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Self-Harm Subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP): Predicting Suicide Attempts Over 8 Years of Follow-Up
Objective: We examined the predictive power of the self-harm subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP) to identify suicide attempters in the Collaborative Longitudinal Study of Personality Disorders (CLPS).
Method: The SNAP, a self-report personality inventory, was administered to 733 CLPS participants at baseline, of whom 701 (96%) had at least 6 months of follow-up data. Cox proportional hazards regression analyses were performed to examine the SNAP–self-harm subscale (SNAP-SH) in predicting the 129 suicide attempters over 8 years of follow-up. Possible moderators of prediction were examined, including borderline personality disorder, major depressive disorder (MDD), and substance use disorder. We also compared baseline administration of the SNAP-SH to subsequent administrations more proximal to the suicide attempt, and to a higher-order SNAP-negative temperament (SNAP-NT) subscale. Receiver operating characteristic analyses were conducted using suicide attempts (n = 58) over the first year of follow-up to provide reference points for sensitivity and specificity.
Results: The SNAP-SH demonstrated good predictive power for suicide attempts (hazard ratio = 1.28, P < .001) and appeared relatively consistent across borderline personality disorder, MDD, and substance use disorder diagnoses. Using more proximal scores did not increase predictive power. The SNAP-SH compared favorably to the predictive power of the higher-order SNAP-NT. Receiver operating characteristic analyses indicate several cutoff scores on the SNAP-SH that yield moderate to high sensitivity and specificity for predicting suicide attempts over the first year of follow-up.
Conclusions: The SNAP-SH may be a useful screening instrument for risk of suicide attempts in nonpsychotic psychiatric patients.
J Clin Psychiatry
Submitted: April 8, 2009; accepted April 27, 2010.
Online ahead of print: January 25, 2011 (doi:10.4088/JCP.09m05583blu).
Corresponding author: Shirley Yen, PhD, 700 Butler Drive, Duncan Bldg, Providence, RI 02906 (Shirley_Yen_PhD@Brown.edu).