Research Roundup September 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…

• The structure of an individual’s social network may play a part in reducing suicidal behavior
• Adverse childhood experiences may be connected to risk for suicidal thoughts and behaviors
• Dialectical behavior therapy is a strong treatment for youth with suicidal thoughts and behaviors, and
• Improving sleep with melatonin may be helpful for reducing the risk of self-harm in adolescents struggling with mental health issues

Researcher: Munmum De Choudhury, PhD
Institution: Georgia Institute of Technology
Grant Type: 2022 Standard Research Grant – $99,993
Grant Title: Machine Learning Approaches to Identify and Predict the Presence and Severity of Suicidal Thoughts and Behaviors by Integrating Online Activity and Clinical Information

The network of relationships that make up an individual’s social life is intimately connected to suicide risk and protection. Research has shown that interventions aimed at enhancing individuals’ social network bonds through focusing on social skill competencies and perceived social support can reduce risk of suicide ideation, attempts, and death. However, few interventions seek to directly modify the structure of social networks of people at risk for suicide. That is, these interventions may aim to strengthen an individual’s ability to interact with their network, without addressing the characteristics of the surrounding social network that may have their own risk and protective influence.

With this in mind, Dr. Munmum De Choudhury looked at social network structure as a worthwhile focus of suicide intervention. To do this, she constructed a simple computational model to see what would happen if the way people are connected was changed. For example, what if new connections between people were randomly added to friendship networks of 10 people? The simulation showed that even with this basic approach, changing one feature of network connections, there was a good chance of reducing overall suicide risk. Importantly, it didn’t seem to increase the risk for those who were already doing well. The team also found that this method could help change groups of people who are at high risk of suicide. These results align with early findings from real-world interventions that focus on social networks can be impactful. More research on social network alteration in real-world settings is needed

Citation: Cero, I., De Choudhury, M., & Wyman, P. A. (2024). Social network structure as a suicide prevention target. Social Psychiatry and Psychiatric Epidemiology, 59(3), 555-564. https://doi.org/10.1007/s00127-023-02521-0

Researcher: Ian Colman, PhD
Institution: University of Ottawa (Canada)
Grant Type: 2021 Standard Research Grant – $98,682
Grant Title: Factors that Modify the Relationship Between Adversity and Suicide Attempt in a Brazilian Birth Cohort

Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood, which can have long-term effects on a person’s health and well-being. ACEs include abuse (e.g., physical, emotional, and sexual abuse), neglect, discrimination, and household challenges such as substance abuse, mental illness, parental separation or divorce, domestic violence, financial hardship, and incarceration of a family member. Past research has indicated a potential association between ACEs and future suicidal behavior. However, most of the studies contributing to this association were cross-sectional (i.e., collecting data only at one point in time, raising possibility of recall bias) and conducted in high-income countries, which limits the generalizability or representativeness of these findings.

To expand this research, Dr. Ian Colman used longitudinal data (e.g., data collected over time) from the 1993 Pelotas Birth Cohort in Southern Brazil, which collected data from 3810 adolescents at ages 11, 15, 18, and 22 to see if there was a relationship between experienced ACEs and suicidal thoughts and behaviors. Dr. Colman found that adolescents who experienced financial hardship, parental divorce, and maternal mental illness at 11 years old were more likely to report suicidal ideation at 22 years old. He also found that adolescents who experienced financial hardship, physical abuse, discrimination, maternal mental illness, or parental divorce were more likely to report a lifetime suicide attempt. While more research on the relationship between ACEs and suicide is needed, these findings demonstrate prevention of ACEs and mental support following encounters with certain ACEs during childhood is crucial.

Citation: Calegaro, G., Soares, P. S. M., Colman, I., Murray, J., Wehrmeister, F. C., Menezes, A. M. B., & Gonçalves, H. (2023). Adverse childhood experiende lucaces (ACEs) and suicidal behaviors in emerging adulthood: The 1993 Pelotas birth cohort. Child Abuse & Neglect, 146, 106517. https://doi.org/10.1016/j.chiabu.2023.106517   

Researcher: Michele Berk, PhD, Marsha Linehan, PhD, Joan Asarnow, PhD
Institution: University of California, Los Angeles, University of Washington
Grant Type: 2014 Linked Standard Research Grant – $214,000
Grant Title: Safety Planning with Motivational Interviewing for Healthy Coping (MI-SafeCope)

Suicide is the second leading cause of death among 10- to 14-year-olds and the third leading cause of death among 15- to 24-years-olds in the United States, yet there is a limited amount of evidence-based interventions that have demonstrated efficacy in decreasing suicide attempts and nonsuicidal self-injury (NSSI) in adolescents. Dialectical behavior therapy (DBT) is a talk therapy grounded in mindfulness and behavior therapy that includes teaching skills to manage intense emotions, cope with challenging situations, and improve relationships. Previous research has shown that DBT can be effective in reducing risk for suicide attempt and NSSI, but more studies are needed to inform optimal treatment approaches.

Drs. Michele Berk, Joan Asarnow, and Marsha Linehan conducted a randomized, controlled trial with 173 adolescents aged 12-18 years old with repetitive self-harm (including at least one prior suicide attempt) and elevated suicidal ideation. Each adolescent received six months of DBT or individual and group supportive therapy (IGST) and were followed up with for six months following treatment. The team found that over 70% of adolescents reported remission of suicide attempts after receiving either treatment. For adolescents who received DBT rather than IGST, there were significantly higher rates of remission and recovery, and lower rates of relapse and recurrence for suicide attempts. While DBT was more effective for stopping suicidal behavior, both therapies had similar effects on non-suicidal self-injury (NSSI), though DBT showed better long-term results.

Citation: Berk, M. S., Gallop, R., Asarnow, J. R., Adrian, M. C., Hughes, J. L., & McCauley, E. (2024). Remission, Recovery, Relapse, and Recurrence Rates for Suicide Attempts and Nonsuicidal Self-Injury for Suicidal Youth Treated With Dialectical Behavior Therapy or Supportive Therapy. Journal of the American Academy of Child & Adolescent Psychiatry. https://doi.org/10.1016/j.jaac.2024.01.012  

Researcher: Brian D’Onofrio, PhD
Institution: Indiana University Medicine  
Grant Type: 2020 Distinguished Investigator Grant – $124,984
Grant Title: Risks and Benefits of ADHD Medication for Suicidal Behavior: A National Study of At-Risk Youth

Sleep disorders such as insomnia are not unusual in youth, particularly among those who have psychiatric disorders. Disturbances in sleep have been associated with increased risks of injury, including suicidal behavior, due in part to the impact that a night of poor sleep may have on emotional reactivity. As a result, treating sleep problems has been suggested as a potential target that may reduce the risk of self-harm in youth. Beyond behavioral interventions focusing on sleep routines, one common sleep aid administered to adolescents is melatonin, but there have been no studies evaluating its impact on self-harm.

With this in mind, Dr. Brian D’Onofrio analyzed data from 25,575 individuals in Sweden who received a melatonin prescription between the ages of 6 and 18 years old. After comparing the number of injuries in the year before and after starting the medication, Dr. D’Onofrio found that while the rates of general injuries like falls or accidents didn’t change much, the risk of self-harm was highest just before being prescribed melatonin and dropped after it was prescribed. This was especially true for teenage girls with depression or anxiety. For these girls, the risk of self-harm was nearly cut in half in the month after they were prescribed melatonin, even when they weren’t taking antidepressants. These results suggest that clinicians can consider prescribing melatonin and other sleep interventions to reduce self-harm in youth struggling with sleep disorders.

Citation: Leone, M., Kuja-Halkola, R., Lagerberg, T., Bjureberg, J., Butwicka, A., Chang, Z., Larsson, H., D’Onofrio, B. M., Leval, A., & Bergen, S. E. (2023). Melatonin use and the risk of self-harm and unintentional injuries in youths with and without psychiatric disorders. Journal of Child Psychology and Psychiatry, 64(7), 1027-1036. https://doi.org/10.1111/jcpp.13785  

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