Investigating alexithymia as a predictor of suicidality and aggression in prisoners

Alexithymia reflects a deficit in the cognitive processing of emotions. Difficulties identifying and managing subjective emotional states is associated with an increased likelihood of risky behaviours, e.g. suicide & violence, in the general population. Suicidal and aggressive behaviour is more prevalent within prisoner samples and yet the role of alexithymia within this high risk group has yet to be explained.

The objective is to investigate the relationship between alexithymia and suicidal and aggressive behaviours within adult male prisoners.

Hypotheses:
1. Alexithymia significantly predicts suicidality and aggression, and these associations remain after controlling for known risk factors.
2. Alexithymia significantly predicts suicidality and aggression across time, independent of initial levels of suicidality and aggression.
3. Core schema (beliefs about self and others) and impulsivity will moderate the link between alexithymia and suicidality / aggression.

All three studies will recruit prisoners with recent experiences of suicidal or aggressive behaviours. The first study will use qualitative methods (grounded theory) to investigate the origins of alexithymia and how it links with suicidality and aggression. The second study will collate a large dataset to investigate key psychological predictors, with regression modelling used to validate a model of alexithymia and suicidal/aggressive behaviours. A subsequent longitudinal study will examine this model over time. The final study will develop Experience Sampling (diary studies) to build on the work of the first three studies. ESM is particularly suited to research in clinical domains because it collects rich data which captures subjective experiences that are amenable to quantitative analyses.

This is a novel research area which will make a substantial theoretical contribution to understanding the mechanisms for risky behaviours. It has clear potential for clinical application by informing the more precise risk assessment of suicidality / aggression, as well as informing the content of psychological therapy programmes for at-risk prisoners.

Situating the project within the School of Psychological Sciences, and recruiting service user advisors with personal experience of prisoner suicidality, will support the PhD student's development of the following additional skills:
1. The implementation of patient and public involvement (PPI) initiatives in forensic mental health research and ways of addressing wider issues of social responsibility, such as the need to carry out impactful research and to disseminate findings accessibly and broadly. Taking advantage of links with our existing service user research groups, one of the first steps of this PhD project will involve setting up a dedicated Forensic Service User Reference Group, the members of which will contribute to all aspects of the research process. Pratt is the School lead for PPI & Social Responsibility in Research, which will help to nurture the development of these PPI skills.
2. Collaborative skills involving our NHS and HM Prison Service colleagues which will involve a rigorous understanding of the operation of NHS services within prisons, and of the challenges and priorities of the development and delivery of offender health services, including public health perspectives.