U.S. National Suicide Prevention Research Efforts: 2008-2013 Portfolio Analyses
Short-Term Research Objective 5.B.
Short-Term Research Objective 5.B.
Determine if policies that affect risk factors in the populations (e.g., tobacco and alcohol
advertising; medication prescribing practices) also reduce suicide risk.
Funding Organization: American Foundation for Suicide Prevention
Study Title: Smoking and Suicide: Changes in State Tobacco Policies as Natural Experiments
Principal Investigator: Richard Grucza
Year When Study First Received Funding: 2011
Abstract: While smoking and suicide are strongly related, the nature and direction of that relationship is
unclear: We don’t know whether smoking increases the risk for suicide or whether it serves as ‘selfmedication’ for individuals already at risk. Using several population-based data sets, Dr. Grucza aims to
determine whether policies at the state level intended to lower the smoking rate, such as taxes on cigarettes
or limiting access for youth, are related to changes in suicide rates. Residents in states with anti-smoking
policies will be compared with residents in states without such policies. Dr. Grucza will also study the impact
of smoking policies by examining the suicide rates of policy-holding states before and after the policy was
implemented. These natural experiments may help to increase our understanding of the relationship between
smoking and suicide.
Funding Organization: Brain & Behavior Research Foundation
Study Title: Preventing Firearms Violence and Suicide Among Adults with Serious Mental Illness: Brining
Evidence to Public Policy Reform
Principal Investigator: Jeffrey W. Swanson
Year When Study First Received Funding: 2013
Abstract: The proposed research project will: (1) examine the prevalence and correlates of firearms‐related
suicide and other‐directed violence in a sample of approximately 23,000 adults with schizophrenia, bipolar
disorder, or major depression who received services in Florida’s public behavioral healthcare system between
2002 and 2012; (2) examine the prevalence and correlates of gun‐disqualifying mental health adjudications,
criminal disqualification from firearms, and the overlap between these categories of prohibited persons; (3)
describe patterns of psychiatric hospitalization and (Medicaid‐funded) outpatient mental health services
utilization in this cohort and evaluate the effectiveness of services—pharmacological and other behavioral
health treatment—specifically in preventing firearms suicide and other violence; (4) describe patterns of
historic and current criminal justice involvement in the cohort—arrests and incarcerations—and evaluate their
effects on access to firearms and risk of gun violence and suicide; and (5) evaluate the effectiveness of federal
and state gun laws, as implemented in Florida through the NICS, to identify mentally ill individuals prohibited
from purchasing firearms and to prevent gun‐related suicide and other violence in these individuals. The study
will use a quasi‐experimental design with multivariable statistical analysis of a longitudinal database of
matched records of mental health treatment, criminal justice involvement, and deaths in Florida over 10
years. The findings will be used to inform the development of targeted interventions, services, and public
policies—such as more accurate screening and reporting of gun‐disqualifying records to NICS—designed to
effectively reduce firearms injury and mortality in persons with mental illness. The proposed study will address
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U.S. National Suicide Prevention Research Efforts: 2008-2013 Portfolio Analyses
Short-Term Research Objective 5.B.
evidence gaps at a time when behavioral science may have a unique opportunity for public impact in the
design and implementation of new approaches to reduce gun violence.
Funding Organization: Federal Railroad Administration (Department of Transportation)
Study Title: Countermeasures to Reduce Suicides on Railway Rights-of-Way: Phase IV Continuation
Principal Investigator: Michael Martino
Year When Study First Received Funding: 2010
Abstract: The current grant provides funding for year 4 of a 5 year phased study. The period of performance
for the current grant shall be approximately 12 months, beginning August 2010 and ending October 31, 2011.
The scope of the overall project includes a detailed prevalence assessment and causal analysis of rail-related
suicides representative of the U.S. railroad industry. Appropriate and cost-effective prevention
countermeasures will be developed and scaled for implementation in one or more selected pilot projects,
where feasible. Accurate documentation of the true extent of suicides that occur on railway rights-of-ways
will provide an important baseline to assist in the monitoring of rail suicide trends and help determine the
effectiveness of prevention strategies. The objectives of the research to be undertaken with this project are
to: 1) Determine the prevalence of and underlying causal factors for rail-related suicides. The purpose of the
prevalence assessment is to better understand the scope of suicides and attempted suicides on railroad
property, which will support the development of effective prevention strategies; and
2) Develop effective measures to reduce the incidence of suicide along railway rights of way (including
crossings).
Funding Organization: Federal Railroad Administration (Department of Transportation)
Study Title: Countermeasures to Reduce Suicides on Railway Rights-of-Way: Phase V Continuation
Principal Investigator: Michael Martino
Year When Study First Received Funding: 2010
Abstract: The current grant provides funding for year 5 of a 5 year phased study. The scope of the work
proposed for the additional funding will include the finalization of the Prevalence, Causal Analysis, and
Railroad Recommendations draft reports, based on already collected data. Additionally, this additional funding
will include a report of any preliminary indications of the effectiveness of suicide prevention signs near
railroad rights-of-way, as well as a report or outline of an implementation plan for at least one
countermeasure pilot study as determined most feasible for implementation in the Recommendations report.
All deliverables produced during this grant phase will be completed according to FRA standards. Accurate
documentation of the true extent of suicides that occur on railway rights-of-ways will provide an important
baseline to assist in the monitoring of rail suicide trends and help determine the effectiveness of prevention
strategies. The objectives of the research to be undertaken with this project are to: 1) Determine the
prevalence of and underlying causal factors for rail-related suicides. The purpose of the prevalence
assessment is to better understand the scope of suicides and attempted suicides on railroad property, which
will support the development of effective prevention strategies; and 2) Identify potential measures to reduce
the incidence of suicide along railway rights of way (including crossings).
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U.S. National Suicide Prevention Research Efforts: 2008-2013 Portfolio Analyses
Short-Term Research Objective 5.B.
Funding Organization: National Institutes of Health
Study Title: Suicidality Associated with Antidepressants in TennCare Children and Adolescents
Principal Investigator: William Cooper
Year When Study First Received Funding: 2008
Abstract: DESCRIPTION (provided by applicant): Depressive disorders account for substantial morbidity and
mortality among children and adolescents and are most commonly treated with antidepressants. In recent
years, increasing concerns have arisen that antidepressants in and of themselves might increase the risk of
suicidality specifically among children and adolescents. However, the available evidence regarding suicidality
and antidepressants in children is limited due to the small sample size of the clinical trials (even when
combined in meta-analysis) resulting in insufficient power to assess the risk of suicide deaths and the risk of
suicide-related behaviors for individual antidepressants. In addition, the short duration of clinical trials has
precluded assessment of the risk of serious suicide attempts and suicidality over the course of treatment.
Understanding the relationship between antidepressant treatment and injuries from suicidal behavior in
children and adolescents is vital for clinical practice. The research described in this proposal will address three
specific aims: 1) test the hypothesis that the risk of medically treated suicide attempts is lower for fluoxetine
than for other antidepressants; 2) test the hypothesis that the risk of medically treated suicide attempts is
increased in the time 4 and 12 weeks following initiation of antidepressant therapy; and, 3) test the hypothesis
that periods on antidepressants represent greater risk for medically treated suicide attempts and suicide
deaths than periods off antidepressants. To address these aims, a retrospective study cohort will be
assembled from Tennessee Medicaid files and will include an estimated 85,000 6-18 year old children who are
users of antidepressant medications with evidence suggesting treatment of major depression. Cohort follow
up will be from 1995-2006 and will include an estimated 73,000 person-years of follow-up. Every person-day
of follow-up will be classified by exposure to study medications and potential confounding factors. A case
definition drawn from Medicaid claims, death certificates, and confirmed through medical record review will
define medically treated suicide attempts and suicide deaths among children in the cohort. Poisson regression
will be used to estimate the effects of the individual study drugs and the duration of study drug exposure on
study endpoints. A case-crossover design will compare risk for periods on vs. off antidepressants. This research
will address questions of enormous public health importance. Patients, families, and physicians urgently need
to know whether or not individual drugs affect the risk of suicidality differently. Whether or not risk is
increased early in the course of treatment will have implications for monitoring of children on these
medications. Finally, understanding the risk of suicidality for periods off and on treatment will inform
practitioners, patients, and families faced with treating an important condition.
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