Bridging Assessment and Treatment for Repeat Suicidality in Prisons: Development and Validation of a Risk Model

Overview

Journal BMJ Ment Health

Specialties Psychiatry
Psychology

Date 2025 Feb 28

PMID 40021209

Authors

Seena Fazel

Leanne Heathcote

Leen Farouki

Jane Senior

Amanda Perry

Thomas R Fanshawe

Jenny Shaw

Affiliations

Soon will be listed here.

Abstract

Background: Suicidal thoughts and behaviours are common in people in prison and associated with poor health outcomes, including suicide, injury and repeat self-harm.

Objective: To develop and validate a model to stratify risk of repeat suicidality up to 3 months in people in prison.

Methods: In 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.

Findings: Of 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/.

Interpretation: A novel assessment approach for repeat suicidality can provide an evidence-based approach to stratify risk and better allocate resources.

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