Nature has an important article on why virtually no-one is trying to develop treatments to prevent suicide because research with such high-risk patients is almost impossible to get approved.
Most psychiatric drug trials today—the majority of which are industry sponsored—exclude anyone expressing thoughts of suicide. This is for ethical as well as practical reasons: physicians consider it taboo to give people on the brink of suicide an experimental drug, let alone a placebo, if other options are available, and many additional safety precautions are required to run trials in this vulnerable population. To complicate matters, few mental health experts are trained in how to conduct suicide research, and those who do are often afraid of lawsuits.
As a result, institutional review boards aren’t always so amenable to this kind of high-risk research. “It takes forever to get anything approved to do suicide prevention research, and it’s incredibly frustrating,” says Marjan Holloway, a clinical psychologist who is running clinical trials with suicidal military personnel at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Kate Comtois, a psychologist at the University of Washington in Seattle who has run psychotherapy trials in people with borderline personality disorder (BPD), expresses a similar concern. “I hear many stories from other institutions where people have basically given up recruiting high-risk patients because their institutional review boards are so cautious that they throw up roadblocks,” she says.
Suicide research also suffers from a practical problem related to the development of risk-assessments.
Normally, if I want to develop a way of predicting who will develop depression or not, I can assess a group of people and I can return later and see whether my predictions were right or not.
If I do the same with a suicide assessment and it suggests that several people are at high-risk of suicide, I have a moral duty to intervene and help them.
What complicates the issue is that this often applies regardless of the quality of my assessment. In other words, imagine that my suicide assessment is useless but I don’t know it – I will still intervene.
This means it’s often hard to get the assessment ‘off the ground’ in terms of its testing and development and this is why most scales are based on research looking at less serious outcomes, like having suicidal thoughts, that aren’t a very good predictor of whether someone will actually try to kill themselves or not.
This is also one reason why ethical review boards, and indeed researchers, are reluctant to get involved in this research.
Who wants to be known as someone who had several patients kill themselves during a trial to test an experimental form of suicide prediction? Despite the fact that, actually, virtually all the established scales are equally as ‘experimental’ due to lack of data.
The Nature article does a fantastic job of tackling these delicate issues and highlighting the need for better research on a crucial issue.