title: Self-harm subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP): predicting suicide attempts over 8 years of follow-up.
abstract: 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).
  
  
  METHODS
  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.
authors.affiliation: Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence, RI, USA. Shirley_Yen_PhD@Brown.edu
authors.forename: Shirley
authors.initials: S
authors.lastname: Yen
authors.forename: M Tracie
authors.initials: MT
authors.lastname: Shea
authors.forename: Zach
authors.initials: Z
authors.lastname: Walsh
authors.forename: Maria O
authors.initials: MO
authors.lastname: Edelen
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hopwood
authors.forename: John C
authors.initials: JC
authors.lastname: Markowitz
authors.forename: Emily B
authors.initials: EB
authors.lastname: Ansell
authors.forename: Leslie C
authors.initials: LC
authors.lastname: Morey
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Grilo
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sanislow
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Skodol
authors.forename: John G
authors.initials: JG
authors.lastname: Gunderson
authors.forename: Mary C
authors.initials: MC
authors.lastname: Zanarini
authors.forename: Thomas H
authors.initials: TH
authors.lastname: McGlashan
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000293:Adolescent; D000328:Adult; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010555:Personality Inventory; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult