Conducting Research with Individuals at Risk for Suicide: Protocol for Assessment and Risk Management

Abstract

Objective Suicide prediction, prevention, and intervention are urgent research areas. One barrier for research with high‐risk populations is limited resources to manage risk in a research setting. We describe using the University of Washington Risk Assessment Protocol (UWRAP) to assess and manage suicide risk during phone‐administered eligibility assessments in two clinical trials. Method Study 1 (N = 151) recruited suicidal adults who were not engaged in mental health treatment and Study 2 (N = 135) recruited suicidal adults who used alcohol to regulate emotions. Pre‐ and postassessment ratings of stress, urge to harm self, urge to use drugs/alcohol, and intent to harm self were compared and strategies to manage increased suicide risk following screening interviews were implemented, as indicated. Results In both studies, average postassessment ratings were significantly lower than pre‐assessment. A minority of participants reported higher ratings on one or more domains; however, following more thorough suicide risk assessment, risk was appropriately managed by providing low‐level interventions (e.g., validation). Conclusions Suicide risk in research involving community participants can be managed by using appropriate risk protocols.

Core components and strategies for suicide and risk management protocols in mental health research: a scoping review

“…Other examples of written materials included: a suicide referral card [32], an information card with mental health resources [36], and a list of referral information or a referral document [35,51]. 3.2: Immediate support services: Several documents (see Table 1) recommended including information on immediate support services for research participants who may be in acute distress or require urgent mental health interventions [1,2,14,34,40,43,44,46,47,49,50,52,53]. Immediate mental health support services endorsed by research staff included the use of a 24-h help-crisis line [52] and directing those in crisis to a URL link that consists of relevant resources [47].…”

“…These notes capture information including a research subject's desire to continue to participate in the study or to be connected with a mental health professional that can provide them with referral information. Another example of structured SRMP includes the University of Washington Risk Assessment Protocol (UWRAP) that provides guidelines on determining participant risk level and interventions for staff to offer to participants [14,15]. 4.2: Identification of risk level: Luxton et al [42] highlight that suicide risk levels are dynamic and change frequently.…”

“…4.3: Utilization and scoring of validated risk assessment measures: In total, 11 documents utilized the administration and scoring of a validated risk assessment measure to assess for the presence of mental health conditions (e.g. depression), suicidal ideation or self-harm behaviours associated with increased risk of suicide attempts and death by suicide [14,30,32,33,35,37,43,46,50,52,55]. The results of these measures provide research staff with another level of information needed to respond.…”

“…Several documents [1,6,14,29,30,37,38,44,50,54,56] note that providing clinical back-up delivers timely support and guidance to research staff during research assessments if a participant is in crisis. Clinical back-up by licensed clinicians (e.g.…”

“…Thus, once a study has received REB approval, it is at the discretion of research teams to develop relevant SRMPs for mitigating risk and prioritizing the safety of research participants. This activity is particularly important where there is a real or perceived risk, including studies where the population may be at higher risk of self-harm or suicidal ideation, or death from suicide [14,15]. Having standardized expectations for the content of SRMPs across REBs is in the best interest of researchers, REBs, and research participants [16].…”