Self-harm in Prisons in Serbia: Correlates of Non-Suicidal Self-Injury and Suicide Attempts

Self-harm, including non-suicidal self-injury (NSSI) and suicide attempts (SA), is highly prevalent among incarcerated populations, yet no study has examined their co-occurrence and correlates in Serbian prisons. This study included 609 offenders from five correctional facilities, recruited as part of the national PrisonLIFE project. The prevalence of NSSI and SA was 17% and 9%, respectively, with 73% of those who engaged in NSSI also reported SA. Correlates were examined across four domains: sociodemographic (e.g., gender, age, education), institutional (e.g., isolation, disciplinary measures, prolonged cell time, lack of visits, absence of work), criminogenic (e.g., violent offenses, repeat offending, early criminal onset, pre-incarceration drug use, sentence length), and psychological (e.g., depressive symptoms, aggression, prior psychological treatment). NSSI and SA were significantly associated and shared multiple risk factors, particularly within the psychological and institutional domains. NSSI was further linked to pre-incarceration drug use and criminal history (e.g., repeat offending, early criminal onset), whereas SA was more strongly associated with older age, higher education, and longer sentences. Overall, findings reveal substantial overlap between the two behaviors, while also highlighting distinct patterns that suggest partially independent mechanisms.