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The Vital Role of Suicide Prevention Research

Suicide is a leading cause of mortality globally, resulting in an estimated 700,000 deaths worldwide each year. Relative to suicide deaths, even more individuals experience suicidal thoughts and engage in suicidal behavior. In the United States, suicide deaths occur across all age groups from late childhood through late adulthood. For decades, federal, state, and local governments have been trying to improve efforts to address this public health crisis with the help of suicide prevention researchers.

Suicide prevention can range from universal programs, like teaching everyone in a school the warning signs for suicide, to specific treatment programs for individuals who struggle with chronic suicidal thinking. This wide array of programming facilitates differing levels of care, but it presents challenges in ensuring that suicide prevention efforts are implemented consistent with the available supporting scientific data. Recently, RTI International has begun working with federal and academic partners to increase the scientific rigor of existing large-scale suicide prevention and intervention programs.

The 988 Suicide and Crisis Lifeline

One recent and significant change across the suicide prevention landscape is the implementation of the three-digit dialing code, “988,” following a law passed by Congress. Beginning in July 2022, dialing “988” from any phone in the United States now connects callers or texters with the 988 Suicide and Crisis Lifeline.

988 is a 24-hour crisis service that is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). 988 connects individuals with trained crisis staff with the goal of reducing overall immediate distress and, in the case of suicide risk, reducing the likelihood that a person will attempt suicide. Additionally, crisis staff can coordinate use of other components in the crisis continuum, including mobile crisis and crisis stabilization units. 988 is the largest, publicly accessible, free mental health service in the United States. Yet, our knowledge about how 988 works to prevent suicide deaths and address other mental health crises is surprisingly limited.

Understanding the Impact of 988

In 2022, RTI led a study funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) to examine the readiness of the U.S. crisis response system for implementation of 988. Our findings demonstrated that availability and accessibility of call centers, mobile crisis groups, and crisis stabilization units vary widely across states. This variability underscores the importance of scientific rigor in defining and assessing the effectiveness of the behavioral health crisis system. We recently published a paper in JAMA Psychiatry that outlines a research agenda to improve our understanding of the mechanisms that make 988 effective for a given individual.

SAMHSA, ASPE, and other federal partners recognize the need to evaluate the effectiveness of 988 as it relates to several key outcomes, including preventing suicide deaths and suicide attempts and reducing suicidal ideation and related immediate distress. RTI, in collaboration with Madelyn Gould, PhD, at Columbia University, is conducting a SAMHSA-funded study to design an evaluation of 988 and the crisis continuum. This study provides a key opportunity to guide future research questions, data sources, and methods used to inform our understanding of 988 and its immediate and cascading impacts on suicide prevention efforts in the United States.

Examining the Implementation of the Zero Suicide Initiative

Continuous research and evaluation of federal, state, and local initiatives is critical to understanding how effective these programs are in preventing suicide deaths. RTI experts are contributing to this body of research, having previously led an ASPE-funded study to assess the implementation and sustainability of Zero Suicide, a system-wide approach for health systems to improve the quality and safety of care for those at risk of suicide.

In consultation with subject matter experts, RTI conducted an environmental scan and series of case studies to identify ways in which health care organizations fund and sustain the Zero Suicide initiative. These findings were presented in a report that underscored key policy and practice implications for health care organizations and for potential funders and supporters of Zero Suicide.

Using New Technology to Identify Trends in Crisis Conversations

To increase understanding of suicide risk, especially for certain at-risk populations, researchers are leveraging innovative technologies. RTI is using machine learning in a grant project funded by the Centers for Disease Control and Prevention in which researchers are examining how firearms are discussed during crisis conversations, with an emphasis on understanding how firearms may confer risk for suicide death. 

We have developed machine learning algorithms that use natural language processing to identify mentions of rare events, such as firearm violence or suicide, in crisis conversations. As part of this project, our researchers have demonstrated that crisis conversations mentioning firearms spiked following the mass shooting at an elementary school in Uvalde, Texas. This type of work can begin to sort through large datasets to intelligently identify potential match cases for further investigation.

Contributing to the Scientific Rigor of Suicide Prevention Research

RTI’s suicide prevention researchers also are contributing to the larger suicide research literature to improve prevention efforts. Recently, we published a theoretical paper in the Journal of Clinical Child & Adolescent Psychology, one of the field’s leading journals. In this paper, we argue that researchers need to begin looking earlier in development to identify the earliest possible opportunities to intervene and offset negative trajectories towards suicide risk during adolescence. Additionally, Dr. Miller recently served as lead author on a paper in American Psychologist that calls for a more culturally responsive way to assess suicide risk among youth of color.

Suicide is an exceedingly complex problem that requires focused, multidisciplinary research. RTI is responding to this challenge by driving scientifically rigorous research for our clients with the goal of preventing suicide deaths. Suicide deaths are preventable, and we are committed to working with our clients and partners to help address this public health problem. 

Learn more about RTI’s expertise and capabilities in behavioral health research.

Disclaimer: This piece was written by Adam Bryant Miller (Research Clinical Psychologist) and Kiersten Johnson (Research Public Health Analyst) to share perspectives on a topic of interest. Expression of opinions within are those of the author or authors.