(PS1-D94) Using Nonverbal Response Cards to Examine Reporting of Self-injurious Thoughts and Behaviors Among Adolescents in Rural Burkina Faso

Self-injurious thoughts and behaviors (SITBs; i.e., a range of suicidal and nonsuicidal thoughts and actions related to deliberate and self-directed harm that are nonfatal) are a major health concern among global youth, however, the majority of this research has been conducted almost exclusively in high-income countries. This is concerning since low and middle-income countries contain 90% of the world’s youth population and account for around 75% of suicide deaths.

SITB prevalence is difficult to reliably estimate due, in part, to the stigma associated with them, which can lead to underreporting of SITBs in face-to-face interviews. While self-completed interviews that may reduce misreporting are feasible in many settings, this is less true in low-literacy populations such as in rural Burkina Faso, where only half of adolescents attend school.

Nonverbal response cards (NVRC) are one method proposed to reduce underreporting of stigmatized thoughts and behaviors, previously used for reporting physical and sexual violence. NRVC is a low-tech and low-cost interviewer-administered approach which avoids revealing the interviewee’s response to the interviewer while still allowing interviewers to guide the interview process.

In the present study, we examined the reporting of SITBs in a trial where participants were randomized to either a traditional verbal response or NRVC and were asked to report on SITBs. Participants were 1,538 adolescents (aged 12-20 years) in rural and semirural northwestern Burkina Faso. Respondents in the NVRC arm reported higher levels of a wide range of SITBs, compared to the verbal response arm. Using chi-square analyses, these differences were significant (all p’s > 0.05) for lifetime nonsuicidal self-injury, lifetime life not worth living, lifetime active suicide ideation, past 12-month active suicide ideation, and past 12-month suicide plan with higher levels of reporting in the NVRC arm. The differences were not statistically significant for lifetime passive suicide ideation and lifetime suicide plan, and could not be calculated for suicide attempts, reflecting the rarity of these outcomes in both arms.

While further evaluation is required, NVRC appears to be a potentially effective interviewer-administered approach to assess SITBs among youth and may aid in providing more accurate estimates of SITBs than traditional verbal responses, particularly where literacy or wider question comprehension cannot be relied on.