Category: Suicide and Self-Injury
Alexander Millner, Ph.D.
Research Associate
Harvard University
Cambridge, Massachusetts
Rebecca Fortgang, Ph.D.
Postdoctoral Fellow
Harvard University
Cambridge, Massachusetts
Matthew Nock, Ph.D. (he/him/his)
Research Scientist
Harvard University
Cambridge, Massachusetts
Evan Kleiman, Ph.D. (he/him/his)
Assistant Professor
Rutgers University
Piscataway, New Jersey
Rebecca Fortgang, Ph.D.
Postdoctoral Fellow
Harvard University
Cambridge, Massachusetts
Kelly Zuromski, Ph.D. (she/her/hers)
Research Associate
Harvard University
Cambridge, Massachusetts
Kate Bentley, Ph.D. (she/her/hers)
Clinical Psychologist
Massachusetts General Hospital
Boston, Massachusetts
Suicide is a leading cause of death and a public health crisis. There is a pressing need to identify indicators of imminent suicide risk to guide clinical decision-making for just-in-time interventions. This work has recently been aided by intensive longitudinal research leveraging smartphone-based technology to ascertain real-time information about suicide risk. This method allows us to study STBs where they actually occur – in patients’ real lives – rather than asking retrospective questions while the patient is sitting in the office. Although the benefits of getting in situ data regarding STBs are many, one challenge is how to handle situations where the researchers learns that a participant is suicidal at the very moment. There are myriad issues researchers face when protecting participants in these studies, including decisions regarding what constitutes high-risk, and whether to intervene and if so, how often and in what form. The answers to such decisions may depend on available clinical and technological resources. Recent papers have proposed approaches to address the ethical, logistical, clinical, empirical, and practical concerns involved in monitoring and intervening on suicide risk but there have been few instances of people doing this work in a large scale sample of suicidal individuals.
This symposium brings together collaborators at the forefront of this research. Collectively the team has decades of experience conducting this work, have been PI or Co-I of over a dozen NIMH-funded projects using digital monitoring to study suicide risk, and have extensive experience from both a researcher and regulatory perspective (i.e., IRB members and a former IRB chair). We propose to present and make available our resources for decision-making and implementation for suicide risk management in intensive longitudinal research that has been used to monitor more than 700 suicidal participants. The symposium also aligns with this year’s convention theme by creating and investigating practices to support digital mental health research and practice, which significantly extends access, promoting inclusivity and representation in our research and equity in access to clinical care.
After an introduction from our co-chairs laying out ethical considerations, our first presentation will include findings from a qualitative study of adolescents and their parents that discusses preferences regarding risk management from the stakeholder perspective. Our next presenter will introduce a detailed protocol for the management of suicide risk in these studies, showing practices for adults and adolescents, and highlighting procedures for staffing, training, and developing a user interface. The third presentation will share data from the implementation of this protocol over more than four years, highlighting pragmatic considerations and evidence of successful implementation. Fourth, results will be presented from a recent study investigating impact of these protocols on real-time participant responses. Finally, our discussant will integrate implications from the work presented in this symposium to highlight critical priorities for safely extending digital monitoring for suicide risk to broader contexts in research and clinical practice.
