Research
For a summary of our NIH grant portfolio, visit here: The Notre Dame Suicide Prevention Initiative: A one-year progress report
Current Research:
Leveraging Noninvasive Transcutaneous Vagus Nerve Stimulation and Smartphone Technology to Reduce Suicidal Behaviors and Suicide Among Highly Vulnerable Adolescents
Funding Source:
National Institute of Mental Health
Description:
U.S., suicide rates increased 36% in the last 20 years, and continue on an upward trajectory. The predominant approach to mitigating suicide risk in the U.S. is secondary prevention. Typically, these programs identify risk of recurrence among those who have already attempted suicide at least once. Although secondary prevention is crucial, the majority of deaths by suicide occur on first attempt. Thus, targeted primary prevention earlier in development is essential. Current programs are intensive, expensive, and delivered by highly trained mental health providers, who are in short supply. Traditional face-to-face therapy is also unavailable to many who live in underserved communities, and disliked by adolescents, who much prefer digital delivery on their devices. This high-risk, high-reward proposal addresses these limitations and needs. We use an experimental therapeutics approach to evaluate the independent and combined efficacies of two unconventional but scalable interventions: transcutaneous vagus nerve stimulation (tVNS) to target emotion dysregulation, and a peer-support smartphone app to combat social isolation. These low-cost interventions, which hold strong promise but have not been used before, can reach large numbers of adolescents, with much potential to reduce pro- spective suicide risk. We will enroll 212 adolescents, ages 13-17 years, who show elevations on at least two prominent risk factors for suicide (e.g., self-injury, maltreatment). Using a 2 × 2 design, adolescents will be assigned randomly to receive 30 days of treatment with (1) tVNS to tar- get emotion dysregulation, (2) a peer-support phone app to target social isolation, (3) tVNS + a peer-support phone app, or (4) enhanced treatment as usual with monitoring and access to re- sources. Intervention effects on mechanisms (emotion dysregulation, social isolation) proximal efficacy signals (e.g., physiological reactivity, self-harm) and target outcomes (suicidal ideation, suicidal behaviors) will be evaluated immediately post-intervention and at one-year follow-up. Treatment data will be monitored daily to fine-tune dosing of both interventions.
Advancing Real-Time Suicide Risk Detection Through the Digital Phenotyping Smartphone Application Screenomics
Funding Source:
National Institute of Mental Health
Description:
Studies using ecological momentary assessment to collect data at several intervals per day demonstrate that suicidal ideation and suicide risk factors change rapidly across the course of the day, yet there is a need to improve the granularity of assessment to improve identification of real-time risk elevation. To improve reliable detection of suicide risk within a relatively short window of time (e.g., minutes) we propose the use of a novel form of digital phenotyping, termed Screenomics, that captures screenshots from participant’s phones every five seconds. These data will be utilized to indirectly identify suicidal thoughts and behaviors in real-time (via generated and viewed text), as well as prospectively predict suicie risk via individual engagement in produced and consumed social interactions (via application usage, text messages, and social media text), which have known links to suicidal thoughts and behaviors.
Effects of Parental History of Suicidal Behavior on Early/Middle Childhood: Longitudinal Assessment of Early Markers of Suicide Risk
Funding Source:
National Institute of Mental Health
Description:
A significant risk factor for early onset of a first suicide attempt is a parental history of suicidal behavior (PH+). PH+ status is associated with a 4- to 6-fold increased risk of offspring suicidal behavior. Although familial transmission of suicidal behavior is well documented, research examining specific factors that account for this risk is limited. We are following 500 PH+ youth, ages 7-12 years, across three annual assessments to identify neurobiological (e.g., autonomic dysfunction), individual (e.g., emotion dysregulation), and social (e.g., interpersonal communication) mechanisms of risk and protection. Findings should have implications for future prevention and treatment programs.
EMERGE: Ecological Momentary Evaluation of Responses to Gain/Loss and Emotions
Funding Source:
National Institute of Mental Health
Description:
Most research on suicide risk factors has identified static, dispositional factors. These data inform us about groups at actuarial risk, but do very little to predict with useful precision when people will have suicidal thoughts or act on suicide thoughts. Thus, there is an urgent need to identify proximal risk factors for suicide risk. Two of the leading factors distally associated with increased suicide risk are dysfunctional emotional responses5 and decision-making deficits. Suicidal individuals have poorer reinforcement learning, demonstrating impaired ability to learn and modify behavior in response to reward and punishment. Individuals at high risk for suicide also show difficulties learning from punishment and reward. In this study we will examine both emotional and cognitive processes associated with suicidal thoughts and behaviors using ecological momentary assessment methods.
Acceptability, Feasibility, and Appropriateness of a System of Suicide Prevention Services for Youth with a Parental History of Suicide Attempt
Center for Accelerating Suicide Prevention in Real-world Settings [ASPIRES] P50 subaward
Funding Source:
National Institute of Mental Health
Description:
A major risk factor for early onset suicidal behavior is parental history of suicide attempt (PH+). This study will characterize PH+ youth; identify interventions designed to engage proximal targets for PH+ youth to develop a clinical workflow to match youths’ clinical needs to best-fitting interventions; and examine acceptability, feasibility, and appropriateness of the proposed case-intervention mapping guide and clinical workflow from the perspectives of key stakeholders (e.g., parents, clinicians/providers, administrators).
Leveraging Biomarkers and New Technologies to Reduce Self-Injury and Substance Abuse Risk Among Highly Vulnerable Adolescents
Funding Sources:
Institute for Precision Health Award
Description:
Adolescent nonsuicidal-self injury (NSSI) and alcohol misuse, both alone but especially in combination, predict significant problems in adulthood, including relationship dysfunction, depression, underemployment, and suicidality). Although effective for some, psychosocial interventions for are expensive and require highly trained clinicians. As a result, treatments are often unavailable to disadvantaged adolescents, and to adolescents who live rurally. We are testing a promising new technology—transcutaneous vagus nerve stimulation (tVNS)—which uses an earbud to apply a very small electric current to the vagus nerve, which runs through the ear. This changes brain activity in structures involved in emotion regulation, and is effective in treating depression.
Understanding the Impact of COVID-19 on Problematic Substance Use through the Quality of Sobriety Framework
Funding Sources:
Institute for Precision Health Award (Formerly Advanced Diagnostics & Therapeutics Discovery Fund)
Description:
Substance use is a public health concern with widespread impairment, which has been increasing since the inception of the COVID-19 pandemic and is notable suicide risk factor. COVID-19-related adversities may disproportionately influence those with substance use disorder by negatively impacting numerous spheres of daily functioning important for sobriety (i.e., social, vocational). This study collects daily level data on substance use cognitions (i.e., cravings) and behaviors (i.e., problematic use), in addition to subjective and objective data across several domains of functioning outlined by the Quality of Sobriety framework. Findings will shed light on whether substance use cognitions and behaviors are both directly and indirectly impacted by the current COVID-19 circumstance and, if so, to what extent each domain of functioning is most relevant.
Identifying Momentary Risk Factors in the Co-Occurrence of Substance Use Disorders and Self-Injurious Thoughts and Behaviors
Funding Sources:
Institute for Precision Health Award (Formerly Advanced Diagnostics & Therapeutics Discovery Fund)
Description:
Substance use is a public health concern with widespread impairment. Moreover, the significant overlap of substance use disorders and self-injurious thoughts and behaviors heighten the potential for physical harm, including death, among these individuals. Prior research highlights the potential role of negative mood states as a factors contributing this co-occurrent, however, very little research has directly investigated these relationships. The overarching goal of this project is to improve our understanding of the co-occurrence of SUD and SITB through a nuanced evaluation of key risk factors via multiple modalities. More specifically, we examine emotion regulation and chronic interpersonal stress, in addition to the momentary experiences of elevated negative mood states and interpersonal contexts, as drivers in the joint occurrence of substance use and self-injurious thoughts and behaviors.
Using Integrative Data Mining to Improve the Prediction of Suicide: An Initial Application
Funding Sources:
Institute for Precision Health Award (Formerly Advanced Diagnostics & Therapeutics Discovery Fund)
Description:
In this project we utilize data integration to combine multiple datasets to examine the complex relationship between risk factors and suicidal ideation, plans, and attempts through machine learning techniques. It was one of the first projects to combine the use of data integration to create a large-scale database (allowing for sufficient predictive power to identify small effects and interactions) in service of improving suicide prediction.
Development and Prevention of Self-inflicted Injury and Suicide
Funding Sources:
American Foundation for Suicide Prevention, National Institute of Mental Health
Description:
With this work, we seek better ways to identify people who are at risk for suicide across the lifespan. Self-injury (which often predates suicidal behaviors), suicide attempts, and suicide are growing public health problems in the U.S. and in Europe. We evaluate (1) biological vulnerabilities (e.g., abnormal brain responses to reward and emotion evocation, structural brain abnormalities, low serotonin levels, low heart rate variability), (2) environmental risk factors (e.g., financial stress in adulthood; abuse and other forms of family dysfunction in childhood and adolescence), and (3) how biological vulnerabilities and environmental risk factors interact to predict emotion dysregulation, development of self-injury, and suicidal behaviors. These studies demonstrate that neither biological vulnerability nor environment risk are strong predictors of self-injury or suicidal behaviors. In combination, however, they are often potent predictors. Our ultimate objective is to gain a better understanding of self-inflicted injury and suicidal behaviors so we can formulate effective prevention programs and improve existing interventions.
Past Research:
Specifying Transdiagnostic Vulnerabilities to Psychopathology
Funding Sources:
National Institute of Mental Health, National Institutes of Health Common Fund
Description:
Across the many revisions of the Diagnostic and Statistical Manual of Mental Disorders since 1952, increasingly more categories of psychopathology have been added. Traditionally, it was assumed that each diagnostic category was a discrete disorder. More recently, it had become clear that a limited set of functional neural systems--far fewer in number than disorders in the DSM--interact to yield complex patterns of psychopathology. For many years, our group has used advanced technologies (structural and functional MRI, genetic markers, autonomic psychophysiology) and statistical methods (e.g., automated computer vision and machine learning, hierarchical Bayesian modeling, nonlinear dynamic modeling, advanced factor analytic techniques) to identify transdiagnostic vulnerabilities to psychopathology and the neural systems that subserve them. These vulnerabilities include trait impulsivity, trait anxiety, and emotion dysregulation. This work dovetails with the Research Domain Criteria initiative of the National Institute of Mental Health.
Neural Bases of Trait Impulsivity
Funding Sources:
National Institute of Mental Health
Description:
Trait impulsivity, defined as a predisposition to engage in behaviors that, although rewarding in the short-term have adverse long-term consequences. Impulsive behaviors characterize all externalizing disorders (ADHD, conduct problems, substance use disorders), as well as borderline personality disorder and suicide. In this program of research, we identify common neural and autonomic vulnerabilities to these disorders. This work follows from recognition that transdiagnostic vulnerabilities contribute to psychopathology (see above), and dovetails with the Research Domain Criteria initiative of the National Institute of Mental Health.
Development of and Treatments for Trait Impulsivity, ADHD, and Externalizing Behaviors Across the Lifespan
Funding Sources:
National Institute of Mental Health, National Institute of Dental and Craniofacial Research
Description:
Trait impulsivity, expressed early in life as the hyperactive-impulsive and combined presentations of ADHD, confers vulnerability to adjustment problems later in life, including conduct problems, and substance use disorders, and antisociality for boys; and self-injury, substance use disorders, and borderline traits for girls. However, these outcomes are not pre-determined. Rather, they are much more likely in contexts of poverty, abuse, maltreatment, and are much less likely in the absence of environmental risk. In this multifaceted line of research (some of which is described above), we specify neurobiological vulnerability x environmental risk interactions that lead to progression of adverse mental health outcomes for impulsive boys vs. girls, and develop prevention and intervention programs for impulsive children and their families.
Heterotypic Comorbidity and Continuity of Internalizing and Externalizing Behaviors
Funding sources:
National Institute of Mental Health, National Institute on Drug Abuse
Description:
Both conduct problems and depression increase markedly in middle childhood, and despite different symptom presentations, co-occur at far greater levels than expected by chance. This suggests common etiologies. In this program of research, which stems from our interest in transdiagnostic causes of psychopathology (described above), we seek to specify biological vulnerabilities to and environmental risk factors for conduct problems, depression, and their comorbidity across the lifespan.
Emerging Mental Health Disparities Among Underrepresented Groups
Funding Sources:
National Institute of Minority Health and Health Disparities, National Institute of Child Health and Human Development.
Description:
In the United States, traditionally under-represented groups, including racial and ethnic minorities, immigrant populations, and sexual minorities (LGBTQ), are at much higher risk of adverse physical and mental health outcomes compared with majority group members. In this line of research, we seek to identify mechanisms through which mental health disparities develop, with the ultimate goal of informing prevention.