It Started with a Simple Call

in contact with the health system. So investigators have had to get creative. They’ve teamed up with community systems outside the Medical Center—schools, courts and criminal justice programs, social services, and aging-support agencies—to understand the societal and individual causes of suicide and to find ways to prevent it.

The Center has received continuous funding from the National Institutes of Health, the Centers for Disease Control, and several foundations since the early 1990s.

In 2000, it launched the nation’s first NIH-funded T32 postdoctoral training fellowship in suicide prevention. Fellows are core team members and some, like co-director Van Orden, have stayed on as URMC faculty members.

According to Conwell, their work is based on a longstanding belief “that we can make the most progress and best contribution to suicide prevention by recognizing it as a multi-determined phenomenon that requires lots of different perspectives to be brought together.”

The key, says Caine, is to ask, “What can we do for people who are suicidal now—what are the acute treatments? And then, what are the interventions that we can do upstream that prevent them from ever becoming suicidal?”

In the 1980s, Eric Caine, MD, picked up the phone and called Nick Forbes, the Monroe County medical examiner, to ask if he’d like “a couple of free psychiatric consultants.” As a psychiatrist, Caine, a self-described optimist, wanted to understand what causes people to take their own lives.

He and Yeates Conwell, MD, looked at hundreds of files of adult deaths—autopsies, toxicology reports, narratives—for whom manner of death was uncertain.

Their work helped pioneer the psychological autopsy, a review of information culled from interviews with friends and family in order to understand how things unfolded in the final weeks of life.

Conwell started the Laboratory of Suicide Studies in 1989 to study late-life depression. Soon he and Caine, fueled by funding from the National Institutes of Health, expanded the team to include psychologists, sociologists, and others through hiring and fellowship programs. By the mid-1990s, the CSPS had taken shape.

The center’s influence widened in the 2000s. It began a robust research collaboration and exchange with scientists in Hong Kong and China that continues today. From 2001 to 2005, CSPS conferences in Washington, D.C., cemented its reputation as a leader in its publichealth approach.

In 2021, CSPS faculty developed a plan to answer these questions. It established three focus areas: innovative methodologies, the full lifespan, and diverse populations. These priorities—achieved through everything from texting to companionship programs—will guide the Center’s direction for the next several years, carrying their work to new frontiers.

Can a Text Save Lives?

The use of smartphones and digital health platforms in suicide prevention science is exploding. “Many of our early career scientists are eager to study these innovative methodologies,” co-director Van Orden says.

Rochester investigators are using technology to find new avenues for their work in assessment and intervention on suicide risk factors. New technology also makes it easier to deliver mental health services to underserved populations.

In a study with Spanish speakers, assistant professor of psychiatry Caroline Silva, PhD, connects with participants through their smartphones to assess social engagement and suicide risk. Van Orden and Silva are using this method with older adults as well.

Text4Strength, developed by Anthony Pisani, PhD, an associate professor in Psychiatry and Pediatrics, sends automated text messages to students enrolled in Sources of Strength, a high school suicide prevention program. The goal is for students to build help-seeking skills, emotion self-regulation, and stronger connections. Pisani has developed texting and social media components for a similar program, led by Wyman, for young enlisted airmen in the U.S. Air Force.

Center investigators are also working on a crisis text suicide prevention program for young people. They’re collaborating with the nation’s largest crisis text provider to test the potential. Others are working with computer scientists on the University’s River Campus to develop an online social skills coach for older adults that mimics human interaction.

Part of the idea behind these new methodologies is reaching people where they live. But there’s also a need to address the growing age span of suicide.

Addressing the Troubling Age Range

Understanding what drives suicide and finding ways to prevent it along the entire lifespan is another key focus area for the Center.

Suicide rates among children and teens are rising at an alarming pace. From 1990 to 2020, the youngest age at suicide fell from nine to just five years old. In that same timespan, the number of deaths by suicide among five- to twelve-year-olds shot up 195 percent.

At the University’s Mt. Hope Family Center, director of research Elizabeth Handley, PhD, studies the ways childhood maltreatment increases risk for suicide among youth. For children who live in high-risk environments, family depression and substance-use disorders can increase vulnerability. Handley, a research associate professor in Psychiatry, is among a cadre of CSPS investigators who are deeply involved in Mt. Hope, a national leader in research and clinical care in developmental psychopathology.

Sheftall is studying emotion regulation and neurocognitive functioning in nine- to elevenyear-olds who have a parental history of suicide attempts. The study, funded by a grant from the National Institute of Mental Health, will follow 300 youth in Rochester over four years.

“I really believe at the adolescent stage, we’re coming to the party late already,” says Sheftall, who also focuses on racial disparities in suicidal behavior among children and teens. “If we attack emotion dysregulation early on in a child’s life, we might have a fighting chance at saving that child and making sure they get the help they need.”

But she knows the need is there for older children as well. The NIH-funded research project she’s co-leading with colleagues from the University of Notre Dame will enroll 212 teen participants in Rochester and Indiana.

Some will use an FDA-approved device, which looks like ear buds, to stimulate the transcutaneous vagus nerve. This has been shown to decrease anxiety and depression in adults. Another group will use a peer-support phone app with a journaling component for expressing their feelings in words, “in a space instead of in their heads,” Sheftall says. It also will