Research

One of the greatest obstacles to studying suicidal behavior has been that although it is a leading cause of death, it occurs at a fairly low base-rate in the general population. As a result, very large samples of people are required to study suicidal behavior in a detailed way. Because virtually all prior studies have used small, selective samples (e.g., clinic patients)—mostly in Western countries— even the most basic characteristics of suicidal behavior have remained unknown. Understanding who is most at risk for suicide and how these behaviors develop is an essential first step in understanding the nature of this problem.

To overcome this long-standing challenge, we are studying the prevalence, characteristics, and risk & protective factors for suicidal behaviors (i.e., suicidal thoughts, plans, and attempts) in the largest, most representative study of suicidal behaviors ever conducted. As an example of this work, we have been working collaboratively with colleagues in the WHO World Mental Health Survey Initiative - a series of nationally representative surveys conducted in 28 countries around the globe. We similarly have been members of the large-scale Army STARRS study team. Our primary questions include: What is the prevalence of suicidal behaviors ? When do these behaviors typically begin? What factors increase the risk of suicidal behaviors? This study provides an unprecedented opportunity to learn about the nature of this leading cause of death. 

Sample publications:

Zuromski, K. L., Wilks, C. R., Al‐Suwaidi, M., Wittler, E., Scherban, L., Hite, B., Raymong, L., Dempsey, C. L., Stein, M. B., Ursano, R. J., Benedek, D., & Nock, M. K. (2024). Perspectives of suicide loss survivors: Qualitative analysis of data from a psychological autopsy study of US Army soldiers. Suicide and Life‐Threatening Behavior, 54, 437-449.

Castro-Ramirez, F., Paz-Pérez, M. A., McGuire, T. C., Rankin, O., Alfaro, M. C. G., Audirac, A. M., Campuzano, M. L. G., Coady, P., Núñez-Delgado, M., Manana, J., Hernández-de la Rosa, C., Tambedou, T., Vergara, G. A., Barranco, L. A., Cudris-Torres, L., Nock, M. K., Naslund, J. A., & Benjet, C. (2023). A Qualitative Examination of the Impact of Suicidal Thoughts and Behavior on Help-Seeking Among University Students in Colombia and Mexico. Journal of Behavioral and Cognitive Therapy, 33(2), 67-80.

Jones, G. M., & Nock, M. K. (2022). MDMA/ecstasy use and psilocybin use are associated with lowered odds of psychological distress and suicidal thoughts in a sample of US adults. Journal of Psychopharmacology, 36(1), 46-56.

Another major and long-standing challenge to understanding self-harm is that because these behaviors are transient in nature and cannot be induced for study in the laboratory for ethical reasons, they have never been observed in a single research study! Obtaining data on the actual occurrence of a phenomenon is essential for understanding why it occurs, but has not previously been done in the case of suicidal/self-injurious behaviors. Toward this end, we are conducting studies using electronic diaries and ambulatory physiological monitoring methods to measure suicidal/self-injurious thoughts and behaviors as they naturally occur in real-time. In this work we also are examining the experience of other self-destructive behaviors, such as: bingeing/purging, alcohol/substance use, and risky sexual behaviors. This research is funded by the National Institute of Mental Health's U01 grant, the American Foundation for Suicide Prevention, Star-Friedman Challenge for Promising Scientific Research, The Tommy Fuss Fund, S. Sydney DeYoung Foundation, the Chet and Will Griswold Suicide Prevention Fund, the Foundations of Human Behavior Initiative at Harvard University, and the For the Love of Travis Fund . Some of this work was described in an article by Nature, on an episode of PBS Newshour, and in the articles below.

Sample publications:

Wang, S. B., Van Genugten, R. D. I., Yacoby, Y., Pan, W., Bentley, K. H., Bird, S. A., Buonopane, R. J., Christie, A., Daniel, M., Haim, A., Follet, L., Fortgang, R. G., Kelly-Brunyak, F., Kleiman, E. M., Millner, A. J., Obi-Obasi, O., Onnela, J. P., Ramlal, N., Ricard, J. R., Smoller, J. W., Tambedou, T., Zuromski, K. L., & Nock, M. K. (2024). Idiographic prediction of suicidal thoughts: Building personalized machine learning models with real-time monitoring data. Nature Mental Health.

Coppersmith, D. D., Ryan, O., Fortgang, R. G., Millner, A. J., Kleiman, E. M., & Nock, M. K. (2023). Mapping the timescale of suicidal thinking. Proceedings of the National Academy of Sciences, 120(17), e2215434120.

Bentley, K. H., Millner, A. J., Bear, A., Follet, L., Fortgang, R. G., Zuromski, K. L., Kleiman, E. M., Coppersmith, D. D. L., Castro-Ramirez, F., Millgram, Y., Haim, A., Bird, S.A., & Nock, M. K. (2024). Intervening on high-risk responses during ecological momentary assessment of suicidal thoughts: Is there an effect on study data? Psychological Assessment, 36(1), 66-80.

In addition to describing the nature of and risk factors for suicidal/self-injurious behaviors, we are developing and testing theoretical models that explain why people intentionally hurt themselves, with a special focus on understanding the psychological factors that influence the development and maintenance of these behaviors. We test different aspects of our explanatory model in laboratory-based studies of factors that we believe work together to cause suicidal and self-injurious behaviors, including: high emotional/physiological reactivity to stressful life events, poor distress tolerance, and poor social problem-solving and decision-making skills. 

Sample publications:

Nock, M. K., Jaroszewski, A. C., Deming, C. A., Glenn, C. R., Millner, A. J., Knepley, M., Naifeh, J. A., Stein, M. B., Kessler, R. C., & Ursano, R. J. (2024). Antecedents, reasons for, and consequences of suicide attempts: Results from a qualitative study of 89 suicide attempts among army soldiers. Journal of Psychopathology and Clinical Science.

Millgram, Y., Goldenberg, A., & Nock, M.K. (2024). Suicidal thoughts are associated with reduced source attribution of emotion. Journal of Psychopathology and Clinical Science.

Millner, A.J., den Ouden, H.E.M., Gershman, S.J., Glenn, C.R., Kearns, J., Bornstein, A.M., Marx, B.P., Keane, T.M., & Nock, M.K. (2019). Suicidal thoughts and behaviors are associated with an increased decision-making bias for active responses to escape aversive states. Journal of Abnormal Psychology

We ultimately are interested in using what we learn to help individuals struggling with suicidal/self-injurious thoughts and behaviors. Therefore, we are conducting several projects aimed at developing new approaches to the measurement and modification of these problems. One example is our work conducted in local hospital emergency departments and inpatient units in which we are using performance-based cognitive tests developed in our laboratory to measure the cognitive state of people at risk for suicidal behavior. This work can help us to better understand the psychological state that leads to suicidal behavior and is expected to help us improve methods for detecting and predicting suicidal thoughts and behaviors in the future.

Sample publications:

Kleiman, E. M., Bentley, K. H., Jaroszewski, A. C., Maimone, J. S., Fortgang, R. G., Zuromski, K. L., Kilbury, E. N., Stein, M. B., Beck, S., Huffman, J. C., & Nock, M. K. (2024). Acceptability and Feasibility of an Ecological Momentary Intervention for Managing Emotional Distress Among Psychiatric Inpatients at Risk for Suicide. Archives of Suicide Research, 1-18.

Coppersmith, D. D., Bentley, K. H., Kleiman, E. M., Jaroszewski, A. C., Daniel, M., & Nock M. K. (2024). Automated Real-Time Tool for Promoting Crisis Resource Use for Suicide Risk (ResourceBot): Development and Usability Study. JMIR Mental Health, 11, e58409.

Franz, P. J., Mou, D., Kessler, D. T., Stubbing, J., Jaroszewski, A. C., Ray, S., Cao-Silveira, V. B., Bachman, S., Schuster, S., Graupensperger, D., Alpert, J. E., Porath, M., & Nock, M. K. (2022). Digital bibliotherapy as a scalable intervention for suicidal thoughts: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 90(8), 626-637.