Assessment of suicide and self-harm risk in foreign offenders. Evaluating the use of tree-drawing test

Background: Among foreigners, imprisonment is a potential traumatic event characterized by further afflictions due to language difficulties and cultural differences. For these reasons, the psychological diagnosis with this prison population, appears complicated and misleading, despite their tendency to engage in self-harm and suicidal behavior. However, an early and correct diagnosis process is at the core of prevention and reduction of suicides and self-harm. The clinical interview and specific rating scales are inefficient to achieve the diagnosis in foreign subjects because of poor education levels, linguistic barriers and cultural differences. The aim of this study is to explore the efficacy of the Tree-drawing test (Koch, 1958) evaluating the risk factors for suicide and self-harm. Methods: We administered to 100 inmates (34 Italians; 66 foreigners) of an Italian prison the Tree-drawing test in order to establish its effectiveness in identifying the subjects most at risk for suicide and self-harm. After developing a numerical score associated to the tree-drawing test we performed descriptive statistics and a binary logistic regression analysis to test the hypothesis. Results: The analysis, supported by the software SPSS, revealed how the Tree-drawing test is sensitive for identifying individuals with vulnerabilities compatible with the risk of self-harm. Conclusions: Our results represent a first step in guiding the choice of the most suitable tools to support self-harming and suicide risk assessment in foreign offenders.