Horton Mike C, Dyer Wendy, Tennant Alan, Wright Nat M J
Section of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, D Floor, Martin Wing, LGI, LS1 3EX, Leeds, UK.
School of Arts and Social Sciences, Northumbria University, Lipman Building Room 216, Newcastle Upon Tyne, NE1 8ST, UK.
Health Justice. 2018 Sep 21;6(1):18. doi: 10.1186/s40352-018-0076-3.
Prisoners are at increased risk of self-harm and when either intent is expressed, or an act of self-harm carried out, prisoners in the UK are subject to self-harm/suicide monitoring (referred to as "open ACCT" monitoring). However, there is a paucity of validated instruments to identify risk of self-harm in prisoner populations. In response to the need to support prison staff to determine who is at increased risk of self-harm or repeat self-harm, the aim of this study was to determine whether any pre-existing, standardised instruments could usefully identify future self-harm events in prisoners undergoing ACCT monitoring.
A multi-stage prospective cohort study was conducted, where the Prison Screening Questionnaire (PriSnQuest), a modified Borderline Symptom List-23 (BSL-23), Self-Harm Inventory (SHI), Patient Health Questionnaire-9 (PHQ-9) and Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) instruments were administered to prisoners aged 18 and above, who were judged to be at an increased risk of self-harm (on open ACCT monitoring) during the recruitment phase. A 6-month follow-up determined self-harm occurrence since baseline, and Area-Under-the-Curve (AUC) analysis examined the ability of the instruments to predict future self-harm.
Prison records established that 29.1% self-harmed during the follow up period, involving a total of 423 self-harm events reported from 126 individuals, followed up for 66,789 prisoner days (median 167 days; IQR 71-207.5 days). This translated to an 'event incidence' of 6.33 per 1000 prisoner days of those who had been placed upon an ACCT, or 'prisoner incidence' of 1.89 per 1000 days, with considerable variation for both gender and participating prisons. None of the summary scores derived from the selected instruments showed a meaningful ability to predict self-harm, however, exploratory logistic regression analysis of individual background and instrument items revealed gender-specific item sets which were statistically significant in predicting future self-harm.
Prospective self-harm was not predicted by any of the pre-existing instruments that were under consideration. Exploratory logistic regression analysis did reveal gender-specific item sets, producing predictive algorithms which were statistically significant in predicting future self-harm; however, the operational functionality of these item sets may be limited.
囚犯自残风险较高，在英国，一旦有自残意图表达或发生自残行为，囚犯就会受到自残/自杀监测（称为“开放式ACCT”监测）。然而，缺乏经过验证的工具来识别囚犯群体中的自残风险。为了满足支持监狱工作人员确定谁有更高自残或重复自残风险的需求，本研究的目的是确定是否有任何现有的标准化工具能够有效识别接受ACCT监测的囚犯未来的自残事件。
进行了一项多阶段前瞻性队列研究，向18岁及以上、在招募阶段被判定有更高自残风险（处于开放式ACCT监测）的囚犯发放监狱筛查问卷（PriSnQuest）、改良版边缘症状清单-23（BSL-23）、自残量表（SHI）、患者健康问卷-9（PHQ-9）和常规评估临床结果-结果测量（CORE-OM）工具。6个月的随访确定了自基线以来的自残发生情况，曲线下面积（AUC）分析检验了这些工具预测未来自残的能力。
监狱记录显示，在随访期间29.1%的人有自残行为，共报告了来自126人的423起自残事件，随访了66789个囚犯日（中位数167天；四分位间距71 - 207.5天）。这相当于被置于ACCT监测的人每1000个囚犯日的“事件发生率”为6.33，或每1000天的“囚犯发生率”为1.89，性别和参与研究的监狱之间差异很大。从所选工具得出的汇总分数均未显示出有意义的预测自残的能力，然而，对个体背景和工具项目的探索性逻辑回归分析揭示了特定性别的项目集，这些项目集在预测未来自残方面具有统计学意义。
所考虑的任何现有工具均未预测到前瞻性自残情况。探索性逻辑回归分析确实揭示了特定性别的项目集，生成了在预测未来自残方面具有统计学意义的预测算法；然而，这些项目集的操作功能可能有限。
