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Self-harm before and during imprisonment: cohort study of males in prison linking population-based routinely collected data in Wales

Marcos del Pozo Banos Orcid Logo, Mark Atkinson Orcid Logo, Sze Chim Lee Orcid Logo, Ann John Orcid Logo

BJPsych Open, Volume: 12, Issue: 1, Start page: e10

Swansea University Authors: Marcos del Pozo Banos Orcid Logo, Mark Atkinson Orcid Logo, Sze Chim Lee Orcid Logo, Ann John Orcid Logo

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DOI (Published version): 10.1192/bjo.2025.10898

Abstract

Background: Self-harm among UK prisoners has risen over the past decade. Aims: To explore self-harm risk factors and mental health conditions in prisoners, pre- and during imprisonment, compared with the general population. Method: This retrospective cohort study linked electronic health records and...

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Published in: BJPsych Open
ISSN: 2056-4724
Published: Cambridge University Press (CUP) 2026
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Aims: To explore self-harm risk factors and mental health conditions in prisoners, pre- and during imprisonment, compared with the general population. Method: This retrospective cohort study linked electronic health records and Ministry of Justice data for Welsh male prisoners (2019), and a comparison general population cohort. We examined imprisonment likelihood based on prior self-harm and mental health conditions using logistic regression. We also studied self-harm risk up to three years during imprisonment through Generalised Estimating Equations and time-stratified Cox regression, using a pre-imprisonment comparator (3 years before). Results: Prisoners (N = 6095) had higher rates of self-harm and mental health conditions pre-imprisonment compared with non-prisoners (e.g. self-harm odds ratio: 2.1 (1.9, 2.2)). Self-harm risk was 5.25&#x2013;6.47 times higher in prisoners than non-prisoners, both pre- and during imprisonment. Risk was highest shortly after incarceration, then declined, becoming lower than pre-imprisonment after 7 months. While most conditions correlated with higher self-harm risk during imprisonment (e.g. drug use, hazard ratios: 1.5&#x2013;3.0), some (e.g. depression and alcohol use) showed weaker links in prisoners than non-prisoners, particularly from 7 months after imprisonment. Self-harm risk was seemingly higher in prisoners on remand compared with those sentenced. Conclusions: Pre-imprisonment, self-harm in male prisoners is already high compared with the general population, potentially driving a saturation effect, where known general population risk factors have a weaker effect in prisoners. Self-harm prevention should target people in contact with criminal justice, irrespective of imprisonment. In prisons, prevention efforts deployed at inception should target those with prior self-harm, drug use, learning difficulties, bipolar disorder and those on remand.</abstract><type>Journal Article</type><journal>BJPsych Open</journal><volume>12</volume><journalNumber>1</journalNumber><paginationStart>e10</paginationStart><paginationEnd/><publisher>Cambridge University Press (CUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2056-4724</issnElectronic><keywords>Data linkage, mental health, prisoners, routinely collected data, self-harm</keywords><publishedDay>1</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2026</publishedYear><publishedDate>2026-01-01</publishedDate><doi>10.1192/bjo.2025.10898</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>This study has been carried out as part of the Administrative Data Research (ADR) Wales programme of work. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation)-funded ADR UK (grant ES/S007393/1). A.J. and M.D.P.-B. were also funded by the Medical Research Council and Health Data Research UK (Grant DATAMIND: Data Hub for Mental Health Informatics Research Development, with Ref.: MR/W014386/1) and by Health and Care Research Wales (Grant NCSSHP: National Centre for Suicide and Self-Harm Prevention).</funders><projectreference/><lastEdited>2025-12-19T15:00:59.0653875</lastEdited><Created>2025-10-16T12:56:41.5745900</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Marcos</firstname><surname>del Pozo Banos</surname><orcid>0000-0003-1502-389X</orcid><order>1</order></author><author><firstname>Mark</firstname><surname>Atkinson</surname><orcid>0000-0003-4237-3588</orcid><order>2</order></author><author><firstname>Sze Chim</firstname><surname>Lee</surname><orcid>0000-0001-5822-6633</orcid><order>3</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>4</order></author></authors><documents><document><filename>70702__35876__80dfae97336a4bda8fe069ded140d912.pdf</filename><originalFilename>70702.VOR.pdf</originalFilename><uploaded>2025-12-19T14:58:42.8714952</uploaded><type>Output</type><contentLength>400165</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2025-12-19T15:00:59.0653875 v2 70702 2025-10-16 Self-harm before and during imprisonment: cohort study of males in prison linking population-based routinely collected data in Wales f141785b1c0ab9efe45665d35c081b84 0000-0003-1502-389X Marcos del Pozo Banos Marcos del Pozo Banos true false 8f85ae301cc97a48eaf58fe343c5a797 0000-0003-4237-3588 Mark Atkinson Mark Atkinson true false 10628af4988d624b49c4de7bd78b4694 0000-0001-5822-6633 Sze Chim Lee Sze Chim Lee true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2025-10-16 MEDS Background: Self-harm among UK prisoners has risen over the past decade. Aims: To explore self-harm risk factors and mental health conditions in prisoners, pre- and during imprisonment, compared with the general population. Method: This retrospective cohort study linked electronic health records and Ministry of Justice data for Welsh male prisoners (2019), and a comparison general population cohort. We examined imprisonment likelihood based on prior self-harm and mental health conditions using logistic regression. We also studied self-harm risk up to three years during imprisonment through Generalised Estimating Equations and time-stratified Cox regression, using a pre-imprisonment comparator (3 years before). Results: Prisoners (N = 6095) had higher rates of self-harm and mental health conditions pre-imprisonment compared with non-prisoners (e.g. self-harm odds ratio: 2.1 (1.9, 2.2)). Self-harm risk was 5.25–6.47 times higher in prisoners than non-prisoners, both pre- and during imprisonment. Risk was highest shortly after incarceration, then declined, becoming lower than pre-imprisonment after 7 months. While most conditions correlated with higher self-harm risk during imprisonment (e.g. drug use, hazard ratios: 1.5–3.0), some (e.g. depression and alcohol use) showed weaker links in prisoners than non-prisoners, particularly from 7 months after imprisonment. Self-harm risk was seemingly higher in prisoners on remand compared with those sentenced. Conclusions: Pre-imprisonment, self-harm in male prisoners is already high compared with the general population, potentially driving a saturation effect, where known general population risk factors have a weaker effect in prisoners. Self-harm prevention should target people in contact with criminal justice, irrespective of imprisonment. In prisons, prevention efforts deployed at inception should target those with prior self-harm, drug use, learning difficulties, bipolar disorder and those on remand. Journal Article BJPsych Open 12 1 e10 Cambridge University Press (CUP) 2056-4724 Data linkage, mental health, prisoners, routinely collected data, self-harm 1 1 2026 2026-01-01 10.1192/bjo.2025.10898 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) This study has been carried out as part of the Administrative Data Research (ADR) Wales programme of work. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation)-funded ADR UK (grant ES/S007393/1). A.J. and M.D.P.-B. were also funded by the Medical Research Council and Health Data Research UK (Grant DATAMIND: Data Hub for Mental Health Informatics Research Development, with Ref.: MR/W014386/1) and by Health and Care Research Wales (Grant NCSSHP: National Centre for Suicide and Self-Harm Prevention). 2025-12-19T15:00:59.0653875 2025-10-16T12:56:41.5745900 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Marcos del Pozo Banos 0000-0003-1502-389X 1 Mark Atkinson 0000-0003-4237-3588 2 Sze Chim Lee 0000-0001-5822-6633 3 Ann John 0000-0002-5657-6995 4 70702__35876__80dfae97336a4bda8fe069ded140d912.pdf 70702.VOR.pdf 2025-12-19T14:58:42.8714952 Output 400165 application/pdf Version of Record true © The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence. true eng https://creativecommons.org/licenses/by/4.0/
title Self-harm before and during imprisonment: cohort study of males in prison linking population-based routinely collected data in Wales
spellingShingle Self-harm before and during imprisonment: cohort study of males in prison linking population-based routinely collected data in Wales
Marcos del Pozo Banos
Mark Atkinson
Sze Chim Lee
Ann John
title_short Self-harm before and during imprisonment: cohort study of males in prison linking population-based routinely collected data in Wales
title_full Self-harm before and during imprisonment: cohort study of males in prison linking population-based routinely collected data in Wales
title_fullStr Self-harm before and during imprisonment: cohort study of males in prison linking population-based routinely collected data in Wales
title_full_unstemmed Self-harm before and during imprisonment: cohort study of males in prison linking population-based routinely collected data in Wales
title_sort Self-harm before and during imprisonment: cohort study of males in prison linking population-based routinely collected data in Wales
author_id_str_mv f141785b1c0ab9efe45665d35c081b84
8f85ae301cc97a48eaf58fe343c5a797
10628af4988d624b49c4de7bd78b4694
ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv f141785b1c0ab9efe45665d35c081b84_***_Marcos del Pozo Banos
8f85ae301cc97a48eaf58fe343c5a797_***_Mark Atkinson
10628af4988d624b49c4de7bd78b4694_***_Sze Chim Lee
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Marcos del Pozo Banos
Mark Atkinson
Sze Chim Lee
Ann John
author2 Marcos del Pozo Banos
Mark Atkinson
Sze Chim Lee
Ann John
format Journal article
container_title BJPsych Open
container_volume 12
container_issue 1
container_start_page e10
publishDate 2026
institution Swansea University
issn 2056-4724
doi_str_mv 10.1192/bjo.2025.10898
publisher Cambridge University Press (CUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
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description Background: Self-harm among UK prisoners has risen over the past decade. Aims: To explore self-harm risk factors and mental health conditions in prisoners, pre- and during imprisonment, compared with the general population. Method: This retrospective cohort study linked electronic health records and Ministry of Justice data for Welsh male prisoners (2019), and a comparison general population cohort. We examined imprisonment likelihood based on prior self-harm and mental health conditions using logistic regression. We also studied self-harm risk up to three years during imprisonment through Generalised Estimating Equations and time-stratified Cox regression, using a pre-imprisonment comparator (3 years before). Results: Prisoners (N = 6095) had higher rates of self-harm and mental health conditions pre-imprisonment compared with non-prisoners (e.g. self-harm odds ratio: 2.1 (1.9, 2.2)). Self-harm risk was 5.25–6.47 times higher in prisoners than non-prisoners, both pre- and during imprisonment. Risk was highest shortly after incarceration, then declined, becoming lower than pre-imprisonment after 7 months. While most conditions correlated with higher self-harm risk during imprisonment (e.g. drug use, hazard ratios: 1.5–3.0), some (e.g. depression and alcohol use) showed weaker links in prisoners than non-prisoners, particularly from 7 months after imprisonment. Self-harm risk was seemingly higher in prisoners on remand compared with those sentenced. Conclusions: Pre-imprisonment, self-harm in male prisoners is already high compared with the general population, potentially driving a saturation effect, where known general population risk factors have a weaker effect in prisoners. Self-harm prevention should target people in contact with criminal justice, irrespective of imprisonment. In prisons, prevention efforts deployed at inception should target those with prior self-harm, drug use, learning difficulties, bipolar disorder and those on remand.
published_date 2026-01-01T05:33:30Z
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