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Self-harm subscale of the Schedule of Nonadaptive and Adaptive Personality (SNAP): Predicting suicide attempts over 8 years of follow-up
Journal of Clinical Psychiatry (2011)
  • Shirley Yen
  • M. Tracie Shea
  • Zach Walsh
  • Maria O. Edelen
  • Christopher J. Hopwood, Michigan State University
  • John C. Markowitz
  • Emily B. Ansell
  • Leslie C. Morey, Texas A & M University - College Station
  • Carlos M. Grilo
  • Charles A. Sanislow, Wesleyan University
  • Andrew E. Skodol
  • John G. Gunderson
  • Mary C. Zanarini
  • Thomas H. McGlashan

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.

Publication Date
November, 2011
Citation Information
Yen, S., Shea, M. T., Walsh, Z., Edelen, M. O., Hopwood, C. J., Markowitz, J. C., Ansell, E. B., Morey, L. C., Grilo, C. M., Sanislow, C. A., Skodol, A. E., Gunderson, J. G., Zanarini, M. C., & McGlashan, T. H. (2011). Self-harm subscale of the Schedule of Nonadaptive and Adaptive Personality (SNAP): Predicting suicide attempts over 8 years of follow-up. Journal of Clinical Psychiatry, 72, 1522-1528.