The predictive validity of the Depression Hopelessness Suicide screening form for self-harm among prisoners |
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Authors: | Michael S. Martin Shannon K. Dorken Alexander I.F. Simpson Kwame McKenzie Ian Colman |
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Affiliation: | 1. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada;2. Centre for Addiction and Mental Health, Toronto, Canada;3. Mental Health Branch, Correctional Service of Canada, Ottawa, Canada;4. Centre for Addiction and Mental Health, Toronto, Canada;5. Department of Psychiatry, University of Toronto, Toronto, Canada |
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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. |
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Keywords: | deliberate self-harm suicide prisons mass screening |
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