Non-suicidal Self Injury
Date of SC final approval
About the Measure Domain:
Suicide
Measure:
Non-suicidal Self Injury
Definition:
A questionnaire to assess self-injurious thoughts and behaviors.
Purpose:
This measure can be used to distinguish among the different types of self-injurious thoughts and behaviors. Non-suicidal self-injury is associated with a range of externalizing and internalizing conditions and is associated with risk of suicide behavior.
About the Protocol Description of Protocol:
The Self-injurious Thoughts and Behaviors Interview (SITBI) is a structured interview that includes five modules assessing the presence, frequency, and characteristics of five types of self-injurious thoughts and behaviors: suicidal ideation, suicidal plans, suicidal gestures, suicidal attempts (including aborted and interrupted), and nonsuicidal self-injury. Each module begins with a screening question about lifetime presence of a self-injurious thought or behavior followed by items that measure age of onset, recent thoughts and behaviors, severity of thoughts and behaviors, probability of future behavior, and self-reported precipitants and functions of the behavior. In addition to the adult and adolescent sort form presented below, other versions of the SITBI are available: adult and adolescent long form, follow-up short form (prospective studies), and self-report.
Selection Rationale:
Specific Instructions: Protocol Text:
The Self-injurious Thoughts and Behaviors Interview (SITBI) is a brief, low-burden questionnaire that is widely used in epidemiology studies of adults and adolescents. The SITBI has demonstrated interrater reliability and test-retest reliability, convergent validity (ideation) and corresponds to definitions for suicidal ideation and suicidal behavior endorsed by the Centers for Disease Control and Prevention (CDC – Crosby et al., 2011) and the US Food and Drug Administration (FDA -Guidance for Industry Suicidal Ideation and Behavior: Prospective Assessment of Occurrence in Clinical Trials Office of Communications, Division of Drug Information Center for Drug Evaluation and Research Food and Drug Administration, 2012). None
SITBI 2.1 Short Form These questions ask about your thoughts and feelings of suicide and selfinjurious behaviors. Please listen carefully and respond as accurately as you can. Do you have any questions before we begin? Suicidal Ideation
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1. Have you ever had thoughts of killing yourself? [ ] 0 no [ ] 1 yes 2. How old were you the first time you had thoughts of killing yourself? _____________ 3. How old were you the last time?
_____________
4. How many days in your life have you had thoughts of killing yourself? _____________ (Please give your best estimate) 5. How many days in the past year? _____________ 6. How many days in the past month? _____________ 7. How many days in the past week? _____________ Here is a scale we will use for a number of the upcoming questions. (See the last page of the questionnaire or directions) 8. On this scale of 0 to 4, at the worst point how intense were your thoughts of killing yourself? _____________ 9. On the scale of 0 to 4, on average, how intense were these thoughts? _____________ 10. When you had thoughts of killing yourself, how long did they usually last? [ ] 0 0 seconds [ ] 1 1-60 seconds [ ] 2 2-15 minutes [ ] 3 16-60 minutes [ ] 4 less than one day [ ] 5 1-2 days [ ] 6 more than 2 days [ ] 7 wide range (spans >2 responses)
11. On the scale of 0 to 4, what do you think the likelihood is that you will have a thought of killing yourself in the future? _____________ Suicide Plan 12. Have you ever actually made a plan to kill yourself? [ ] 0 no [ ] 1 yes 13. How old were you the first time you made a suicide plan? _____________ 14. How old were you the last time? _____________ 15. How many days in your life have you made a suicide plan? _____________ Version 10 – 10/21/09
Non-suicidal Self Injury
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16. How many days in the past year? _____________ 17. How many days in the past month? _____________ 18. How many days in the past week? _____________ 19. On the scale of 0 to 4, at the worst point, how seriously did you consider acting on the plan? _________ 20. On the scale of 0 to 4, on average, how seriously have you considered acting on the plan(s)? _____________ 21. When you had a plan(s), what method(s) did you think of using? _____________ [ ] 1 own prescription drugs [ ] 2 illicit drugs (not rx) [ ] 3 over-counter drugs [ ] 4 other's rx drugs [ ] 5 poison [ ] 6 firearms [ ] 7 immolation [ ] 8 sharp object [ ] 9 auto exhaust [ ] 10 other gases [ ] 11 train/car [ ] 12 jump from height [ ] 13 drowning [ ] 14 suffocation [ ] 15 hanging [ ] 16 other ____________________ [ ] 17 multiple methods ___________
22. When you had a plan, how long did you think about it before either moving onto something else or acting on the plan? _____________ [ ] 0 0 seconds [ ] 1 1-60 seconds [ ] 2 2-15 minutes [ ] 3 16-60 minutes [ ] 4 less than one day [ ] 5 1-2 days [ ] 6 more than 2 days [ ] 7 wide range (spans > 2 responses) 23. When you had a plan(s), did you take steps to prepare to act on the plan(s)? _____________ If “yes”: 24. What did you do? _____________ 25. On the scale of 0 to 4, what do you think the likelihood is that you will make a Version 10 – 10/21/09
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suicide plan in the future? ________ Suicide Gesture 26. Have you ever done something to lead someone to believe that you wanted to kill yourself when you really had no intention of doing so? [ ] 0 no [ ] 1 yes 27. What have you done to lead someone to believe that you wanted to kill yourself when you really had no intention of doing so? __________________________ 28. How old were you the first time you did something to lead someone to believe that you wanted to kill yourself when you really had no intention of doing so? _____________ 29. How old were you the last time? _____________ 30. How many times in your life have you done something to lead someone to believe that you wanted to kill yourself when really you had no intention of doing so? _____________ 31. How many times in the past year? _____________ 32. How many times in the past month? _____________ 33. How many times in the past week? _____________ 34. When you did something to lead someone to believe that you wanted to kill yourself when you really had no intention of doing so, how long did you think about it before doing it? _____________ [ ] 0 0 seconds [ ] 1 1-60 seconds [ ] 2 2-15 minutes [ ] 3 16-60 minutes [ ] 4 less than one day [ ] 5 1-2 days [ ] 6 more than 2 days [ ] 7 wide range (spans > 2 responses) 35. On the scale of 0 to 4, what do you think the likelihood is that you will do something to lead someone to believe that you want to kill yourself when you really have no intention of doing so in the future? _____________ Aborted Suicide Attempt 36. Have you ever been close to killing yourself and at the last minute decided not to kill yourself? [ ] 0 no [ ] 1 yes (Only if he/she did not sustain injuries – see question below, mark “yes” for this question) If “yes”:
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37. Did you sustain any physical injury? [ ] 0 no [ ] 1 yes
38. What happened? 39. How many times in your life have you stopped yourself from attempting suicide right before you got hurt? __________ 40. How many times in the past year? _____________ 41. How many times in the past month? _____________ 42. How many times in the past week? _____________ Interrupted Suicide Attempt 43. Have you ever been very close to killing yourself and at the last minute someone or something else stopped you? [ ] 0 no [ ] 1 yes (Only if he/she did not sustain injuries – see question below, mark “yes” for this question) If “yes”: 44. Did you sustain any physical injury? [ ] 0 no [ ] 1 yes
45. What happened? 46. How many times in your life have you been close to killing yourself but were stopped by someone or something else right before you got hurt? _____________ 47. How many times in the past year? _____________ 48. How many times in the past month? _____________ 49. How many times in the past week? _____________ Suicide Attempt 50. Have you ever made an actual attempt to kill yourself in which you had at least some intent to die? [ ] 0 no [ ] 1 yes 51. How old were you the first time you made a suicide attempt? _____________ 52. How old were you the last time? _____________ Version 10 – 10/21/09
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53. To your knowledge, what was the approximate date of the most recent attempt? _____________ (Note to the data enterer: Please calculate how many days the most recent suicide attempt was from the interview date) 54. How many suicide attempts have you made in your lifetime? _____________ 55. How many in the past year? _____________ 56. How many in the past month? _____________ 57. How many in the past week? _____________ 58. For your most recent suicide attempt, what method did you use? _____________ [ ] 1 own prescription drugs [ ] 2 illicit drugs (not rx) [ ] 3 over-counter drugs [ ] 4 other's rx drugs [ ] 5 poison [ ] 6 firearms [ ] 7 immolation [ ] 8 sharp object [ ] 9 auto exhaust [ ] 10 other gases [ ] 11 train/car [ ] 12 jump from height [ ] 13 drowning [ ] 14 suffocation [ ] 15 hanging [ ] 16 other ____________________ [ ] 17 multiple methods ___________ 59. What were the circumstances that contributed most to your most recent attempt? _____________ (Put in order of importance) [ ] 1 job loss/stress/academic failure [ ] 2 problems with family or friends [ ] 3 problems with spouse/lover [ ] 4 financial problems [ ] 5 eviction [ ] 6 health problems [ ] 7 death of another person [ ] 8 psychiatric symptoms [ ] 9 humiliating event [ ] 10 loneliness [ ] 11 other: ____________________ 60. What kind of injuries did you have as a result of this attempt? _____________ (Use Lethality Scale; e.g., LSARS-II; Berman, Shepard, & Silverman, 2003) Regarding the most lethal attempt:
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61. How old were you when you made the suicide attempt that caused you the most physical harm? _____________ 62. To your knowledge, what was the approximate date of the attempt that caused you the most physical harm? _________ (Note to the data enterer: Please calculate how many days the most lethal suicide attempt was from the interview date.) 63. What kind of injuries did you have as a result of this attempt? _____________ (Use Lethality Scale) 64. Is the most harmful attempt also the most recent? _____________ [ ] 0 no [ ] 1 yes Regarding all your past suicide attempts: 65. How long did you usually think about suicide before making an attempt? _____________ [ ] 0 0 seconds [ ] 1 1-60 seconds [ ] 2 2-15 minutes [ ] 3 16-60 minutes [ ] 4 less than one day [ ] 5 1-2 days [ ] 6 more than 2 days [ ] 7 wide range (spans > 2 responses) 66. On the scale of 0 to 4, what do you think the likelihood is that you will make a suicide attempt in the future? _________ Suicide History 67. Has anyone you have ever known died by suicide? If so, how many? _____________ If “yes”: 68. What was/were their relationship(s) to you? _____________ [ ] 1 mother [ ] 2 father [ ] 3 brother [ ] 4 sister [ ] 5 daughter [ ] 6 son [ ] 7 biological aunt [ ] 8 biological uncle [ ] 9 grandmother [ ] 10 grandfather [ ] 11 cousin [ ] 12 partner/lover [ ] 13 personal friend [ ] 14 family friend Version 10 – 10/21/09
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[ ] 15 acquaintance [ ] 16 other relative_______________ 69. Has anyone you have ever known ever attempted suicide but lived? If so, how many? _____________ If “yes”: 70. What was/were their relationship(s) to you? _____________ [ ] 1 mother [ ] 2 father [ ] 3 brother [ ] 4 sister [ ] 5 daughter [ ] 6 son [ ] 7 biological aunt [ ] 8 biological uncle [ ] 9 grandmother [ ] 10 grandfather [ ] 11 cousin [ ] 12 partner/lover [ ] 13 personal friend [ ] 14 family friend [ ] 15 acquaintance [ ] 16 other relative_______________ Thoughts of Nonsuicidal Self-Injury People sometimes have thoughts about hurting themselves without wanting to die. Other times they actually do things to hurt themselves. Right now I’m going to ask you some questions about what some people think, and then I’ll ask you about what some people do in a bit. 71. Have you ever had thoughts of purposely hurting yourself without wanting to die? (for example, cutting or burning) [ ] 0 no [ ] 1 yes 72. How old were you the first time you thought of purposely hurting yourself without wanting to die? _____________ 73. How old were you the last time? _____________ 74. How many days in your life have you had thoughts of purposely hurting yourself without wanting to die? (Please give your best estimate) _____________ 75. How many days in the past year? _____________ 76. How many days in the past month? _____________ 77. How many days in the past week? _____________ 78. On the scale of 0 to 4, at the worst point, how intense were your thoughts of purposely hurting yourself without wanting to die? _____________
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79. On the scale of 0 to 4, on average, how intense were these thoughts? _____________ 80. What method did you think of using? _____________ [ ] 1 cut or carved skin [ ] 2 burned your skin (i.e., with a cigarette, match or other hot object) [ ] 3 inserted sharp objects into your [ ] 4 picked areas of your body to the point of drawing blood [ ] 10 hit yourself on purpose [ ] 11 gave yourself a tattoo [ ] 12 scraped your skin to the point skin or nails of drawing blood [ ] 13 other (specify):_____________ 81. When you had these thoughts, how long did they usually last? _____________ [ ] 0 0 seconds [ ] 1 1-60 seconds [ ] 2 2-15 minutes [ ] 3 16-60 minutes [ ] 4 less than one day [ ] 5 1-2 days [ ] 6 more than 2 days [ ] 7 wide range (spans > 2 responses) 82. On the scale of 0 to 4, what do you think the likelihood is that you will think about purposely hurting yourself without wanting to die in the future? _____________ Nonsuicidal Self-Injury 83. Have you ever actually purposely hurt yourself without wanting to die? _____________ [ ] 0 no [ ] 1 yes 84. How old were you the first time you purposely hurt yourself without wanting to die? _____________ 85. How old were you the last time? _____________ 86. Now I’m going to go through a list of things that people sometimes purposely do to harm themselves without wanting to die. Please let me know which of these you’ve done: [ ] 1 cut or carved skin [ ] 2 burned your skin (i.e., with a cigarette, match or other hot object) [ ] 3 inserted sharp objects into your skin or nails [ ] 4 picked areas of your body to the point of drawing blood [ ] 5 hit yourself on purpose [ ] 6 gave yourself a tattoo [ ] 7 scraped your skin to the point of drawing blood [ ] 8 other (specify):___________________________ 87. How many times in your life have you purposely hurt yourself without wanting to die? (Please give your best estimate)
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88. How many times in the past year? _____________ 89. How many times in the past month? _____________ 90. How many times in the past week? _____________ 91. On average, how long have you thought of purposely hurting yourself without wanting to die before actually doing it? [ ] 0 0 seconds [ ] 1 1-60 seconds [ ] 2 2-15 minutes [ ] 3 16-60 minutes [ ] 4 less than one day [ ] 5 1-2 days [ ] 6 more than 2 days [ ] 7 wide range (spans > 2 responses) 92. Have you ever received medical treatment for harm caused by purposely hurting yourself without wanting to die? [ ] 0 no [ ] 1 yes 93. On a scale of 0 to 4, what do you think the likelihood is that you will purposely hurt yourself without wanting to die in the future? _____________
0-4 SCALE
0 Not at all
1 A little bit
2 Somewhat
3 Very Much
4 Extremely
Participant:
Adolescents and adults, ages 12 and older
Source:
Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-Injurious Thoughts and Behaviors Interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309-317 English, German
Language of Source: Personnel and Training Required:
Equipment Needs:
The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a “don’t know” response is provided. The PhenX Working Group acknowledges these questions can be administered in a computerized or noncomputerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire.
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Non-suicidal Self Injury
Protocol Type:
Date of SC final approval
Interviewer-administered questionnaire
Requirements: Requirements Category
Common Data Elements: General References:
Required (Yes/No):
Major equipment
No
Specialized training
No
Specialized requirements for biospecimen collection Average time of greater than 15 minutes in an unaffected individual TBD by PhenX Staff
No No
Cha, C.B., Najmi, S., Park, J.M., Finn, C., & Nock, M.K. (2010). Attentional bias toward suicide-related stimuli predicts suicidal behavior. Journal of Abnormal Psychology, 119(3):616-622. Janis, I. B., & Nock, M. K. (2009). Are self-injurers impulsive? Results from two behavioral laboratory studies. Psychiatry Research, 169(3):261-7.
Additional Information About the Measure Essential Data:
Current Age, Gender
Related PhenX Measures:
Classification of Suicidal Ideation and Suicidal Behavior, Intensity of Suicide Ideation (Continuum), Suicidal Intent of Suicide Attempts, Lethality of Suicide Attempts None Suicide, suicide ideation, suicide attempts, suicide behavior, suicide gestures, suicide plans, nonsuicidal self-injury, self-injurious thoughts, self-injurious behaviors, SITB, Self-injurious thoughts and behaviors interview, SITBI
Derived Variables: Keywords/Related Concepts:
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