Client ID #: _________________________________ Interviewer’s ID #: ___________________________

Date: ______________________________________

LINEHAN SUICIDE ATTEMPT-SELF-INJURY INTERVIEW (SASII) -STANDARD (SHORT) VERSION -2006

Linehan, M.M., Comtois, K.A., Brown, M.Z., Heard, H.L., Wagner, A. (2006). Suicide Attempt Self-Injury Interview (SASII):
Development, Reliability, And Validity of A Scale To Assess Suicide Attempts And Intentional Self-Injury. Psychological
Assessment, 18(3), 303-312.

S1______ At any time in the last year [your life, since last assessment, etc.] have you deliberately harmed or injured yourself or
attempted suicide? (0 = No, 1 = Yes).

S2 _________ How many times have you deliberately harmed or injured yourself or attempted suicide in the last year [your life, since last
assessment, etc.]?

S3______ INTERVIEWER: HOW RELIABLE IS THIS NUMBER? (0 = Unreliable, 1 = Somewhat reliable, 2 = Reliable)

S4______ HOW MANY EPISODES WERE COUNTED AS THRESHOLD “SUICIDE ATTEMPT/INTENTIONAL SELF-
INJURY”? (Answer at end of interview)

Use this horizontal dateline to note suicide attempts or intentional self-injury episodes, in chronological order. Start in the lower right
corner, on the first line, and move from right to left. Make a short vertical mark for each suicide attempt/intentional self-harm. Next to the
mark, write the date of the episode, the method and if the subject received medical treatment as a result. Circle any events that the subjects
describe as suicide attempts. Any further details should be written in the body of the interview.

(Start date ) ___/___/__

___________________________________________________ /___________________________________________________
12 months/ One year ago 11 months ago

___________________________________________________ /___________________________________________________
10 months ago 9 months ago

___________________________________________________ /___________________________________________________
8 months ago 7 months ago

___________________________________________________ /___________________________________________________
6 months ago 5 months ago

___________________________________________________ /___________________________________________________
4 months ago 3 months ago

___________________________________________________ /___________________________________________________
2 months ago 1 month ago/ Most recent month
(Yesterday’s Date)___/___/___

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01 ______ SASII SEQUENCE NUMBER (Count most recent SASII as “1”) (If no SASII, code 0 and stop interview)

02 ______ BASIS FOR SEQUENCE NUMBER (1 = All episodes, 2 = All medically treated episodes, 3 = Most serious
episode, 4 = First episode, 5 = Most recent episode, 6 = most serious last year 7 = Other _______.

03 ______ Think back to the most recent time (time before that) when you harmed yourself. Was this a single event or a
series or cluster of events?

INTERVIEWER: RATE EPISODE AS A SINGLE EVENT OR CLUSTER OF EVENTS.

0 = Single event. An act clearly remembered and/or distinguishable from another act by any detail.
1 = Cluster of events. A repetitive or habitual series of low lethality acts in which all circumstances were
identical, or a series of acts so poorly recalled by subject such that acts cannot be differentiated from each
other in any way other than count.

DESCRIBE BASIS FOR LABELING AS A CLUSTER:

1a _________________________________________________________________________________________
____________________________________________________________________________________________
04 _______ Was the initiation of your action to (method)/(self-injury/suicide attempt/overdose) deliberate, accidental, or
somewhere in between? (1 = Accidental, 2 = Semi-deliberate, 3 = Deliberate) (INTERVIEWER: IF
INITIATION OF ACT ITSELF WAS AN ACCIDENT, I.E. CODE=1, BEHAVIOR IS NOT A SASII.)

05 _______ Exact/estimated number of suicide attempts or self-harm events in this cluster (IF SINGLE EVENT, ENTER
"1")

5a___ ___/ ___ ___/ ___ ___ First date of cluster (IF SINGLE EVENT ENTER DATE OF EVENT)

5b___ ___/ ___ ___/ ___ ___Last date of cluster (IF SINGLE EVENT ENTER DATE OF EVENT.)

06______ How accurate is this date (1=Exact, 2=Within two weeks, 3=Within one month, 4=Anytime in last year)

METHOD AND LETHALITY OF METHOD

07_____ Before we try to understand what led up to and followed your self-injury/attempted suicide/overdose, I want to
first understand exactly what you did. Tell me again/describe exactly what method(s) you used to injure
yourself?
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

INTERVIEWER: CODE PRIMARY METHOD FOR #07

FOR EACH OF THE FOLLOWING METHODS, CODE 0 = Not used, 1 = Used.

7.1______ = Alcohol (used with direct intent to self-harm):

71a ______ What were you drinking?

(1 = BEER, 2 = WINE, 3 = LIQUOR,
4 = COMBINATION OF 1 & 2,
5 = COMBINATION OF 1 & 3,
6 = COMBINATION OF 2 & 3,
7 = COMBINATION OF 1, 2, & 3,
6 = OTHER, 71ao ___________________)
71b _____How much did you drink? (CODE SEC’s) ____________________________________

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7.2______ = Drugs/Medications (used with direct intent to self-harm): ___________________________________

72a _____How many different drugs or medications did you take?

72b What drugs or medication did you take? ___________________________________________

72c DRUG CODE ______
72d How much did you take? 72d1 # tablets: ______ 72d2 # mg:______
72g What other drugs or medication did you take? ______________________________________
72h DRUG CODE ________
72i How much did you take? 72i1 # tablets: ___________ 72i2 # mg: ________
72l What other drugs or medication did you take? _______________________________________
72m DRUG CODE ________
72n How much did you take? 72n1 # tablets: _________ 72n2 # mg: _________

72q List any other drugs that you took ________________________________________________

7.3______ = Poison/caustic substance:
73a What substance did you take? _______
(1=LYSOL, 2=RAT POISON, 3=AMMONIA, 4=POLISH REMOVER,
5=OTHER 73ao________________________________
73b How much did you take? ________________.
7.4______ = Burning:
74a What did you use? ______
(1=CIGARETTE, 2=LIGHTER/MATCH, 3=OVEN/STOVE,
4=CURLING IRON/FLAT IRON, 5=CLOTHES IRON, 6=HOT METAL, 7=HEATED KNIFE,
8=CANDLE, 9=CHARCOAL, 10=GREASE,
11=BOILING WATER, 12=LIGHT BULB, 13=INCENSE STICK,
14=OTHER 74ao______________)
74b Where did you burn yourself? ______
(1=WRISTS/ARMS, 2= TORSO, 3=LEGS,
4=OTHER/MIXED 74bo_______________, 5=RECTUM, 6=VAGINA)
74c VERIFICATION BY SCARS? ______ (0 = No, 1 = Yes)
7.5______ = Scratch/cut
75a What did you use? ______
(1=RAZOR, 2=KITCHEN KNIFE,
3=EXACTO KNIFE/BOX CUTTER/CARPET KNIFE/UTILITY KNIFE, 4=POCKET
KNIFE/SWISS ARMY KNIFE, 5=SCISSORS/WIRE CUTTER, 6=FINGERNAILS,
7=GLASS/LIGHT BULB/POTTERY, 8=CAN LID/POP CAN, 9=EATING UTENSILS,
10=TWEEZERS, 11=PLASTIC, 12=NAILS,
13=SAFETY PIN/PUSH PIN/TACK, 14=OTHER 75ao__________)
75b Where did you scratch/cut? ______
(1=WRISTS/ARMS, 2=THROAT, 3= TORSO, 4=LEGS,
5=OTHER/MIXED 75bo _____________________________________________________
75c How many stitches did you have? (if none, code 0 ___________________________________
75d SEVERITY? ______
(1=SCRATCH, 2=CUTS, NO TENDON, ARTERY, NERVE DAMAGE, 3=TENDON, ARTERY,
NERVE DAMAGE)
75e VERIFICATION BY SCARS? (0 = No, 1 = Yes)

7.6______ = Stabbing, puncture:

76a What did you use? ______
(1=NEEDLE, 2=KITCHEN KNIFE, 3=POCKET KNIFE, 4=UTILITY KNIFE, 5=PEN/PENCIL,
5=NAILS, 7=SCISSORS, 8=GLASS, 9=KEYS, 10=PINS, 11=OTHER 76ao ________.
76b Where did you stab/puncture? ______
(1=WRISTS/ARMS, 2= TORSO, 3=LEGS, 4=OTHER/MIXED 76bo _________________
76c How many stitches did you have? ________________________________________________
76d VERIFICATION BY SCARS? (0 = No, 1 = Yes)

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7.7______ = Gun:
77a What kind of gun did you use? ______
(1=BB GUN, 2=HAND GUN, 3=RIFFLE, 4=AUTOMATIC, 5=DART GUN, 6=OTHER
77ao_____________________)
77b Where did you shoot? ______
(1=HEAD, 2= CHEST, 3=LOWER TORSO, 4=LIMBS, 5=OTHER/MIXED 77bo _______
77c VERIFICATION BY SCARS? (0 = No, 1 = Yes)

7.8______ = Hanging:
78a What did you use? ______
(1= STRING, 2=ROPE, 3=SHEET, 4=OTHER 78ao__________, 5=BELT/STRAP, 6=TOWEL)

7.9______ = Strangling:
79a What did you use? ______
(1= STRING, 2=ROPE, 3=SHEET, 4=OTHER 79ao__________, 5=BELT/STRAP, 6=TOWEL,
7=HANDS)

7.10______ = Asphyxiation:
710a What did you use? ______
(1=CARBON MONOXIDE, 2=PLASTIC BAG, 3=OTHER 710ao ________, 4=PILLOW)

7.11______ = Jumping:
711a On what did you land? ______
(1= SOLID GROUND, 2=WATER, 3=OTHER 711ao______,
4=DIDN'T FALL BUT WOULD HAVE BEEN LAND,
5=DIDN'T FALL BUT WOULD have LANDED IN WATER
711b From how high did you jump? (IN FEET)____________.

7.12______ = Drowning:
712a How far from shore or safety did you swim ?(IN FEET) ____________.
712b Was the water warm or cold? (1=WARM, 2=COLD) ______
712c Can you swim? (0 = NO, 1 = YES) ______

7.13______ = Hitting body:

713a What object did you hit? ______
(1=WALL, 2=FLOOR, 3=WALL AND FLOOR, 4=OTHER 713ao _________5=FISTS, 6=SINK,
7=APPLIANCES, 8=HAMMER, 9=FURNITURE, 10=WHIP)
713b How many times did you hit yourself? )___________.
713c What part of your body was hit? ______
(1=HEAD AGAINST OBJECT, 2=FISTS AGAINST OBJECTS,
3=FISTS AGAINST HEAD, 4=OTHER 713co _____________.
713d VERIFICATION BY BRUISE/SWELLING? (0 = No, 1 = Yes)
7.14______ = Stopped required medical treatments or medications (with direct intent to self-harm):
714a What did you stop doing? ______
(1= STOPPED NEEDED MEDICAL TREATMENTS,
2= STOPPED MEDICATIONS, 3=OTHER 714ao_________,
714b For how long was the treatment/medication stopped (hours)? ___________
714c What was the treatment for? _____________________________________
714d What were expected consequences of stopping treatment: ________________-
_____________________________________________________

7.15______ = Transportation related injury (e.g., drove car off a cliff).

715a describe:____________________________________________________________

7.16______ = Stepped into traffic.

716a describe:____________________________________________________________

7.17 = Other: _____________________________________________

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08 ______ INTERVIEWER: RATE MEDICAL RISK OF DEATH BASED ON METHOD AND ON OTHER
SUBSTANCES PRESENT AT TIME
1 = Very low. Less than/equal to 5 pills (unless medication potentially lethal in low doses); scratching;
reopening partially healed wounds; head banging, swallowing small, non-sharp objects; going
underdressed into cold for brief time, lying down at night in the middle of a non-busy road but getting up
when a car doesn’t come or swimming out to middle of lake and returning upon getting tired. Minor
heroin overdose 1.5 times usual dependent dose.
2 = Low. Superficial cut on surface or limbs; 6-10 pills (or fewer if medication potentially lethal in low doses);
cigarette burn(s), jumping feet first from very low place (less than 10 feet). Heroin overdose 1.5 times
usual dependent dose combined with other drugs and/or alcohol.
3 = Moderate. Overdose on 11-50 pills or two or more types of pills or 6-10 pills potentially lethal in low doses
and combined with alcohol; deep cuts anywhere but neck, swallowing ≤ 12 oz shampoo or astringent, ≤ 2
oz. lighter fluid, or ≤ 4 tbsp. cleaning compounds; igniting flammable substance on limb. Moderate heroin
overdose 2 - < 3 times usual dependent dose.
4 = High. Overdose with over 50 pills or 11-30 pills potentially lethal in low doses or combined with large
amount of alcohol, stabbing to body; pulling trigger of a loaded gun aimed at a limb (arm or leg),
swallowing > 2 oz lighter fluid, > 12 oz shampoo or astringent or > 4 tbsp. cleaning compounds, igniting
flammable substance on multiple limbs and torso, walking into heavy traffic.
Heroin overdose 2 - < 3 times usual dependent dose combined with other drugs and/or alcohol.
5 = Very high. Overdose with over 30 pills lethal in small doses or combined with large amount of alcohol;
poison (unless small amount not potentially lethal); attempted drowning; suffocation; deep cuts to the
throat or limbs; jumping from low place (less that 20 feet), igniting flammable substance all over body,
electrocution, throwing self in front of or from car going less than 30 miles/hr, strangulation. Serious
heroin overdose 3 or more times usual dependent dose.
6 = Severe. Pulling trigger of loaded gun aimed at vital area (such as torso or head); Russian roulette, jumping
from a high place (more than 20 feet); hanging (feet above the ground); asphyxiation (such as carbon
monoxide suffocation); jumping in front of auto going faster than 30 miles/hr or off overpass in rush hour
traffic, attempted drowning after ingesting alcohol or other drugs, swallowing nail polish remover,
turpentine or similar substances. Serious heroin overdose 3 or more times usual dependent dose combined
with other drugs and/or alcohol.

INTENT

09_____ At the time of your self-injury/suicide attempt/overdose, what final outcome did you most intend and expect?
(RECORD ANSWER VERBATIM.)
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

INTERVIEWER: RATE SUBJECT’S CONSCIOUS INTENT TO CAUSE SELF-INJURY, I.E., DEGREE

THAT BEHAVIOR WAS INITIATED AND PERFORMED IN ORDER TO CAUSE SELF-INJURY OR IN
ORDER TO RISK SELF-INJURY.
0 = No bodily or physiological harm intended or expected (e.g., expected to fly from window ledge; habitual
substance abuser expected to get high as usual; bulimic expected to purge as usual)
1 = Ambivalent intent to cause bodily injury or physiological harm to self and took a chance (e.g., Russian
roulette, habitual substance abuser took more than normal amount)
2 = Clear expectations of some bodily injury, physiological harm to self (e.g., expected to sleep for a whole
weekend, expected skin to be broken, bulimic expected to disrupt electrolyte balance), or death

10 ______ Just before or at the time of this self-injury/overdose, were you thinking about suicide or wishing you were
dead?
0 = Not at all
1 = I was wishing I was dead, but the thought of suicide did not go thru my mind
2 = The thought of suicide passed thru my mind
3 = I briefly considered it, but not seriously
4 = I was thinking about it and was somewhat serious
5 = I was very serious about dying but was also somewhat ambivalent
6 = I was extremely serious, intended to die and was not ambivalent at all

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11. Would you say that you injured yourself/attempted suicide/overdosed for any of the reasons on this list and, if
so, which ones? (0 = Not mentioned, 1 = Mentioned) Please Give Card A to client

_____1 To stop bad feelings

_____2 To communicate to or let others know how desperate you were
_____3 To get help
_____4 To gain admission into a hospital or treatment program
_____5 To die
_____6 To feel something, even if it was pain
_____7 To punish yourself
_____8 To get a vacation from having to try so hard
_____9 To get out of doing something
_____10 To shock or impress others
_____11 To prove to yourself that things really were bad
_____12 To give you something, anything to do
_____13 To get other people to act differently or change
_____14 To get back at or hurt someone
_____15 To make others better off
_____16 To get away or escape
To get away or escape from what? (check all that apply)
_____16a. your thoughts and memories
_____16b. your feelings
_____16c. other people
_____16d. yourself
_____17 To stop feeling numb or dead
_____18 To prevent being hurt in a worse way
_____19 To stop feeling angry or frustrated or enraged
_____20 To demonstrate to others how wrong they are/were
_____21 To relieve anxiety or terror
_____22 To distract yourself from other problems
_____23 To relieve feelings of aloneness, emptiness or isolation
_____24 To stop feeling self-hatred, shame
_____25 To express anger or frustration
_____26 To obtain relief from a terrible state of mind
_____27 To make others understand how desperate you are
_____28 To stop feeling sad
_____29 Other________________________________

12______ At the time it occurred, did you consider the episode a suicide attempt, even if you did not really intend to die?
(0 = No, 1 = Yes).

13______ Do you now consider that episode a suicide attempt? (0 = No, 1 = Yes).

If Q. 12 & 13 ARE CODED DIFFERENTLY, ASK THE FOLLOWING AND RECORD ANSWER
VERBATIM.
What accounts for this change?
13a ________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
14_____ INTERVIEWER: RATE SUBJECT’S CONSCIOUS EXPECTATION OF FATAL OUTCOME.
0 = No expectation
1 = Uncertain of outcome
2 = Clear expectations of fatal outcome

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COMMUNICATION OF SUICIDE INTENT

15_______ At the time or near the time of this episode, did you tell anyone, directly or indirectly, that you were thinking of
suicide or that you wished you were dead? (ASSESS IF SUBJECT COMMUNICATED SUICIDE
IDEATION: 0=No, 1=Indirect communication, 2=Direct communication.)

15a DESCRIBE: _____________________________________________________________________________

____________________________________________________________________________________________
____________________________________________________________________________________________
16 ______ At the time or near the time of this episode, did you threaten suicide to anyone or do anything that could be or
was interpreted by someone else as a threat to harm or kill yourself?
(ASSESS IF SUBJECT THREATENED: 0=No, 1=Indirect threat, 2=Direct threat.)

16a DESCRIBE: _____________________________________________________________________________

____________________________________________________________________________________________
____________________________________________________________________________________________

IMPULSIVITY AND PROBABILITY OF INTERVENTION

17 ______ Did you plan your self-injury/suicide attempt/overdose, or was it an impulsive act? (RECORD ANSWER
VERBATIM)
17a ________________________________________________________________________________________
____________________________________________________________________________________________

INTERVIEWER: RATE IMPULSIVITY OF ACT.

1 = Commitment to act, followed by very careful or elaborate plan carried out over a period of time.
2 = Actively planned and/or got implements. Had impulse, resisted for _____ days, then acted.
3 = Actively planned and/or got implements. Had impulse, resisted for less than 24 hours.
4 = No active planning. Had impulse, resisted for _____ days, then acted.
5 = No active planning. Had impulse, resisted for less than 24 hours, then acted.
6 = No active planning. Occurred impulsively, with no forethought and without very strong emotion.
7 = No active planning. Occurred impulsively, with no forethought and with very strong emotion.

18_______ At the time or near the time of this episode, did you write a suicide note? (0 = No, 1 = Yes)

19 ______ Did you arrange your self-injury/suicide attempt/overdose in such a way that it would be difficult for anyone to
find, stop, or save you? (0 = No, 1 = Somewhat, 2 = Yes) Describe the circumstances: (RECORD ANSWER
VERBATIM.)
____________________________________________________________________________________________

20 ______ INTERVIEWER: RATE PROBABILITY OF INTERVENTION BASED ON ALL INFORMATION

1 = Chance of intervention remote. Act committed by person in a solitary or isolated place without access to
telephone (i.e., a wooded area, cemetery, etc.).
2 = Improbable intervention. Act committed by person alone, with intervention by a passerby possible although
not expected (i.e., in a motel room, an office late at night, at home alone with no one expected).
3 = Ambiguous chance of intervention. Act committed by person alone, with no certainty of immediate
assistance. However, a reasonable chance for intervention existed (i.e., the victim is aware of the
impending arrival of others).
4 = Probable intervention. Act committed with another person in the immediate vicinity but not visibly present
(such as in the same dwelling/building). Or made phone call but did not directly communicate intention.
5 = Certain intervention. Act committed in the presence of another person/made phone call immediately before
or after in order to advise of act or to say good-bye.

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LEVEL OF MEDICAL TREATMENT

21. Following your self-injury/suicide attempt/overdose were you taken to any of these places or did you turn to
any of these places or people for help? (Give Card B); 0 = Not contacted, 1 = Contacted).
_______1 Physician/nurse (Visit)
_______2 Crisis outreach/after hours team/mental health professional (In person visit)
_______3 Police/wellness check (At home or other residence)
_______4 Paramedics/ambulance/aid car (At home or other residence)
_______5 Hospital emergency room
_______5b 0 = Not medically treated, 1 = Treated
_______6 Inpatient, psychiatric unit
_______6b Number of days (CODE = “0” if 6 = 0)
_______6c Voluntary (1 = Yes; 2 = voluntary but threatened with legal commitment if not agreed to;
3 = legally detained on a 24-48 hr. hold; 4 = 72+ hold)
_______ 7 Hospital medical floor
_______7b Number of days (CODE = “0” if 7 = 0)
_______ 8 Intensive care
_______8b Number of days (CODE = “0” if 8 = 0)

22 ______ What was your physical condition afterward? (RECORD VERBATIM ANSWER.)
22a_________________________________________________________________________________________
____________________________________________________________________________________________

22b RECORD INFORMATION FROM MEDICAL RECORDS _______________________________________

____________________________________________________________________________________________
INTERVIEWER: RATE PHYSICAL CONDITION FOLLOWING EPISODE
0 = No effect
1 = Very mild effect. Death impossible.
(e.g., went to sleep at regular time, woke up ok; slightly queasy or nauseous, but no vomiting; rash type
abrasion, bruise; chilled; small non-sharp objects in digestive tract)
2 = Mild effect. Death is highly improbable; could only occur due to secondary complications or very unusual
circumstance.
(e.g., nauseous; slept significantly more than normal, woke up ok; 1st degree burn; superficial lacerations
without tendon, nerve or vessel damage and not requiring sutures; minimal blood loss; larger non-sharp
objects in digestive tract)
3 = Moderate effect. Death is improbable; could only occur due to secondary effects; medical aid is warranted,
but not required for survival.
(e.g., vomiting; slept significantly more than normal, woke up still drowsy; 2nd degree burn; non-septic
infection; shallow lacerations on limbs or torso with slight tendon damage requiring sutures; broken digits
or limbs; slight to moderate hypothermia or frost bite; slight concussion with no disorientation)
4 = Severe effect. Death is improbable if first aid or medical attention is administered.
(e.g., respiratory failure, elevated blood pressure, convulsions or seizures; 3rd degree burn covering 20%
or less of body surface; septicemia; deep lacerations on face, limbs or torso with tendon damage or
severing and possible nerve, vessel or artery damage; cuts on neck which may require sutures but no major
nerves or vessels severed; blood loss less than 100 cc.; bullet in or deep piercing of limbs; severe head
injury with decreased orientation; moderate tissue damage; sharp objects in digestive tract; vertebral
fracture without cord injury)
5 = Very severe effect. Death is somewhat probable unless first aid or medical attention is administered.
(e.g., caustic substance; hypertensive crisis; stroke; 3rd degree burn covering 40% of body surface; severe,
deep lacerations on face, limbs or torso with severing of major arteries; blood loss more than 200 cc; loss
of eye, ear or digits; bullet or deep piercing in lower torso; severe tissue loss; vertebral fracture with cord
injury; mild hypoxia; comatose but still responding to pain)
6 = Extremely severe effect. Death is highly probable without out immediate and vigorous medical attention,
and may occur even with vigorous first aid or medical attention.
(e.g., 3rd degree burn covering 50% or more of body surface; loss of limb; deep lacerations on neck with
major artery damage, i.e., cutting jugular vein; irreparable damage and/or systemic organ failure; gun shot
or bullet in chest or head; closed airways, severe hypoxia and/or respiratory arrest; severe hypothermia;
cardiac arrest; comatose and not responding to pain)
7 = Lethal effect. Death occurred.

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23 ______ INTERVIEWER: USE ALL APPROPRIATE INFORMATION REGARDING TREATMENT THAT HAS
BEEN GATHERED THROUGHOUT INTERVIEW TO CODE HIGHEST APPLICABLE NUMBER FROM
LIST BELOW
0 = No medical treatment sought/required
1 = Went to emergency room or physician, had no medical treatment or assessment and went home (e.g., talked
to social worker or resident and left)
2 = Went directly to an in-patient psychiatric unit
3 = Medically treated while on in-patient psychiatric unit, without going to emergency room
4 = Went to emergency room or physician, was medically treated and went home
5 = Went to emergency room, was treated and admitted to psychiatry unit
6 = While on psychiatric unit, went to emergency room for medical treatment and then returned to psychiatric
unit
7 = Admitted to medical unit, whether or not via emergency room, for observation (hours to overnight)
8 = Admitted to medical unit, whether or not via emergency room, for required treatment
9 = Admitted to intensive care unit, whether or not via emergency room or medical floor
10 = Mortuary

24 _____ INTERVIEWER: RATE SUBJECT’S INTENT TO DIE, I.E., THE SERIOUSNESS OR INTENSITY OF THE
WISH TO TERMINATE HIS OR HER OWN LIFE. RATINGS SHOULD REFLECT YOUR BEST
ESTIMATE BASED ON ALL INFORMATION.
1 = Obviously no intent
2 = Only minimal intent
3 = Definite intent but very ambivalent
4 = Serious intent
5 = Extreme intent (careful planning and every expectation of death)

DESCRIBE REASON FOR RATING: 24a ________________________________________________________

____________________________________________________________________________________________

25 _____ INTERVIEWER: BASED ON DEFINITION OF SASII ON APPENDIX, CATEGORIZE BEHAVIOR.

CODING SHOULD REFLECT YOUR BEST JUDGMENT BASED ON ALL INFORMATION.
1 = Accidental self-harm, without undue risk taking and without unreasonable expectation of safety
2 = Accidental self-harm, with undue risk taking or with unreasonable expectation of safety
3 = Victim-precipitated self-harm, without intent to be harmed by others but with undue risk taking or with
unreasonable expectation of safety
4 = “Victim-precipitated” self-harm with intent to be harmed by other
9 = OTHER, including absence of a behavior, which results in harm or illness (e.g., stopped taking important
medicines such as insulin)
5 = Intentional self-injury, but not a suicide attempt
6 = Ambivalent suicide attempt
7 = Suicide attempt with no ambivalence
8 = Suicide attempt that is a “failed suicide”, with continued life purely accidental and a near miracle

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Supplemental and experimental questions for the Suicide Attempt Self-Injury Interview

26. If you had to pick one thing that you think most triggered your self-injury/suicide attempt, what would you say
it was? (PROBE FOR MAIN PRECIPITATING EVENT)
____________________________________________________________________________________________
____________________________________________________________________________________________
_____26a. Did that happen on the day you injured yourself/attempted suicide? (0=no, 1=yes) _____26b. IF
NO: did that happen right before you felt the urge to injure yourself or attempt suicide? (0=NO,
1=YES)

IF NO TO BOTH: In thinking about the trigger, ask yourself what was it about that particular
day and that particular time that was different. What was the “straw that broke the camel’s back”
that triggered your action or your final decision to act? What was different about the day you
harmed yourself from a day or a week before or after? Why did you injure yourself on that
particular day, as opposed to the day before or the week before? What specific events, thoughts,
or feelings were most important?

27. Did any of the events or experiences on this list happen to you in the 24 hours before your self injury/suicide
attempt? Give Card D (0 = Not mentioned, 1= Mentioned) ASSESSOR CHECK ALL ITEMS LISTED BY
CLIENT.

THINGS THAT HAPPENED IN THE ENVIRONMENT

_____1 You had an argument or conflict with another person
_____2 You tried to spend time with someone but couldn’t
_____3 Someone was disappointed with you
_____4 Someone was angry with you, criticized you, or put you down
_____5 Someone let you down or broke a promise
_____6 Someone rejected you
_____7 You lost someone important (even if temporary loss)
_____8 Therapist went out of town or took a break from having sessions
_____9 You were isolated or alone more than you wanted to be
_____10 You had financial problems
_____11 You lost a job
_____12 You had health problems or physical discomfort
_____13 You had a new demand 13a ________________________.
_____14 You tried to get (or continue) something you wanted but couldn’t
_____15 You heard of someone else attempting suicide or harming themselves
_____16 You saw things that you could use to harm yourself or attempt suicide with
_____17 You talked to someone about sexual abuse or rape
_____18 You talked with your therapist about sexual abuse or rape
_____19 You had a therapy session before your self-injury/suicide attempt (on the same day)
_____20 You had a therapy session scheduled for later in the day (after self-injury/suicide attempt)
_____21 Other important negative events happened which could have triggered your suicide attempt/self-injury
21a____________________________________________________

CLIENT’S FEELINGS
____ 22 Upset, miserable or distressed _____31 Like a failure or inferior
_____23 Out of control _____32 Like a burden to others
_____24 Anxious, afraid, or panicked _____33 Felt bad about yourself
_____25 Overwhelmed _____34 Guilty
_____26 Angry, frustrated or enraged _____35 Sad or disappointed
unspecified _____36 Depressed
_____27 Angry, frustrated or enraged at _____37 Tired or exhausted
someone else _____38 Lonely, isolated, or abandoned
_____28 Angry frustrated or enraged at _____39 Trapped or helpless
yourself _____40 Discouraged or hopeless
_____29 Self-hatred or shame, or thought you were _____41 Confused
“bad” _____42 Emotionally empty or numb
_____30 Like you deserved to be punished or hurt
CLIENT’S THOUGHTS _____44 About physical abuse or assault
_____43 About sexual abuse or rape _____45 Had flashbacks or nightmares

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28. During the 24 hours before your self-injury/suicide attempt/overdose, did you:
_____1 Drink alcohol? (0 = No, 1 = Yes)
_____1b. How much did you drink? (CODE SEC’s)
_____1c. How many hours were you drinking?
_____1d. How long before your self-injury did you stop drinking? (CODE HOURS;
CODE = “0” IF DRANK IMMEDIATELY PRIOR TO INJURY)
_____2 Take illegal drugs or more than the prescribed amount of medications?
_____2a. How many different drugs did you use?
_____2b. What did you use?
_____2c. How much did you use?
_____2d. How long before your self-injury did you take the drugs/medications? (CODE
HOURS; CODE = “0” IF USED IMMEDIATELY PRIOR TO INJURY
_____2e. What did you use?
_____2f. How much did you use?
_____2g. How long before your self-injury did you take the drugs/medications? (CODE
HOURS; CODE = “0” IF USED IMMEDIATELY PRIOR TO INJURY
_____2h. What did you use?
_____2i. How much did you use?
_____2j. How long before your self-injury did you take the drugs/medications? (CODE
HOURS; CODE = “0” IF USED IMMEDIATELY PRIOR TO INJURY
2k. List any additional ones used.__________________________________
_____3 Sleep worse than you usually do?
_____4 Ask someone for help?
_____4b Did you get the help you asked for?
_____5 Eat a lot more food that you usually do (i.e., binge eating)?
_____6 Engage in illegal behavior (other than using drugs)?

29______ Were you feeling disconnected from your feelings or as if you were unreal during or prior to your self-
injury/suicide attempt/overdose? (0 = No, 1 = Yes).

30______ Did this state of being disconnected or unreal begin after you decided to self-injury/suicide attempt/overdose?
(0 = No, began before, 1 = Maybe, 2 = Yes, began after, -8 = No dissociation).

31_______ Were you hearing voices that were telling you to harm yourself during or prior to your self-injury/suicide
attempt/overdose? (0 = No, 1 = Yes).

32_____ Did you feel physical pain during your self-injury/suicide attempt/overdose? IF YES: How much pain did you
feel on a scale of 1 to 5 with 1=little pain but mostly none and 5=extreme pain. (Score 0=none or number 1-5).

33. Following your self-injury/suicide attempt/overdose were you taken to any of these places or did you turn to
any of these places or people for help? (Give Card C and code in the order that Subject contacted each) 0 =
Not contacted, 1 = Contacted first, 2 = Contacted 2nd, etc.).
_______1 Relative
_______2 Friend
_______3 Supervisor/teacher
_______4 Co-worker/other student
_______5 Stranger, neighbor
_______6 Crisis service/after hours team. (By phone)
_______7 Psychotherapist (By phone)
_______8 Physician/nurse (By phone)
_______9 Psychotherapist (Extra visit)
_______10 Other 10a________________

34. How helpful were each of the people/agencies with whom you had contact? Please rate on a scale of 1 to 5 with 1
= they made things worse to 5 = they made things much better.
_______1 Relative _______6 Crisis service/ after hours team. (By phone)
_______2 Friend _______7 Psychotherapist (By phone)
_______3 Supervisor/teacher _______8 Physician/nurse (By phone)
_______4 Co-worker/other student _______9 Psychotherapist (Extra visit)
_______5 Stranger, neighbor _____10 Other 10a _______________

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(For those items answered with a number in question #21, ask the above question. Code = “-8” if person/agency
was coded “0” in #21)

_______1 Physician/nurse (Visit)

_______2 Crisis outreach/after hours team/mental health professional (In person visit)
_______3 Police/wellness check (At home or other residence)
_______4 Paramedics/ambulance/aid car (At home or other residence)
_______5 Hospital emergency room
_______6 Inpatient, psychiatric unit
_______7 Hospital medical floor
_______8 Intensive care

35 ______ Did your self-injury/suicide attempt/overdose have any of the following consequences on your job? (CODE “-8”
IF SUBJECT UNEMPLOYED)
1 = Strongly improved my job performance by causing me to work more, be more focused, etc.
2 = Slightly improved my job performance
3 = No effect or overall neutral effect
4 = Impaired my job performance
5 = Reprimanded/demoted
6 = Lost job

36 ______ How many work days did you miss because of your self-injury? (CODE = “-8” IF SUBJECT UNEMPLOYED)

37 ______ Did your self-injury/suicide attempt/overdose have any of the following consequences on your school work?
(CODE = “-8” IF SUBJECT NOT ENROLLED)
1 = Strongly improved my school performance by causing me to study more, be more focused, etc.
2 = Slightly improved my school performance
3 = No effect or overall neutral effect
4 = Impaired my school performance
5 = Dropped a class(es) / Failed a class(es)
6 = Expelled

38 ______ How many days did you miss because of your self-injury? (CODE = “-8” IF SUBJECT NOT ENROLLED)

39 ______ Did your self-injury/suicide attempt/overdose have any of the following consequences on your housing situation?
1 = Strongly improved living situation by making roommates/family with whom you live more understanding,
reducing housework, etc.
2 = Slightly improved living situation
3 = No effect or overall neutral effect
4 = Housemates/neighbors upset / Restrictions placed on me
6 = Neighbors called the authorities to complain / Threatened with an eviction
7 = Evicted

40 ______ Did your self-injury/suicide attempt/overdose have any of the following consequences on your financial situation?
1 = Significantly improved my financial situation by causing others to give me money, reduce my debt, etc.
2 = Slightly improved my financial situation
3 = No effect or overall neutral effect
4 = Costs paid for by insurance or other third party or paid less than $100 out of pocket
5 = Paid costs out of pocket of more than $100
6 = Bankrupt

41 ______ Did your self-injury/suicide attempt/overdose have any of the following consequences on your relationships with
people that you care about?
1 = Much closer, much more contact
2 = Somewhat closer or somewhat more contact
3 = No effect or overall neutral effect
4 = Somewhat more distant or strained or somewhat less contact
5 = More distant or strained or less contact
6 = Relationship(s) ended

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42_____ Did any of the events or experiences on this list happen immediately following your self-
harming/suicidal incident? Give Card E. If so please give a rating for each question on the following
1-5 scale: 1 = “Not true at all/ did not happen at all,” to 5 = “Very true/ happened a lot”.

_______1. Bad feelings stopped

_______2. Others understood how desperate you are/were
_______3. You got help
_______4. You gained admission into a hospital or treatment program
_______5. You felt something, even if it was pain
_______6. You felt punished or succeeded in punishing yourself
_______7. You got a vacation from having to try so hard
_______8. You got out of doing something
_______9. You shocked or impressed others
_______10. You proved to yourself that things really were bad
_______11. It gave you something, anything to do
_______12. Other people treated you better
_______13. You got back at or hurt someone
_______14. Other people were better off than before you harmed yourself
_______15. You got away or escaped
_______16. You stopped feeling numb or dead
_______17. You prevented yourself from being hurt in a worse way
_______18. Feelings of anger, frustration, or rage stopped
_______19. Others realized how wrong they are/were
_______20. Feelings of anxiety or terror stopped
_______21. You were distracted from other problems
_______22. Feelings of aloneness, emptiness, or isolation stopped
_______23. Feelings of self-hatred/shame stopped
_______24. Your (self-injury/suicide attempt/overdose) expressed your anger or frustration
_______25. You experienced relief from a terrible state of mind
_______26. Feelings of sadness stopped
_______27. You stopped feeling empty inside, as if you were unreal, or disconnected from your feelings
_______28. Feelings of depression stopped
_______29. You felt worse about yourself or felt more self-hatred/shame
_______30. Other _____________________

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Appendices

SASII Card A
(Question #11)

Would you say that you injured yourself/attempted suicide for any of the reasons on this list and, if so, which ones?

1. To stop bad feelings

2. To communicate to or let others know how desperate I was
3. To get help
4. To gain admission into a hospital or treatment program
5. To die
6. To feel something, even if it was pain
7. To punish myself
8. To get a vacation from having to try so hard
9. To get out of doing something
10. To shock or impress others
11. To prove to myself that things really were bad
12. To give me something, anything to do
13. To get other people to act differently or change
14. To get back at or hurt someone
15. To make others better off
16. To get away or escape
To get away or escape from what? (tell assessor all that apply)
16a. my thoughts and memories
16b. my feelings
16c. other people
16d. myself
17. To stop feeling numb or dead
18. To prevent being hurt in a worse way
19. To stop feeling angry or frustrated or enraged
20. To demonstrate to others how wrong they are/were
21. To relieve anxiety or terror
22. To distract myself from other problems
23. To relieve feelings of aloneness, emptiness or isolation
24. To stop feeling self-hatred, shame
25. To express anger or frustration
26. To obtain relief from a terrible state of mind
27. To make others understand how desperate I am
28. To stop feeling sad
29. Other_____________________________

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SASII CARD B
(Question #21)

Following your self-injury/suicide attempt/overdose were you taken to any of these

places or did you turn to any of these places or people for help?

1. Physician/nurse (Visit)
2. Crisis outreach/after hours team/mental health professional (In person visit)
3. Police/wellness check (At home or other residence)
4. Paramedics/ambulance/aid car (At home or other residence)
5. Hospital emergency room
6. Inpatient, psychiatric unit
7. Hospital medical floor
8. Intensive care

SASII CARD C
(Question # 33)

Following your self-injury/suicide attempt/overdose were you taken to any of these

places or did you turn to any of these places or people for help?

1. Relative
2. Friend
3. Supervisor/teacher
4. Co-worker/other student
5. Stranger, neighbor
6. Crisis service/after hours team (by phone).
7. Psychotherapist (by phone)
8. Physician/nurse (by phone)
9. Psychotherapist (extra visit)
10. Other ___________________________________

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SASII
CARD D
(Question #27)

Did any of the events or experiences on this list happen to you in the 24 hours before your self injury/suicide attempt?

THINGS THAT HAPPENED IN THE ENVIRONMENT

1. I had an argument or conflict with another person
2 I tried to spend time with someone but couldn’t
3. Someone was disappointed with me
4. Someone was angry with me, criticized me, or put me down
5. Someone let me down or broke a promise
6. Someone rejected me
7. I lost someone important (even if temporary loss)
8. Therapist went out of town or took a break from having sessions
9. I was isolated or alone more than I wanted to be
10. I had financial problems
11. I lost a job
12. I had health problems or physical discomfort
13. I had a new demand
14. I tried to get (or continue) something I wanted but couldn’t
15. I heard of someone else attempting suicide or harming themselves
16. I saw things that I could use to harm myself or attempt suicide with
17. I talked to someone about sexual abuse or rape
18. I talked with my therapist about sexual abuse or rape
19. I had a therapy session before my self-injury/suicide attempt (on the same day)
20. I had a therapy session scheduled for later in the day (after self-injury/suicide attempt)
21. Other important negative events happened which could have triggered my self injury/ suicide attempt

FEELINGS
22. Upset, miserable or distressed 35. Sad or disappointed
23. Out of control 36. Depressed
24. Anxious, afraid, or panicked 37. Tired or exhausted
25. Overwhelmed 38. Lonely, isolated, or abandoned
26. Angry, frustrated or enraged unspecified 39. Trapped or helpless
27. Angry, frustrated or enraged at someone else 40. Discouraged or hopeless41. Confused
28. Angry frustrated or enraged at myself 42. Emotionally empty or numb
29. Self-hatred or shame, or thought I was “bad”
30. Like I deserved to be punished or hurt THOUGHTS
31. Like a failure or inferior 43. About sexual abuse or rape
32. Like a burden to others 44. About physical abuse or assault
33. Felt bad about myself 45. Had flashbacks or nightmares
34. Guilty

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SASII CARD E
(Question #42)

Did any of the events or experiences on this list happen immediately following your self-harming/suicidal
incident? If so please give a rating for each question on the following 1-5 scale:
1 = “Not true at all/ did not happen at all,” to 5 = “Very true/ happened a lot”.

1. Bad feelings stopped

2. Others understood how desperate I am/was
3. I got help
4. I gained admission into a hospital or treatment program
5. I felt something, even if it was pain
6. I felt punished or succeeded in punishing myself
7. I got a vacation from having to try so hard
8. I got out of doing something (PH2909)
9. I shocked or impressed others (PH2910)
10. I proved to myself that things really were bad
11. It gave me something, anything to do (PH2912)
12. Other people treated me better
13. I got back at or hurt someone
14. Other people were better off than before I harmed myself
15. I got away or escaped
16. I stopped feeling numb or dead
17. I prevented myself from being hurt in a worse way
18. Feelings of anger, frustration, or rage stopped 19. Others realized how wrong they are/were
20. Feelings of anxiety or terror stopped
21. I was distracted from other problems
22. Feelings of aloneness, emptiness, or isolation stopped
23. Feelings of self-hatred/shame stopped
24. My (self-injury/suicide attempt/overdose) expressed my anger or frustration
25. I experienced relief from a terrible state of mind
26. Feelings of sadness stopped
27. I stopped feeling empty inside, as if I was unreal, or disconnected from my feelings 28. Feelings of
depression stopped
29. I felt worse about myself or felt more self-hatred/shame
30. Other _____________________

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