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Predicting self-harm in prisoners: risk factors and a prognostic model in a cohort of 542 prison entrants
European Psychiatry ( IF 7.8 ) Pub Date : 2020-01-01 , DOI: 10.1192/j.eurpsy.2020.40
Howard Ryland 1 , Charlotte Gould 2 , Tristan McGeorge 3 , Keith Hawton 1 , Seena Fazel 1
Affiliation  

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.

中文翻译:

预测囚犯的自我伤害:风险因素和 542 名入狱者队列的预后模型

背景。自残在囚犯中很常见。囚犯的自残与随后的自杀之间存在关联,无论是在监狱内还是在释放时。本研究的目的是开发和评估一个预测模型,以识别具有高自残风险的男性囚犯。方法。我们根据文献中确定的风险因素开发了一个 11 项筛选模型。在抵达英格兰的两所男性监狱后的 7 天内,对 542 名囚犯进行了筛查。参与者接受了为期 6 个月的随访,以确定随后在监狱中自残的人。使用 Cox 比例风险回归进行分析。确定模型的鉴别和校准。该模型随后使用多变量分析、加权变量和删除表现不佳的项目进行了优化。结果。17 名 (3.1%) 的参与者在随访期间(中位数 53 天)自残。最强的风险因素是之前在监狱中自残(调整后的风险比 [aHR] = 9.3 [95% CI:3.3-16.6])和当前的自杀意念(aHR = 7.6 [2.1-27.4])。作为连续得分,自杀筛查增加一分与自残显着相关(HR = 1.4、1.1-1.7)。在预先指定的截止分数 5 处,筛选模型的曲线下面积 (AUC) 为 0.66 (0.53–0.79),校准较差。优化后的模型从原始筛选工具中删除了两个项目,基于多变量模型的风险因素加权,以及 0.84 (0.76–0.92) 的 AUC。结论。需要进一步的工作来澄清风险因素与监狱中自残之间的关联。尽管表面效度很好,
更新日期:2020-01-01
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