Wednesday, January 15, 2025
1/15/2025
PROJECT SUMMARY Suicidal thoughts and behavior (STB) lead to the death of nearly 50,000 Americans and contribute >$90 billion in disease burden annually. Existing treatments for STB cannot address the enormity of this problem because they are not scalable. Recent research shows that low aversion to suicide (i.e., perceiving suicide as not so negative/aversive) is a novel STB risk factor and promising treatment target. However, no study has examined whether increasing suicide-aversion (making suicide seem worse) reduces STB. This K23 project follows an experimental therapeutic approach to answer this question. We will randomize 120 adults with recent and frequent STB to receive 30 days of either active- or inactive Therapeutic Evaluative Condition for Suicide (TEC- S). TEC-S is a gamified, classical conditioning-based intervention delivered daily via smartphone and adapted to modify suicide-aversion specifically. We predict that active vs. inactive TEC-S will be associated with increased suicide-aversion (primary target) over the 30-day treatment period, as assessed via weekly self-report and behavioral assay. Also, we predict that active vs. inactive TEC-S will be associated with reduced STB severity (e.g., level of suicidal desire) and incidence (e.g., presence of suicide thoughts, plans, attempts) during treatment, and that increases in suicide-aversion will be associated with these STB reductions (target validation). STB outcomes will be measured via ecological momentary assessment (EMA) three times per day during the 30-day treatment period, and once daily during a subsequent 30-day follow up. This smartphone-delivered randomized clinical trial will produce the data required to develop an R-level optimization trial testing TEC-S among higher-risk suicidal participants leaving inpatient care. Study aims perfectly align with the candidate’s training goals: (1) conduct an RCT for STB delivered via smartphone; (2) design and implement EMA to measure STB severity and incidence; (3) ethics and human subjects protections in EMA with suicidal participants; (4) advanced statistics for multilevel, longitudinal data, including mediation and sensitivity analyses; and (5) career development. These training goals will be accomplished through the expert mentorship and guidance of the candidate’s primary mentor Dr. Sabine Wilhelm (expert in RCTs and digital mental health), co-mentor Dr. Evan Kleiman (expert in STB and EMA), ethics and safety advisor Dr. Kate Bentley (expert in ethics and safety/risk management in EMA of STB), statistical advisor Dr. Walter Dempsey (expert in analyzing longitudinal and mobile health interventions), and technical advisor Dr. Alex Millner (expert in self-injury and TEC). If successful, this project could establish an evidence base for a highly scalable, cost-effective, and mechanistically informed STB treatment that could be easily disseminated to prevent the tragic loss of life and burden caused by STB. The proposed project and training plan would provide unparalleled learning/growth opportunities, launching the candidate’s independent research career focused on developing and testing scalable, targeted STB treatments.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).