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. 2022 Aug;52(4):615-630.
doi: 10.1111/sltb.12847. Epub 2022 Mar 7.

The Screen for Nonsuicidal Self-Injury: Development and initial validation among veterans with psychiatric disorders

Tate F Halverson  1   2 , Tapan A Patel  1   3 , Adam J D Mann  4 , Mariah K Evans  1   3 , Kim L Gratz  4 , Jean C Beckham  1   2   3 , Patrick S Calhoun  1   2   3   5 , Nathan A Kimbrel  1   2   3   5
Affiliations

The Screen for Nonsuicidal Self-Injury: Development and initial validation among veterans with psychiatric disorders

Tate F Halverson et al. Suicide Life Threat Behav. 2022 Aug.

Abstract

Introduction: Nonsuicidal self-injury (NSSI) is associated with significant impairment and is a robust predictor of suicidal ideation, attempts, and death by suicide; however, the present lack of a brief screening instrument for NSSI coupled with consistent underidentification of NSSI in male adults has led to concerning rates of missed identification of NSSI.

Methods: The Screen for Nonsuicidal Self-Injury (SNSI) is a brief, 10-item screen designed to identify individuals currently engaging in NSSI with an emphasis on behaviors more frequently endorsed by male adults. The present study examined the development and validation of the SNSI.

Results: In a sample of veterans (N = 124) with complex psychiatric presentations, SNSI scores demonstrated good internal consistency and strong construct validity with area under the curve (AUC) estimates of 0.85-0.93 for the identification of NSSI disorder. SNSI scores also demonstrated good convergent (rs 0.59-0.90) and external validity (rs = 0.25-0.42), and excellent predictive validity identifying future NSSI Suicide and Life-Threatening Behavior disorder (AUC = 0.88) and NSSI behaviors (AUC = 0.90). Importantly, SNSI performance was not affected by participants' race, sex assigned at birth, or age.

Conclusion: The SNSI is an efficient screen to identify patients engaging in NSSI who are likely to benefit from more comprehensive assessment and treatment programs.

Keywords: nonsuicidal self-injury; nonsuicidal self-injury disorder; self-harm; veterans.

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Conflict of interest statement

Conflict of Interest Disclosure: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the United States Government or Department of Veterans Affairs (VA). The authors have no other conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Comparison of Full-Length Initial SNSI and Brief SNSI Predicting Current Nonsuicidal Self-Injury Disorder. Note: SNSI predicting current nonsuicidal self-injury disorder as assessed by the Clinician-Administered NSSI Disorder Index (CANDI). No significant differences between area under the curve (AUC) values (all Venkatraman’s tests p>.05).
Figure 2
Figure 2
Comparison of SNSI (Dichotomous) Predicting Nonsuicidal Self-Injury Disorder by Age, Sex Assigned at Birth, and Race Note: SNSI predicting current NSSI disorder as assessed by the Clinician-Administered NSSI Disorder Index (CANDI); NSSI = nonsuicidal self-injury, Sex = sex assigned at birth; No significant differences between area under the curve (AUC) values (all Venkatraman’s tests p>.05).
Figure 3
Figure 3
Predictive Validity of the SNSI (Dichotomous) Note: SNSI dichotomous items predicting current Nonsuicidal Self-Injury Disorder (NSSI disorder), NSSI disorder assessed 12 months after baseline, and Columbia Suicide Severity Rating Scale (C-SSRS) NSSI assessed 12 months after baseline. NSSI disorder assessed at baseline and 12 months after baseline with the Clinician-Administered NSSI Disorder Index (CANDI).
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