TARGETED INTERVENTIONS FOR SUICIDE PREVENTION

There is change happening in clinical trials. In the past, people with current or past suicidal ideation and behavior (SIB) are automatically excluded from clinical trials. Fortunately, this is changing. With about one third of people with significant mental health disorders, especially affective, psychotic and substance use disorders, having experienced SIB, inclusion becomes critical. We know that certain populations such as older people, and people with substance use disorders have elevated rates of suicide necessitating the inclusion of people with SIB. Youth have higher than expected rates of suicide attempts though, the rate of death by suicide is the lowest when compared to other age groups. The goal of this panel is to highlight research that has been conducted without excluding people with SIB and findings have been informative for more precise treatment decisions. We start with a study examining the trajectory of SIB using digital ecological momentary assessment (EMA) and sleep. Multilevel modeling was used to examine the association between sleep and next-day suicidal ideation among youth, 20% of whom had suicidal thoughts. Data will be presented to demonstrate that worse sleep quality was associated with next-day suicidal ideation among adolescents. This study highlights that suicide risk is not static, it fluctuates in relation to a host of factors including sleep. Monitoring mood, SIB and sleep is feasible and informative and provides important information for understanding and preventing suicide among youth. Next, the first study of a GLP-1 receptor agonist in individuals with moderateto-severe methamphetamine use disorder. Data will be presented from demonstrate the differential impact of GLP-1 treatment on clinical symptoms and SIB, highlighting the importance of inclusion to identify who may benefit most from GLP-1 receptor agonist in the context of methamphetamine use disorder. Interesting, SIB was unchanged while clinical symptoms were otherwise affected. While those age 65 and up have the highest rates of suicide they are an often neglected population for intervention development, particularly those with mild cognitive impairment. The aims of the study presented are to compare depression, emotion regulation, and suicide-related outcomes between two psychosocial interventions for older adults after a suicide related hospitalization: Problem Adaptation Therapy for Suicide Prevention (PATH-SP) and Supportive Therapy (ST). The forty-six 50 to 90 year-olds who participated were inpatients with depression, mild cognitive impairment and suicidal ideation. The treatments were compared and improvement and subsequent remission rates varied depending on the treatment and variables considered, Most importantly, improvement in depression and suicide was demonstrated., The final study is one of the first to systematically study the use of psilocybin for the treatment of individuals with SIB. To evaluate the efficacy, safety, and durability of a single dose of psilocybin with psychological support employed an open-label, single-arm, naturalistic study with a 12-week follow-up period was conducted. The preliminary data show that SIB severity and depression decreased without any adverse events. The studies presented demonstrate the variability of treatment impact on SIB, highlighting the importance of including people with SIB and using relevant measures to assess impact. Precision medicine includes matching patient with treatment and requires broad based studies that include all potential people who may benefit from treatment. We invite discussion about the methods, considerations and findings of these important, potentially life saving studies.

Learning Objective 1: Attendees will be able to describe at least three methodological considerations that facilitate the study of promising treatments for suicide prevention.

Learning Objective 2: Attendees will be able to list at least two populations with higher rates of suicide.

References

Arslanoglou, E., Banerjee, S., Pantelides, J., Evans, L., and Kiosses, D. N. (2019) Negative Emotions and the Course of Depression During Psychotherapy in Suicidal Older Adults With Depression and Cognitive Impairment. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 27(12), 1287-1295. https://doi.org/10.1016/j.jagp.2019.08.018 Athey, A., Shaff, J., Kahn, G., Brodie, K., Ryan, T. C., Sawyer, H., DeVinney, A., Nestadt, P. S., and Wilcox, H. C. (2025) Association of substance use with suicide mortality: An updated systematic review and meta-analysis. Drug and alcohol dependence reports, 14, 100310. https://doi.org/10.1016/j.dadr.2024.100310 Aaronson, S. T., Sackeim, H. A., Jiang, M., Badejo, S., Greco, T., Bunker, M. T., Conway, C. R., Demyttenaere, K., Young, A. H., McAllister-Williams, R. H., and Rush, A. J. (2024) Alternative metrics for characterizing longer-term clinical outcomes in difficult-to-treat depression: II. Sensitivity to treatment effects. Australian and New Zealand Journal of Psychiatry, 58(3), 250-259. https://doi.org/10.1177/00048674231209837