Risk Factors for Suicidal Ideation, Intent, and Behavior among Trauma-affected Adults in Low- and Middle-income Countries

Johns Hopkins University, Baltimore MD

Investigators

Linked publications & trials

Abstract

Project Summary. The applicant, Mr. Samuel B. Doty, proposes research to contribute cross-cultural and cross- national information on risk factors for suicidality in the context of trauma among adults (ages 18+) in low- and middle-income countries (LMICs). The project will be the first to provide a systematic review of the state of the evidence on risk factors for suicidality?a term encompassing suicidal ideation, intent, and behavior?among trauma-affected adults in LMICs (Aim 1). In addition, through secondary analysis of clinical trial data from trauma- affected adults, the project aims to explore whether individual psychiatric symptoms or certain symptom clusters can elucidate risk for suicide in diverse global contexts (Aims 2 and 3). The project will contribute to Mr. Doty?s career goal of becoming an independent investigator in global suicide prevention research. Mr. Doty will conduct the research while completing intensive pre-doctoral training that integrates mentorship, coursework, workshops, and dissemination activities. The project is structured around three objectives: (1) develop a sophisticated understanding of the factors that contribute to suicidality among trauma-affected adults; (2) acquire proficiency in advanced statistical methods, including latent variable modeling; and (3) build skills for effectively disseminating scientific findings. In meeting the objectives, Mr. Doty will gain methodological skills and content expertise, enhancing his ability to conduct research independently. Suicide is a significant public health problem in the United States and globally; it is a leading cause of death across all age groups. Nearly 80% of suicides globally occur in LMICs, where exposure to traumatic events (e.g., war, natural disaster, displacement) is 10 times more common than in high-income countries. Exposure to trauma increases the risk for psychiatric conditions and suicidality. In research on trauma-affected populations in LMICs, a particular issue concerns the validity and utility of psychiatric diagnoses. Individual diagnoses?as defined in conventional classification systems (e.g., DSM)?are relatively poor discriminant predictors of suicide due to the high symptom overlap across disorders. This is a critical problem for the field of global suicide prevention and compels researchers to move beyond studying individual disorders. The proposed research will address this problem by exploring symptomatology across multiple psychiatric conditions to determine whether certain patterns of symptoms related to depression, anxiety, and post-traumatic stress increase risk for suicidality. The research draws on a notable ?ideation-to-action? theory of suicide and will employ state-of-the-art latent variable modeling techniques to test the theory. The systematic review will inform the secondary data analysis and will provide a much needed synthesis of the peer-reviewed and gray literatures. The systematic review and secondary analysis findings could inform global suicide research priorities and programming, such as WHO?s mental health Gap Action Program. Per NIMH Director Gordon and the Strategic Plan for Research, this project addresses a priority topic for the Institute?research to inform suicide prevention