{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T19:56:05Z","timestamp":1772222165059,"version":"3.50.1"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019418","name":"NIHR Maudsley Biomedical Research Centre","doi-asserted-by":"publisher","award":["IS-BRC-1215-20018"],"award-info":[{"award-number":["IS-BRC-1215-20018"]}],"id":[{"id":"10.13039\/100019418","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Self-harm is a major public health issue in the imprisoned population. Limited high-quality evidence exists for the potential impact of prison environmental factors such as solitary confinement. This exploratory pilot prospective cohort study in a large male remand prison in England sought to estimate effect sizes for a comprehensive range of prison environmental factors in relation to self-harming behaviours.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A random sample of all prisoners (N = 149) starting a period of imprisonment at the study prison took part in a clinical research interview, which assessed a range of known risk factors for self-harm in prison. Information concerning environmental factors, including staff numbers, cell placement and movements, and engagement in work and activities were collected from prison records. Incidents of self-harm behaviour in the 3 months after entering prison were measured using medical records and self-report at end of follow-up. Multivariable logistic regression models were calculated individually for each predictor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>55.7% of participants completed follow-up (83\/149). Single cell placement (OR 4.31, 95% CI 1.06\u201318.24, p = 0.041) and more frequent changes of cellmate (OR 1.52, CI 1.14\u20132.17, p = 0.009) and cell (OR 1.83, 95% CI 1.28\u20132.86, p = 0.003) were associated with an increased risk of self-harming behaviour. Time spent in areas with a higher number of prisoners per member of prison staff was significantly associated with reduced self-harm behaviour in adjusted models (OR 0.89, CI 0.78\u20130.99, p = 0.039). Following sensitivity analyses, the associations between frequent cell changes and self-harm behaviour, and between single cell placement and self-harm ideation, remained statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This exploratory pilot study provides prospective longitudinal data regarding relationships between prison environmental factors and self-harm behaviour. Findings regarding single cell accommodation and frequent cell changes are consistent with the prior evidence base largely derived from case-control study data. The finding regarding frequent cellmate changes predicting self-harm is novel. Findings regarding prisoner-staff ratio and self-harm most likely reflect a reverse causal relationship. Replication in larger cohort studies is required to address the limitations of this pilot study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0318200","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T13:40:28Z","timestamp":1738676428000},"page":"e0318200","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Environmental risk factors for self-harm during imprisonment: A pilot prospective cohort study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7623-7317","authenticated-orcid":true,"given":"Thomas","family":"Stephenson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imogen","family":"Harris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Armstrong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seena","family":"Fazel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxanna","family":"Short","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5909-203X","authenticated-orcid":true,"given":"Nigel","family":"Blackwood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"issue":"9923","key":"pone.0318200.ref001","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1016\/S0140-6736(13)62118-2","article-title":"Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide","volume":"383","author":"K Hawton","year":"2014","journal-title":"Lancet"},{"key":"pone.0318200.ref002","unstructured":"Ministry of Justice. 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