by Michael D. Anestis, M.S.
When researchers are looking to conduct an experiment, one of the first steps they must take is seeking approval of the Institutional Review Board (IRB) at their location. The IRB reviews study proposals to ensure that they are ethical, unlikely to cause harm, and of enough potential value to warrent the use of resources. This is a great thing, as it helps prevent research participants from experiencing harm. That being said, as a suicide researcher, I have often encountered significant resistence from IRBs, as members have worried that questions regarding suicide risk could actually cause the participants harm. In addition to the inherent moral concerns inherent in such potential harm, this would obviously put the institution at great legal liability as well.
In the past, I have written on PBB about the work of Madelyn Gould, who convincingly demonstrated that assessing students for suicide risk does not increase thoughts of suicide and that, even more importantly, appears to decrease thoughts of suicide risk in depressed participants and participants with a history of suicidality (click here to read about those results in greater detail). Providing IRB members with those data as well as a well-designed risk assessment and intervention protocol typically alleviates concerns, but you can never be too careful on this front.
With that in mind, I'd like to very briefly summarize the results from another study today. In this study, published in Suicide and Life-Threatening Behavior in 2010 by Phillip Smith, Erin Poindexter, and PBB guest author Kelly Cukrowicz, the authors examined whether participation in an intensive suicide research protocol would increase thoughts of suicide, suicidal behaviors, and other self-harm behaviors in a sample of depressed individuals with suicidal ideation, half of whom had at least one prior suicide attempt and half of whom had no prior attempts.
In the original study, which was testing a specific component of the acquired capability for suicide, participants were shown a number of images, including graphic images of suicide, as the authors collected psychophysiological data (affectively modulated startle reflex). Additionally, each participant filled out a number of questionnaires related to suicidality. Participants were then contacted at 1 and 3 months post-experiment to assess for changes in suicidal ideation, suicidal behavior, and non-suicidal self-injury. 21 (68%) of the original 31 participants participated in both follow-up sessions.
Interestingly (although in my opinion not surprisingly), the authors found that no individuals experienced an increase in suicidal ideation post-experiment and that, in fact, by far the most frequent response was a significant decrease in suicidal ideation. Even more importantly, however, is that no individuals engaged in non-suicidal self-injury or suicidal behavior post-experiment.
Now, to be fair, there are a number of limitations to this study. First of all, not every participant from the original study participated in the follow-ups. What's important to note about that however, is that those who did and did not participate in follow-ups did not differ on any variables (e.g., suicidal ideation levels, past history of suicide, level of depression), so this was not a situation in which the more severe participants dropped out, thereby artificially shifting the numbers to favor the authors' hypotheses. A second limitation is the small sample size. A greater number of participants could have resulted in a different pattern of results. That being said, the complete absence of increases in any of the suicide-related outcomes makes it difficult to believe that a larger sample would yield results indicating that participation in the study increased suicidality. A final limitation worth noting is that short follow-up period. It could be that the suicide-related outcomes might shift with more time. The thing with that, however, is that after several months have gone by, it becomes increasingly questionable to assume that the experiment impacted those changes.
So what's the moral of the story here? IRBs, while often annoying, are incrediby important and perform a thankless job, but the concerns of some IRB members that research on suicide might increase suicide risk appears to be unwarrented. The answer to suicide risk is not now and never will be ignoring the topic. Assessing for risk, asking direct questions about thoughts and behaviors, directing individuals at imminent risk to treatment facilities, and using data from one study to inform the next will always be a clearer path towards better outcomes. It is understandable that people would want to see evidence to support that notion - clearly that's a standard we demand of others here at PBB - and hopefully this evidence will be taken to heart.
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Mike Anestis is a psychology resident at the University of Mississippi Medical Center (one more month!) and a doctoral candidate in the clinical psychology department at Florida State University.
Smith, P., Poindexter, E., & Cukrowicz, K. (2010). The effect of participating in suicide research: Does participating in a research protocol on suicide and psychiatric symptoms increase suicide ideation and attempts? Suicide and Life-Threatening Behavior, 40, 535-543.
