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Background. Self-harm is common in prisoners. There is an association between self-harm in prisoners and subsequent suicide, both within prison and on release. The aim of this study is to develop and evaluate a prediction model to identify male prisoners at high risk of self-harm. Methods. We developed an 11-item screening model, based on risk factors identified from the literature. This screen was administered to 542 prisoners within 7 days of arrival in two male prisons in England. Participants were followed up for 6 months to identify those who subsequently self-harmed in prison. Analysis was conducted using Cox proportional hazard regression. Discrimination and calibration were determined for the model. The model was subsequently optimized using multivariable analysis, weighting variables, and dropping poorly performing items. Results. Seventeen (3.1%) of the participants self-harmed during follow up (median 53days). The strongest risk factors were previous self-harm in prison (adjusted hazard ratio [aHR] = 9.3 [95% CI: 3.3-16.6]) and current suicidal ideation (aHR= 7.6 [2.1-27.4]). As a continuous score, a one-point increase in the suicide screen was significantly associated with self-harm(HR=1.4, 1.1-1.7). At the prespecified cut off score of 5, the screening model was associated with an area under the curve (AUC) of 0.66 (0.53-0.79), with poor calibration. The optimized model saw two items dropped fromthe original screening tool, weighting of risk factors based on amultivariablemodel, and an AUC of 0.84 (0.76-0.92). Conclusions. Further work is necessary to clarify the association between risk factors and selfharm in prison. Despite good face validity, current screening tools for self-harm need validation in new prison samples. [ABSTRACT FROM AUTHOR]

Self-inflicted deaths in prisons in England and Wales, recently reported as the highest in over a decade, are a significant cause of mortality. A lack of guidelines surrounding the screening and identification of suicide risk of new prisoners along with a dearth of effective screening tools indicate the need for review. Our aims are to examine findings on the effectiveness of prison specific suicide screening tools used with adult prisoners. Papers were identified via systematic searches of databases, scanning grey literature, and reference checking. Included studies were published over the period between 2000-2016. PRISMA guidelines were followed. Studies were selected based on population - adult imprisoned offenders; intervention - suicide screening tool; comparators - participants screened vs. not screened outcome - suicide or attempted suicide. Data was extracted manually. A narrative synthesis presented the findings between different screening tools. Eight screening tools were critically appraised. Evidence suggested that the VISCI and Dutch screening tools are most effective in identifying those at risk and reducing suicide and/or self-harm behavior. Variance in methodological quality and associated factors indicate the need for further development of prospective studies to develop robust screening tools. This study is registered with PROSPERO (CRD42016035471). [ABSTRACT FROM AUTHOR]