Recently, I had the opportunity to once again attend the International Suicide Research Summit, which took place this year in Henderson, Nevada. If I had to pick just one conference to go to every year (or every other year), this would be it. Organized by the International Academy of Suicide Research (IASR) and the American Foundation for Suicide Prevention (AFSP), this biannual three-day event brings together researchers from around the world who come to share and discuss advances in the field of suicide research.
I have been to this conference twice now, and both times I left feeling inspired, enlightened, and excited to have the opportunity to be actively engaged in the crucial work of understanding and preventing suicide alongside peers and mentors from all over the world. Now, back in New York, I wanted to relive some of my favorite moments from the conference. So, briefly, here are some of the insights and innovations from the conference about the prediction, prevention, and treatment of suicidal thoughts and behaviors that especially resonated with me.
1. Prediction of suicidal thoughts & behaviors: What differentiates attempters from ideators?
A major challenge in the field of suicide research is improving the prediction of suicidal thoughts and behaviors, and particularly identifying the factors differentially associated with the transition from suicidal ideation to attempt. Most people who have suicidal thoughts don’t act on them. The question is, why do the ones who act on them do so?
To this end, we saw several presentations from thought leaders in the field, including Rory O’Connor and David Klonsky, on the psychological models focused on an ideation to action framework. These talks highlighted the importance of distinguishing suicidal desire from ideation, and ideation from attempt. Toward the latter, a particularly interesting group of talks from their students and colleagues highlighted advances in the identification of informative neurocognitive risk factors. Boaz Saffer from the University of British Columbia presented a meta-analysis that, despite tentative findings due to small sample size, found two subdomains of executive functioning as differentially predicting attempts over ideation: inhibition and decision-making. In a close examination of the construct of decision-making along with impulsivity, presented by Marco Antonio Rios Salinas from the University of Glasgow, revealed that examining specific dimensions of such constructs and their combinations helps to distinguish attempters from ideators. These studies highlighted the importance of nuanced research into the mechanisms that underpin ideation and attempts in order to inform suicide risk assessments – something we focused on in our own research presented at the conference this year.
— Miranda Lab (@MirandaLabCUNY) November 6, 2017
Two other presentations in this session focused on neurocognitive factors associated with suicidal behavior that potentially run in families. John Keilp from Columbia University presented findings that non-depressed offspring of suicide attempter parents with a history of depression had significantly worse cognitive control (as measured by the Stroop) than offspring of non-attempter parents with a history of depression. Arielle Sheftall from the Research Institute at Nationwide Children’s Hospital presented a different (and new) kind of study: one examining factors within parents of suicide attempter and non-attempter adolescents to see if mothers of these teens differ on inhibitory control and aggression. Indeed, they seem to, as mothers of suicide attempters were worse at inhibiting responses on an impulse control task (i.e., Stop Signal Task) and exhibited more aggression. These studies suggested that the neurocognitive factors that play a role in adolescent suicide attempts may actually be enduring within families and be passed on to offspring long before these youth decide to act on suicidal feelings.
And too, these findings left me with new questions. Specifically, many parents probably do pass on these more enduring neurocognitive traits to their kids, and their kids still don’t attempt suicide. The question that remains then is why. What protects these other kids with these enduring risk factors from not attempting? Which brings me back to another thought I always seem to return to: that studies on protective factors that interact with risk factors we find at every part of the suicidal pathway are essential.
2. Intervention: Reaching vulnerable youth post-discharge.
One of the things I’ve been thinking about since I started doing research on youth cognition and suicide is that most kids do not disclose suicidal ideation or seek help in a suicidal crisis. Another is that right after a suicide attempt, risk for another attempt increases. Even if some of these kids go to therapy or seek help, suicidal feelings likely fluctuate during the day, and when emotions are high, that’s when an intervention could really come in handy. So a question in my mind has been: How do we create interventions that target these kids at their most vulnerable moments, which often take place away from clinicians, parents, and peers who could help?
I’m a fan of technology, and harnessing it for communication and science, and this year at the Summit, I saw a potential solution: the Brite App, part of a project called As Safe As Possible (ASAP), presented by David Brent from the University of Pittsburg. The app is a brief digital intervention designed to keep youth safe post-discharge. It works by prompting kids to rate their distress levels several times a day; based on their responses, they are then given brief in-app interventions involving emotion regulation and interpersonal strategies to increase support. So that it becomes a habit and youth actually use it, the intervention starts before discharge. Outcomes from the 6-month trial presented in this talk included lower suicidal ideation, higher reasons to live, and lower re-attempt rates post-discharge for youth who received the treatment (compared to youth given treatment as usual).
Dr. Brent presented participant quotes (given, they were his personal favorites), and youth said the app acted like an emotional thermometer that helped them understand their emotions and gave them concrete skills to calm down, feel more grounded, and tolerate distress. I am excited about the idea of this app – to me, it highlights the promise of technology to reach vulnerable kids in a way we had no capacity of doing just 10 years ago.
3. Diagnosis & Treatment: Why isn’t suicidal behavior a DSM disorder yet?
A thought-provoking keynote was delivered by Maria Oquendo. She proposed that suicidal behavior should be classified as a separate disorder in the DSM. Currently, suicidal behavior is listed as a symptom under two DSM diagnoses: major depression and borderline personality disorder. This setup presents a serious problem: If patients don’t meet criteria for these two disorders, clinicians may not even inquire about recent or past suicidal behavior. Even if clinicians inquire about current suicidal ideation, patients may deny it, given that it tends to wax and wane. As a result, an assessment of recent or past suicidal behavior may be skipped, leading to an underestimation of suicide risk in clinical settings. Yet, as Dr. Oquendo highlighted, suicidal behavior is not only associated with other disorders – including alcoholism and PTSD – but previous suicidal behavior is the most reliable predictor of future suicidal behavior. Thus, she argued, it is crucial that Suicidal Behavior Disorder becomes a separate diagnosis; were it to be separate, clinicians would not fail to assess for it, and suicide risk status would be included in every single medical note and record. Dr. Oquendo’s fluid argument made intuitive sense to me, and I wondered why this has not been done yet.
In truth, there were many more talks that I enjoyed than I’ve written about here – from studies on social-cognitive risk factors for suicide, to presentations on social media data, and several way-too-advanced-for-me methodological talks (network analysis anyone?) that were still useful in helping me understand what is possible in the field. For brevity’s sake, I won’t write about these, but I suspect I’ll be coming back to them in future entries in the months to come (the beauty of blogging J). And of course, the connections I made with international peers in the course of the three days offered many more valuable and enjoyable moments for me at the conference.
One final thought: As a second-year graduate student, the feeling I left the conference with this year is that this field is stimulating and the learning opportunities are endless. The most exciting thing of all is the big picture: that the kind of innovation we do daily, in both research and intervention, has the potential to save lives … and change the lives of families for the better. So I look forward to taking the time to step away from our daily research life here at the Miranda Lab in order to continue connecting with others, learning from others, and contributing to the field at future conferences to come.
What was your favorite part of the conference? Tell us in the comments below …