JMIR Publications

ABSTRACT

Background:

Non-suicidal self-injury (NSSI) is a major mental health concern. Despite increased research efforts on establishing the prevalence and correlates of the presence or severity of NSSI, we still lack basic knowledge of the course, predictors, and relationship of NSSI with other self-harming behaviors in daily life. Such information will be helpful for better informing mental health professionals and allocating treatment resources. The Detection of Acute rIsk of seLf-injurY (DAILY) project will address these gaps among treatment-seeking individuals.

Objective:

This protocol paper presents the DAILY project's aims, design, and materials. The objectives are to advance understanding of (1) the short-term course and contexts of elevated risk of NSSI thoughts, urges, and behavior, (2) the transition from NSSI thoughts/urges to NSSI behavior, (3) and the association of NSSI with disordered eating, substance use, and suicidal thoughts and behaviors. A secondary aim is to evaluate the perspectives of treatment-seeking individuals and mental health professionals regarding the feasibility, scope, and utility of digital self-monitoring and interventions that target NSSI in daily life.

Methods:

The DAILY project is funded by the Research Foundation Flanders (Belgium). Data collection involves three phases, including a baseline assessment (Phase 1), 28 days of Ecological Momentary Assessment (EMA) followed by a clinical session and feedback survey (Phase 2), two follow-up surveys and an optional interview (Phase 3). The EMA protocol consists of regular EMA surveys (six times per day), additional burst EMA surveys spaced at a higher frequency when experiencing intense NSSI urges (three times within 30 minutes), and event registrations of NSSI behavior. Primary outcomes are NSSI thoughts, NSSI urges, self-efficacy to resist NSSI, and NSSI behavior, with disordered eating (restrictive eating, binge eating, purging), substance use (binge drinking, smoking cannabis), and suicidal thoughts and behaviors surveyed as secondary outcomes. Assessed predictors include emotions, cognitions, contextual information, and social appraisals.

Results:

We will recruit at least 120 treatment-seeking individuals aged 15-39 years from mental health services across the Flanders region of Belgium. Recruitment began in June 2021 and is anticipated to conclude in spring 2023.

Conclusions:

The findings of the DAILY project will provide a detailed characterization of the short-term course of NSSI and advance understanding of how, why, and when NSSI and other self-harming behaviors unfold among treatment-seeking individuals. This will inform clinical practice and provide the scientific building blocks for novel intervention approaches outside the therapy room that support people who self-injure in real-time.