Dr. Cheryl King is the recipient of this year’s Research Award, presented at the American Foundation for Suicide Prevention’s annual Lifesavers Gala. Dr. King is a professor in the Departments of Psychiatry and Psychology at the University of Michigan. She has focused her career on improving suicide risk screening, assessment, and intervention strategies for teens and young adults with suicidal thoughts and behaviors. Dr. King serves on AFSP’s Scientific Advisory Board, and has mentored AFSP Young Investigators. AFSP has funded Dr. King’s research, as well as those she has mentored, helping to expand our understanding of youth suicide prevention.
How did you first get involved in suicide prevention research?
I first became involved in suicide prevention research as a postdoctoral fellow, working with Alan Raskin at the Lafayette Clinic and Institute in Detroit, Michigan. I had trained to become a clinical child and adolescent psychologist and was returning to professional work after my children were born. The postdoctoral fellowship enabled me to combine advanced clinical training on an adolescent psychiatric inpatient unit (working with suicidal teens) with further research training. Suicide prevention research had strong public health and clinical significance, which was important to me.
What led you to focus on young people in your work? When did you start, and where has it led you?
My focus on suicide prevention was a choice I made very early on. After completing my undergraduate degree in psychology at the University of Michigan, I took a position as a “therapeutic parent,” in a residential treatment setting for youth who had been abused/neglected as children and were severely emotionally impaired. I worked full-time with a group of seven boys for one and a half years – serving as their parent; helping them to manage disappointments and conflicts with others; and teaching them to use money, take public transportation, shop for clothes, and cook. We were trained to use “life space counseling” when challenges arose. This was a highly rewarding and challenging position, and I wanted to learn more about what would and wouldn’t be helpful to youth with emotional and behavioral challenges. I then completed doctoral training in clinical psychology with a specialization in clinical child and adolescent psychology.
Are there specific considerations regarding suicide prevention with younger people?
First of all, we need to understand the capacity of the parents or guardians to provide a safe environment and nurture the young person’s physical and mental health, and involve them in the young person’s care and treatment to the extent possible. We also need to appreciate that young people usually cannot change their family living situation, and there are sometimes, although not always, real difficulties in this situation such as drug abuse, child maltreatment, and domestic violence.
We must also keep in mind that young people have more limited life experiences, often need help with coping skills, and may not understand fully that circumstances and living situations can change, effective treatments are available, problems can resolve, and new opportunities can arise over time.
As a third major consideration, adolescence is a common time of onset for several major mental illnesses (e.g., major depressive disorder, bipolar disorder) and behavioral concerns (alcohol abuse, drug abuse) associated with suicide. Adolescence is also a time of rapid physical and social/behavioral changes. This translates to a heavy stress load and a vulnerable period, especially for those already at risk.
Could you tell us a little about your different studies?
Working with a large team of collaborators and staff, I have three major studies in progress at this time. The first one, Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) is a national study involving 15 pediatric emergency departments and a hospital serving a tribal nation. We are developing a more optimal suicide risk screen for adolescents who present to medical emergency departments – one that is brief, personalized, and takes into account differing combinations of risk factors that can place youth at risk.
A second study, 24-hour Warning Signs for Adolescent Suicide Risk, builds upon ED-STARS as it involves following the youth at highest risk for suicide from this study for an additional 18 months. If a youth makes a suicide attempt during this period, we follow-up with detailed parent and teen interviews to learn what differed during the 24-hours before the suicide attempt.
Finally, we are completing a multi-site study involving four universities, which is called Electronic Bridge to Mental Health for College Students (eBridge). This study examines the effectiveness of eBridge, which incorporates an online suicide risk screen with the option of brief, confidential online counseling for college students. Using motivational interviewing, which considers’ students’ values, goals and behavioral choices, the online counselors aim to facilitate students’ linkage to needed mental health services. These studies are funded by the National Institute for Mental Health.
What is the Youth and Young Adult Depression and Suicide Prevention Research Program?
This research program encompasses the three major, NIMH-funded projects above as well as many other funded and unfunded studies. The members and affiliates of this program include several junior faculty developing careers in this area, senior faculty collaborators, two postdoctoral fellows, multiple doctoral students, research assistants, and paid research staff. It is a highly collaborative and energetic group. We share ideas, consult with each other regularly, and offer moral support for the perseverance and lifelong learning that a scientific career requires.
What are the next steps you’d like to see happen in suicide prevention young people?
Our goal is to decrease the suicide prevalence rate among young people, and it is currently trending upwards. This will likely require an approach that reaches more youth, including those who do not seek out or receive specialty mental health services. We have to keep in mind that many youth who die by suicide have never received any mental health services.
Changing the suicide rate for young people will likely require (1) a careful modeling of suicide prevention strategies and their expected impact (taking into account effectiveness and the numbers of youth at risk who would be reached); (2) further research to improve strategies with the potential for highest impact, including research on cost effectiveness and broad scale implementation; (3) strong advocacy to facilitate the funding and implementation of these strategies; and (4) a highly strategic use of our resources. It will take the dedication and perseverance of many, working together, to bring down the youth suicide rate. We can do this! I feel fortunate to work in an area with such profound clinical and public health significance – and cannot imagine a more meaningful career as a clinical scientist.
To learn more about suicide prevention research, click here.