عنوان انگلیسی مقاله:
Risk factors for self-harm in prison: a systematic review and meta-analysis
ترجمه فارسی عنوان مقاله:
عوامل خطر برای صدمه به خود در زندان: یک بررسی سیستماتیک و فراتحلیل
Sciencedirect - Elsevier - The Lancet Psychiatry, 7 (2020) 682-691. doi:10.1016/S2215-0366(20)30190-5
Louis Favril, Rongqin Yu, Keith Hawton, Seena Fazel
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 selfharm
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.