The predictive validity of the Depression Hopelessness Suicide screening form for self-harm among prisoners

Abstract

The Depression Hopelessness Suicide Screening Form (DHS) includes 12 ‘critical items’, which have not been validated for the prospective prediction of self-harm. We conducted a retrospective cohort study (N = 4196) to validate the ability of the DHS critical items to prospectively predict inmates with at least one incident of self-harm during the first six months of imprisonment. While the critical items were highly sensitive (89.5%) at predicting incidents of self-harm, 51.3% of the inmates endorsed at least one item. Five items reflecting more recent and specific risk factors reduced the referral rate to 17.7%, while maintaining high sensitivity (84.2%). While the DHS has high sensitivity to predict inmates at risk of self-harm, treating all items as equally critical results in excessive numbers of false positives that likely exceed the capacity of prison resources for professional assessment and intervention. Referral rules based on recency and specificity of risk factors are proposed.

Keywords:

• deliberate self-harm
• suicide
• prisons
• mass screening

Acknowledgements

The first author is supported by a Vanier Canada Graduate Scholarship, and was previously supported by Canadian Institutes of Health Research Training Fellowship through the Social Aetiology of Mental Illness Training Program. Dr Colman is supported by the Canada Research Chairs program. This research was supported by CSC who provided access to data. However, CSC had no role in the conduct of the study. The views expressed are those of the authors, and do not necessarily reflect the views of the department or the Government of Canada.

Notes

1. Twenty-six inmates were released prior to 180 days, most of whom were released in the first 30 days.