Research Roundup December 2024: Recently Published Findings From AFSP-Funded Studies

The Research Roundup is a regular update of recently published findings in suicide prevention research. AFSP-funded studies included in this roundup examined how…

• Suicide attempt survivors may benefit from sharing their experience with others
• Opioid use disorder may play a role in perinatal and postpartum suicidal behavior
• Droughts and the accompanying financial burdens affect farmer suicide rates in India, and
• Connectivity in the brain could provide insights into adolescent suicidal behavior

Researcher: Lindsay Sheehan, PhD
Institution: Illinois Institute of Technology
Grant Type: 2020 Young Investigator Grant – $90,000
Grant Title: Randomized Controlled Trial of a Strategic Disclosure Intervention for Suicide Attempt Survivors

Sharing one’s experience after surviving a suicide attempt can be both empowering and challenging. Effective disclosure can foster social support, which are both critical for recovery and reducing risk for further suicidal thoughts and behaviors during a particularly vulnerable time. However, survivors of suicide attempts can resist sharing their experience due to the potential for negative reactions from confidants and the internalization of stigma. Internalization of stigma is a process where one becomes aware of stigma, agrees with it, applies to themselves, and experiences harm as a result. Despite the knowledge about this process, few interventions exist to reduce suicide-specific self-stigma and help survivors of suicide attempts disclose.

To address this, Dr. Lindsay Sheehan developed the 2Share program, a peer-led group intervention, to help survivors navigate disclosure decisions and reduce the psychological burdens of secrecy and shame. Participants in the 2Share program engaged in three group sessions where they learned strategies for strategic disclosure, practiced crafting personal narratives, and received peer feedback. Compared to a control group, participants demonstrated reduced self-stigma and depressive symptoms after group sessions. Constructive feedback also shaped recommendations for enhancing future iterations of the program, including expanding session time and addressing non-disclosure choices. While preliminary, these findings underscore the value of interventions designed to empower survivors, foster social connection, and mitigate stigma.

Citation: Sheehan, L., Oexle, N., Bushman, M., Glover, L., Lewy, S., Armas, S. A., & Qin, S. (2023). To share or not to share? Evaluation of a strategic disclosure program for suicide attempt survivors. Death studies, 47(4), 392–399. https://doi.org/10.1080/07481187.2022.2076266  

Researcher: Jangho Yoon, PhD, MSPH
Institution: Uniformed Services University for the Health Sciences
Grant Type: 2021 Standard Research Grant – $99, 699
Grant Title: A Systems Approach to Perinatal Opioid Exposure and Maternal Suicidality

Suicide is among the most common causes of perinatal (i.e., the period before and after childbirth) mortality and accounts for one-fifth of all postpartum (i.e., the 6 weeks to 12 months after childbirth) deaths. Research has shown that depression and substance use are contributors to perinatal and postpartum suicidal thoughts and behaviors. Some suggest that the rising rates of opioid use disorder (OUD) and suicide among pregnant and postpartum women represent critical public health challenges that may be related to each other.

To investigate this potential link, Dr. Jangho Yoon compiled data from Oregon Medicaid records, birth certificates, and hospital discharge files for a cohort of 61,481 women aged 15-44 who gave birth between 2008 and 2016. Dr. Yoon observed a three-fold increase in postpartum suicide attempts by opioid poisoning in women diagnosed with prenatal OUD compared to those without such a diagnosis. Additionally, postpartum OUD was identified as a mediator of this relationship. Findings also showed rising trends in both prenatal OUD and postpartum suicide attempts over the study period (2008–2016) as opiate use increased in the United States. This study underscores the need for close monitoring of opioid use during pregnancy and the postpartum period, the integration of behavioral health care into routine perinatal services, and further research to inform interventions that address overlapping risks of substance use and suicide in reproductive-age women.

Citation: Yoon, J., Masoumirad, M., Bui, L. N., Richard, P., & Harvey, S. M. (2024). Prenatal opioid use as a predictor of postpartum suicide attempts among reproductive-age women enrolled in Oregon Medicaid. BMC women's health, 24(1), 196. https://doi.org/10.1186/s12905-024-03019-w   

Researcher: Ram Fishman, PhD
Institution: Tel-Aviv University (Israel)
Grant Type: 2018 Standard Research Grant – $100,000
Grant Title: Climatic and Economic Drivers in Suicides in Rural India

Farmer suicides remain a major public health issue in India, with economic and environmental factors suspected to be playing a significant role. A growing body of research suggests that natural disasters, such as droughts, exacerbate financial distress for farmers, which can contribute to tragic outcomes. In regions with heavy reliance on agriculture and minimal irrigation systems in place, droughts can lead to crop failures, increased debt, and severe emotional strain. More research has been needed to understand how these economic shocks disproportionately affect farmer suicide rates, particularly in rural areas with limited support systems.

Dr. Ram Fishman examined the relationship between droughts and farmer suicides across various Indian states, finding a significant 19% increase in male farmer suicides during drought years. Notably, this impact was more pronounced in areas with lower irrigation coverage and higher agricultural debt. The suicide rate also increased more sharply with age, suggesting that older farmers are particularly vulnerable to the economic shock caused by droughts, perhaps because they have fewer alternatives to employment. Through both inter-state and intra-state analyses, the study confirmed that droughts, while not affecting non-farmer suicide rates significantly, substantially increased suicide risk among male farmers. These results suggest that improving irrigation systems and addressing debt burdens could help mitigate the impact of droughts on farmers’ mental health.

Citation: Rothler, Y., Blakeslee, D., Malghan, D., & Fishman, R. (2024). Economic factors mediate the impact of drought on farmer suicides in India. Global Environmental Change, 86, 102844. https://doi.org/https://doi.org/10.1016/j.gloenvcha.2024.102844      

Researcher: Olga Tymofiyeva, PhD
Institution: University of California, San Francisco
Grant Type: 2019 Standard Research Grant – $100,000
Grant Title: Suicidality in Depressed Adolescents: A Study of Neural Changes with a Mind-Body Intervention

Understanding the neurobiological underpinnings of suicide risk in adolescents is a critical area of research. While adult studies suggest a role for serotonergic dysfunction in suicide (i.e., dysregulation in neurotransmitters related to emotional and mood stability), particularly involving the brain’s putamen (i.e., an area of the brain involved in motor control and emotion regulation), less is known about these mechanisms in adolescents. There has been a question about whether differences in resting-state functional connectivity (RSFC), which can be thought of as how the brain is function without external stimulation, of the putamen may be linked to suicide attempts in depressed youth. More research could potentially offer insights into the brain areas that influence suicidal thoughts and behaviors.

Using resting-state brain scans, Dr. Olga Tymofiyeva examined brain connectivity in 30 adolescents with depression, comparing 17 who had no suicide attempt history to 13 who did. Dr. Tymofiyeva found that adolescents with a history of suicide attempts showed reduced RSFC between the putamen and regions implicated in motor and brain regulation. A possible explanation for the results is that in teens who have attempted suicide, the way serotonin is transported to the putamen and other areas might not match up properly, which could lead to weaker communication between these two brain areas. These findings suggest that putamen circuitry may play a role in adolescent suicidal thoughts and behaviors, informing future models of suicide risk and potential neurobiological targets for treatment in teens.

Citation: Tymofiyeva, O., Ho, T. C., Connolly, C. G., Gorrell, S., Rampersaud, R., Darrow, S. M., Max, J. E., & Yang, T. T. (2024). Examining putamen resting-state connectivity markers of suicide attempt history in depressed adolescents. Frontiers in psychiatry, 15, 1364271. https://doi.org/10.3389/fpsyt.2024.1364271

Learn more about the AFSP research grants featured in this monthly roundup, as well as others, here.