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Sources of Strength

An evidence-based suicide prevention and well-being program in high schools. 

Team: Dorothy Espelage, PhD (lead); Marisa Marraccini, PhD (lead); Alberto Valido Delgado

Sources utilizes the power of student peer leaders to promote a positive school climate, connections with trusting adults, help-seeking and coping skills. The SPI has selected 16 high schools across North Carolina to participate in the two-year implementation and evaluation of Sources of Strength starting in the Fall 2023. 



Brief and effective treatment of anxiety and depression in a pediatric primary care clinic. 

Team: Danielle Roubinov, PhD (lead); Emily Pisetsky, PhD; Danielle Lowe, MD; Katie Gaffney, MD; Gabby Hodgins, MD; Patrick Sullivan, MD; Kori Flower, MD; Katie Jordan, MD

Child and adolescent mood and anxiety disorders are common and there is a shortage of trained mental health care providers who can provide care. Brief, research-backed programs that are delivered in primary care settings can increase access to effective services. A brief intervention may be a “stand alone” approach to treating symptoms, or may the first step before more intensive care is delivered. First Approach Skills Training (FAST) is a suite of 4-session brief interventions that have been adapted from longer evidence-based programs to treat pediatric anxiety and depression. In partnership with a UNC pediatric primary care clinic, we are conducting a proof-of-concept study to test the feasibility and preliminary effects of FAST for anxiety (FAST-A) and depression (FAST-D). Results will be used to refine and expand FAST programs to other settings within and outside of UNC.



Help people who have made a medically serious suicide attempt transition to outpatient care

Team: Jimmy Chen, MD; Patrick Sullivan, MD; Danielle Roubinov, PhD; Danielle Lowe, MD

In the process of recovery following a medically serious suicide attempt, most people get a referral to an outpatient mental health provider. This is important as these individuals have a very high risk of death in the following few years, and the appropriate mental health treatment can save lives. However, it is all too common for people not to get outpatient treatment. CLASP is specifically designed to help people make the inpatient-to-outpatient transition successfully.


Data Science

Care pathways following a medically serious suicide attempt at UNC Health

Team: Michael Kane, MD; Danielle Lowe, MD PhD; Patrick Sullivan MD

Suicidal behavior and suicide are top flight public health problems and a major cause of morbidity and mortality in most countries. People seen medically following a suicide attempt have a massively increased relative risk of completed suicide in the following year. Put another way, hospitalization after a suicide attempt is a chance to save a life. Our long-term goal is to maximize these chances by improving therapeutic delivery in hospital. As a prelude to this, our goal is to develop a detailed understanding of the clinical paths taken by individuals who attempt suicide at UNC Health. Our research question is descriptive: using retrospective UNC Health Epic data from Carolina Data Warehouse for 2014 to 2022, we wish to describe in detail the clinical paths for people who have a medically serious suicide attempt and who are seen at UNC Health. We wish to describe the number of patients, how they enter the system, where they are treated, the therapeutics received, how Psychiatry is involved, and their immediate and longer term outcomes. The answers we obtain will form the bedrock to our longer term intentions.


An epidemiological study of medically serious suicide attempts in Sweden

Team: Lu Yi PhD, Fang Fang MD PhD, Karen Borges MBBS, Thuy-Dung Nguyen MSc, Kejia Hu MD PhD, and Patrick Sullivan MD

In 2021 approximately 7580 individuals attempted suicide1 and 1200 died by suicide2 in Sweden. The rate of suicide death in Sweden is higher than the global average3. For every person who dies by suicide, many more have attempted suicide. A prior attempt remains the strongest predictor of subsequent suicide4. Recent studies in this field have centered on completed suicide, specifically focusing either on risk in population sub-groups or various patient populations. Healthcare utilisation immediately prior to death by suicide has also been explored. However, there is a knowledge gap in those who attempt suicide for the first time. This is a critical time point for suicide prevention. We propose a comprehensive characterization of those who present to healthcare services with a suicide attempt – we label this as a ‘medically serious suicide attempt’ (MSSA). We aim to better understand risk factors leading to an initial suicide attempt and what happens to these individuals after this first attempt.

Using the Swedish national registry data, we will describe the incidence of the first MSSA using key demographic factors. We will then investigate potential risk factors of MSSA, including socioeconomic status, comorbidities, and the occurrence of certain adverse life events. We will describe healthcare utilization before and after individuals’ first MSSA and follow up individuals to describe their subsequent MSSA and death by suicide. With respect to genetic susceptibility, we will estimate familial risk and heritability of MSSA as well as genetic correlations between MSS and other psychiatric disorders. Finally, we will attempt to decipher the heterogeneity of MSSA, through clustering individuals with MSSA based on risk factors and outcomes.


Describe NC

Team: Anna Bauer, PhD; Patrick Sullivan, MD

Our project seeks to develop a data pipeline to obtain and integrate relevant demographic, school, vital records, emergency department, and environmental data to understand the epidemiology of suicide in North Carolina and support implementation of interventions. These data will be used to understand the landscape of suicide risk and mortality in North Carolina, identify areas of greatest need, establish sites for implementation of interventions, and monitor and evaluate suicide prevention efforts. SPI team members participate in statewide meetings of the Comprehensive Suicide Prevention Advisory Council and are collaborating with partners at the Injury and Violence Prevention Branch, Division of Public Health, NC Department of Health and Human Services to align with priorities in the North Carolina Suicide Prevention Action Plan.


Analysis of Suicide Biomarkers

Team: James Crowley, PhD; Patrick Sullivan, MD

Suicide is difficult to predict and prevent. Dr. Crowley’s suicide research is utilizing Sweden’s unique national databases to improve prediction of suicide by integrating the many environmental factors captured by national registers and genetic information using multi-modal modeling. We are creating a large national suicide death biobank and aim to create useful predictive models combining different types of data and using new analytic approaches to best make use of those data. The goal is to increase our understanding of suicidal behavior. This work is being funded by the American Foundation for Suicide Prevention. In parallel work, Drs. Crowley, Sullivan and colleagues aim to examine gene expression in postmortem brain tissue from suicide death cases.