With a grant from the National Institute of Mental Health, two Texas Tech faculty members are leading a collaboration to address fundamental, and yet unanswered, questions.
In 2018, an estimated 10.7 million American adults had thought seriously about trying to kill themselves, according to the National Survey on Drug Use and Health. Of those, 3.3 million made suicide plans and 1.4 million attempted suicide.
What makes a person transition from merely thinking about suicide to actually trying it, and who is most at risk? The short answers are, we don't know – yet. But with a new grant from the National Institute of Mental Health, two Texas Tech University psychology researchers are leading a collaborative effort to answer these questions.
Sarah Victor, an assistant professor of clinical psychology in the Department of Psychological Sciences, is the principal investigator on a two-year project titled "Dynamic Regulatory Processes in the Transition from Suicidal Ideation to Action: The Roles of Cognitive Control, Emotion-Related Impulsivity, and Sleep in the Context of Negative Affective Experiences," as announced Wednesday by U.S. Sen. John Cornyn.
Also involved in the research are co-investigators Jason Van Allen, an associate professor of clinical psychology and director of clinical training at Texas Tech, and Sheri Johnson at the University of California-Berkeley, as well as consultants from the Alpert Medical School of Brown University, the University of Pittsburgh School of Medicine and Covenant Health System. The project will begin Dec. 1.
"Suicide is a devastating personal and social problem that impacts individuals, families and communities," said Victor, director of Texas Tech's Tracking Risk Over Time Lab, which seeks to better understand non-suicidal self-injury and suicide. "Although suicide rates have decreased worldwide, U.S. suicide deaths have continued to rise in the past decade, particularly in rural areas. The risk of suicide is especially high in the weeks and months after someone leaves inpatient psychiatric treatment, particularly for people who were hospitalized because of suicidal thoughts or behaviors.
"In order to prevent suicide among this high-risk group, more research is needed to understand what contributes to suicidal thinking after people leave the hospital, as well as what moves a person from thinking about suicide to acting on their thoughts."
The study will follow 130 suicidal adults receiving inpatient behavioral health treatment at Covenant Health in Lubbock, which in 2019 served more than 800 people in crisis through its inpatient behavioral health unit. Patients will be recruited for the study shortly before they are discharged from the hospital, then followed for eight weeks using ambulatory assessment methods, including brief cell phone surveys, short, web-based cognitive tasks and wearing a Fitbit-like device that measures sleep. These methods allow people to share information about their experiences as they go about their daily lives. Participants also will complete follow-up interviews about their experiences with self-harm and suicide after leaving the hospital.
"Many different risk factors have been identified for suicidal thinking, including feeling trapped, hopeless, burdensome or isolated," Victor said. "We will ask participants to rate how much they experience each of these feelings many times a day for 28 days after they leave the hospital, and we'll also ask them to rate how suicidal they feel at the same time. This will help us understand whether any of these feelings are more or less strongly tied to considering suicide, and how much they overlap."
To examine the transition from suicidal ideation to a suicide attempt, researchers will have participants complete a web-based task that measures how quickly and accurately a person can stop themselves from doing something, and whether that differs if the emotional context is negative or positive.
"One potential contributor for suicide risk is related to cognitive control, or the ability to intentionally change where you put your attention or mental effort," Victor explained. "Some people who struggle with suicide seem to have difficulty controlling their behavior when they experience intense emotions, which is sometimes referred to as emotion-related impulsivity. There also is some evidence that people who struggle with non-suicidal self-injury, like cutting and burning, may have a harder time inhibiting certain behaviors when they are experiencing negative emotions."
Researchers expect that problems with this task, especially in the context of negative emotions, may put a person at greater risk of suicidal behavior if they are feeling suicidal.
Victor is grateful to the National Institute of Mental Health for funding the work and the continued support of leadership at Covenant Health. But there's another group, she says, who make this research possible.
"People who participate in this type of research show tremendous bravery in their willingness to share intimate details of their lives and their struggles with our team," she said. "We are so thankful for their insights, without which this work could not be done."