Community Suicide Prevention Group

Our Research

Community Suicide Prevention Group

Research Overview

Our research studies focus on:

  • Crisis intervention and suicide prevention strategies
  • Suicide contagion/clusters
  • Screening and assessment of suicide risk

Crisis Intervention/Suicide Prevention 

Our work evaluating the National Suicide Prevention Lifeline (NSPL) has vastly changed the landscape of prevention efforts in the United States. As a national “safety net,” the NSPL now plays a vital role in suicide prevention, largely due to our research, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). In contrast to the 2001 U.S. National Strategy for Suicide Prevention in which crisis hotlines were not mentioned at all, the 2010 National Action Alliance for Suicide Prevention prominently references NSPL and telephone crisis services as an integral part of the national strategy.  Moreover, the findings from Dr. Gould’s research have been used by SAMHSA and the Lifeline to support the recent passage of the National Suicide Hotline Designation Act of 2020.  This legislation establishes a new three-digit number (988) for a national suicide prevention and mental health crisis hotline.  Now that crisis hotlines are recognized as a critical component of suicide prevention and mental health services, the current work that Dr. Gould is conducting  is timelier and more relevant than ever.  Given the essential role of NSPL and its goals, our SAMHSA-funded evaluations of its effectiveness in 1) preventing at-risk individuals from engaging in suicidal behavior, and 2) enhancing the continuity of care for suicidal individuals, continues to be of the utmost clinical and public health relevance.

Suicide Contagion/Clusters

Our identification of an association between newspaper reports about suicide and the initiation of teenage suicide clusters, published in The Lancet Psychiatry, provided empirical support for collaboration between mental health professionals, community officials, and the media to identify and prevent the onset of suicide clusters.

Screening and Assessment of Suicide Risk

Our evaluation of the safety of school-based suicide screening programs is considered a landmark study. We devised innovative strategies for this work, employing a randomized, controlled study within the context of a two-day screening protocol. The findings—that no iatrogenic effects of suicide screening emerged and that such programs were safe— were published in The Journal of the American Medical Association and have had a significant influence on the promulgation of suicide-screening programs in schools, both nationally and internationally. Moreover, numerous suicide researchers worldwide have reported that our findings were essential in addressing the concerns of their Institutional Review Boards and obtaining approval of their research applications.

Current Research

National Suicide Prevention Lifeline Evaluation (NSPL)

Continuity of care for suicidal individuals who are engaged with a variety of health and mental health care systems has become a national priority. Crisis hotlines are assuming a growing role in the risk management and continuum of care for these individuals.

With funding from the Substance Abuse and Mental Health Services Administration, we are evaluating three critical priorities of the NSPL, the national network of suicide crisis hotlines in the U.S:

  • Clinical follow-up of suicidal individuals who have received care from emergency departments and hospitals
  • Interventions using emerging technologies, specifically chat interventions
  • Phone interventions for callers at imminent risk of suicide

The evaluation of clinical follow-up of suicidal individuals discharged from emergency departments (EDs) and hospitals involves a quasi-experimental design using multiple comparison groups/conditions. Clients referred from EDs and hospitals and followed by crisis counselors at six NSPL crisis centers are participants.

The analysis of the impact of chat interventions entails coding a random sample of de-identified chat transcripts provided by the 26 crisis centers in the “Lifeline Crisis Chat (LCC)” network over a two-year period.

Review of the interaction between Lifeline crisis counselors and callers who are deemed to be at imminent risk of suicide involves an evaluation of crisis counselors’ reports in order to provide a general profile of these callers and assess the interventions implemented to keep them safe.

Earlier phases of the National Suicide Prevention Lifeline Evaluation, funded by SAMHSA, involved data collection at over 60 crisis centers between 2003 and 2016. The projects have involved the following evaluations of the effectiveness of telephone crisis services/hotlines:

  • Proximal outcomes as measured by changes in callers’ suicide state from the beginning to the end of their calls, and then a few weeks after the crisis call
  • Mental health care utilization following NSPL calls and attitudinal and structural barriers to service utilization
  • The impact of Applied Suicide Intervention Skills Training (ASIST) across the NSPL network
  • The clinical characteristics of crisis callers determined by telephone crisis helpers as being at imminent risk of suicide, and the interventions implemented with these callers
  • The efficacy of post-crisis telephone follow-up to suicidal hotline callers

Youth Who Text a Crisis Line: Understanding Needs and Help-Seeking

In collaboration with Anthony R. Pisani, Ph.D., at the University of Rochester and the Crisis Text Line (CTL), we are attempting to determine the reasons why youth choose to text an anonymous crisis line, and how they view their access to support from adults in their lives. Thousands of youth who contact CTL will be randomly selected for a mobile web-based questionnaire immediately after the crisis intervention. Specifically, we aim to describe the severity of suicide risk and the relevant risk factors and to identify:

  • Why youth in crisis contact an anonymous text line
  • Where else they turned for support
  • Whether they recently engaged in other help-seeking experiences
  • What adults they know who could support their recovery

Emergency Department Screen for Teens at Risk for Suicide (ED-STARS)

In collaboration with Dr. Cheryl King at the University of Michigan, we are one site in a multi-­site collaborative project conducted with the Pediatric Emergency Care Applied Research Network (PECARN) and the Whiteriver PHS Indian Hospital. The Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) project is funded by the National Institute for Mental Health.

The specific aims of the project are to: (1) develop a computerized adaptive screening (CAS) for predicting suicide attempts; (2) compare the psychometric properties (e.g., sensitivity, specificity) of the CAS to those of a standard screen—the Ask Suicide-­Screening Questions (ASQ); (3) test the ability of the Implicit Association Test (IAT), a behavioral test of implicit suicidal cognitions, to incrementally improve the prediction of suicide attempts above and beyond screening scores; and (4) develop and validate a parsimonious CAS-based algorithm for risk stratification of suicidal youths. We plan to develop an optimal screening test from this collaborative work that will enhance the capacity of emergency departments to identify and effectively triage youth at acute risk for suicide attempts.

Evaluating Iatrogenic Risk of Suicide Screening Programs

Universal screening for mental health problems and suicide risk is at the forefront of the national agenda for youth suicide prevention; yet no study has directly addressed the potential harm of suicide screening. The objective of our study, funded by the National Institute of Mental Health, is to examine whether asking about suicidal ideation or behavior during a screening program creates distress or increases suicidal ideation among high school students generally, or among high-risk students reporting depressive symptoms, substance use problems or past suicide attempts.

We conducted a randomized experimental design within the context of a two-day screening strategy. Participants were 2342 students in six high schools in New York State in 2002–2004. Data collection is completed; additional data analyses are ongoing.

Psychological Autopsy of Teenage Suicide Clusters

Ours is the only study that has addresses the question of why a cluster of youth suicides occurs in one community following the occurrence of a suicide, while in another community the occurrence of a suicide does not have the same aftermath. Clusters among youth aged 13–20 in the U.S. from 1988–1996 were identified using the time-space Scan statistic. For each cluster community, two matched non-cluster control communities, where the suicides of similarly aged youth occurred, were selected from non-contiguous counties within the same state as the cluster. A diverse array of psychosocial risk factors was assessed. This project, examining the largest sample of suicide clusters ever studied (over 50), yielded a seminal article in The Lancet Psychiatry. Data collection is completed; additional data analyses are ongoing.