Piloting a Next Generation Psychological Autopsy Study including Digital and Contextual Exposures

Suicide is a leading cause of death in the United States among young people aged 10-19. Despite decades of suicide prevention research and advances in clinical practice, suicide rates remain stubbornly high, with particularly sharp increases in preteen females and minoritized youth. Psychological autopsy (PA) studies attempt to better understand suicide by analyzing existing records, interviewing friends and family, and trying to reconstruct risk and protective factors and events leading up to the suicide death and have informed the field about the role of mental health challenges, early trauma, and family history of suicidal behavior as key risk factors for suicide in young people. Those findings were translated to improved recognition and treatment of depression, which may have accounted for the long decline in teen suicide from the early 1990’s until 2007. Four decades later, there are likely other factors at play. While pure mental health related suicides have declined, those involving substance abuse have increased. Four decades ago, suicide was viewed as an all-white phenomenon whereas now youth of color show increases in suicidal behavior. Suicide was almost unheard of in pre- and younger adolescents but has increased significantly, and prior PA studies focused on teens and adults. Emerging societal trends may be plausibly related to upward trends in pre-teen and teen suicide. We evaluated previously known and potential new risk factors that have increased in frequency in youth since 2007 and focus on those that are biologically or psychosocially plausibly related.

Our long-term goal is to prevent suicide in children and adolescents through in-depth evaluation of the psychological, social, behavioral and digital profiles of youth shortly before death by suicide. The objective of this application is to determine the feasibility and acceptability of our innovative social media data collection methods, to pilot new computational methods with social media data and to collect preliminary pilot data by conducting a systematic PA study of children and adolescents in Maryland and Pennsylvania, states with high proportions of racial and ethnically diverse youth living in rural and urban settings, and disproportionally affected by the opioid epidemic. The sample will consist of 2 groups of youth ages 5-18: youth suicide decedents and a living control group. We will enroll and interview families and peers of 60 youth. In addition to assessments of individual psychopathology, sleep, trauma, family history and environment, this PA study will be innovative by including SM data; decedent exposure to the morbidity and mortality associated with opioid use and DoD; social determinants of health (SDoH), neighborhood factors and exposure to racial and SGM related- trauma and discrimination, both in-person and online, which have not previously been assessed in PA studies.