The Direct and Indirect Self-Harm Inventory (DISH): A New Measure for Assessing High-Risk and Self-Harm Behaviors Among Military Veterans

Screeners in use at the Department of Veterans Affairs (VA) do not query high-risk and self-harm behaviors that are thought to be more common among veterans, especially male veterans, and may use stigmatizing language to query self-harm behaviors, resulting in underreporting. As such, many veteran's high-risk and self-harm behaviors may go undetected. The present study outlines the development and initial validation of the Direct and Indirect Self-Harm Inventory (DISH), a measure designed to detect high-risk and self-harm behaviors thought to be more common among veterans and to avoid the use of stigmatizing language. We also examined whether, and to what degree, novel behaviors assessed on the DISH longitudinally predict future suicide-related outcomes. Seventy-eight veterans enrolled in VA care and presenting with varying degrees of suicide risk completed the DISH as part of a larger study. Participants also completed the Self-Injurious Thoughts and Behaviors Interview (SITBI; Nock, Holmberg, Photos, & Michel, 2007), a well-validated assessment of self-harm behaviors. The DISH demonstrated good convergent validity with overlapping items on the SITBI (percent agreement ranged from 66.7% to 88.9%). Participants were more likely to report high-risk and indirect self-harm behaviors, but not direct self-harm behaviors, on the DISH than on the SITBI. None of the behaviors assessed on the DISH or the SITBI predicted future suicide-related outcomes. Though additional research is needed to further validate the DISH (e.g., test-retest reliability), the present study suggests that the DISH may be an improvement over existing measures for detecting high-risk and indirect self-harm behaviors in veterans.