Current Research Initiatives

24-Hour Warning Signs for Adolescent Suicide Attempts

Funded by the National Institute of Mental Health (R01MH113582)
Principal Investigator: Cheryl A. King, Ph.D.
Co-Investigators: Iqbal Ahamed, Ph.D., Courtney Bagge, Ph.D., David Brent, M.D., Charlie Casper, Ph.D., Polly Gipson, Ph.D., Jacqueline Grupp-Phelan, M.D, MPH

This large-scale NIMH project recruited 1097 youth at elevated risk for suicide from the ED-STARS study. The project is designed to identify the warning signs that are associated with near-term risk for suicide. We also hope to determine why a patient attempted suicide on a given day versus a day without a suicide attempt. Youth will complete biweekly text message surveys across an 18-month period, regarding their mental health status. The Warning Signs for Suicide Attempt Interview – Adolescent (WSSA-A), a computer-assisted telephone interview, will be conducted with adolescents who report a suicide attempt (and matched control adolescents). Using a case-crossover within-subject design, we will compare the events, behaviors, emotions and thoughts of these adolescents during the 24-hour case window (day of attempt) to those during a matched 24-hour control window. Using a case-control group comparison design, we also will identify differences between suicide attempters and non-attempters in events, behaviors, emotions and cognitions during the 24-hour case window.

Emergency Department Screen for Teens at Risk for Suicide (ED-STARS)

Funded by the National Institute of Mental Health (U01MH104311)
Principal Investigators: Cheryl A. King, Ph.D., Jacqueline Grupp-Phelan, M.D., M.P.H., David Brent, M.D.
University of Michigan Co-Investigators: Alex Rogers, M.D., Rebecca Cunningham, M.D., Kyle Grazier, Ph.D.

Dr. King together with Dr. David Brent (University of Pittsburgh) and Dr. Jackie Grupp-Phelan (Cincinnati Children’s Hospital) are leading this large-scale NIMH collaborative project (U Award) aimed at improving the identification of youth at risk for suicide. This project is designed to develop and validate a computerized adaptive screen (CAS) for adolescent suicide risk. This screen will be brief, tailored and adaptive – with individualized sequences of screening questions conditional on previous responses. A wide range of acute suicide risk indicators will be tested for possible inclusion in the CAS. This project will test how the computerized adaptive screen performs as a screen relative to the Ask Suicide-Screening Questions (ASQ). We will also examine the incremental value of the Implicit Association Test (IAT), a behavioral test of implicit suicidal cognitions, which is important as many at-risk youth may deny suicidal thoughts. ED-STARS is a collaborative project with the Pediatric Emergency Care Applied Research Network (PECARN) in addition to the Whiteriver PHS Indian Hospital.

Electronic Bridge to Mental Health for College Students (eBRIDGE)

Funded by the National Institute of Mental Health (R01MH103244)
Principal Investigator: Cheryl A. King, Ph.D.
Co-Investigators: Daniel Eisenberg, Ph.D., Todd K. Favorite, Ph.D., Inbal Nahum-Shani, Ph.D., Kai Zheng, Ph.D.
Site Principal Investigators: Ronald Albucher, M.D., William Coryell, M.D., Jacqueline Pistorello, Ph.D. 

This research initiative began with an intervention development grant funded by the National Institute of Mental Health (NIMH), which enabled us to develop, pilot-test and iteratively refine a theoretically-driven intervention, Students’ eBridge to Mental Health (eBridge). This online intervention screens students for mental health concerns that include elevated suicide risk and facilitates their linkage to mental health (MH) services. eBridge is designed to work on computers, tablets and smartphones (i0S, Android) and is easily adaptable to evolving technologies in the future. It incorporates motivational interviewing (MI) principles and draws from health behavior models that emphasize autonomy and self-determination. Following a web-based screen using standardized scales to identify students at elevated risk, eBridge offers students options for personalized feedback (provided online in a conversational MI-adherent format) and corresponding online with professionals trained in MI and knowledgeable about university and community resources. We are currently conducting a larger more definitive efficacy trial at four universities: the University of Michigan, the University of Nevada-Reno, the University of Iowa, and Stanford University.

Developing an Adaptive Intervention for Suicidal Adolescents Following Inpatient Hospitalization: A Pilot SMART 

Funded by the National Institute of Mental Health (K23MH113776)
Principal Investigator: Ewa Czyz, Ph.D.

This NIMH K award will be used to conduct a Sequential, Multiple Assignment, Randomized Trial (SMART) pilot with teens at risk for suicide (ages 13-17). Given the heterogeneity of responses to intervention and post-discharge suicide risk among suicidal youth, this personalized approach represents a critical first step in developing an innovative, technology-augmented adaptive intervention for hospitalized adolescents aimed at reducing suicide-related outcomes following the transition from inpatient care. Findings from this study will provide the groundwork for the construction of a technology-augmented adaptive intervention that could lead to a reduction in suicidal behaviors and related events during the high-risk post-discharge period—an important suicide prevention target.

Psychiatric Emergency Services Family Support and Follow-Up Program 

Funded by Substance Abuse and Mental Health Services Administration and Michigan Department of Health and Human Services
Principal Investigator: Cynthia Ewell Foster, Ph.D. 

Based on work completed in Michigan’s cohort 5 GLS project and in partnership with the University of Michigan Health System’s Psychiatric Emergency Services (PES), the Family Support and ED Follow-up Program aims to inform enhancements to crisis and emergency care for youth and families. 250-500 families will be enrolled at PES.  Youth ages 10-18 with any suicide-related risk factors are eligible. Youth and parents complete surveys in PES and participate in follow-up surveys online (parents at 3 days and 2 weeks after discharge; youth at 2 weeks after discharge). Surveys are designed to help improve our understanding of how to care for youth seeking emergency services for suicide risk. Eventually, some families will be asked to join a focus group to inform the development of a text-message-based follow-up intervention for parents/caregivers of high risk youth.  Funded by the state-wide youth suicide prevention grant, we hope to disseminate best practices to other emergency departments across Michigan.

Transforming Youth Suicide Prevention in Michigan 

Funded by Substance Abuse and Mental Health Services Administration to State of Michigan
Co-Principal Investigators: Patricia Smith & Cynthia Ewell Foster, Ph.D. 

The TYSP-MI 2 Project is a 3.75 million dollar five year grant awarded to the State of Michigan’s Department of Community Health to support a state-wide public health approach to youth suicide prevention. Focused on sustainable systems change, this grant establishes collaborative relationships between state agencies focused on injury prevention and control, child protective services, behavioral health, and education. The grant provides gatekeeper and clinical provider training and community-based technical assistance, funds state-wide data surveillance initiatives, and supports the development of urban and rural “model communities” working to establish a continuum of best-practice services in their counties.