Research Roundup January 2024: Recently Published Findings From AFSP-Funded Studies

The Research Roundup is a regular update of recently published findings in suicide prevention research. AFSP-funded studies included in this roundup examined how…

• Substance use plays a wide-ranging role in suicide attempts
• A cognitive process called “mentalization” affects how suicide loss survivors process grief
• Involving significant others may help in the treatment of Borderline Personality Disorder, and
• Trauma exposure in Veterans can moderate genetic risk for suicidal thoughts and behaviors

Researcher: David Tolin, PhD
Institution: Institute of Living/Hartford Hospital
Grant Type: 2019 Focus Grant – $1,049,024
Grant Title: Inpatient Cognitive-Behavioral Therapy to Reduce Suicide Risk Post-Discharge

Substance use has long been established as a risk factor for suicide attempts. However, there is limited knowledge of the role this risk factor plays in suicidal behaviors. By understanding whether substance use plays a part in suicide attempts as a baseline vulnerability (i.e., if it increases risk by affecting an individual’s physiological, social, emotional, and cognitive states over time); as a short-term risk factor (i.e., if acute intoxication alters an individual’s decision making and behavioral control); as the lethal means used for suicide attempt; or as a combination of all three, researchers could help identify treatment targets for clinicians and substance use counselors.

To uncover more about the role of substance use in suicide attempts, Dr. David Tolin and his team recruited 213 adult inpatients admitted for treatment following a suicidal crisis, 127 of whom had a substance use disorder (SUD). After administering assessments for suicide attempt history, along with demographic and clinical suicide risk factors, Dr. Tolin found that the presence of alcohol use disorder (AUD) or drug use disorder (DUD) was associated with a higher number of lifetime suicide attempts. Dr. Tolin then assessed the role of substance use in each person’s suicidal crisis. Substance use was found to play a part at baseline, as a short-term risk factor, and as a means of suicide attempt. These results underline the dynamic relationship between substance use and suicidal behavior and the importance of understanding individual differences during treatment.

Citation: Diefenbach, G. J., Stubbing, J., Rice, T. B., Lord, K. A., Rudd, M. D., & Tolin, D. F. (2023). Uncovering the role of substance use in suicide attempts using a mixed-methods approach. Suicide & life-threatening behavior, 10.1111/sltb.13019. Advance online publication. https://doi.org/10.1111/sltb.13019

Researcher: Yossi Levi-Belz, PhD
Institution: Ruppin Academic Center (Israel)
Grant Type: 2015 Pilot Research Grant – $29,791
Grant Title: Post Traumatic Growth among Suicide Survivors: Longitudinal Effects of Interpersonal Characteristics

In psychological research, a major way of getting to know a condition on a deeper level –– and ultimately, more effectively treat it –– is to study the underlying processes, also known as moderators, that facilitate or maintain certain outcomes. In the case of suicide loss bereavement, moderators can play a role in whether suicide loss survivors’ grief progresses to a more intensely debilitating level (i.e., prolonged grief, suicidal ideation), or if they more healthily process the loss in a way that facilitates healing and positive psychological growth (i.e., post-traumatic growth). One cognitive process that has been thought to be a potential moderator at play in loss survivors’ grief journeys is mentalization, which refers to one’s capacity for reflecting on and making sense of their internal thoughts and feelings and connecting it to their behaviors. For example, survivors who experience difficulties with mentalization may find it harder to decipher and explain their thoughts and feelings to themselves and to others, which could preclude them from the prospect of receiving help and alleviating pain.

To test this, Dr. Yossi Levi-Belz recruited 152 suicide-loss survivors to report on their experience. The participants initially completed assessments that gathered information on their loss, and then were administered three questionnaires that measured complicated grief, suicidal ideation, and mentalization capacity. Dr. Levi-Belz found that difficulties with mentalization were significantly associated with complicated grief and suicidal ideation, and that when the mentalization difficulties were greater, complicated grief’s contribution to suicidal ideation was stronger. Dr. Levi-Belz also outlined how strengthening mentalization abilities, through interventions such as Mentalization-Based Therapy, may have an effect in the opposite direction by facilitating processes that have been proven to lead to post-traumatic growth, such as self-disclosure and self-forgiveness.

Citation: Yossi Levi-Belz & Lilac Lev-Ari (2023) Thinking for healing: The role of mentalization deficits as moderator in the link between complicated grief and suicide ideation among suicide-loss survivors, Death Studies, 47:3, 360-369, https://doi.org/10.1080/07481187.2022.2065707  

Researcher: Skye Fitzpatrick, PhD
Institution: York University (Canada)
Grant Type: 2020 Pilot Research Grant – $30,000
Grant Title: Development and Initial Testing of a Couple-Based Intervention to Optimize Suicide and Self-Injury Treatment: COMPASS (Connecting, Overcoming, and Moving Past Suicide and Self-Injury)

Borderline Personality Disorder (BPD) is a debilitating mental health condition that is associated with a wide range of distressing and destructive behaviors. The diagnostic criteria of BPD include distressed, volatile, and dysfunctional interpersonal relationships. Research has shown that approximately 84% of individuals with BPD engage in nonsuicidal self-injury and suicidal behaviors, and 75% attempt suicide at least once. Therefore, BPD deeply impacts not only the individuals with the disorder, but also their significant others. Few BPD interventions include significant others, missing an opportunity to dismantle emotional and relational factors that contribute to the maintenance of BPD and suicidal behavior.

To address this, Dr. Skye Fitzpatrick and her team developed a conjoint intervention (i.e., involving a couple) called Sage to help people with Borderline Personality Disorder and suicidal and self-injuring behavior, and their significant others. Sage is composed of 12 sessions informed by interventions proven to help individuals with BPD and suicidal ideation and behavior, such as Dialectical Behavioral Therapy and Cognitive Behavioral Conjoint Therapy. There are three targets for Sage: BPD symptoms and emotion regulation, relationship functioning, and partner mental health. Early pilot evidence from Dr. Fitzpatrick’s lab suggests that participants receiving Sage reported high satisfaction with the intervention, along with a reduction in suicidal thoughts and behaviors, BPD symptoms, and other mental health outcomes people with BPD may experience.

Citation: Fitzpatrick, S., Liebman, R. E., Varma, S., Norouzian, N., Chafe, D., Traynor, J., Goss, S., Earle, E., Di Bartolomeo, A., Latham, M., Courey, L., & Monson, C. M. (2023). Protocol development of sage: A novel conjoint intervention for suicidal and self-injuring people with borderline personality disorder and their significant others. Cognitive and Behavioral Practice, 30(4), 707–720. https://doi.org/10.1016/j.cbpra.2022.11.002  

Researcher: Matthew Girgenti, PhD
Institution: Yale School of Medicine  
Grant Type: 2021 Young Investigator Grant – $90,000
Grant Title: Understanding Suicide through Postmortem Targeted Brain Multi-omics

Genetic researchers in the field of suicide prevention research have shown that risk for suicidal behaviors is partly hereditary. Previous studies have identified specific genes that are associated with an individual’s genetic predisposition for suicide. Researchers use statistical modeling to combine these identified genes to estimate a level of genetic risk, which is known as a polygenic (i.e., influenced by two or more genes) risk score. Keeping in mind that genetics are not a sole contributor to suicide, factors related to an individual’s environment, such as exposure to traumatic events, likely also affects the development of suicidal behavior.

To explore this further in the context of Veterans and trauma exposure, Dr. Matthew Girgenti and his team analyzed genetic and environmental data from the National Health and Resilience in Veterans Study (NHRVS). Data were drawn from 1,664 Veterans, of which 555 had seen combat and 85 had made a suicide attempt. The Veterans submitted saliva samples for genotyping and completed a web-based survey that assessed suicide attempt history and trauma exposure. Using a suicide attempt-specific statistical model, Dr. Girgenti calculated a polygenic risk score for each person, which was significantly associated with individuals who made a suicide attempt. After adding trauma exposure to his model, he found that a combination of a high polygenic risk score and high exposure to trauma together was best at identifying who had made a suicide attempt. Further research is needed to learn more and clarify the contributions of genetic liability and trauma to suicide behavior.

Citation: Nichter B et al (2023). Genetic liability to suicidal thoughts and behaviors and risk of suicide attempt in US military veterans: moderating effects of cumulative trauma burden. Psychological Medicine 53,6325–6333. https://doi.org/10.1017/S0033291722003646  

Learn more about the AFSP research grants featured in this monthly roundup, as well as others, here.