ArticleBMJ mental health2025
Bridging assessment and treatment for repeat suicidality in prisons: development and validation of a risk model.
Article in BMJ mental health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Understanding barriers and facilitators of implementing a new assessment and bridging tool to support those at risk of repeat self-harm in prison: the qualitative RAPPS study.Health technology assessment (Winchester, England) · 2026Article
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7 authors.
Funding
Abstract
backgroundSuicidal thoughts and behaviours are common in people in prison and associated with poor health outcomes, including suicide, injury and repeat self-harm.
objectiveTo develop and validate a model to stratify risk of repeat suicidality up to 3 months in people in prison.
methodsIn seven English prisons, we identified 754 people aged over 17 who had been placed on a suicide risk management plan after a self-harm episode or elevated risk. We developed a multivariable model to stratify risk of repeat suicidality at 3 months using routinely collected sociodemographic, clinical and prison-related factors, which were tested using Cox proportional HR models. In a prospective validation sample of 390 people from 13 prisons, we tested this model to assess risk of repeat suicidality at 3 months across a range of performance measures.
findingsOf the overall sample of 1144 people in prison (n=966 men or 84%, mean age 33 years), 22% had the outcome of repeat suicidality over 3 months. The final risk model consisted of nine factors, including sex, calendar age and features of recent suicidal behaviour. Calibration and discrimination were similar in both development and validation samples, with O:E ratio=1.09 (95% CI 0.88 to 1.35) and c-statistic=0.66 (95% CI 0.60 to 0.72) in external validation. At a 25% cut-off, sensitivity was 58% (50 to 66) and specificity was 72% (68 to 75) in external validation. The tool (Risk Assessment for people in Prison at risk of Self-harm and Suicide, RAPSS) is available as an online risk calculator at https://oxrisk.com/rapsstrial/.
interpretationA novel assessment approach for repeat suicidality can provide an evidence-based approach to stratify risk and better allocate resources.
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