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The aggressor at the mirror: Psychiatric correlates of deliberate self-harm in male prison inmates

Published online by Cambridge University Press:  23 March 2020

N. Verdolini ,
A. Murru ,
L. Attademo ,
R. Garinella ,
I. Pacchiarotti ,
C. del Mar Bonnin ,
L. Samalin ,
L. Pauselli ,
M. Piselli  and
A. Tamantini
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N. Verdolini
Affiliation:
Bipolar Disorders Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS CIBERSAM, Hospital Clínic, c/Villarroel, 170, 12-0, 08036Barcelona, Spain Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant’Andrea delle Fratte, 06132Perugia, Italy
A. Murru
Affiliation:
Bipolar Disorders Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS CIBERSAM, Hospital Clínic, c/Villarroel, 170, 12-0, 08036Barcelona, Spain
L. Attademo
Affiliation:
Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant’Andrea delle Fratte, 06132Perugia, Italy Department of Mental Health, Division of Psychiatry 1, “Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII”, Piazza OMS 1, 24127Bergamo, Italy
R. Garinella
Affiliation:
Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant’Andrea delle Fratte, 06132Perugia, Italy Centro di Selezione e Reclutamento Nazionale dell’Esercito, Italian Ministry of Defence, Viale Mezzetti, 2, 06034 Foligno, Perugia, Italy
I. Pacchiarotti
Affiliation:
Bipolar Disorders Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS CIBERSAM, Hospital Clínic, c/Villarroel, 170, 12-0, 08036Barcelona, Spain
C. del Mar Bonnin
Affiliation:
Bipolar Disorders Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS CIBERSAM, Hospital Clínic, c/Villarroel, 170, 12-0, 08036Barcelona, Spain
L. Samalin
Affiliation:
Bipolar Disorders Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS CIBERSAM, Hospital Clínic, c/Villarroel, 170, 12-0, 08036Barcelona, Spain EA 7280, Department of Psychiatry, CHU Clermont-Ferrand, University of Auvergne 58, rue Montalembert, 63000Clermont-Ferrand, France Pôle de psychiatrie, Fondation FondaMental, hôpital Albert-Chenevier 40, rue de Mesly, 94000Créteil, France
L. Pauselli
Affiliation:
Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant’Andrea delle Fratte, 06132Perugia, Italy New York Psychiatric Institute Columbia University Medical Center, 1051 Riverside Dr, Unit 100 New York City, NY10032, USA
M. Piselli
Affiliation:
Functional Area of Psychiatry, University of Perugia, AUSL Umbria 2, Servizio Psichiatrico Diagnosi e Cura Ospedale “S. Giovanni Battista”, via Massimo Arcamone, 06034 Foligno, Perugia, Italy
A. Tamantini
Affiliation:
Functional Area of Psychiatry, University of Perugia, AUSL Umbria 2, Servizio Psichiatrico Diagnosi e Cura Ospedale “S. Giovanni Battista”, via Massimo Arcamone, 06034 Foligno, Perugia, Italy
R. Quartesan
Affiliation:
Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant’Andrea delle Fratte, 06132Perugia, Italy
A.F. Carvalho
Affiliation:
Department of Clinical Medicine, Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Av. da Universidade, 2853, 60020-180 Benfica, Fortaleza - CE, Brazil
E. Vieta*
Affiliation:
Bipolar Disorders Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS CIBERSAM, Hospital Clínic, c/Villarroel, 170, 12-0, 08036Barcelona, Spain
A. Tortorella
Affiliation:
Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant’Andrea delle Fratte, 06132Perugia, Italy
*
* Corresponding author. Fax: +34 932279228. E-mail address:evieta@clinic.cat (E. Vieta).
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Abstract

Background:

Deliberate self-harm (DSH) causes important concern in prison inmates as it worsens morbidity and increases the risk for suicide. The aim of the present study is to investigate the prevalence and correlates of DSH in a large sample of male prisoners.

Methods:

A cross-sectional study evaluated male prisoners aged 18+ years. Current and lifetime psychiatric diagnoses were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders - DSM-IV Axis I and Axis II Disorders and with the Addiction Severity Index-Expanded Version. DSH was assessed with The Deliberate Self-Harm Inventory. Multivariable logistic regression models were used to identify independent correlates of lifetime DSH.

Results:

Ninety-three of 526 inmates (17.7%) reported at least 1 lifetime DSH behavior, and 58/93 (62.4%) of those reported a DSH act while in prison. After multivariable adjustment (sensitivity 41.9%, specificity 96.1%, area under the curve = 0.854, 95% confidence interval CI = 0.811–0.897, P < 0.001), DSH was significantly associated with lifetime psychotic disorders (adjusted Odds Ratio aOR = 6.227, 95% CI = 2.183–17.762, P = 0.001), borderline personality disorder (aOR = 6.004, 95% CI = 3.305–10.907, P < 0.001), affective disorders (aOR = 2.856, 95% CI = 1.350–6.039, P = 0.006) and misuse of multiple substances (aOR = 2.024, 95% CI = 1.111–3.687, P = 0.021).

Conclusions:

Borderline personality disorder and misuse of multiple substances are established risk factors of DSH, but psychotic and affective disorders were also associated with DSH in male prison inmates. This points to possible DSH-related clinical sub-groups, that bear specific treatment needs.

Keywords

Deliberate self-harmForensic psychiatryAffective disordersSubstance use disordersPsychosisaOR, adjusted Odds RatioASI-X, Addiction Severity Index-Expanded VersionAUC, area under the curveCI, confidence intervalDSH, deliberate self-harmDSHI, Deliberate Self-Harm InventoryDSM, Diagnostic and Statistical Manual of Mental DisordersOR, Odds RatioPD, personality disordersROC, receiver operating characteristicSCID-I, Structured Clinical Interview for DSM-IV Axis I DisordersSCID-II, Structured Clinical Interview for DSM-IV Axis II DisordersSD, standard deviation
Type
Original article
Information
European Psychiatry , Volume 44 , July 2017 , pp. 153 - 160
Copyright
Copyright © European Psychiatric Association 2017

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