Evidence map›Paper›PMID 41022455›Full record

ArticleBMJ open2025

Psychosis and self-harm in prison: a population-based case-control study.

Nabila Z Chowdhury, Ye In Jane Hwang, Erin Spike, Azar Kariminia, Kimberlie Dean, Armita Adily, Andrew Ellis, David M Greenberg, Luke Grant, Stephen Allnutt and 1 more

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Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Nabila Z ChowdhurySchool of Population Health, University of New South Wales, Sydney, New South Wales, Australia nabila.chowdhury1@unsw.edu.au.ORCID http://orcid.org/0000-0002-4023-3760
Ye In Jane HwangSchool of Population Health, University of New South Wales, Sydney, New South Wales, Australia.
Erin SpikeThe Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.ORCID http://orcid.org/0009-0003-4343-1599
Azar KariminiaSchool of Population Health, University of New South Wales, Sydney, New South Wales, Australia.
Kimberlie DeanUniversity of New South Wales, Sydney, New South Wales, Australia.
Armita AdilySchool of Population Health, University of New South Wales, Sydney, New South Wales, Australia.
Andrew EllisJustice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia.
David M GreenbergJustice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia.
Luke GrantCorrective Services New South Wales, Sydney, New South Wales, Australia.
Stephen AllnuttUniversity of New South Wales, Sydney, New South Wales, Australia.
Tony ButlerSchool of Population Health, University of New South Wales, Sydney, New South Wales, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSelf-harm and suicide are common among prison inmates, but less is known about these phenomena in those with psychosis.

objectivesThe aim of this study was to examine self-harm behaviour in New South Wales (NSW) prisons in Australia among inmates diagnosed with psychosis. This study also examined self-harm-related alerts applied by Corrective Services to assist staff with the management of the security and well-being of inmates. DESIGN AND

settingA retrospective case-control data-linkage study was conducted using administrative data collections in NSW, Australia.

participantsThe study included all individuals diagnosed with psychosis and incarcerated between 2001 and 2020 in NSW as cases and an age and sex matched control group with no such diagnosis with a record of incarceration in the same time period. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was self-harm among the cases and controls. The secondary outcome measure was the application of alerts by Corrective Services in relation to self-harm incidents.

resultsMultivariate regression analysis was used to examine predictors of self-harm in prison. Prisoners with psychosis (n=14 900) were more likely to self-harm than controls (n=2713), with 15.0% versus 3.6% engaging in self-harm (highest odds of self-harm observed in those with schizophrenia and related psychoses, aOR=4.84, 95% CI: 3.93 to 5.98). Those of Aboriginal heritage had an increased risk of self-harm (aOR=1.58, 95% CI: 1.43 to 1.75). Factors associated with a lower risk of self-harm were male sex and older age (≥25 years) at the time of their first incarceration. 35.6% of those released from prison with a prior psychosis diagnosis had at least one alert applied during incarceration compared with 10.1% of prisoners without a diagnosis of psychosis. Overall, 35 individuals with psychosis and 1 individual from the control group died while in prison between 2001 and 2020. 17 prison suicides were recorded from the study population; all occurred in the psychosis group.

conclusionsGiven the heightened risk of self-harm in those with histories of psychosis, consideration should be given to sharing mental health information between agencies to improve the care and management of this group during incarceration. Prison alerts may be a useful tool to help staff manage inmates' well-being if used appropriately.

Indexed as

PrisonersPsychotic DisordersSelf-Injurious BehaviorAdultCase-Control StudiesFemaleHumansMaleMiddle AgedNew South WalesPrisonsRetrospective StudiesRisk FactorsYoung AdultForensic psychiatryMENTAL HEALTHSchizophrenia & psychotic disordersSuicide & self-harm

Identifiers

PMID41022455
PMCPMC12481374

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