Sorting Out Self-harm From Suicide Risk: A Novel Assessment

Research Aim:

The proposed study aims to identify distinct warning signs for transition points from ideation to action for suicide attempts and nonsuicidal self-injury (NSSI) using the Card Sort Task for Self-Harm (CaTS), as well as determining the acceptability and feasibility of utilizing the CaTS as a clinical assessment tool. 

Hypotheses:

We have two hypotheses about factors identified by the CaTS:

(1a) We expect that unique sets of high frequency proximal and distal factors will be identified for suicide attempts compared to NSSI. 

(1b) We expect that distinct sequences of proximal and distal factors (thoughts, feelings, behaviors, and events) will be seen for suicide attempts versus NSSI.

We also aim to demonstrate potential clinical utility of the CaTS:

(2) We expect that individuals who participate in the CaTS for either NSSI or a suicide attempt will report that they found the process acceptable and potentially helpful in understanding their self-harm experience. Participants will complete an exit interview after finishing the study protocol and qualitative responses will be coded and analyzed to determine feasibility and acceptability of the CaTS.

Sample: Two hundred adults ages 18-34 with past-year NSSI or suicide attempts will be recruited from a university in the United States. The study aims to recruit 100 participants with at least one past-year suicide attempt and 100 with past-year NSSI only (no history of suicide attempts).

Measures: Demographics, Beck Scale for Suicide Ideation, Self-Injurious Thoughts and Behaviors Interview, Inventory of Statements About Self-Injury, Beck Hopelessness Scale, OQ45, Qualitative Interview.

Procedures: Participants will be recruited broadly through an on-line screening survey sent to all full- and part-time students at the main and regional campuses. Those who meet criteria will be contacted for a follow-up study in an on-campus research laboratory. Participants will be administered the research protocol, which includes using the CaTS for most recent suicide attempt or NSSI.  They will complete self-report measures and qualitative exit interviews.

Potential Impact: This study will utilize the CaTS for both NSSI and suicide attempts to determine if different patterns and sequences of cards emerge for the different behaviors, which will identify distinct proximal and distal risk factors. This is particularly helpful to understand in young adults, as suicide remains the second leading cause of death for 18-34-year-olds and up to 25% reported serious thoughts of suicide in 2020. It will also evaluate the CaTS as a potential tool that clinicians could use to design more personalized treatment for individuals with NSSI and suicide risk through tailored safety planning and treatment goals.

Next Steps in this Line of Proposed Research: The PI will seek funding to extend this study to include clinical samples of adults and adolescents, with continued efforts to evaluate acceptability of the CaTS and feasibility of its use in clinical settings from client and clinician perspectives. Results will inform future work on implementing and evaluating the CaTS as a supplemental clinical tool to personalize the treatment of self-harm behavior.