Public Library of Science
Browse

Environmental risk factors for self-harm during imprisonment: A pilot prospective cohort study

Posted on 2025-02-04 - 18:40

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.

CITE THIS COLLECTION

DataCite
No result found
or
Select your citation style and then place your mouse over the citation text to select it.

SHARE

email
need help?