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

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.

Examining the Presence, Frequency, and Associated Characteristics of Nonsuicidal Self-Injury by Proxy: Initial Validation of the Nonsuicidal Self-Injury by Proxy Questionnaire (NSSIBPQ)

“…Consistent with Mann et al's (2022) suggestion that it may be more likely for NSSI by proxy to follow traditional NSSI in time, findings across both studies revealed a significantly earlier age of onset for traditional NSSI versus NSSI by proxy. One explanation may be that individuals transition from NSSI to NSSI by proxy due to the stigma associated with traditional NSSI behaviors and the greater ability to hide the self-injurious intentions of their behaviors in the context of NSSI by proxy.…”

“…The top four reasons for preferring traditional NSSI to NSSI by proxy were consistent across samples and focused on the perception of traditional NSSI as more in the respondent's control, easier to do, easier to hide, and more immediate. Conversely, for the small subset of participants who reported preferring NSSI by proxy, one of the most commonly endorsed reasons for this preference across both studies was the perception of NSSI by proxy as more socially acceptable, consistent with Mann et al's (2022) proposal that NSSI by proxy may be preferred by some individuals because it is viewed as more socially acceptable than traditional NSSI. As noted above, it is possible that the perception of NSSI by proxy as more socially acceptable could, for some individuals, lead to a transition from traditional NSSI to NSSI by proxy over time (within or outside the context of therapy).…”

“…Following identification of the NSSI by proxy behaviors of interest, items were developed to assess the frequency and age of onset of each behavior. These items were modeled after the Screen for Nonsuicidal Self-Injury (SNSI; Halverson et al, 2022), which assesses the lifetime and past-year presence and frequency, as well as the age of onset, of a variety of traditional NSSI behaviors. Next, given the expectation that NSSI by proxy behaviors may also meet criteria for NSSID (Mann et al, 2022), and to ensure a comprehensive assessment of the associated characteristics of NSSI by proxy relevant to an NSSID diagnosis, items were generated to assess the motives for, emotional and cognitive antecedents of, and preoccupation with and thoughts about these behaviors.…”

Hiding in the open: Consideration of nonsuicidal self‐injury by proxy as a clinically meaningful construct

“…Indeed, although tattooing and body piercing are most frequently performed by an “other” (Bone et al, 2008), past NSSI research has examined these behaviors as NSSI when they are performed by the individual themselves (see Lloyd‐Richardson et al, 2007). For example, the Self‐Injurious Thoughts and Behaviors Interview (SITBI; Nock et al, 2007) and the Functional Assessment of Self‐Mutiliation (FASM; Lloyd et al, 1997) include tattooing oneself as a form of NSSI, the Screen for Nonsuicidal Self‐Injury (Halverson et al, 2022) includes the self‐insertion of needles into one's body as a form of NSSI (without excluding body piercing), and the Alexian Brothers Assessment of Self‐Injury (Washburn et al, 2015) includes both tattooing and piercing oneself as forms of NSSI. Thus, given that the only difference between self‐tattooing/self‐piercing and conventional tattooing/body piercing by a professional/“other” is the involvement of another person as the inflictor of the bodily tissue damage, considering tattooing and piercing by an “other” as a potential form of NSSI by proxy is consistent with extant operational definitions of NSSI that consider self‐tattooing/self‐piercing as a form of NSSI.…”

Increased risk of postpartum depression in women with lactational mastitis: a cross-sectional study

“…Further, our results indicated that lactational mastitis was associated with an increased risk of self-harm or suicidal ideation. Recent studies suggested that self-harm is a strong predictor of suicide attempts and a more powerful predictor than other suicide risk factors ( 29 ). Therefore, our findings provide evidence that lactational mastitis increases the risk of depression and self-harm or suicidal ideation during the postpartum period.…”