{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T01:29:07Z","timestamp":1774315747106,"version":"3.50.1"},"reference-count":26,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["HTA 16\/159\/09"],"award-info":[{"award-number":["HTA 16\/159\/09"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Ment Health"],"accepted":{"date-parts":[[2025,1,10]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Suicidal thoughts and behaviours are common in people in prison and associated with poor health outcomes, including suicide, injury and repeat self-harm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop and validate a model to stratify risk of repeat suicidality up to 3 months in people in prison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In seven English prisons, we identified 754 people aged over 17 who had been placed on a suicide risk management plan after a self-harm episode or elevated risk. We developed a multivariable model to stratify risk of repeat suicidality at 3 months using routinely collected sociodemographic, clinical and prison-related factors, which were tested using Cox proportional HR models. In a prospective validation sample of 390 people from 13 prisons, we tested this model to assess risk of repeat suicidality at 3 months across a range of performance measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Of the overall sample of 1144 people in prison (n=966 men or 84%, mean age 33 years), 22% had the outcome of repeat suicidality over 3 months. The final risk model consisted of nine factors, including sex, calendar age and features of recent suicidal behaviour. Calibration and discrimination were similar in both development and validation samples, with O:E ratio=1.09 (95% CI 0.88 to 1.35) and c-statistic=0.66 (95% CI 0.60 to 0.72) in external validation. At a 25% cut-off, sensitivity was 58% (50 to 66) and specificity was 72% (68 to 75) in external validation. The tool (Risk Assessment for people in Prison at risk of Self-harm and Suicide, RAPSS) is available as an online risk calculator at\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/oxrisk.com\/rapsstrial\/\">https:\/\/oxrisk.com\/rapsstrial\/<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>A novel assessment approach for repeat suicidality can provide an evidence-based approach to stratify risk and better allocate resources.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjment-2024-301280","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T23:25:48Z","timestamp":1740698748000},"page":"e301280","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Bridging assessment and treatment for repeat suicidality in prisons: development and validation of a risk model"],"prefix":"10.1136","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5383-5365","authenticated-orcid":false,"given":"Seena","family":"Fazel","sequence":"first","affiliation":[{"name":"Department of Psychiatry, University of Oxford, Oxford, UK"},{"name":"Oxford Health NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leanne","family":"Heathcote","sequence":"additional","affiliation":[{"name":"Division of Psychology and Mental Health, University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leen","family":"Farouki","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Senior","sequence":"additional","affiliation":[{"name":"Division of Psychology and Mental Health, University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Perry","sequence":"additional","affiliation":[{"name":"Health Sciences, University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas R","family":"Fanshawe","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenny","family":"Shaw","sequence":"additional","affiliation":[{"name":"Division of Psychology and Mental Health, University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"2026010702305645000_28.1.e301280.1","unstructured":"Ministry of Justice . Safety in Custody Statistics, England and Wales: deaths in prison custody to March 2024; assaults and self-harm to December 2023. 2024. Available: https:\/\/www.gov.uk\/government\/statistics\/safety-in-custody-quarterly-update-to-december-2023\/safety-in-custody-statistics-england-and-wales-deaths-in-prison-custody-to-march-2024-assaults-and-self-harm-to-december-2023 [Accessed 15 May 2024]."},{"key":"2026010702305645000_28.1.e301280.2","unstructured":"Office for Health Improvement and Disparities . Public health profiles: self-harm. 2024. Available: https:\/\/fingertips.phe.org.uk\/search\/self%20harm [Accessed 15 May 2024]."},{"key":"2026010702305645000_28.1.e301280.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2022.102190"},{"key":"2026010702305645000_28.1.e301280.4","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(17)30430-3"},{"key":"2026010702305645000_28.1.e301280.5","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30190-5"},{"key":"2026010702305645000_28.1.e301280.6","doi-asserted-by":"publisher","DOI":"10.1080\/14789949.2010.518245"},{"key":"2026010702305645000_28.1.e301280.7","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2021.101266","article-title":"Interventions to reduce suicidal thoughts and behaviours among people in contact with the criminal justice system: A global systematic review","volume":"44","author":"Carter","year":"2022","journal-title":"EClinicalMedicine"},{"key":"2026010702305645000_28.1.e301280.8","doi-asserted-by":"publisher","DOI":"10.3310\/hta18520"},{"key":"2026010702305645000_28.1.e301280.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.2044-8260.2010.02007.x"},{"key":"2026010702305645000_28.1.e301280.10","doi-asserted-by":"publisher","DOI":"10.1002\/cbm.2103"},{"key":"2026010702305645000_28.1.e301280.11","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(17)30367-X"},{"key":"2026010702305645000_28.1.e301280.12","doi-asserted-by":"publisher","DOI":"10.1037\/ser0000516"},{"key":"2026010702305645000_28.1.e301280.13","doi-asserted-by":"crossref","DOI":"10.1136\/bmjment-2023-300673","article-title":"Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS)","volume":"26","author":"Fazel","year":"2023","journal-title":"BMJ Ment Health"},{"key":"2026010702305645000_28.1.e301280.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62118-2"},{"key":"2026010702305645000_28.1.e301280.15","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(20)30233-4"},{"key":"2026010702305645000_28.1.e301280.16","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g7594","article-title":"Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement","volume":"350","author":"Collins","year":"2015","journal-title":"BMJ"},{"key":"2026010702305645000_28.1.e301280.17","doi-asserted-by":"publisher","DOI":"10.1111\/sltb.12395"},{"key":"2026010702305645000_28.1.e301280.18","doi-asserted-by":"crossref","DOI":"10.1192\/j.eurpsy.2020.40","article-title":"Predicting self-harm in prisoners: Risk factors and a prognostic model in a cohort of 542 prison entrants","volume":"63","author":"Ryland","year":"2020","journal-title":"Eur Psychiatry"},{"key":"2026010702305645000_28.1.e301280.19","doi-asserted-by":"publisher","DOI":"10.1108\/IJPH-12-2021-0115"},{"key":"2026010702305645000_28.1.e301280.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2023.01.032"},{"key":"2026010702305645000_28.1.e301280.21","unstructured":"National Institute for Health and Care Excellence (NICE) . Self-Harm: Assessment, Management and Preventing Recurrence NICE Guideline NG225]. London, UK: National Institute for Health and Care Excellence, 2022."},{"key":"2026010702305645000_28.1.e301280.22","doi-asserted-by":"publisher","DOI":"10.1136\/bmjment-2024-301062"},{"key":"2026010702305645000_28.1.e301280.23","unstructured":"Office of the Surgeon General . 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action. Washington, DC: US Department of Health & Human Services, 2012."},{"key":"2026010702305645000_28.1.e301280.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2011.06.003"},{"key":"2026010702305645000_28.1.e301280.25","doi-asserted-by":"crossref","DOI":"10.1038\/s41398-019-0428-3","article-title":"The prediction of suicide in severe mental illness: development and validation of a clinical prediction rule (OxMIS)","volume":"9","author":"Fazel","year":"2019","journal-title":"Transl Psychiatry"},{"key":"2026010702305645000_28.1.e301280.26","doi-asserted-by":"crossref","DOI":"10.1136\/bmjment-2024-301180","article-title":"Risk of repeat self-harm among individuals presenting to healthcare services: development and validation of a clinical risk assessment model (OxSET)","volume":"27","author":"Fazel","year":"2024","journal-title":"BMJ Mental Health"}],"container-title":["BMJ Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjment-2024-301280","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T10:31:22Z","timestamp":1767781882000},"score":1,"resource":{"primary":{"URL":"https:\/\/mentalhealth.bmj.com\/lookup\/doi\/10.1136\/bmjment-2024-301280"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,2,27]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bmjment-2024-301280"],"URL":"https:\/\/doi.org\/10.1136\/bmjment-2024-301280","relation":{},"ISSN":["2755-9734"],"issn-type":[{"value":"2755-9734","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}