Social Psychiatry and Psychiatric Epidemiology

, Volume 44, Issue 10, pp 853–861 | Cite as

Detecting and predicting self-harm behaviour in prisoners: a prospective psychometric analysis of three instruments

  • Amanda E. Perry
  • Simon Gilbody
Original Paper



Research has revealed high levels of suicide and self-harm within young adult prisoners, but many studies have not considered the applicability and validity of its measurement for both male and female prisoners. Previous studies have focused on retrospective evaluations of instruments which are not useful evidence in informing clinical practice and decision making.


To evaluate the validation and prediction of suicide and self-harm risk in young adult prisoners.


The study was divided into two stages. Stage one used a cross-sectional design of 1,166 prisoners across six HM Prisons to validate the use of three questionnaires: the Beck Depression Inventory, the Beck Hopelessness Scale and a newly devised instrument (SCOPE tool). The second stage assessed the predictive validity of the three instruments using a 4-year-follow-up study of female prisoners across two HM Prisons in UK. Self-report and official records were used to measure suicide and self-harm risk. Logistic regression methodology, receiver operator characteristic curves and Youden’s index were used to determine the range of thresholds for the three tools.


Self-report measurement of suicide and self-harm behaviour using the three instruments presented a range of sensitivity and specificity values (65.9–72.3% and 64.9–74.0%, respectively). Predictive measurement of suicide and self-harm behaviour in the follow-up study presented a range of sensitivity and specificity values (54.6–80% and 62.2–69.4%, respectively).


Screening for self-harm and suicidal behaviour in young prisoners has generated a range of cut off points for the identification of those at risk. These serve as a bench mark for service planners and practitioners.


Screening Suicide Self-harm Prisoners Assessment 



Ethical approval was provided by each Governor at the prisons and the Ethics Committee, Department of Psychology, University of York. The authors would also like to thank the support of Mathew Johnson for his assistance with collecting the follow-up data for this project.

Conflict of interest statement



  1. 1.
    Arboleda-Florez J, Holley HL (1989) Predicting suicide behaviours in incarcerated settings. Can J Psychiatry 34:668–674PubMedGoogle Scholar
  2. 2.
    Beck AT, Ward CH, Mendelson M et al (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571PubMedGoogle Scholar
  3. 3.
    Beck AT, Weissman A, Lester D et al (1974) The measurement of pessimism: The Hopelessness Scale. J Consult Clin Psychol 42:861–865PubMedCrossRefGoogle Scholar
  4. 4.
    Beck AT, Rush AJ, Shaw BF, Emery G (1979) Cognitive therapy of depression. Guildford Press, New YorkGoogle Scholar
  5. 5.
    Beck AT, Steer RA, Brown GK (1996) BDI-II manual, 2nd edn. The Psychological Corporation, San AntonioGoogle Scholar
  6. 6.
    Beck AT, Brown G, Berchick RJ, Stewart BM, Steer RA (1990) Relationship between hopelessness and ultimate suicide. A replication with psychiatric patients. Am J Psychiatry 147:190–195PubMedGoogle Scholar
  7. 7.
    Boothby JL, Durham TW (1999) Screening for depression in prisoners using the Beck Depression Inventory. Crim Justice Behav 26:107–124CrossRefGoogle Scholar
  8. 8.
    Crighton DA, Towl GJ (1997) Self inflicted deaths in prison in England and Wales. An analysis of the data from 1988–1990 and 1994–1995. In: Towl GJ (ed) Suicide and self injury in prisons: issues in criminological and legal psychology. The British Psychological Society, LeicesterGoogle Scholar
  9. 9.
    Dyer JAT, Krietman N (1984) Hopelessness, depression and suicidal intent in parasuicide. Br J Psychiatry 144:127–133PubMedCrossRefGoogle Scholar
  10. 10.
    Frühwald S, Frottier P (2005) Suicide in prison. Lancet 366:1242–1244PubMedCrossRefGoogle Scholar
  11. 11.
    Gray NS, McGleish A, MacCulloch MJ (2003) Prediction of violence and self-harm in mentally disordered offenders: a prospective study of the efficacy of HCR-20, PCL-R and psychiatric symptomatology. J Consult Clin Psychol 71:443–451PubMedCrossRefGoogle Scholar
  12. 12.
    Hawton K, Bergen H, Casey D, Simkin S, Palmer B, Cooper J, Kapur N, Horrock J, House A, Lilley R, Noble R, Owens D (2007) Self-harm in England: a tale of three cities. Soc Psychiatry Psychiatr Epidemiol 42:513–521PubMedCrossRefGoogle Scholar
  13. 13.
    Home Office (1999) Suicide is everyones concern: a thematic review by HM Chief Inspector of Prisons in England and Wales. Research, Development and Statistics Department, LondonGoogle Scholar
  14. 14.
    Howard League for Penal Reform (2006) Prison weekly reports. Accessed on 28th December 2006
  15. 15.
    Lader D, Singleton N, Meltzer H (1998) Psychiatric morbidity among young offenders in England and Wales. Office of National Statistics, LondonGoogle Scholar
  16. 16.
    McMillan D, Gilbody SM, Beresbord E, Neilly L (2007) Can we predict suicide and non-fatal self-harm with the Beck Hopelessness Scale? A meta-analysis. Psychol Med 37:769–778PubMedCrossRefGoogle Scholar
  17. 17.
    O’Loughlin S, Sherwood J (2005) A 20-year review of trends in deliberate self-harm in a British town 1981–2000. Soc Psychiatry Psychiatr Epidemiol 40:446–453PubMedCrossRefGoogle Scholar
  18. 18.
    Palmer EJ, Connelly R (2005) Depression hopelessness and suicide ideation among vulnerable prisoners. Crim Behav Ment Health 15:164–170PubMedCrossRefGoogle Scholar
  19. 19.
    Perry AE (2005) Suicide and self-harm risk in offenders: the development of a new psychometric scale. University of York, PhD ThesisGoogle Scholar
  20. 20.
    Perry AE, Olason DT (2008) A new psychometric instrument assessing vulnerability to risk of suicide and self-harm behaviour in offenders: SCOPE. Int J Offender Ther Comp Criminol. doi:10.1177/0306624x08319418
  21. 21.
    Sackett DL, Haynes RB (2002) Evidence base of clinical diagnosis: the architecture of diagnostic research. Br Med J 324:539–554CrossRefGoogle Scholar
  22. 22.
    Shaw J, Baker D, Hunt IM et al (2004) Suicide by prisoners. National clinical survey. Br J Psychiatry 184:263–267PubMedCrossRefGoogle Scholar
  23. 23.
    Wetzel RD, Marguiles T, Davies R et al (1980) Hopelessness, depression and suicide intent. J Clin Psychiatry 41:159–160PubMedGoogle Scholar
  24. 24.
    White P, Cullen C, Minchris M (1999) Prison population brief. Research Development Statistics. Accessed 28th December 2006
  25. 25.
    Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Centre for Criminal Justice Economics and Psychology, Wentworth CollegeUniversity of YorkYorkUK
  2. 2.Department of Health SciencesUniversity of YorkYorkUK

Personalised recommendations