Protocol - Non-suicidal Self Injury

SITBI 2.1 Short Form

These questions ask about your thoughts and feelings of suicide and self-injurious behaviors. Please listen carefully and respond as accurately as you can. Do you have any questions before we begin?

Suicidal Ideation

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? _____________

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 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":

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? _____________

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:

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

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? _____________

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 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 skin or nails of drawing blood

8[ ]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)

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