Self-harm subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP): predicting suicide attempts over 8 years of follow-up. Academic Article uri icon


  • 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.

published proceedings

  • J Clin Psychiatry

author list (cited authors)

  • Yen, S., Shea, M. T., Walsh, Z., Edelen, M. O., Hopwood, C. J., Markowitz, J. C., ... McGlashan, T. H.

citation count

  • 14

complete list of authors

  • Yen, Shirley||Shea, M Tracie||Walsh, Zach||Edelen, Maria O||Hopwood, Christopher J||Markowitz, John C||Ansell, Emily B||Morey, Leslie C||Grilo, Carlos M||Sanislow, Charles A||Skodol, Andrew E||Gunderson, John G||Zanarini, Mary C||McGlashan, Thomas H

publication date

  • November 2011