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Innovative Methodologies

person using a cellphone with blue lines projecting out

CSPS investigators are using novel social network interventions and digital health methodologies to assess suicide risk and treatment efficacy. CSPS investigators are also pioneers in foundational methods in suicide prevention science, including psychological autopsy.

Digital health

An emerging area of focus among CSPS investigators is the promise of digital heath methodologies to assess and intervene on suicide risk factors and suicide ideation and behaviors. Dr. Caroline Silva is conducting a study with Spanish speakers that uses passive and active monitoring via smartphones to assess ‘cultural social engagement’ and suicide risk. Drs. Van Orden and Silva are applying those methods to the study of social connection and suicide risk in older adults and will use smartphone-based assessments as primary outcomes in a clinical trial of Social Connection Coaching. CSPS investigators are also partnering with the UR Health Lab to test the role of digitally-collected patient reported outcomes on depression (and other suicide risk factors) in suicide risk management at the level of a health system (Van Orden, Lutz, Silva, and colleagues, 2021). Dr. Jonah Meyerhoff at the in collaboration with Dr. Van Orden, studies digital mental health interventions for suicide prevention (Meyerhoff, Kruzan, Kim, Van Orden, & Mohr, 2022). 

Social network interventions

 Dr. Peter Wyman studies interventions that utilize natural social networks to deliver programs, strengthen protective processes within those relationships systems (Wyman et al., 2019) and use influence among group members to sustain program impacts. One program is Sources of Strength, a universal school-based intervention that prepares diverse youth peer leaders to disseminate a model of healthy coping to peers, shown to enhance suicide protective factors at the school level (Wyman et al., 2010). Dr. Wyman and his team developed the Connect Program suite of interventions, a group intervention through which members of natural networks together learn healthy coping skills while strengthening their social connections. Connect Programs are currently being implemented in the US Air Force (Wingman-Connect), workplace (Police-Connect), and community settings (HAVEN-Connect in predominantly Black churches). An RCT with 1,400 emerging adults undergoing career training showed Wingman-Connect decreased suicide risk, depression, and occupational problems (Wyman et al., 2020), and did so through the hypothesized mechanism of increased belonging to a healthy group. Wyman and team are adapting Connect in active projects for youth in predominantly Black churches and in training for first-responders in collaboration with New York State. Dr. Ian Cero is developing and testing Youth-Connect for adolescents transitioning out of acute programming to outpatient services. This innovative suicide prevention approach leverages adolescents’ existing adult relationships and social networks to build suicide-protective skills.

Psychological autopsy

 CSPS investigators, including Drs. Caine, Conwell, Conner, and Duberstein, are pioneers in the development and refinement of methods for conducting psychological autopsies in order to understand the experiences of individuals who died by suicide in the weeks leading up to their deaths via interviews with family members and friends. Dr. Conwell’s research on suicide prevention in older adults includes psychological autopsy studies that involved collaborations with coroner and medical examiner offices that identified a constellation of characteristics of older adults who die by suicide. Dr. Paul Duberstein contributed to the CSPS’ portfolio on suicide prevention in older adults, including how personality traits such as low openness to experience may place older adults at risk by decreasing the likelihood that others will detect their distress and provide assistance. Dr. Ken Conner and colleagues published the Psychological Autopsy Methodology Checklist to provide guidance to researchers who want to use this method, as well as articles that describe the content and procedures of psychological autopsy interviews.

Big data and machine learning

 Dr. Yue Li is a collaborator with Dr. Conwell on suicide prevention research in older adults; he is a health services researcher with a focus on disparities in quality of care and is conducting a study funded by NIMH to use big data and statistical machine learning methods to identify risk and protective factors for suicide deaths among older adults in long-term care settings.

Suicide risk assessment

CSPS investigators apply their expertise in suicide prevention to the development and testing of strategies for suicide risk assessment and management in clinical settings.

  • Dr. Tony Pisani is the developer of an ‘prevention-oriented risk formulation’ approach to clinical suicide risk assessment and intervention.
  • Dr. Wendi Cross brings expertise in implementation science to the CSPS and has conducted studies to identify best practices for training physicians and other learners in suicide risk assessment (e.g., Cross and colleagues, 2019).
  • Dr. Van Orden and her colleagues developed a brief intervention to address social connection (during the COVID 19 pandemic and beyond) called Connection Planning, which has been developed into a clinical program in the VA.

A public health approach

The CSPS has been a leader in the development and dissemination of a public health approach to suicide prevention.

  • Dr. Eric Caine served as Co-Director of the CSPS since its founding in 1998 and lead three funded centers that guided the CSPS: the NIMH funded CRC for the Study of the Psychopathology of the Elderly (1986-1995), the NIMH/NIDA developing suicide prevention research center, the Center for Public Health and Population Interventions for Preventing Suicide (PHP-Center; 2004-2010), and the CDC funded Injury Control Research Center for Suicide Prevention (ICRC-S; 2012-2018).
  • CSPS investigators are leaders in the design and testing of comprehensive suicide prevention models, including Drs. Knox and Caine’s collaboration with the US Air Force to develop and evaluate the Air Force Suicide Prevention Program, which focused on risk factors for suicide and found a 33% relative risk reduction in suicide deaths in the years following the implementation of this comprehensive program. Implications for suicide prevention policy gleaned from this program were shared by Knox and colleagues (2010). Dr. Wyman’s current work with the US Air Force involves refining and preparing a network-based suicide prevention program (Wingman-Connect) for broader implementation and deployment across multiple career phases as a comprehensive, developmentally continuous suicide prevention approach.