title: A national survey of self-injurious behavior in American prisons.
abstract: OBJECTIVE
  This study sought information about the prevalence, epidemiology, and management of self-injurious behavior by inmates in U.S. prison systems. Although self-injurious behavior has long been the source of significant challenges in correctional settings, limited research is available on this topic.
  
  
  METHODS
  Mental health directors in all 51 state and federal prison systems were invited to respond to a 30-item questionnaire available online or in hard copy. Univariate statistics were used to describe significant aspects of the national experience with self-injurious behavior, and bivariate statistics were used to examine relationships between variables.
  
  
  RESULTS
  Thirty-nine systems (77%) responded to the survey. Responses indicated that <2% of inmates per year engage in self-injurious behavior, but such events were reported to occur at least weekly in 85% of systems, with occurrences more than once daily in some systems, thus causing substantial disruptions to operations and draining resources. The highest rates of occurrence of these behaviors were in maximum-security and lockdown units and most often involved inmates with axis II disorders. Despite the seriousness of the problem, systems typically collect few, if any, data on self-injurious behaviors, and management approaches to dealing with them lack consistency within and across systems. Eighty-four percent of respondents expressed interest in participating in further studies on this topic.
  
  
  CONCLUSIONS
  The survey responses indicated the disruptive effects of self-injurious behavior in the nation's prisons, a need for better epidemiologic monitoring and data on such behavior, and the importance of developing and widely using effective interventions. The high response rate and expressed interest in follow-up projects suggest that state and federal correctional mental health directors see a need for better information and management in this area.
authors.affiliation: Center for Health Policy and Research, University of Massachusetts Medical School, 333 South St. 13E779, Shrewsbury, MA 01545, USA. kenneth.appelbaum@umassmed.edu
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Appelbaum
authors.forename: Judith A
authors.initials: JA
authors.lastname: Savageau
authors.forename: Robert L
authors.initials: RL
authors.lastname: Trestman
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Metzner
authors.forename: Jacques
authors.initials: J
authors.lastname: Baillargeon
mesh_terms: D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D011329:Prisoners / Q000523:psychology*; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology