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Journal Article


Perry AE. Lancet Psychiatry 2020; 7(8): 649-650.


(Copyright © 2020, Elsevier Publishing)






Research has consistently shown that the prevalence of poor mental health among prisoners is considerably higher than that in the community. Mental health services in prisons cite several other vulnerabilities, such as substance misuse problems and poor physical health, and report high rates of self-harm behaviour. In prisons, little is known about the underlying mechanisms for self-harm behaviour and research on this topic is crucial to understand more about how the problem can be addressed. Louis Favril and colleagues reported on the results of a systematic review and meta-analysis of four databases with the aim of identifying risk factors for self-harm in prison.

The research identified 35 independent studies from 20 countries comprising a total of 663 735 prisoners. Favril and colleagues grouped risk factors into five categories: sociodemographic, criminological, custodial, clinical, and historical. 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 (odds ratio 13·8, 95% CI 8·6-22·1), lifetime history of suicidal ideation (8·9, 6·1-13·0), and previous self-harm (6·6, 5·3-8·3). Other strong associations included current psychiatric diagnosis and prison-specific environmental risk factors. Sociodemographic and criminological factors were only modestly associated with self-harm in prison. Many of the identified risk factors are similar to those found for self-harm in the general population. The majority of studies included in the article were case-control studies comparing someone with an incidence of self-harm (a case) to someone with no known history of self-harm behaviour (a control). Only two of the 35 studies were prospective in design. This paucity of prospective studies means that we have sparse research knowledge about how repeat self-harm behaviour in prison is affected by future life events, and how the risk of self-harm can change with the life course of an individual who might pass in and out of prison on many different occasions...

Language: en


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