Inmates have higher rates of a history of suicide attempts (SA) and deliberate self harm (DSH) and, in general, higher rates of suicide than the general population. Also, male inmates engage in more severe forms of the behavior than females. The aim of the current study was to profile male inmate population with a history of SA and/or DSH, on characteristics from across key domains, according to a coherent theoretical framework. The first research priority was to examine the key characteristics which were associated with self-harm, and the predictors of self-harm, in a male inmate population. The second priority was to examine whether there were similarities/differences among the self-harm groups. The lack of confirmation of the risk factors for self-harm may be due to the lack of an effective diagnostic classification system. Three key nomenclatures of SA and DSH were, therefore, explored in Chapter Two in terms of eight areas of difficulty in classification to inform the approach to definition in the current study. In Chapter Three, eight theories of SA, DSH and which referred to SA and/or DSH were reviewed, to determine a theoretical framework for application in an examination of 64 characteristics from across four domains. The four domains were static (e.g., socio-demographic, criminal), trait (e.g., personality disorder), environmental (e.g., social support) and current/state psychological (e.g., depression). A comprehensive clinical assessment and file review was conducted on 87 male inmates with a history of SA and/or DSH who were not currently at risk of suicide or DSH. The self-harm and comparison group were compared in Chapter Seven, and found to differ significantly across the four domains, particularly on psychological characteristics. The self-harm group was associated with childhood trauma, violent offences, institutional misconduct and lower levels of social support significantly more than the comparison group. Being single, childhood abuse, impulsivity, Antisocial Personality Disorder and global psychopathology were the five key predictors, based on multivariate analysis, that contributed to 87.4 per cent of all cases being correctly classified. The three self-harm groups were compared in Chapter Eight with each other, and with the comparison group. The co-existing SA/DSH group was found to differ from the SA group on 18 characteristics, and the DSH group on 10 characteristics. The two DSH groups differed from the SA group on young age, young age of first offending, Borderline Personality Disorder, methadone, global psychopathology and two psychiatric disorders. The differences were that the co-existing SA/DSH group had the highest levels of criminality, trait (e.g., anxiety, neuroticism), and state disturbance (e.g., anxiety, depression), in comparison with the SA group. The DSH group had higher levels of Antisocial Personality Disorder and Drug Abuse Disorder. The co-existing SA/DSH and DSH groups differed from the comparison group on a similar number of characteristics to those which differed in the comparison of the self-harm and comparison group albeit with some additional significant factors (i.e., Aboriginality, unemployment, escape history). The SA group differed from the comparison group on only two factors (suicide ideation, childhood physical abuse), which has implications for risk assessment as this group was the most difficult to detect. The highest levels of trait and state disturbance, and criminality, were associated with the co-existing SA/DSH group. The behavioural characteristics of SA and DSH profiled in Chapter Nine showed that the co-existing SA/DSH group had the highest levels of behavioural disturbance. Four behavioural characteristics were associated with DSH which were: severe and recent SA and DSH; highly frequent DSH; use of multiple methods of DSH; co-existing SA/DSH. The implications for risk identification were consistent with the policy to screen broadly before gathering comprehensive information. A combination of static and proximal risk factors were likely to be important in the development of screening protocols. Also, it was recommended that comprehensive risk assessment involve a detailed behavioral assessment and diagnostic screening. This assessment, and the full diagnostic assessment, will inform the referral and treatment pathway planning. There were a number of research and practical application recommendations made. These are detailed in Chapter Ten and include: offence specific programs, and substance abuse programs, may be efficacious in inmates with DSH; programs which focus on mood management skills may reduce co-existing SA/DSH; non-specific interventions may be delivered by correctional staff; conjoint correctional and health intensive behavioural and mental health programs may be required for those with complex presentations.
| Date of Award | 2014 |
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| Original language | English |
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