The Center for the Prevention and Treatment of Depression, in the Psychiatry Department at Columbia University Irving Medical Center, hosted a virtual Depression Summit on February 14 and February 16, 2023. The theme was "Understanding Suicide Risk in Children, Adolescents, & Young Adults" and includes two distinguished keynote speakers as well as numerous experts from Columbia and other academic institutions.
You can access each speaker’s session below.
Day 1 Keynote: Saving Holden Caulfield: Long-term and Short-term Strategies for Suicide Prevention
David A. Brent, MD
University of Pittsburgh School of Medicine
Holden Caulfield hopes to catch kids playing “in a field of rye” as they fall off of a cliff. Our approach to suicide prevention in youth is analogous—we have all our ambulances at the base of the cliff. We will talk about four broad approaches to youth suicide prevention that improve upon catching youth as they fall off of a cliff.
- (1) put a fence around the cliff (method restriction);
- (2) go where the kids are (improve access to care through collaborative care);
- (3) lead kids away from the cliff (evidence-based preventive interventions); and
- (4) change the rules of the game (health system change).
These are all approaches that are feasible to implement now. We do have the potential to reduce the suicide rate if we have the will to implement these evidenced based approaches.
Day 2 Keynote: Social and Biological Underpinnings of Disparities in Risk for Suicidal Behavior and Strategies to Reduce These Disparities
Nadine M. Melhem, MD
University of Pittsburgh School of Medicine
During this keynote presentation, the following will be shared:
A review epidemiological evidence of disparities in risk for suicidal behavior and the social underpinnings of these disparities in terms of exposure to adversity, less access to care and resources, etc.
- Present on the biological impact of adversity on risk for suicidal behavior
- Present on strategies to reduce disparities
Session 1: Suicide Prevention in Youth
Leveraging technology to assess and intervene with adolescents at risk for suicide
Ewa Czyz, PhD
Department of Psychiatry, University of Michigan
The prevention of suicide deaths and related outcomes in youth, including non-lethal attempts and suicidal thoughts, is an urgent public health priority. The pervasiveness of mobile phones has paved the way for near- or real-time assessment of suicidal thoughts and related risk states (via intensive longitudinal assessments) and delivery of interventions that can be sensitive to individuals' changing risk levels. Using data from high-risk adolescent samples, this presentation will highlight what intensive longitudinal assessments can tell us about:
(1) near-term change patterns in adolescents’ suicidal thoughts,
(2) identifying proximal elevations in suicidal thinking and related crises, as well as
(3) informing suicide-focused interventions.
Challenges and opportunities in context of youth suicide prevention will be considered.
Measuring Adolescent Suicide Ideation Subtypes: Implications for Risk
Regina Miranda, PhD
Hunter College and The Graduate Center, City University of New York
This presentation addresses the measurement and classification of adolescent suicide ideation subtypes as a way of improving assessment of short-term risk of future suicide attempts.
Novel Approaches to Detect Suicidal Thoughts and Behaviors in Adolescents
Randy P. Auerbach, PhD, ABPP
Co-Director, Center for the Prevention and Treatment of Depression
Department of Psychiatry, Columbia University Irving Medical Center
Presently, there is a public health crisis, as rates of suicide continue to increase among young people. Directly addressing this issue, Dr. Auerbach will present data from projects using intensive longitudinal designs—inclusive of experience sampling and mobile sensor data—to predict the emergence of suicidal thoughts and behaviors. Future directions will focus on potential clinical tools that can be developed and implemented across a range of clinical settings.
Session 2: Advancements in Treatment for Suicidal Behavior
Reducing Suicide Risk by Providing Adolescents Strategies to Improve the Health of Emotion Regulation Brain Circuitry
Hilary Blumberg, MD
Yale School of Medicine
Dr. Blumberg will present multimodal neuroimaging evidence supporting a key role for alterations in the brain circuitry that subserves emotion regulation in suicide risk in adolescents with mood disorders. She will discuss results from a program of research, Brain Emotion Circuitry-Targeted Self-Monitoring and Regulation Therapy (BE-SMART), that provide evidence that providing adolescents strategies that enhance emotion regulation can reduce suicide risk. A focus will be on the beneficial effects of regularizing sleep patterns and other daily rhythms.
Targeting Social Connections in Multi-Component Treatments for Youth Suicide Risk
Cheryl King, PhD
Department of Psychiatry, University of Michigan
This presentation will review converging empirical evidence arguing for the importance of belongingness and connectedness to youth suicide risk and prevention. The Youth-Nominated Support Team intervention (YST), which builds an informed, supportive network of adults around youth at risk, will then be described, including results from a long-term mortality outcomes study. Next steps will be discussed briefly.
Decreasing Suicide Risk Among Youth with Bipolar Disorder
Tina Goldstein, PhD
University of Pittsburgh Medical Center, Western Psychiatric Hospital
Dr. Goldstein will present data on suicide outcomes from a large randomized controlled trial of Dialectical Behavior Therapy (DBT) for adolescents with bipolar disorder. Mechanisms of treatment response will be discussed, along with implications for personalized psychosocial treatment recommendations for this high-risk population, including a data-driven risk calculator for near-term suicide risk that can be implemented in clinical practice. Future directions from cost effectiveness to neural mechanisms will be discussed.
Session 3: Suicide Prevention in Youth
Ketamine in Prevention of Suicidal Behaviors in Adults; potential for youth and young adults
J. John Mann, MD
Paul Janssen Professor of Translational Neuroscience in Psychiatry and Radiology
Director, Molecular Imaging and Neuropathology Division, Department of Psychiatry
Co-Director, Columbia Center for Prevention and Treatment of Depression
Ketamine has been shown in RCTs in adults to produce a rapid and robust antidepressant effect in major depression. It works in younger and older adults, and even in medication-resistant depression. It also produces a robust benefit for suicidal ideation in hours and that benefit is partially explained by cognitive and other effects independent of the antidepressant benefit. As such ketamine may also bring important benefits to adolescents and young adults in terms of depression and suicidal ideation. This presentation will reviewed the available literature with regard to these therapeutic benefits of ketamine extending into younger age groups.
Realizing the potential of social determinants of health to promote mental health equity and reduce youth suicide
Yunyu Xiao, PhD
Department of Population Health Sciences, Weill Cornell Medicine
Suicide is a major public health issue that disproportionately affects marginalized populations. In this talk, I will explore the epidemiological trends of health disparities and suicide, present models of Social Determinants of Health (SDoH) from the social sciences, and discuss why integrating the SDoH framework into marketing and biomedical research is essential for improving mental health equity.
I will also introduce different methods for identifying, studying, and addressing SDoH, and present results from interdisciplinary teamwork using electronic health records and large population-based studies to unlock the potential of SDoH to enhance mental health equity.
Session 4: Suicide Prevention Strategies in School Children and the Emergency Department
Management of suicide risk in young adults
Michael Grunebaum, MD
Department of Psychiatry
Columbia University Medical Center, New York State Psychiatric Institute
I will review key topics in clinical management of suicide risk in young adults i.e. those approximately in the 18-29 year age range. Examples of topics include: SSRI agitation syndrome/worsened suicidality with antidepressant treatment risks, medication side effects, safety planning, co-occurring substance use, family involvement.
Public health approaches to youth suicide prevention
Holly Wilcox, PhD
Johns Hopkins Schools of Public Health, Medicine and Education; Department of Population Health Sciences, Weill Cornell Medicine
In 2020, suicide was the second leading cause of death in school-aged children ages 10-18 in the United States. Provisional 2021 suicide data from the CDC show that the overall US suicide rate has decreased but has increased in people of color. Over the past several years, there has been a significant increase in the rate of suicide and suicide ideation and behaviors (SIB) among Black and Latinx youth.
Because the majority of people who die by suicide do so on their first attempt (and a ‘cry for help’ could be fatal), it is essential that sectors serving children such as school systems have clear and robust pathways for identifying and responding to suicide risk.
e-Connect: Use of a digital clinical decisional-support system to effectively identify suicidal behavior, triage and link youth on probation to care
Katherine Elkington, PhD
Director, Center for Behavioral Health and Youth Justice, Columbia University Irving Medical Center
This presentation will cover the following:
- Briefly describe the epidemiology of suicide thoughts and behaviors in justice-involved youth, and discuss reasons for heightened risk in this population
- Describe state of the field with respect to failure in identification, referral and linkage
- Describe the components of e-Connect (screening, risk classification, triage with specific referral pathways) and present findings from a clinical trial on outcomes
- Discussion of
use of CDSS in justice system and unintended (positive) impact;
scaling up and sustaining e-Connect in justice system settings
extending approach to other youth serving systems that manage vulnerable youth