Assessment of nonsuicidal self-injury: Development and initial validation of the Non-Suicidal Self-Injury–Assessment Tool (NSSI-AT).

Abstract

Research tools for assessing nonsuicidal self-injury (NSSI) epidemiology in community populations are few and are either limited in the scope of NSSI characteristics assessed or included as part of suicide assessment. Though these surveys have been immensely useful in establishing the presence of NSSI and in documenting basic epidemiological characteristics, they have been less useful in describing secondary NSSI features such as NSSI context, habituation, or perceived life impact. The aim of the current study was to examine the reliability of the test scores and validity of test score interpretations in a university population for the Non-Suicidal Self-Injury-Assessment Tool (NSSI-AT), a web-based measure of NSSI designed to assess primary (such as form, frequency, and function) and secondary (including but not limited to NSSI habituation; contexts in which NSSI is practiced; and NSSI perceived life interference, treatment, and impacts) NSSI characteristics for research purposes. Data for these analyses were drawn from 3 samples, all of which were originally part of a 2007 study of randomly selected students from 8 northeast and midwest public and private universities that participated in a web-based study entitled the Survey of Student Wellbeing. Overall, results provide support for the reliability of NSSI-AT test scores (as assessed by test-retest) and validity of NSSI-AT test score interpretations for the behavior and frequency modules (as assessed using concurrent, convergent, and discriminant evidence) in this population. Implications for research as well as next steps are discussed.

Frequency and functions of non-suicidal self-injury: Associations with suicidal thoughts and behaviors

“…This is consistent with the emotion regulation functions of NSSI that have been widely reported in the literature (Nock and Prinstein, 2004;Klonsky, 2007;Whitlock et al, 2014). A common motivation for suicide attempts is to obtain relief from an intolerable state of mind, which is supported by empirical observations (Boergers et al, 1998;Jacobson et al, 2013;Kraft et al, 2010) and theoretical work (Shneidman, 1998).…”

“…Participants were then presented with a list of 26 reasons for why they had hurt themselves and asked to check all that applied. The list of reasons for NSSI was identified through analyses of qualitative interviews with individuals with NSSI history and clinicians, as well as through review of NSSI function literature (Whitlock et al, 2014). Rather than assess suicidal intent in the screening question, the NSSI-AT differentiates between NSSI and suicide through function; individuals who indicate that they self-injure primarily "as an attempt to commit suicide" are removed from the NSSI pool and do not receive the remaining NSSI-AT questions.…”

“…Due to similarity with the outcome measures, participants who reported that the primary reason they had used any of the behaviors was to attempt (yes ¼35, not sure¼ 25) or practice suicide (n¼ 39) were not considered to have engaged in NSSI. Since the NSSI functions items were not designed to be subscales and were dichotomous (Whitlock et al, 2014), we examined the remaining 17 NSSI functions individually in relation to suicide outcomes. In Tables 3 and 4, NSSI functions are presented in six categories based on the content of the items to aid visual interpretation of the findings.…”

Initial Psychometric Validation of the Non-Suicidal Self-Injury Scar Cognition Scale

“…Furthermore, a recently published psychometric analysis of an extensive scale designed primarily to assess the occurrence and frequency of a range of methods of NSSI, included three dichotomous prompts regarding scar-related cognitions (Non-Suicidal Self-Injury-Assessment Tool (NSSI-AT); Whitlock et al 2014). A factor analysis of the tool resulted in a factor entitled, “Ambivalence” based on four items, three of which include the prompts related to NSSI scarring: “The lasting marks/scars are constant reminders of a bad/rough time,” “My scars are my battle wounds—I made it through,” and “The remaining marks/scars are a source of embarrassment for me.” The ambivalence subscale evidenced an alpha of .57.…”

Non-Suicidal Self-Injury in Swedish Adolescents : Prevalence, Characteristics, Functions and Associations With Childhood Adversities

“…The issue of suicidal intent is addressed differently across measures. Some clarify it in the introduction (e.g., OSI, ISAS), others, such as the Non-suicidal Self-Injury Assessment Tool (NSSI-AT; Whitlock et al, 2014), an online measure used on college populations, do not ask about suicidal intent directly but it is screened for in the function items. DSHI has only specified the wording "without suicide intent", in the cutting item.…”