These questions ask about your thoughts and feelings of suicide and self-injurious behaviors. Please listen carefully and respond as accurately as you can. Do you have any questions before we begin? | ||||
Suicidal ideation | ||||
1. Have you ever had thoughts of killing yourself? | 1. ________________ | |||
(0) No | (1) Yes | |||
2. How old were you the first time you had thoughts of killing yourself? (age) | 2. ________________ | |||
3. How old were you the last time? (age) | 3. ________________ | |||
4. How many separate times in your life have you had thoughts of killing yourself? (Please give your best estimate) | 4. ________________ | |||
5. How many separate times in the past year? | 5. ________________ | |||
6. How many separate times in the past month? | 6. ________________ | |||
7. How many separate times in the past week? | 7. ________________ | |||
8. When was the last time? | 8. ________________ | |||
Hand respondent 0 to 4 rating scale. On the last page, at the bottom, is a 0 to 4 rating scale for a number of the upcoming questions. | ||||
9. On this scale of 0 to 4, at the worst point, how intense were your thoughts of killing yourself? | 9. ________________ | |||
10. On the scale of 0 to 4, on average, how intense were these thoughts? | 10. ________________ | |||
11. When you had thoughts of killing yourself, what method did you think of using? | 11. ________________ | |||
(1) Own prescription drugs (2) Illicit drugs (not prescription) (3) Over-counter drugs (4) Other's prescription drugs (5) Poison (6) Firearms | (7) Immolation (8) Sharp object (9) Auto exhaust (10) Other gases (11) Train/car (12) Jump from height | (13) Drowning (14) Suffocation (15) Hanging (16) Other: ________________ | ||
12. When you had thoughts of killing yourself, how long did they usually last? | 12. ________________ | |||
(0) 0 seconds (1) 1 to 60 seconds (2) 2 to 15 minutes (3) 16 to 60 minutes | (4) Less than 1 day (5) 1 to 2 days (6) More than 2 days (7) Wide range (spans >2 responses) | |||
13. On the scale of 0 to 4, what do you think the likelihood is that you will have thoughts of killing yourself in the future? | 13. ________________ | |||
Suicide plan | ||||
14. Have you ever actually made a plan to kill yourself? | 14. ________________ | |||
(0) No | (1) Yes | |||
We will refer to this as a suicide plan. | ||||
15. How old were you the first time you made a suicide plan? (age) | 15. ________________ | |||
16. How old were you the last time? (age) | 16. ________________ | |||
17. How many separate times in your life have you made a suicide plan? | 17. ________________ | |||
18. How many separate times in the past year? | 18. ________________ | |||
19. How many separate times in the past month? | 19. ________________ | |||
20. How many separate times in the past week? | 20. ________________ | |||
21. On the scale of 0 to 4, at the worst point, how seriously did you consider acting on the plan? | 21. ________________ | |||
22. On the scale of 0 to 4, on average, how seriously have you considered acting on them? | 22. ________________ | |||
23. When you had a plan(s), what method(s) did you think of using? | 23. ________________ | |||
(1) Own prescription drugs (2) Illicit drugs (not prescription) (3) Over-counter drugs (4) Other's prescription drugs (5) Poison (6) Firearms | (7) Immolation (8) Sharp object (9) Auto exhaust (10) Other gases (11) Train/car (12) Jump from height | (13) Drowning (14) Suffocation (15) Hanging (16) Other: ________________ | ||
24. When you had a plan, how long did you think about it before either moving onto something else or acting on the plan? | 24. ________________ | |||
(0) 0 seconds (1) 1 to 60 seconds (2) 2 to 15 minutes (3) 16 to 60 minutes | (4) Less than 1 day (5) 1 to 2 days (6) More than 2 days (7) Wide range (spans >2 responses) | |||
25. When you had a plan(s), did you take steps to prepare to act on the plan(s)? | 25. ________________ | |||
(0) No | (1) Yes | |||
(If "yes", go to question 26) | ||||
26. What did you do? | 26. ________________ | |||
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27. On the scale of 0 to 4, what do you think the likelihood is that you will make a suicide plan in the future? | 27. ________________ | |||
Suicide gesture | ||||
Say slowly – make sure they understand exactly what you are saying. | ||||
28. Have you ever done something to lead someone to believe that you wanted to kill yourself when you really had no intention of doing so? | 28. ________________ | |||
(0) No | (1) Yes | |||
(Only score if there was NO suicidal intent, and they wanted someone else to BELIEVE they wanted to make a suicide attempt) | ||||
We will refer to this as a suicide gesture. | ||||
29. How old were you the first time you made a suicide gesture? (age) | 29. ________________ | |||
30. How old were you the last time? (age) | 30. ________________ | |||
31. How many separate times in your life have you made a suicide gesture? | 31. ________________ | |||
32. How many separate times in the past year? | 32. ________________ | |||
33. How many separate times in the past month? | 33. ________________ | |||
34. How many separate times in the past week? | 34. ________________ | |||
35. What have you done? | 35. ________________ | |||
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36. When you made a suicide gesture, how long did you think about it before doing it? | 36. ________________ | |||
(0) 0 seconds (1) 1 to 60 seconds (2) 2 to 15 minutes (3) 16 to 60 minutes | (4) Less than 1 day (5) 1 to 2 days (6) More than 2 days (7) Wide range (spans >2 responses) | |||
37. On the scale of 0 to 4, what do you think the likelihood is that you will make a suicide gesture in the future? | 37. ________________ | |||
Suicide attempt | ||||
38. Have you ever made an actual attempt to kill yourself in which you had at least some intent to die? | 38. ________________ | |||
(0) No | (1) Yes | |||
We will refer to this as a suicide attempt. | ||||
39. How old were you the first time you made a suicide attempt? (age) | 39. ________________ | |||
40. How old were you the last time? (age) | 40. ________________ | |||
41. When was the most recent suicide attempt? | 41. ________________ | |||
42. How many days was that from today? (Note to the data enterer: Please calculate how many days the most recent suicide attempt was from the interview date) | 42. ________________ | |||
43. How many suicide attempts have you made in your lifetime? | 43. ________________ | |||
44. How many separate attempts in the past year? | 44. ________________ | |||
45. How many separate attempts in the past month? | 45. ________________ | |||
46. How many separate attempts in the past week? | 46. ________________ | |||
47. For your most recent suicide attempt, what method did you use? | 47. ________________ | |||
(1) Own prescription drugs (2) Illicit drugs (not prescription) (3) Over-counter drugs (4) Other's prescription drugs (5) Poison (6) Firearms | (7) Immolation (8) Sharp object (9) Auto exhaust (10) Other gases (11) Train/car (12) Jump from height | (13) Drowning (14) Suffocation (15) Hanging (16) Other: ________________ | ||
48. What were the circumstances that contributed most to your most recent suicide attempt? (Put in order of importance) | 48a. 48b. ________________ | |||
(1) Job loss/job stress/academic failure (2) Problems with family or friends (3) Problems with spouse/lover (4) Financial problems | (5) Eviction (6) Health problems (7) Death of another person (8) Psychiatric symptoms | (9) Humiliating event (10) Loneliness (11) Other:________________ | ||
49. What kind of injuries did you have as a result of this suicide attempt? | 49. ________________ | |||
Regarding the most lethal attempt: | ||||
50. How old were you when you made the suicide attempt that caused you the most physical harm? (age) | 50. ________________ | |||
51. When did it occur? | 51. ________________ | |||
52. How many days was that from today? (Note to the data enterer: Please calculate how many days the most lethal suicide attempt was from the interview date) | 52. ________________ | |||
53. What kind of injuries did you have as a result of this attempt? | 53. ________________ | |||
54. Is the most harmful attempt also the most recent? | 54. ________________ | |||
(0) No | (1) Yes | |||
Regarding all your past suicide attempts: | ||||
55. How long did you usually think about suicide before making an attempt? | 55. ________________ | |||
(0) 0 seconds (1) 1 to 60 seconds (2) 2 to 15 minutes (3) 16 to 60 minutes | (4) Less than 1 day (5) 1 to 2 days (6) More than 2 days (7) Wide range (spans >2 responses) | |||
56. On the scale of 0 to 4, what do you think the likelihood is that you will make a suicide attempt in the future? | 56. ________________ | |||
Thoughts of nonsuicidal self-injury | ||||
People sometimes have thoughts about hurting themselves without wanting to die. Other times they actually do things to hurt themselves. Right now I'm going to ask you some questions about what some people think, and then I'll ask you about what some people do in a bit. | ||||
57. Have you ever had thoughts of purposely hurting yourself without wanting to die (for example, cutting or burning)? | 57. ________________ | |||
(0) No | (1) Yes | |||
We will refer to this as a nonsuicidal self-injury (NSSI). | ||||
58. How old were you the first time you thought about engaging in NSSI? (age) | 58. ________________ | |||
59. How old were you the last time? (age) | 59. ________________ | |||
60. How many separate times in your life have you had thoughts about engaging in NSSI? (Please give your best estimate) | 60. ________________ | |||
61. How many separate times in the past year? | 61. ________________ | |||
62. How many separate times in the past month? | 62. ________________ | |||
63. How many separate times in the past week? | 63. ________________ | |||
64. On the scale of 0 to 4, at the worst point, how intense were your thoughts about engaging in NSSI? | 64. ________________ | |||
65. On the scale of 0 to 4, on average, how intense were these thoughts? | 65. ________________ | |||
66. What method did you think of using? | 66. ________________ | |||
(1) Cut or carved skin (2) Burned your skin (ie, with a cigarette, match, or other hot object) (3) Inserted sharp objects into your skin or nails | (4) Picked areas of your body to the point of drawing blood (10) Hit yourself on purpose (11) Gave yourself a tattoo | (12) Scraped your skin to the point skin or nails of drawing blood (13) Other (specify):________________ | ||
67. When you had these thoughts, how long do they usually last? | 67. ________________ | |||
(0) 0 seconds (1) 1 to 60 seconds (2) 2 to 15 minutes (3) 16 to 60 minutes | (4) Less than 1 day (5) 1 to 2 days (6) More than 2 days (7) Wide range (spans >2 responses) | |||
68. On the scale of 0 to 4, what do you think the likelihood is that you will have thoughts about engaging in NSSI in the future? | 68. ________________ | |||
Nonsuicidal self-injury | ||||
69. Have you ever actually purposely engaged in NSSI? | 69. ________________ | |||
(0) No | (1) Yes | |||
70. How old were you the first time you purposely engaged in NSSI? (age) | 70. ________________ | |||
71. How old were you the last time? (age) | 71. ________________ | |||
72. How many separate times in your life have you engaged in NSSI? (Please give your best estimate) | 72. ________________ | |||
73. How many separate times in the past year? | 73. ________________ | |||
74. How many separate times in the past month? | 74. ________________ | |||
75. How many separate times in the past week? | 75. ________________ | |||
76. Now I'm going to go through a list of things that people sometimes purposely do to harm themselves without wanting to die. Please let me know which of these you've done: | 76a. 76b. 76c. 76d. ________________ | |||
(1) Cut or carved skin (2) Burned your skin (ie, with a cigarette, match, or other hot object) (3) Inserted sharp objects into your skin or nails | (4) Picked areas of your body to the point of drawing blood (10) Hit yourself on purpose (11) Gave yourself a tattoo | (12) Scraped your skin to the point skin or nails of drawing blood (13) Other (specify):________________ | ||
77. On average, how long have you thought about NSSI before engaging in it? | 77. ________________ | |||
(0) 0 seconds (1) 1 to 60 seconds (2) 2 to 15 minutes (3) 16 to 60 minutes | (4) Less than 1 day (5) 1 to 2 days (6) More than 2 days (7) Wide range (spans >2 responses) | |||
78. Have you ever received medical treatment for harm caused by NSSI? | 78. ________________ | |||
(0) No | (1) Yes | |||
79. On a scale of 0 to 4, what do you think the likelihood is that you will purposely engage in NSSI in the future? | 79. ________________ | |||
0 to 4 rating scale | ||||
0 Not at all | 1 A little bit | 2 Somewhat | 3 Very much | 4 Extremely |
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