Research Roundup April 2025: Recently Published Findings From AFSP-Funded Studies

The Research Roundup is a regular update of recently published findings in suicide prevention research. AFSP-funded studies included in this roundup examined how…

• Economic hardship, unemployment, and suicide rates interrelate between 2005 and 2017
• Pediatricians implemented a firearm storage program with families during routine visits
• The number of emergency department visits for suicidal thoughts and behaviors varied by geography during COVID-19, and
• The genetics underlying non-suicidal self-injury and suicidal behavior may differ

Researcher: Byungkyu Lee, PhD
Institution: Indiana University
Grant Type: 2022 Young Investigator Grant — $89,888
Grant Title: Estimating the Population Prevalence and Risk of Suicide for the LGBTQ+ Population in the United States

Economic hardship has long been associated with increased suicide risk, yet the relationship between unemployment and suicide is not always straightforward. In the years following the 2008 Great Recession, suicide rates in the U.S. continued to rise even as unemployment rates declined, challenging traditional economic explanations of suicide risk. While personal financial strain can be a contributor, unemployment can also carry social and psychological consequences, including stigma, isolation, and shifts in self-perception. Understanding how broader economic conditions shape the meaning of unemployment — and, in turn, its impact on suicide risk — is critical for developing more effective prevention strategies.

With the data from his AFSP-funded grant on suicide risk in the LGBTQ+ population, Dr. Byungkyu Lee was also able to examine U.S. suicide deaths from 2005 to 2017 using multilevel data, exploring how individual unemployment status interacts with local and national unemployment rates. Dr. Lee found that unemployed individuals faced a higher risk of suicide, but this risk was lower in communities with high unemployment, where joblessness was more common and less stigmatized. Additionally, national spikes in unemployment appeared to reduce suicide risk among the unemployed, suggesting that large-scale economic downturns may shift the perception of job loss from personal failure to systemic failure. These results highlight the importance of social context in shaping suicide risk and suggest that policies aimed at reducing unemployment stigma and strengthening social support during economic crises could play a key role in suicide prevention.

Citation: Lee, B., & Pescosolido, B. A. (2024). Misery Needs Company: Contextualizing the Geographic and Temporal Link between Unemployment and Suicide. American Sociological Review, 89(6), 1104-1140. https://doi.org/10.1177/00031224241288179      

Researcher: Katelin Hoskins, PhD
Institution: University of Pennsylvania
Grant Type: 2021 Postdoctoral Fellowship — $117,753
Grant Title: Promoting Equity in Firearm Safety and Suicide Prevention to Reduce Suicide in Black Youth

The rise in suicide among Black youth has been found to be associated with an increase in gun availability. Research suggests that modest increases in secure firearm storage could prevent a substantial number of firearm suicide deaths among youth. Despite strong recommendations from the American Academy of Pediatrics, few pediatric clinicians routinely provide firearm storage counseling or distribute locking devices during routine visits. Closing this gap is critical for reducing youth access to lethal means and preventing firearm suicides. Effective, scalable strategies are needed to support clinicians in delivering secure firearm storage interventions during routine pediatric care.

Dr. Katelin Hoskins tested two strategies to improve the implementation of a secure firearm storage program, SAFE Firearm, during pediatric visits: an electronic health record (EHR) template reminder (nudge) and the same EHR strategy combined with training and facilitation (nudge+). Dr. Hoskins analyzed over 47,000 well-child visits conducted across 30 primary care clinics in Michigan and Colorado. She found that the nudge+ approach significantly increased program delivery, with 49% of visits including firearm safety counseling and the provision of a cable lock, compared to 22% in the nudge-only condition. While both strategies improved clinician engagement in firearm safety discussions, facilitation proved more effective at embedding these conversations into routine care. These findings underscore the potential of structured implementation strategies to enhance lethal means counseling in pediatric settings. Future analyses will examine findings specifically for Black youth.

Citation: Beidas, R. S., Linn, K. A., Boggs, J. M., Marcus, S. C., Hoskins, K., Jager-Hyman, S., Johnson, C., Maye, M., Quintana, L., Wolk, C. B., Wright, L., Pappas, C., Beck, A., Bedjeti, K., Buttenheim, A. M., Daley, M. F., Elias, M., Lyons, J., Martin, M. L., McArdle, B., … Ahmedani, B. K. (2024). Implementation of a Secure Firearm Storage Program in Pediatric Primary Care: A Cluster Randomized Trial. JAMA pediatrics, 178(11), 1104–1113. https://doi.org/10.1001/jamapediatrics.2024.3274   

Researcher: Margaret Sugg, PhD
Institution: Appalachian State University
Grant Type: 2020 Standard Research Grant — $99, 990
Grant Title: Exploring Place-Based Differences in Adolescent Suicide, Mental Health, and Suicide Mechanism

The COVID-19 pandemic has had profound effects on mental health, with increases in depression, anxiety, and suicidal thoughts and behaviors reported worldwide. While overall suicide rates showed mixed trends during the pandemic, certain communities may have experienced a disproportionate mental health burden. Identifying geographic clusters of depression and suicide-related emergency department (ED) visits can provide insight into the regions most affected and guide targeted interventions. However, little research has examined the spatial and temporal patterns of these mental health crises before and during the pandemic. Understanding these shifts is crucial for addressing disparities and improving access to mental health care in vulnerable areas.

With her AFSP-funded grant, Dr. Maragaret Sugg analyzed ED visit data from North Carolina between 2017 and 2021, identifying geographic clusters of depression and suicide-related outcomes before and during the pandemic. She found that the mental health burden remained high, with rural communities experiencing the largest increases in the co-occurrence of depression and suicide-related ED visits during the pandemic. While urban areas continued to have persistent mental health clusters, new rural clusters emerged, particularly in western North Carolina. These findings highlight the need for sustained and geographically targeted mental health interventions, especially in rural regions that may face barriers to care. Addressing these disparities through improved access to crisis support and community-based mental health services could help mitigate the long-term impact of the pandemic on suicide risk.

Citation: Ryan, S. C., Desjardins, M. R., Runkle, J. D., Wertis, L., & Sugg, M. M. (2023). Evaluating co-occurring space-time clusters of depression and suicide-related outcomes before and during the COVID-19 pandemic. Spatial and spatio-temporal epidemiology, 47, 100607. https://doi.org/10.1016/j.sste.2023.100607

Researcher: Alexis Edwards, PhD
Institution: Virginia Commonwealth University
Grant Type: 2021 Standard Research Grant — $97,858
Grant Title: The Etiology of Suicidal and Non-Suicidal Self-Injury in a Population-Based Sample

Both suicide attempts and non-suicidal self-injury (NSSI) are significant public health concerns, contributing to increased risk for death by suicide. While suicide attempts and NSSI often co-occur, they are believed to have distinct underlying mechanisms, including differences in intent, psychological profiles, and risk factors. Genetic research has shown that both behaviors have heritable components, but whether their genetic underpinnings differ remains unclear. Understanding the genetic factors that separate NSSI from suicidal self-injury could improve risk assessment and inform targeted prevention strategies.

Dr. Alexis Edwards used data from the UK Biobank to examine the genetic differences between individuals with a history of NSSI (n=2,320) and those with a history of suicide attempts (n=2,648). She analyzed polygenic scores (PGS) for various psychiatric disorders and behavioral traits, finding that when she compared people with suicidal behavior to those with NSSI, most disorders had similar PGS. However, for people with anorexia nervosa there was a greater association with suicidal behavior than with NSSI genetic liability. These findings suggest that while NSSI and suicide attempts share genetic risk factors, certain psychiatric vulnerabilities may be more strongly associated with suicidal behaviors. Further research is needed to refine genetic risk models and enhance clinical screening for individuals at heightened suicide risk.

Citation: Edwards, A. C., Singh, M., Peterson, R. E., Webb, B. T., & Gentry, A. E. (2024). Associations between polygenic liability to psychopathology and non-suicidal versus suicidal self-injury. American journal of medical genetics. Part B, Neuropsychiatric genetics : the official publication of the International Society of Psychiatric Genetics, 195(7), e32982. https://doi.org/10.1002/ajmg.b.32982   

Learn more about the AFSP research grants featured in this monthly roundup, as well as others, here.