my name is Zori Kalibatseva I'm a faculty member in the psychology program and I
have the honor today to introduce to you our keynote speaker Dr. Lily Brown Dr.
Lilly Lilly Brown is an assistant professor of psychology at the UPenn at
the University of Pennsylvania in the Center for the Treatment and Study of
Anxiety Dr. Brown received her PhD at the University of California Los Angeles
and she was the recipient of the National Science Foundation graduate
research fellowship the APA dissertation award and numerous other university
grants she completed her pre-doctoral internship training at Brown University
and her research and clinical interests are in the development and testing of
evidence-based treatments for anxiety and trauma based disorders particularly
in those with high suicide risk she's interested in disseminating
evidence-based practice into the community and in further developing
treatments for patients with anxiety at high risk for suicide on a personal note
Dr. Brown and I met several years ago when I was working at Brown University
with her we were both research assistants there so we can definitely
talk to you about our experience going through undergraduate careers and then
working as research assistants and I also hope that she'll be able to share
with you her experience she has been really highly renowned and it's a
pleasure and an honor to have her here today Dr. Brown
so it is such an honor to get to be with you all here today I was sitting in on
the research presentations from the Stockton students just a few moments ago
and was so impressed by the caliber of the research that's going on here you
all are doing great things in the field of Psychology so it's a true honor to
get to be here today to tell you both about my career path and about some
highlights from research projects that I've worked on throughout the recent
years and the goal of my talk today is really not to get into the nitty-gritty
of the kinds of projects that I've been working on instead what I hope to impart
upon you is the path of my research trajectory and to sort of let you in on
the way I think about figuring out what my next research questions are and
trying to navigate the complicated path of academia so to tell you a little bit
about myself in terms of background information when I was an undergrad I
studied at Drexel University and there most of my research was focused on the
treatment of test anxiety and I was involved in trying to design a
randomized control trial comparing a couple of different interventions for
looking at ways to improve test anxiety in undergraduates and that was really
interesting and really exciting to me at the time but I realized I wanted to get
more experience with more severe samples and so that's when I worked with Zuri at
Brown University and Butler Hospital working with patients who had suicide
risk and who had psychosis after Brown University I decided I wanted to pursue
advanced training in clinical psychology and learning and behavior psychology and
so for that I went to the University of California Los Angeles where I studied
with the professor there who specializes in anxiety related disorders and from
there I worked in an another suicide lab at Brown University before finally
ending up where I'm at now at Penn and so my research to date is really focused
on trying to understand why do some people become suicidal and what are the
ways that we can reduce suicide risk for those people who are at high risk for
suicide so to start anxiety related disorders
are one factor associated with increased risk for suicide in general predicting
suicide is really complicated if you ask a hundred people who've made a suicide
attempt why they made a suicide attempt you're likely to get very different
answers and over the past several decades there's been a lot of research
trying to understand these different predictors of suicide risk one that's
come out through many studies is that anxiety is associated with increased
thoughts of death increased thoughts of suicide and engaging in suicidal
behaviors post-traumatic stress disorder reliably shows up as a predictor of
suicide risk in particular so for those of you who don't know post traumatic
stress disorder is a diagnosis following exposure to a traumatic event so after
someone's been through a life-threatening episode a sexual
assault an accident many people develop the symptoms of PTSD following a trauma
most of those people experience natural recovery from those symptoms in the
first year or so after a trauma but for some people these symptoms continue on
for many many years in fact some research has shown that if you just let
PTSD symptoms sit without treatment people as many as 50 years after
exposure to trauma will continue to report symptoms of PTSD and there are a
number of factors that influence whether or not someone goes on to maintain
symptoms of PTSD or not which are somewhat beyond the scope of what I'm
gonna be talking about today but at the end of our talk I will have time for
questions so if you're interested in talking about that I'd be happy to but
one thing that we know about PTSD is that if an individual experiences a
history of abuse they are more likely to report having multiple suicide attempts
compared to if they do not have a history of abuse in addition individuals
who have a suicide attempt history so first of all women are more likely to
make a suicide attempt than men men are more likely to die by suicide
than women this is a really interesting phenomenon that's been showed reliably
over many decades now and the primary differentiating factor seems to be
method of suicide attempts so men tend to use more lethal means of suicidal
behavior compared to women and therefore are more likely to die by suicide but
women make more attempts what's really interesting though is if you consider
the role of having a history of abuse men are just as likely as women to make
a suicide attempt can over time interestingly folks who are middle class
or a higher socioeconomic status are actually more likely to make a suicide
attempt to them those who are not however if you have no insurance or are
on public insurance things like Medicare Medicaid and you have an abuse history
you're just as likely to make a suicide attempt as someone who was already at
higher risk than you so these are some findings that we found in psychiatric
inpatients that history of abuse history of PTSD makes you more likely to report
having engaged in suicidal behavior at some point in the past but this sample
is somewhat unique in that psychiatric inpatients by definition are at the very
severe end of the spectrum what about on the average population if one of our
missions is trying to understand ways to predict suicide and ultimately prevent
suicide we need to look at a larger scale and look at it in epidemiological
data so for this project the next project I'm going to describe in terms
of the background of how I got to this project I was an intern which is the
last year of my clinical psychology training and I was sitting in a chart
room writing probably my millionth note that week feeling totally burnt out
totally tired and a psychiatrist walks into the room and his name was Robert
Cohen and he is a prolific public health researcher at Brown University who's
done amazing studies and he walks in the room and he plops down on his desk and
he says out loud I think hoping no one would hear I wish someone would analyze
my data for me and here I am sitting in the chart room with a
lot of statistical background with a lot of experience in how to analyze data and
I pull my chair back from my desk and I seize this opportunity and say I will
and as a result of being in the right place at the right time and being
willing to take on these extra responsibilities I had the opportunity
to do a really cool study you see Robert Cohn was involved in a major multi
country study trying to look at predictors of depression over time and
as part of this trial he recruited over 3,000 folks from Chile and he measured
them multiple times beginning around 2003 then a year later and a year after
that now many of you may know in 2010 there was a major earthquake that struck
just off the coast of Santiago in Chile and this earthquake caused a major
tsunami and severe destruction in the city and folks who had participated in
this trial starting 10 years before about were exposed to a major natural
disaster and so Robert Cohen and his team seized upon this opportunity to try
to understand what happens for folks before and after natural disaster
exposure and a research question that I became interested in is trying to
understand the extent to which prior trauma exposure affected negative health
outcomes after this natural disaster exposure and we found something really
interesting so here I'm graphing folks who had a diagnosis of PTSD totally
unrelated to the natural disaster this was 8 years before this natural disaster
and they had rates of PTSD related to all kinds of negative traumatic events
versus people who did not have a baseline diagnosis of PTSD and what
you'll see is that at baseline this first assessment folks who had a
diagnosis of PTSD had greater thoughts of death and greater thoughts of suicide
compared to people without a diagnosis of PTSD but what becomes really
interesting is if you follow these spokes over time this is the part
between assessment and this assessment the
natural disaster occurs what you see is for the folks who have a diagnosis of
PTSD there's a significantly steeper increase both in thoughts of death and
thoughts of suicide compared to people who didn't have a diagnosis of PTSD from
the get-go so what does this mean well it means if you have exposure to trauma
and you develop symptoms of PTSD it's possible that experiencing subsequent
negative traumatic events is more likely to result in negative health outcomes
and so for thinking downstream in terms of who do we need to target for
prevention efforts in terms of suicide prevention this group might be a
particularly important group to target those who already had exposure to PTSD
and so these projects led to the next several years of research in terms of
looking at a couple of key research questions so the first one was if we
know that post-traumatic stress disorder leads to greater risk of suicide and by
the way we know that there are many treatments out there that are really
helpful in reducing PTSD do those treatments have a positive
benefit in terms of reducing suicide risk and if they do what are the
mediators of this suicide change so mediator is a fancy statistical term it
basically means what drives the change in suicide over time so the rest of the
projects I'm gonna describe to you focus on these two main research questions and
so I began this topic by looking at a sample of adolescents in particular and
to let you know how I stumbled into this opportunity when I was looking for a job
after graduate school I've applied to a number of different places but I knew I
wanted to end up in a research lab where I had a chance to capitalize on
previously collected data one of the things you'll find out if you're
interested in pursuing a career in research is that it takes a long time to
collect rich data and so if you can collaborate with people who are more
senior than you who've already invested tons and tons of reach
sources and money and time into collecting this data and they're willing
to let you use it take those opportunities that's a really
important thing that I've been able to do over the past years and so for this
project I was working with my current boss her name is Dr. Edna Foa and Dr.
Foa developed in 1999 a treatment designed for post-traumatic stress
disorder and this treatment is called prolonged exposure therapy the name of
it isn't especially important but what is important is the concept behind
prolonged exposure the idea here is many people who experience a traumatic event
who go on to develop PTSD will tell you their natural response is to do whatever
they can to not think about the trauma in fact this is sort of common sense it
makes perfect sense if you've gone through something awful why in the world
would you want to talk about it why in the world would you want to think about
it however avoidance of trauma related cues
in the long run to contributes to the development of PTSD and to the
maintenance of PTSD so this prolonged exposure treatment the goal of this
treatment is to help with processing a traumatic event it's what we call a
trauma focused treatment it targets the trauma and so she developed a study in
2013 trying to look at the efficacy of this treatment for adolescents and for
this project she teamed up with an amazing Center through Philadelphia it's
called WOR it stands for women organized against rape and it's a unique
one-of-a-kind Center that is focused on providing resources to survivors of
sexual violence both men and women and trying to offer group counseling
individual counseling prevention workshops all throughout the city of
Philadelphia through WOR the participants that are that are involved
at WOR are both adolescents so beginning around age 13 and adults for the study
that Dr. foa worked on we targeted adolescents specifically and so for this
study we're looking at female adolescents who had been sexually
victimized in some way who then went on to develop
symptoms of PTSD and we basically measured a variety of symptoms over time
and for this study I'll be talking about measures of PTSD symptom severity and
measures of suicide severity just so you know the treatments basically were 14
different sessions that were between an hour to an hour and a half each and the
study compared this trauma focused treatment PE to what's called client
centered therapy this treatment is basically supportive counseling it's not
trauma focused you don't process the trauma it's focused on building
relationship with the therapist processing daily stressors it's non
directive it's led by the client the main outcome results from this study
came out in 2013 and basically reported that this trauma focused therapy PE here
on the Left was more effective at reducing symptoms of PTSD compared to
client centered therapy this is a finding that's been replicated in
several other kinds of studies with several other kinds of patients but
certainly not in all studies and I'll talk to you about some of those as well
and so this is all well and good but coming back to my research question if
we know that this treatment PE is associated with significant reductions
in PTSD well what about other negative health outcomes it's great if we can
improve PTSD symptoms but people who have PTSD are often very complex they
have higher rates of medical problems they have higher rates of other
psychiatric diagnoses and they're at greater risk for suicide as we've
already talked about so of course I wanted to know what happens in terms of
change in suicide rates and suicidal thoughts over time and so I'm not going
to get into the details beyond about this but basically this gray line here
is folks in the PE condition and this black line here is folks in this
supportive counseling conditions so trauma focused treatment is in gray non
trauma focused treatment is in black what we find is that folks who got this
trauma focused treatment had a steeper reduction in thoughts of suicide over
time you can think of it like if they were randomized to receive this
intervention there thoughts of suicide got better faster if
they were in the trauma focused treatment compared to not and they
tended to maintain their gains over time to this other question though about what
drives change in suicidal thoughts over time what we found was that there was a
significant interaction between time and PTSD symptoms so what does this mean it
means if your PTSD symptoms got better faster your suicidal thoughts got better
faster over time now this is just one potential variable to look at and I'll
go through some other studies where we look at comparing a variety of other
potential drivers of suicidal reduction over time but this is one step getting
us closer to determine that if you can effectively manage symptoms of PTSD
for people whose suicide risk is tied to their trauma you can actually reduce
thoughts of suicide and that's really important now many clinicians who work
with post-traumatic stress disorder will tell you that they're often worried
about engaging patients and trauma focused treatment they'll tell you that
this is especially a concern when patients are complex when they have
suicide risk when they have emotion dysregulation many therapists are
concerned that having patients talk about what they've been through is going
to exacerbate their symptoms it's going to make them worse and if we're thinking
about patients who are at high risk for suicide well this is really scary to a
clinician because people who get into therapy as a counselor usually do so
because they want to help people and they're very concerned in many cases
about doing anything to make the situation worse so by and large
trauma-focused treatments have been contraindicated meaning we suggest you
don't do this for people who are at risk for suicide without any real data to
suggest that trauma focused treatments actually increased risk for suicide so
this is a really interesting sort of policy decision that's been imparted in
our field for quite some time so we looked at rates of what we call
exacerbation of suicidal thoughts so people who had thoughts of suicide
how many of them got worse and for people who denied thoughts of suicide at
baseline how many of them eventually went on to report thoughts of suicide
these are two different ways to think about gauging getting worse and what we
found was that if we compare our client-centered therapy this is again
our support of counselling rates of exacerbation were about a third of
participants and new-onset were about 10% and consistently in our trauma
focused intervention rates were lower not statistically because this was a
relatively small sample size but rate there was no evidence from this study to
suggest that talking about a trauma is more likely to make someone think about
suicide who wasn't already thinking about suicide or just in general and
this is really encouraging but still promising research in this but still new
research in this area so that's exciting because adolescents are at higher risk
for suicide compared to adults by and large but this study had a number of
limitations to it so first of all it only included adolescents and so the
obvious question is woke a fine how about adults also as you might recall
this sample of adolescents only included females but men are more likely to die
by suicide than women so the the natural extension of this research is to look at
a male sample and to try to understand what happens in terms of changes and
thoughts of suicide there and so for this study in our research laboratory we
work a lot with the military we have a number of studies going on with folks
who are active-duty between deployments and so these individuals are home from
deployments have a diagnosis of PTSD sometimes that's related to their
service many times it's not and they're seeking treatment for their PTSD in
between deployments the reason is if you have a diagnosis of PTSD your threat
detector receptors are off you're more likely to see threat in situations that
aren't threatening and you're more likely to act on that threat
in situations that don't warrant it so PTSD can directly impact your
behavior in situations that are high-stakes like being a military
service member so for this study we recruited a very large sample of 366
participants who were post 9-11 service members who had a diagnosis of PTSD the
main outcome results for this study were published in JAMA the Journal of the
American Medical Association several months ago now I believe is in January
and those study results basically suggested that this PTSD trauma focused
treatment resulted in significant reductions in PTSD symptoms compared to
a waitlist condition but I'm really interested in trying to understand what
changes in terms of suicide risk over time the the design of the study was
complicated but I'm gonna make it really simple for you basically we're
interested in two comparisons the first comparison is looking at a trauma
focused treatment compared to supportive counseling this is pretty similar to
that adolescent study that I showed you before and then also a trauma focused
treatment compared to basically wait lists doing not much of anything and so
what we found is for this first comparison trauma treatment versus wait
list if you received trauma focused treatment here in black you had a
significantly faster reduction in thoughts of suicide compared to if you
received this support of counseling intervention and by and large those
gains were maintained in a follow-up period furthermore if you had greater
reduction in PTSD symptoms you had even faster reduction in suicidal thoughts in
terms of our comparison for trauma treatment versus supportive counseling
what we found is that in both conditions there was a significant reduction over
time in suicidal ideation and there was an interaction between condition what
does this mean it means both conditions effectively reduce thoughts of suicide
but folks who had a greater reduction in PTSD symptoms also had a greater
reduction in thoughts of suicide so the story so far is actually fairly
consistent terms of rates of exacerbation between these conditions
so this is our supportive counseling intervention this is a trauma focused
intervention this is waitlist and this is trauma
focused what you can see is that there's no evidence for enhanced rates of
suicide exacerbation statistically compared to supportive counseling or
doing nothing at all furthermore rates of suicide attempts
were really comparable across all the conditions so if we're trying to
understand what drives changes in thoughts of suicide
one natural symptom change to pay a lot of attention to is symptoms of
depression in fact most people when they think about suicide think about
depression but certainly not all people who die by suicide meet criteria for
depression because again suicide is extremely difficult to predict
so I published a study recently where I was trying to understand the temporal
relationship or the relationship over time between symptoms of PTSD and centas
depression the basic idea is this if in a therapy we have measures of PTSD at a
given session and measures the depression at a given session what leads
to what is it that depression at this session leads to PTSD symptoms later or
the opposite or that both directions are important and there's a complicated
statistical way to do this and in terms of thinking about the path that I took
in figuring out career-wise what I wanted to do when I was in graduate
school I took a class with an amazing statistics professor her name was
Jennifer Crawl and she spent hours with me teaching me how to do this very
analysis for a totally unrelated research question she taught me how to
use three new statistics programs that I had never used before and she was
extremely generous with her time when you meet a professor like this who's
willing to sit and teach you things and show you how to answer complicated
questions go with it spend as much time as you can with that person I cannot
explain enough how many people like this having impacted my career
to a great extent and what was amazing was that she taught me how to use
statistical method and now I'm able to use it to answer a number of other kinds
of research questions and I don't need her help anymore because she taught me
so much so for this project I'm not going to go into all the details of this
graph but basically what I found was across three large-scale randomized
controlled trials that I put all together looking at PTSD treatment that
the degree of PTSD symptoms on a given session predicts depression the next
session that seems that makes sense but also the opposite was true so how
depressed you are now is a predictor of how your PTSD symptoms are gonna be next
week and vice-versa there seems to be this reciprocity or
back-and-forth relationship between these two constructs so in terms of
trying to understand what drives suicide change over time this reciprocity seems
really important so to better understand what drives changes in suicide over time
I took this active duty military sample and I collected a number of different
kinds of measures so we have measures on PTSD like I already told you about and
we also have measures of depression there is a totally separate area of
research though on the relationship between a number of other constructs and
suicide risk one of those key areas that have come out is around the relationship
between sleep problems and suicide in fact the highest risk time for suicide
is in the middle of the night some studies show between midnight and 6:00
a.m. some studies show between 2 and 3 a.m.
being awake at the middle of the night is a predictor of not engaging your
exact executive functioning skills being more emotionally disregulated feeling
more disconnected from people and all of these things are probably important for
understanding suicide and so when they look at these large-scale mortality
database as they find that indeed the middle of the night is a high-risk time
for many individuals so I wanted to include insomnia and nightmares for
trying to understand whether this is more
strongly driving the change in thoughts of suicide in this sample and to that
end I didn't know much about insomnia it's a whole other area of research that
is related to PTSD but it's very distinct and very different and so to do
this I was on a research call with a number of different principal
investigators for this big-deal trial that we were working on and there's a
lot of egos on this call there's a lot of opinions on this call and I'm
explaining the kind of research project that I want to do and I'm describing how
I plan to do the research project how I plan to measure suicide over time and
all the sudden I hear a thick Louisiana accent of a researcher who I've never
talked to before and he says I want to know how you're gonna measure suicide
and I've taken aback because I didn't know who this person was and it turns
out it's my great collaborator and friend now named Daniel Taylor who's a
researcher at the University of North Texas who's Louisiana strong and proud
and would not mind me doing his accent I do it all the time with him now and he
is an expert in insomnia and it wasn't until I started working with Daniel that
I realized how little I knew about sleep disorders it's a really complicated area
of research and him being on that call with me at that time was another
opportunity that presented itself that I said yes to after that call Daniel
looked me up and realized that we had both been at Brown University at a
variety of points in our career and so he reached out to me and said do you
want to collaborate on some research projects and so we've been collaborating
ever since and it's been a really fruitful relationship in this model
though we're also interested in a couple of other important predictors of suicide
so these include social support in fact major theoretical models of suicide
suggest that the ability to connect with people and the sense of being a burden
on people versus being a contributor is an important predictor of whether
someone's going to think about suicide and so it's likely that these two
indicators of social support and unit cohesion could theoretically be linked
to change and thoughts of suicide over time
and so long story short we ran these complicated statistical models with
Daniel and I and some of my other friends and after including all of these
different variables you put it all in but the kitchen sink what turned out was
that the most important contributor in this model was depression but if we take
it a step further what we found was that changes in PTSD symptoms lead to changes
in depression and that those changes are what drive change in suicidal thoughts
over time so this is an example of how you start with a really complicated
model and you draw on your collaborators and you draw on outside experts and you
try to help come to a closer approximation of reality but what about
in terms of naturalistic samples so we've done a lot of work on trying to
look at suicide and adolescents in active-duty military what about in
civilians in treatment seeking patients who just come into our clinic
so at the CTSA we have a large clinic of patients presenting for treatment for
anxiety related disorders and we do a number of research projects in
collaboration with these participants to try to understand how our treatments
work and also that they work and we know that anxiety in general beyond just PTSD
is associated with increased risk for suicide so several years ago I published
a paper with my collaborators at Brown showing people who have panic disorder
in addition to to depression have higher rates of thoughts about suicide that's
here and higher rates of suicide plans and the the comorbid diagnosis of panic
disorder is associated with a greater likelihood of having made a suicide
attempt at some point in the past so it's not just PTSD that's associated
with higher risk for suicide in fact across the literature a number of
different anxiety related diagnoses have been associated with suicide risk
including there's some studies suggesting social anxiety is tied to
higher risk for suicide stun showing generalized anxiety and some showing OCD
so what we wanted to do was we wanted to follow our treatment seeking
participants over time and to see what happens to their thoughts of suicide in
treatment and in terms of our diagnostic breakdown we had a diagnostically
diverse sample of participants here many of our about a third of our
participant had a primary diagnosis of obsessive-compulsive disorder or OCD in
terms of baseline differences what we found was that folks who had a diagnosis
of PTSD had higher thoughts of suicide higher severity on that measure compared
to folks with specific phobia interestingly our social anxiety group
had a similar effect and if we look at changes over time what we found is that
across all diagnoses there was a significant reduction in thoughts of
suicide in response to anxiety focused treatment but there was also an
interaction with treatment there with diagnosis rather so there's a
significant reduction for those with PTSD and social anxiety and this other
anxiety category but for other diagnoses there was not a statistically
significant change over time and thoughts of suicide and to just show you
graphically this baby blue line here is PTSD this is social anxiety and this is
our other anxiety diagnosis group and if we look at collapsing across whether
regardless of whether someone has PTSD as their primary concern do they meet
criteria for that disorder at all what we found is that only PTSD was
associated with significant reductions in suicidal thoughts over time and
treatment rates of suicide exacerbation were generally low and when they did
occur it was more likely that they actually occurred in the context of
obsessive-compulsive disorder which is really interesting in fact until 2016
the clinical lore out there was that OCD patients did not have higher risk for
suicide and then in 2016 there was a major meta-analysis that showed the
opposite and showed that indeed most psychiatric disorders are associated
with higher risk for suicide including OCD
so in the last few moments I have here I'm gonna talk a little bit about my
future research directions and I've been working a lot with my colleague Daniel
Taylor to try to figure out ways to better understand the relationship
between sleep and suicide over time and a lot of our research as I mentioned is
in active duty military personnel and that's of high relevance here because
one in five service members meets criteria for insomnia many service
members regardless of whether they have PTSD report nightmares about one in four
and of service members who present to a sleep clinic four out of five of them
will indeed meet criteria for a sleep disorder we know as I mentioned that
insomnia is associated with higher rates of suicide both in terms of thoughts of
suicide suicide attempts and actually death by suicide in fact there have been
some studies that show having a prescription medication for sleep is
associated with higher risk of suicide but there are many questions that remain
here because most military service members who have a sleep disorder don't
die by suicide so it's not a clear predictor of suicide risks so what's
going on with those who do die by suicide so one question to potentially
pursue and we've written a grant on this very question that we're waiting for
feedback on right now is does the perception of having a sleep a problem
predict suicide risk to a greater extent than objective measures of suicide
problems so for instance if we have this model where someone says well I think I
slept poorly but another person actually slept only five hours in the prior night
which of these more strongly drives thoughts of suicide and for that matter
suicidal behaviors we don't really know the second question is are there certain
thresholds after which risk for suicide exponentially increases so
hypothetically if we were to map insomnia severity on suicide risk is it
the case that there's this linear increasing relationship over time the
more sleep disorder symptoms you have the worse or suicide risk
or is it instead like this where maybe I'm fine until I get to a certain point
at which case my risk greatly increases this is something that we don't know the
answer to what differentiates those who think about suicide and those who have a
greater relationship in sleep related problems and suicide there could be a
million different variables that drive the relationship between insomnia and
suicide and we just don't know what those are yet and are some symptoms
really good at predicting whether someone's gonna think about suicide but
bad at predicting who's gonna act on that in fact in the suicide field in
general we do a pretty decent job of predicting who's gonna think about
suicide turns out that that's relatively easy to do predicting who's gonna
transition from those thoughts to engaging in suicidal behavior is a big
black box of uncertainty at this point and if you're interested in trying to
carve out a niche of research or clinical training for yourself that's a
really interesting area to get into because we know very little about this
at this point many of the prior studies on the relationship between sleep and
suicide over time have a number of limitations some of which are listed
here and so what do we need we need to do studies where we look at intensively
monitoring patients over time where we look at comparing objective measures and
subjective measures where we look at non treatment seeking samples because if
we're interested at reducing suicide risk at the level of the general
population we can't just focus on those patients who come into our clinics
seeking help we need to broaden our lens for prevention efforts so I'd just like
to thank all of my collaborators for all over the help that they've given me
throughout my many years of research training I would say my connections to
two amazing collaborators over time has been a major driver of my success and I
built those connections by talking with people taking the advice of people who
had lots of advice to give me and and doing lots of hard work but without the
success of these well without the hard work of these
people I would have never gotten to where I'm at today so thank you very
much
why do you think suicidal thoughts have increased throughout the years so I'm
not sure that they have so it's interesting epidemiological data
suggests death by suicide has increased over the past decade and that's
interesting because it's been a major public health initiative to try to
reduce death by suicide over that same time period in which death by suicide
has increased like a lot of psychological problems I'm not sure
whether this is an issue your question was about do we know whether why are
thoughts of suicide increasing I think it's possible that individuals are more
willing to disclose thoughts of suicide now that we have language for how to
describe it we have national suicide crises hotlines which by the way if you
google the word suicide fortunately it's the first thing that comes up is a
24-hour staffed suicide prevention hotline I'm not sure that thoughts of
suicide have increased I think it's possible that more people are willing to
talk about it we know though that death by suicide has increased so is it that
that's because more people are thinking about it is it that there's different
access to lethal means than there ever has been is it something else I don't
know to be honest but it's a really interesting question if you're think
trying to think strategically again about what area of research to get into
this is going to be one that is going to continue to grow and it's one that is is
growing in terms of the number of researchers working in that area but
there's lots of room for young investigators to get involved in it and
one resource for trying to figure out potential opportunities for research is
the American Foundation for Suicide Prevention which is a national
organization they have a great website with all kinds of resources on it and if
this is a topic area of interest to you I'd encourage you to look at that
website I found your research very interesting I work in a correctional
setting I've been there for 35 years there's a very high risk of suicide in
correctional populations we are tasked with identifying those people and making
sure that it does not happen we also have a growing population of veterans
with post-traumatic stress syndrome so this just gave me food for thought that
you know there's work to be done in in linking that thought
for identification I totally agree with you and given that we've started two
different initiatives through my Center focus on this very idea so one is we're
putting in a research grant in June in response to a call from the National
Institute of Health looking at ways to reduce risk of suicide specifically in
juvenile justice settings and not necessarily incarcerated juveniles but
instead juveniles on home confinement and living in the community because
there's a lot of research to suggest that juveniles involved in the legal
system are at significantly higher risk for suicide and yet the reality is
there's a lot of victim-blaming that goes on with with folks in the juvenile
justice system and to date there has not been a ton of resources allocated
specifically to reduce risk of suicide in that sample I think the good news is
the National Institute of Health is is catching on to this and is investing
research funds and trying to help youth in this way but our project is basically
trying to just understand the scope of the problem because we have some
information on it and there's a lot that we don't know the other thing that we're
trying to do now is a project that we started about six months ago where we're
working with judges at the level of so there are certain judges who work in
what's called a mental health court and there are some individuals involved in
the corrections setting that could refer to mental health course court based on
the presence of a psychiatric diagnosis or condition that otherwise affects
their planning and we're doing interviews with these judges to try to
on and the extent to which PTSD influences
their their plans for for offenders and we're trying to understand the degree of
awareness that judges have about evidence-based treatments for PTSD
because these treatments are out there but they're by and large not being
implemented in in Corrections settings that's not true across the board but by
and large it characterizes the current situation and we're interested in trying
to understand it understand the perspective of judges toward whether
they think PTSD is even treatable and so I think there's a lot to be done in that
area it's also a growing area of interest for me as well I might also add
that correction officers are at a higher risk than the general population for
committing suicide so we we do a lot of training and interventions particularly
if there's an event in the jail that occurs yeah so that's another very
interesting group and we try to do all we can to help them in terms of their
mental health because it's a tough job yeah I agree
in fact in October I gave a presentation at Fort Dix the Fort Dix Correctional
Institute the Federal Correctional Facility there where the majority of the
corrections officers are veterans and so they had a veteran's mental health
retreat day where they asked me to come and speak about what is PTSD and how to
recognize it for this very issue that as I described if you have a diagnosis of
PTSD there are times in which your perception of threat is altered in a way
that can actually accidentally worsen a situation and there are times when that
threat detection being off is actually really helpful to your survival and so
it's all about trying to figure out ways to help people strike a balance in their
perception of threat and I think that's really relevant to the corrections and a
lot of our corrections officers come from the military exactly yeah so thank
you all very much for your time and attention today I appreciate it
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