual outcome data for 34/48 (71%) of prisoners. Access to routinely collected data was inconsistent. Prisoners were frequent users of NHS healthcare. The additional cost of training and intervention delivery was deemed minimal in comparison to 'treatment as usual'. Outcome measures of self-harm, quality of life and depression were found to be acceptable.ConclusionsThe intervention proved feasible to adapt. Staff training was delivered but on the whole it was not deemed feasible for staff to deliver the intervention. A large-scale study is warranted, but modifications to the implementation of the intervention are required.
| S-EPMC6797432 | biostudies-literature
Project description:BackgroundPositive attitudes towards prisoners are important in securing the effectiveness of various correctional rehabilitation programs and the successful reintegration of prisoners after release. We wanted to investigate the attitudes towards prisoners among prison inmates, prison employees and college students.MethodsThe Attitudes Toward Prisoners scale was completed by 298 inmates in 4 Norwegian prisons, 387 employees working in the same prisons, and 183 college students. In addition, all respondents were asked a number of general questions about prisoners, crime and punishment.ResultsThe study groups differed significantly in their attitudes towards prisoners, as measured by the Attitudes Toward Prisoners scale, with prison inmates holding the most positive attitudes. Prison officers held more negative attitudes than other prison employees. Prison employees working in female-only facilities held more positive attitudes than those working in male-only facilities. Students differed significantly in their attitudes, with those studying business economics holding more negative attitudes than those studying nursing. A number of strong correlations emerged between negative attitudes towards prisoners and more pessimistic and punitive answers on general questions about prisoners, crime and punishment.ConclusionThe attitudes towards prisoners differed markedly among the groups investigated. The findings could have important implications, particularly for the preventive work carried out in our prisons. Whether attitudes toward prisoners can be influenced by educational programs and the dispersion of factual information needs to be investigated.
| S-EPMC1891097 | biostudies-literature
Project description:BackgroundPrisoners generally have a higher prevalence of HIV infection compared to the general population from which they come. Whether this higher prevalence reflects a higher HIV prevalence in those entering prisons or intramural transmission of HIV within prisons or both is unclear. Any of these possibilities would increase the prevalence found in resident prisoners above that in the general population. Moreover, comparisons of HIV prevalence in entrants and residents and in men and women in African prisons are not well documented. The purpose of this study was to estimate and compare the prevalence and risk factors for HIV infection amongst both male as well as female and entrant and resident prisoners in a large Ethiopian Federal Prison.MethodsWe studied consenting prisoners cross-sectionally from August 2014 through November 2016. Prison entrants were screened continuously for HIV infection and its associated risk factors and residents were screened in two waves one year apart. HIV was diagnosed at the prison hospital laboratory based on the Ethiopian national HIV rapid antibody testing protocol. An external, internationally-accredited reference laboratory confirmed results. Agreement of results between the laboratories were assessed.ResultsA total of 10,778 participants were screened for HIV. Most participants were young (median age of 26 years, IQR: 21-33), male (84%), single (61%), literate (89%), and urban residents (91%) without prior incarceration (96%). Prevalence of HIV was 3.4% overall. Rates of HIV (p = 0.80) were similar in residents and entrants in wave 1 and in entrants in both waves, but were 1.9-fold higher (5.4% vs 2.8%) in residents than entrants in wave 2 (both p<0.001). At entrance to the prison women were more likely to be HIV+ than men (5.5% in women vs 2.5% in men, p< 0.001). In contrast resident women were less likely to be HIV+, but this difference was not statistically significant (3.2% in women vs 4.3% in men, p = 0.125). Other risk factors associated with HIV infection were increasing age (p<0.001), female gender (p<0.001), marital status (never vs other categories, p = 0.016), smaller number of rooms in their houses pre-imprisonment (p = 0.031), TB diagnosis ever (p<0.001), number of lifetime sex partners (especially having 2-10, p<0.001), and genital ulcer (p = 0.037).ConclusionsPrevalence of HIV in the residents at this large, central Ethiopian prison was higher than that estimated for the general population and lower than in many other studies from other smaller Ethiopian prisons. A higher prevalence in residents than in entrants were found only in our second wave of screening after one year of continuous screening and treatment, possibly representing increased willingness of residents at increased risk of HIV to participate in the second wave. Thus, this findings did not clearly support intramural transmission of HIV or the effectiveness of screening to reduce prevalence. Finally, the higher HIV prevalence in women than men requires that they be similarly screened and treated for HIV infection.
| S-EPMC9910692 | biostudies-literature