Self-Harm Following Release from Prison: A Prospective Data Linkage Study
OBJECTIVE:
Prisoners
are at increased risk of both self-harm and suicide compared with the general
population, and the risk of suicide after release from prison is three times
greater than for those still incarcerated. However, surprisingly little is
known about the incidence of self-harm following release from prison. We aimed
to determine the incidence of, identify risk factors for and characterise
emergency department presentations resulting from self-harm in adults after
release from prison.
METHOD:
Cohort
study of 1325 adults interviewed prior to release from prison, linked
prospectively with State correctional and emergency department records. Data
from all emergency department presentations resulting from self-harm were
secondarily coded to characterise these presentations. We used negative
binomial regression to identify independent predictors of such presentations.
RESULTS:
During
3192 person-years of follow-up (median 2.6 years per participant), there were
3755 emergency department presentations. In all, 83 (6.4%) participants
presented due to self-harm, accounting for 165 (4.4%) presentations. The crude
incidence rates of self-harm for males and females were 49.2 (95% confidence
interval: [41.2, 58.7]) and 60.5 (95% confidence interval: [44.9, 81.6]) per
1000 person-years, respectively. Presenting due to self-harm was associated
with being Indigenous (incidence rate ratio: 2.01; 95% confidence interval:
[1.11, 3.62]), having a lifetime history of a mental disorder (incidence rate
ratio: 2.13; 95% confidence interval: [1.19, 3.82]), having previously been
hospitalised for psychiatric treatment (incidence rate ratio: 2.68; 95%
confidence interval: [1.40, 5.14]) and having previously presented due to
self-harm (incidence rate ratio: 3.91; 95% confidence interval: [1.85, 8.30]).
CONCLUSION:
Following
release from prison, one in 15 ex-prisoners presented to an emergency
department due to self-harm, within an average of 2.6 years of release.
Demographic and mental health variables help to identify at-risk groups, and
such presentations could provide opportunities for suicide prevention in this
population. Transition from prison to the community is challenging,
particularly for those with a history of mental disorder; mental health support
during and after release may reduce the risk of adverse outcomes, including
self-harm.
- 1Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia rohan.borschmann@mcri.edu.au.
- 2Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA.
- 3Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.
- 4Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
- 5Queensland Forensic Mental Health Service, QLD, Australia.
- 6Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia.
- 7Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia Griffith Criminology Institute and Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.
- Aust N Z J Psychiatry. 2016 Mar 24. pii: 0004867416640090.
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