Earbuds, phone apps, text messages. This is the future of a new kind of suicide prevention, especially with hard-to-reach populations like teens.
But technology and new approaches are also being used to reach older adults struggling with isolation and depression. It’s all part of the University of Rochester Medical Center’s latest push to continue leading the way through its Center for the Study and Prevention of Suicide (CSPS).
The Center has been at the forefront of suicide prevention and research for more than two decades. Now, new directions are showing new promise for a tragic problem—one that remains near its peak, even as society only slowly changes to acknowledge it.
Meeting Teens Where They Live
Arielle Sheftall, PhD, is co-leading a five-year, $4.5 million research project funded by the National Institutes of Health to see if nerve-stimulating earbuds and a newly created peer support app can help reduce risk factors (such as depression) in teens to prevent suicidal thoughts from occurring.
The project, co-led by researchers at University of Notre Dame, is enrolling teen participants to use an FDA-approved device, which looks like ear buds, to stimulate the transcutaneous vagus nerve. This has been shown to decrease anxiety and depression in adults.
Another group will use a peer-support phone app with a journaling component for expressing their feelings in words, “in a space instead of in their heads,” Sheftall says. It also will have a gaming feature with a chat component that breaks the ice for conversations with other teens who share what they’re going through.
A third group will use both approaches. Sheftall says she hopes nontraditional methods for a tech-savvy generation will open new doors.
“We know rates of suicide among adolescents and even younger [children] have been increasing drastically over the last decade,” Sheftall says.
Can a Text Save Lives?
New technology is making it easier to deliver mental health services to underserved populations.
In a study with Spanish speakers, assistant professor of psychiatry Caroline Silva, PhD, connects with participants through their smartphones to assess social engagement and suicide risk. The Center’s co-director, Kimberly Van Orden, PhD, and Silva are using this method with older adults as well.
Text4Strength, developed by Anthony Pisani, PhD, an associate professor in Psychiatry and Pediatrics, sends automated text messages to students enrolled in Sources of Strength, a high school suicide prevention program. The goal is for students to build help-seeking skills, emotion self-regulation, and stronger connections.
Pisani has developed texting and social media components for a similar program, led by Peter Wyman, PhD, for young enlisted airmen in the U.S. Air Force. Wyman’s program to help stem a rise in the rate of suicide in the armed forces has begun rolling out to every U.S. Air Force base in the world.
Center investigators are also working on a crisis text suicide-prevention program for young people. They’re collaborating with the nation’s largest crisis text provider to test the potential.
Others are working with computer scientists on the University’s River Campus to develop an online social skills coach for older adults that mimics human interaction.
Younger and Younger Kids Need Help
Suicide rates among children and teens are rising at an alarming pace. From 1990 to 2020, the youngest age at suicide fell from nine to just five years old.
In that same timespan, the number of deaths by suicide among five- to twelve-year-olds shot up 195 percent.
At the University’s Mt. Hope Family Center, director of research Elizabeth Handley, PhD, studies the ways childhood maltreatment increases risk for suicide among youth. For children who live in high-risk environments, family depression and substance-use disorders can increase vulnerability.
Handley, a research associate professor in Psychiatry, is among a group of CSPS investigators who are deeply involved in Mt. Hope, a national leader in research and clinical care in developmental psychopathology.
Center faculty also research suicide risk in midlife, focusing on addiction struggles, sleep problems, and language and cultural isolation. Wilfred Pigeon, PhD, a professor of Psychiatry and former executive director of the VISN2 Center of Excellence for Suicide Prevention at the Canandaigua VA Medical Center, looks at suicide risk and prevention through the lens of sleep disturbance.
Kenneth Conner, PsyD, MPH, professor of Emergency Medicine, led a team studying a brief intervention for use with individuals with alcohol or drug use problems who have been hospitalized following a suicide attempt. He is also developing projects to prevent unintentional drug overdose.
Greater social connection is a crucial factor in healthy aging, and many studies show disconnection is a public health concern.
As a mortality risk, it’s as big as obesity, physical inactivity, alcohol misuse, and smoking.
Van Orden studies interventions that will foster connection among older adults. She and Yeates Conwell, MD, professor of Psychiatry, have tested community-based social services designed to encourage more social connection in later life, including a peer companionship program called The Senior Connection and volunteering with AmeriCorps Seniors.
The team has also developed a brief psychotherapy intervention that Silva is adapting for Spanish speakers at risk for suicide.
A key benefit of how the Medical Center functions is the interplay between research and clinical work.
“URMC is a world leader in the collection of patient-reported outcomes, including depression, as part of routine clinical care,” Van Orden says. It’s a matter of capitalizing on URMC’s “infrastructure and expertise—as both a laboratory for studying suicide prevention efforts as well as a means to optimize the quality of care for patients in UR Medicine.”
Diverse in Many Ways
The Center’s reach into diverse populations includes Black and Hispanic youth and adults and the Deaf community. Deaf and Hard of Hearing people are at greater risk of suicide than the general population. They have higher rates of severe mental health issues and, at the same time, are more likely to mistrust the health care system and so are less likely to receive treatment.
Aileen Aldalur, PhD, senior instructor of Psychiatry, is working on ways to more easily connect Deaf and Hard of Hearing people to mental health services. The Cognitive Behavior Therapy intervention she is adapting uses videophone or Zoom technologies that are more accessible.
Sheftall is particularly interested in a concerning rise in suicide rates among Black teens and children. Her research has shown that five- to 12-year-olds who are Black are twice as likely to take their own lives than are their white counterparts. And in 2020, suicide was tied for the No. 1 cause of death among Black girls ages 12 to 14.
“I think this information is something people are not aware of,” she says. “It’s just not out there.”
HOPE in Later Life
The HOPE (Helping Older People Engage) Lab engages in suicide prevention by helping older adults build healthy social connections.
Van Orden runs the lab, which teams with Lifespan and other community agencies on studies and interventions for loneliness and suicide risk. One study is testing the benefits of volunteering for lonely older adults—making phone calls to isolated individuals or helping out at an animal shelter. Other studies have tested the value of peer companionship programs and behavioral psychotherapy.
Van Orden says older people prioritize emotional well-being, and it increases with age—“a strength we can capitalize on.” She says her mother, despite physical health and cognition problems, was her happiest after moving into a senior living community, where she made new friends and fell in love at age 72.
“To me,” says Van Orden, “suicide prevention in later life is about course correcting—getting older adults back onto the healthy aging trajectory and helping them address risk factors for suicide by growing their own protective factors.”
Serving Those Who Served
The Veterans Administration calls veteran suicide prevention its highest clinical priority. In 2020, the suicide rate for veterans was 57 percent higher than for non-veteran U.S. adults, adjusting for population, age, and gender differences. Nearly 6,200 veterans took their own lives that year.
Since 2007, when Eric Caine, MD, professor emeritus of Psychiatry, helped shape the VISN2 Center of Excellence for Suicide Prevention at the Canandaigua VA Medical Center, CSPS investigators have been deeply involved in studying the issue. Today their work is a national resource.
Studies and interventions seek to reduce suicide risk through a veterans’ crisis line, pain management, violence prevention, and help with depression, sleep disorders, PTSD, and injuries.