October 4, 2016

Let the Data Lead

The Science of Suicide Prevention
by Nimesha Gerlus '17

Nimesha Gerlus is a senior concentrating in Cognitive Neuroscience. She is passionate about combining research and clinical care to develop better suicide prevention efforts.

"As volunteers, we hear from people of all ages who speak of broken relationships, financial problems, substance abuse, traumatic histories, homelessness, mental illness, and so much more."

After finishing up a call at the Samaritans of RI Suicide Hotline where I’ve been volunteering for the past three years, I always experience a range of emotion before the room is penetrated by the piercing ring of another call: frustration that I cannot do more to help, but mainly relief that the hotline exists as a resource for many people who feel like they have no other options to address their emotional pain besides death. As volunteers, we hear from people of all ages who speak of broken relationships, financial problems, substance abuse, traumatic histories, homelessness, mental illness, and so much more. At the end of the call, we hope our listening line has helped deescalate the feelings of the moment and has broken the stigma associated with suicide prevention and asking for help. 

In my experience, some of the most heartbreaking calls come from teens or from family concerned about a suicidal teen. In our Samaritan training program, we have learned that the suicide of a teen can have a contagious influence; due to the spontaneous ways teens react, a friend's suicide can be a risk factor for other friends and young siblings. That knowledge has often made me think about all the teens who do not call us or reach out to someone they trust. According to the National Center for Injury Prevention and Control, suicide remains the second leading cause of death for people between 10 and 34, and can sometimes be the result of impulsive actions or reactions.

Because impulsivity is a risk factor for teen suicidality, it is a focus of a Brown lab project I am involved with, which researches psychiatric treatment outcome in adolescents. 

Sometimes when I’m observing a teenage participant completing a neurocognitive task on the computer, I am amazed by how high-level decision-making processes in the brain can be brought to light by these simple game-like programs. For example, a teen with impulsive behavioral traits might show these characteristics by responding more quickly to task prompts, or making more mistakes in the task.

This summer, I wanted to explore whether a teen’s impulsive response patterns collected right after an initial psychiatric hospitalization could predict the likelihood of a suicide attempt between the hospital discharge and a follow-up assessment six months later. Understanding the role of baseline impulsivity in future suicidal behavior would help clinicians target higher-risk adolescents with more intensive treatment, and hopefully help prevent impulsive attempts.

Translating nuanced human behavior into quantitative data has proved to be an arduous experience. I’ve entered, checked, re-checked, and analyzed impulsivity-related data from 168 teens until the numbers have blurred together. So far, I have experienced waves of anticipatory eagerness when the data is finally ready to be analyzed and waves of disappointment when my initial hypothesis doesn’t turn out the way I expect. But every time, meetings with my mentors have shown me the importance of thinking in new ways and examining results from every angle; I’ve learned that the absence of a result can be just as important as obtaining a result in a population at a high risk for suicide. Herein lies the beauty of clinical research: all patterns and trends related to teen suicide are informative to prevention efforts.

However, one of the biggest roadblocks I’ve encountered thus far is the relatively low number of attempts reported at follow-up assessments, which makes it more difficult to fully parse strong predictive factors. At first, I found myself frustrated because I thought I didn’t have enough attempts for meaningful results. The reality, however, is that a suicide attempt rate lower than what I initially expected is a meaningful result. Herein lies the pitfalls of clinical research: it’s so important not to lose sight of the larger purpose of doing research in the first place, which is to improve the quality of life for real people, especially the people I talk to and befriend on the hotline so often.

I gained a valuable lesson from overlooking the connection between the hotline callers and teen participants who inspired me to do this work in the first place and the suicide attempts I study every day in a spreadsheet.

The true meaning in clinical research is the way the data tells a story of human life just the way it is; this summer, I learned how to stop trying to make my own meaning and how to simply follow where the data leads on its own.