Research Roundup July 2023: 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…

• Different types of violence and victimization affect risk for suicidal thoughts and behaviors,
• Self-disclosure of suicidal ideation or intent may vary, based on who is asking,
• Pharmacists can be trained to be suicide prevention gatekeepers, and
• Ketamine treatment could be improved.

Researcher: Lisa Fedina, PhD, MSW
Institution: University of Michigan
Grant Type: 2020 Young Investigator Grant - $90,000
Grant Title: Profiles of Poly-Victimization and Suicide Risk among Young Adults

In young adulthood and adolescence, there has long been a link between violence victimization and suicidal thoughts and behaviors, but our knowledge has been limited to studies that isolate specific types of victimization (e.g., interpersonal, structural, emotional). Dr. Lisa Fedina and her team aimed to go beyond basic descriptive studies by investigating whether experiencing poly-victimization (i.e., multiple types of violence victimization) increases the risk of suicide, and whether certain patterns of victimization are more strongly related to suicidal thoughts and behaviors than others.

After analyzing data from a nationwide survey on poly-victimization and suicide risk in young adults and adolescents, Dr. Fedina found that experiencing multiple types of victimization, particularly a combination of interpersonal (e.g., caregiver abuse, youth violence, intimate partner violence) and structural violence (e.g., police violence, youth hate crimes) significantly increased the risk of suicidal thoughts and behaviors. These findings make the case for violence and suicide prevention policies specifically addressing structural forms of violence.

Citation: Fedina, L., King, C., DeVylder, J., & Herrenkohl, T. I. (2023). Distinct profiles of violence victimization and suicide risk: Findings from a national survey of emerging adults. American Journal of Orthopsychiatry, http://dx.doi.org/10.1037/ort0000675

Researcher: Sarah Bloch-Elkouby, PhD
Institution: Icahn School of Medicine at Mount Sinai
Grant Type: 2021 Young Investigator Grant – $90,000
Grant Title: Enhancing Suicide Risk Assessment and Prevention Among Diverse Adolescents Using Virtual Human Interaction

The effective assessment of suicide risk depends on a range of variables. One crucial factor in this equation is whether patients are willing to disclose suicidal ideation or intent. Despite clinician’s reliance on self-disclosure, this practice has been called into question due to an accumulation of research suggesting a potential tendency for adults and adolescents to conceal their ideation or intent before engaging in suicidal behavior.

Dr. Sarah Bloch-Elkouby and her team set out to understand more about the characteristics and contexts that could lead psychiatric outpatients to not disclose suicidal thoughts and intent. To do this, 780 psychiatric outpatient participants were assessed for recent and current suicidal ideation and behavior by both clinicians and research assistants in the context of a research study. Results indicated that roughly twice as many participants disclosed suicide ideation or intent to research assistants instead of clinicians, with less than 20% disclosing to both. It’s not clear what leads to these discrepancies, and more research is needed on factors that may influence disclosure, such as concerns about revealing suicidal ideation, help-seeking, and therapeutic relationship (i.e., comfort with the interviewer). These findings also highlight the importance of not relying exclusively on self-report when assessing risk for suicide.

Citation: Bloch-Elkouby, S., Zilcha-Mano, S., Rogers, M. L., Park, J. Y., Manlongat, K., Krumerman, M., & Galynker, I. (2023). Who are the patients who deny suicidal intent? Exploring patients’ characteristics associated with self-disclosure and denial of suicidal intent. Acta Psychiatrica Scandinavica, 147(2), 205-216, http://dx.doi.org/10.1111/acps.13511

Researcher: Delesha Carpenter, PhD, MSPH
Institution: University of North Carolina at Chapel Hill
Grant Type: 2020 Standard Research Grant - $100,000
Grant Title: Developing and evaluating a scalable suicide prevention gatekeeper training program for community pharmacy staff

Pharmacists regularly interact with the public and, due to their accessibility, have been identified as potential community gatekeepers. Gatekeepers are community members trained to identify suicide warning signs and intervene with at-risk individuals. However, pharmacists have noted a few significant barriers to gatekeeping, including discomfort communicating about suicide, lack of time and privacy, and limited referral options for patients.

To address this, Dr. Delesha Carpenter and her team worked with a panel of pharmacy staff and veteran stakeholders over the course of eight months to codesign Pharm-SAVES, a brief, skills-focused, interactive video training series to address the above-mentioned barriers. The modules train pharmacists in suicide prevention practices and demonstrate how and when to contact the 988 Suicide and Crisis Lifeline. Pharm-SAVES also connects pharmacists with local mental health provider directories, and advances the potential to save lives.

Citation: Stover, A. N., Lavigne, J. E., Shook, A., MacAllister, C., Cross, W. F., & Carpenter, D. M. (2023). Development of the Pharm-SAVES educational module for gatekeeper suicide prevention training for community pharmacy staff. Health Expectations, n/a(n/a), http://dx.doi.org/10.1111/hex.13741

Researcher: Lynnette Averill, PhD
Institution: Yale University
Grant Type: 2017 Young Investigator Grant – $85,000
Grant Title: Brain Connectivity Networks and Predictors of Rapid Improvement in Suicidal Ideation Among Veterans

Ketamine treatment has been utilized at an increased pace over recent years due to its rapid effect in reducing suicidal ideation for treatment-resistant Major Depressive Disorder. However, the anti-suicidal effects of ketamine have been found to be short-lived, leaving researchers with the task of understanding the underlying mechanisms of ketamine treatment with the hope of finding ways to maintain its effect.

Prior to administering ketamine treatment to two groups of depressed, suicidal individuals, Dr. Lynnette Averill and her team gave one group a pre-treatment of a protein complex that was suspected to potentially extend ketamine’s effects, and a placebo to the other group. After comparing results between the groups, no difference in effect was found. These findings suggest depression and suicidal ideation may involve distinct neurobiological pathways affected differently by ketamine. More research is needed to understand the mechanisms by which ketamine treatment works.

Citation: Averill, L. A., Averill, C. L., Gueorguieva, R., Fouda, S., Sherif, M., Ahn, K.-H., Ranganathan, M., D’Souza, D. C., Southwick, S. M., Sanacora, G., Duman, R. S., Krystal, J. H., & Abdallah, C. G. (2022). mTORC1 inhibitor effects on rapid ketamine-induced reductions in suicidal ideation in patients with treatment-resistant depression. Journal Of Affective Disorders, 303, 91-97, http://dx.doi.org/10.1016/j.jad.2022.01.104  

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