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.
Highlights
The suicide crisis is a psychiatric emergency, and roughly 900,000 Americans present to the emergency department each year for suicidal thoughts and behaviors [1]
Few evidence-based treatments exist that are targeted toward an active suicidal crisis, and most psychotherapies and pharmacological treatments for suicide risk have a lag of onset of weeks to months or even years
Results from ecological momentary assessment (EMA) and digital phenotyping approaches are unlikely to be as readily interpretable as results from clinical rating scales they may reveal latent suicide risk factors such as variability of suicide ideation (SI) or time spent in the suicidal state, which could serve as valuable metrics of treatment response in future clinical trials
Summary
The need to measure the efficacy of rapid interventions has the potential to spur researchers to develop new tools and techniques for use in next-generation clinical trials, with particular emphasis on assessing momentto-moment changes in suicidal ideation/behaviors using novel digital, neuroimaging, and computational methodologies. These include: [1] ecological momentary assessment (EMA) and digital phenotyping approaches for identifying real-time markers of change in SI and risk factors; [2] cognitive markers of suicide risk, including implicit biases and markers of decision-making associated with suicide risk that could be used to support clinical trials of rapid-acting interventions; and [3] neurobiological markers of suicidal thoughts and risk that could be used to highlight potential avenues connecting SI to changes in specific neural circuitry.
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