How Social Context Changes Individual Risk of Suicide: Breaking through the Bifurcation in U.S. Research with Big Data

The U.S death rate from suicide is stubbornly consistent, promoting calls for research to provide novel directions for prevention and treatment. While previous research has established systematic patterning across psychological, social, and geographical levels, and multilevel influences have been theorized, U.S. research integrating insights across promising etiological streams has been largely blocked by the absence of large-scale data sets combining individual and contextual levels. This webinar presents findings from a project that addressed this bifurcation in research efforts by merging a number of well-known data sets and harmonizing key, available variables. The resulting United States Multi-Level Suicide Data Set (US-MSDS) provides the ability to see how individual level risk factors change depending on geographic residence. The analyses provide some novel findings that have critical implications for future research and programming.

Bernice A. Pescosolido, Ph.D. is Distinguished and Chancellor’s Professor of Sociology at Indiana University, Director of the Indiana Consortium for Mental Health Services Research (ICMHSR), and Co-Director of the Indiana University Network Science Institute (IUNI). Dr. Pescosolido has focused her research and teaching on social issues in health, illness, and healing. Her research agenda addresses how social networks connect individuals to their communities and to institutional structures, providing the “wires” through which people’s attitudes and actions are connected and shaped. In the area of suicide research, she has examined claims on the utility of official suicide statistics, the contemporary effects of religious affiliation, and the potential of a network translation of Durkheim’s theory.

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Nightmares and Suicide: Empirical Evidence and Intervention with Imagery Rehearsal Therapy

Sleep disturbances, including difficulty initiating sleep, difficulty maintaining sleep, nightmares and early morning awakening are believed to be common among people who attempt suicide. (1) Nightmares are disturbing, visual dream sequences that occur in your mind and wake you up from your sleep. Nightmares are very common and can begin at any age. Nightmare disorder develops when you have nightmares on a frequent basis. Nightmare disorder is not as common as nightmares. Dr. Michael Nadorff reviewed the literature on nightmares and suicide, including possible mediators of the relation. He also discussed the literature on nightmare treatments, and how they may hold promise for reducing suicide risk. Dr. Barry Krakow focused his presentation on Imagery Rehearsal Therapy, which is a recommended treatment for nightmare disorder. He also discussed how to conduct the treatment in a time-limited fashion, as well as ways to overcome implementation barriers.

(1)    American Academy of Sleep Medicine. “Sleep Disturbances, Nightmares Are Common Among Suicide Attempters.” ScienceDaily.  2 January 2007. <>

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Measurement of Suicidal Ideation and Behavior in Adults

In this online presentation, Dr. Kim Van Orden defines terms on suicide ideation and behavior, describes reasons for measurement and links them to measurement tools, and discusses considerations in interpreting data from measurement tools. Dr. Wendi Cross moderates the presentation.

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The Good Behavior Game: An Effective Classroom Tool for Suicide Prevention

The Good Behavior Game (GBG), a universal classroom behavior management method, was tested in first- and second-grade classrooms in Baltimore beginning in the 1985–1986 school year. Follow-up at ages 19–21 found significantly lower rates of drug and alcohol use disorders, regular smoking, antisocial personality disorder, delinquency and incarceration for violent crimes, suicide ideation, and use of school-based services among students who had played the GBG. Several replications with shorter follow-up periods have provided similar early results. (1) Evidence shows that Good Behavior Game benefits continue to accrue. In 2008, Holly Wilcox, PhD discovered that children who played the Game were half as likely as young adults to report suicidal thoughts and about a third less likely to report a suicide attempt. As a result, the Good Behavior Game is cited as a promising program in the National Suicide Prevention Strategy. (2) 

In this webinar, Holly Wilcox summarized the evidence behind the Good Behavior Game and described the relevant suicide prevention related research.  Dr. Wilcox also spoke about the development of the GBG, its intended use, and training that is available and needed to use it.  Mr. Longinaker, a first grade teacher in the Baltimore City School system, shared how he has used the Good Behavior Game in his classrooms and described the benefits and challenges of the program. 

  1. The Good Behavior Game and the Future of Prevention and Treatment. Addict Sci Clin Pract. 2011 Jul; 6(1): 73–84. Sheppard G. Kellam, M.D.,Amelia C. L. Mackenzie, B.S., C. Hendricks Brown, Ph.D., Jeanne M. Poduska, Sc.D.,Wei Wang, Ph.D., Hanno Petras, Ph.D., and Holly C. Wilcox, Ph.D.

For more information about the Good Behavior Game, including training for teachers, visit: 

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Collaborative Safety Planning to Reduce Risk in Suicidal Patients: A Key Component of the Zero Suicide Model

The Zero Suicide model builds on the foundational belief that death by suicide for individuals receiving care within the health and behavioral health system is preventable. Collaborative safety planning, a critical component of the model, is an approach that allows clinicians to develop safety plans with any person identified for suicide risk. In this webinar, Adam Swanson of the Suicide Prevention Resource Center provided an overview of the Zero Suicide model and how safety planning contributes to the model. Dr. Barbara Stanley of Columbia University described the role safety planning has in preventing suicide, the six components of the Safety Planning Intervention (Stanley & Brown, 2012), and the research and evidence that supports safety planning. Dr. Stanley detailed how, in order to be effective, safety planning must be treated as a collaborative clinical intervention rather than a form to be completed. She briefly summarized the theoretical underpinnings of safety planning, its intended use, and the training necessary to embed the intervention in health care settings. Mr. Michael Cain of Southwest Behavioral Health Center in Utah discussed why the Center chose to incorporate collaborative safety planning as part of clinical workflows, how it is being implemented, and the challenges and successes encountered.

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Developing Comprehensive, Integrated Approaches to Suicide Prevention

In this 43-minute online presentation, Eric Caine, M.D., Co-Director of the ICRC-S and of the Center for the Study and Prevention of Suicide at the University of Rochester Medical Center (URMC), describes the rationale for a comprehensive and highly coordinated approach to suicide prevention and the role that public health can play in this approach. Yeates Conwell, M.D., Professor and Vice Chair of URMC’s Department of Psychiatry, moderates this session and also provides a framework for a comprehensive approach that is currently being implemented in the state of Colorado.

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The Rationale for Developing Comprehensive Approaches to Suicide Prevention and One State’s Experience with This Approach

In this webinar, Eric Caine, M.D., Co-Director of the Center for the Study and Prevention of Suicide at the University of Rochester Medical Center, discussed the rationale for a comprehensive and highly coordinated approach to suicide prevention and described the role that public health can play in the implementation of this approach.  This presentation also considered what elements are necessary for creating and sustaining the mosaic of efforts that are needed for preventing suicide and its antecedent risks, as well as for preventing other related forms of premature death. Jarrod Hindman, M.S., Deputy Chief of the Violence and Injury Prevention-Mental Health Promotion Branch at the Colorado Department of Public Health and Environment, spoke about how the state of Colorado is adapting this approach in the planning and implementation of the Colorado National Collaborative, an initiative to develop, implement and evaluate a comprehensive approach to reduce suicide in Colorado by 20 percent by 2024. 

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Suicide & Adverse Childhood Experiences (ACEs): Preventing Suicide through Collaborative Upstream Interventions

The Adverse Childhood Experiences (ACEs) study, led by CDC and Kaiser Permanente, was a large-scale, retrospective study of the relationship between childhood trauma and household challenges on lifetime health outcomes, including suicide attempts, adult depression, and substance abuse. In this webinar, Deb Stone, ScD, MSW, MPH, of the Division of Violence Prevention at the Centers for Disease Control and Prevention described: the importance of comprehensive suicide prevention that includes a focus upstream on preventing suicide risk before it happens; ACEs as an important area of that focus, and examples of collaborative, evidence-based interventions to prevent early adversities. Ingrid Bou-Saada MA, MPH, Injury Prevention Program Consultant with the Injury & Violence Prevention Branch at the North Carolina Department of Health and Human Services Division of Public Health, and Elizabeth Cuervo Tilson, MD, MPH, State Health Director and Chief Medical Officer for the North Carolina Department of Health and Human Services, presented on the path North Carolina is taking to use a multi-agency collaborative approach that links ACEs to state behavioral health priorities such as suicide prevention and to multi-disciplinary initiatives. The North Carolina Department of Health and Human Services has provided leadership on a multi-agency collaboration connecting ACEs with state priorities in substance abuse prevention and the opioid epidemic and in the prevention of domestic violence, sexual assault, and suicide. 

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Suicide & Maternal Depression: Uncovering the Prevalence of Maternal Depression Resulting in Self-Harm

In this webinar, M. Camille Hoffman, MD, MSCS, of the departments of Obstetrics & Gynecology and Psychiatry at the University of Colorado School of Medicine discussed national efforts to improve maternal safety, her research on maternal depression and suicide, and opportunities for early identification in health care settings of women at risk of self-harm. This presentation reviewed Colorado’s data on maternal depression and self-harm rates and discussed national data on maternal depression and suicide, strategies to address maternal depression by Colorado and other states, and also explored the implications for researchers and health care practitioners.

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Translating Suicide Research to Practice

In a collaboration between the Northeast Injury Prevention Network (NIPN) and the Injury Control Research Center for Suicide Prevention (ICRC-S), suicide prevention researchers and practitioners from 4 states shared their experiences in translating suicide prevention research to practice.  In this one-hour webinar, representatives from the New York State Office of Mental Health, the Injury Prevention Center at Connecticut Children’s Medical Center, the Vermont Zero Suicide Pilot Project and the Rhode Island Department of Health’s Youth Suicide Prevention Initiative all share a translation experience including an overview of the work, the process used, results, successes and challenges, lessons learned and recommendations. 

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