Development and psychometric validation of the Adolescent Self-Harm Risk Assessment (ASRA) Scale: A multi-dimensional...

Adolescent self-harm has become an increasingly severe public health issue worldwide. However, existing assessment tools mainly rely on self-reporting and fail to effectively capture the multidimensional and systemic risk factors. This study aims to develop and validate a comprehensive self-harm risk assessment tool (ASRA), integrating ecological systems theory and the cumulative ecological risk model, to fill the gaps in current assessment tools.

Through an extensive literature review, two rounds of expert consultations (Delphi method), and a pre-survey, we developed the preliminary ASRA scale. Data from 1073 adolescents (aged 12-24 years) were collected, and exploratory factor analysis (EFA), network analysis, and confirmatory factor analysis (CFA) were used to validate the scale's structural validity, reliability, and validity.

The final scale consists of 8 dimensions and 49 items, with a cumulative variance contribution rate of 72.82%. Network analysis and CFA further confirmed the structural stability of the scale (χ²/df = 2.422, RMSEA = 0.052, CFI = 0.929). The scale showed excellent internal consistency (Cronbach's α = 0.97), test-retest reliability of 0.805, and significant correlations with clinical indicators such as self-harm behavior, depression, anxiety, and impulsivity (p < 0.01).

The ASRA scale demonstrates excellent psychometric properties, with high reliability and validity, making it an effective multidimensional and systematic tool for early screening of self-harm risk in adolescents. Its innovation lies in integrating ecological systems theory and the cumulative risk model, providing significant theoretical and practical support for the prevention and intervention of adolescent self-harm behaviors.