New Methods for Assessing Rapid Changes in Suicide Risk

Abstract

Rapid-acting interventions for the suicide crisis have the potential to transform treatment. In addition, recent innovations in suicide research methods may similarly expand our understanding of the psychological and neurobiological correlates of suicidal thoughts and behaviors. This review discusses the limitations and challenges associated with current methods of suicide risk assessment and presents new techniques currently being developed to measure rapid changes in suicidal thoughts and behavior. These novel assessment strategies include ecological momentary assessment, digital phenotyping, cognitive and implicit bias metrics, and neuroimaging paradigms and analysis methodologies to identify neural circuits associated with suicide risk. This review is intended to both describe the current state of our ability to assess rapid changes in suicide risk as well as to explore future directions for clinical, neurobiological, and computational markers research in suicide-focused clinical trials.

Crisis Concept Re-loaded?—The Recently Described Suicide-Specific Syndromes May Help to Better Understand Suicidal Behavior and Assess Imminent Suicide Risk More Effectively

“…As suicidal behavior is a multicausal phenomenon, an integrated approach and modern tools need to be applied for complex risk assessment on a population level (2). These novel methods may include genetic testing, digital phenotyping, data-driven machine learning approach, machine-learning of electric health records, or Computerized Adaptive Testing (CAT) (2,3,15,32). Although, preliminary results with these new strategies on suicide risk assessment and prediction are promising, further testing and randomized controlled trials are needed to assess their effect and clinical validity (2).…”

“…and do not help to identify warning signs or acute risk and to predict future suicidal behavior (12,13). Because acute suicide risk usually develops rapidly (up to some days or hours) (14), it would be necessary to introduce a category that emphasizes the characteristics of this life-threatening pre-suicidal state of mind requiring urgent intervention (15,16). Furthermore, in the recent, 11th Revision of the International Classification of Diseases (ICD-11), suicidal behavior is also listed outside the chapter on mental, behavioral, or neurodevelopmental disorders (10).…”

Changing gears in the treatment of bipolar disorder through integrated use of electronic devices

“…3 The application of new machine learning methods to the wealth of data collected by digital technologies will further enhance their individualized predictive precision. 4 Increasing the frequency of mood and related symptom assessment enables the detection of rapid changes in illness that are difficult to capture from the relatively blunt instruments of rating scales, often at the temporal scale of weeks or longer, that rely on retrospective reporting. As Malhi et al 1 COMMENTARY to be associated with the worst suffering and increased suicide risk, 5 are comprised of rapid changes in symptom combinations that can be difficult for sufferers to describe and also have been relatively elusive to study.…”

“…Thus, the use of digital technologies may lead to important strides in understanding some of the most difficult symptoms of BD and facilitate interventions at the earliest stages of increased risk, thereby decreasing rates of the most severe symptoms and outcomes including suicide. 4 Beyond the ability of new electronic technologies to reveal salutary treatment mechanisms, these tools may also help to address current BD treatment challenges described by Malhi Stored recordings of recovery patterns from previous episodes can be valuable in providing hope to someone with depression who cannot conjure an end to their symptoms. Similarly, real-time data have the potential to alert persons with BD at the earliest signs, consistent with their previous manic episodes, prior to insight being lost and, with their consent, clinicians and loved ones of signs of mania when insight is diminished.…”

“…Psychological treatments, such as psychoeducation, can be provided through electronic devices, providing an interactive platform for patients and clinicians alike to review personal disorder patterns and treatment responsivities. 4 Technological advances and digital "connectedness" can allow information to be instantaneously fed back to clinical teams and patients, enabling faster and more individually responsive and targeted care. The greatest benefits from these digital technologies may be in the increased information provided directly to patients.…”