Veteran Participation in Intensive Suicide Research Protocols: No Evidence of Iatrogenic Effects

Abstract

Suicide research remains fraught with ethical and methodological issues, including researchers' reservations about conducting intensive suicide research protocols due to potential iatrogenic effects and liability concerns. Such issues significantly impede scientific inquiry related to suicide. To date, no research has explored potential iatrogenic effects of intensive, nontreatment suicide research among Veterans. This study aimed to fill this gap. It was hypothesized that participation in suicide-specific protocols would not significantly increase risk among Veterans. Veterans completed self-reports, structured interviews, and rigorous suicide-specific tasks (Study A, N = 34; Study B, N = 18; Study C, N = 119). Findings indicated there were no significant differences in pre- and postassessment suicide risk variables (all ps > .05). Estimated mean change for "urge to harm self" was -0.24 (95% confidence interval [CI]: -0.60, 0.13), -0.28 (CI: -0.56, 0.01), and -0.01 (CI: -0.09, 0.07) and "intent to harm self" was -0.18 (95% CI: -0.45, 0.10), 0 (CI: -0.17, 0.17), and 0.01 (CI: -0.04, 0.06) for Studies A, B, and C, respectively. Results indicated the respective protocols did not produce iatrogenic effects. The current findings are discussed with attention to safety-monitoring techniques that may reduce iatrogenic effects and considerations for future researchers.

Longitudinal studies support the safety and ethics of virtual reality suicide as a research method

“…Echoing these findings, Bender and colleagues 17 showed that higher-risk individuals actually exhibited lower implicit suicidality after suicidality assessment. Many other studies have detected similar patterns 13 , 18 , 19 . In terms of utilitarian ethics, evidence indicates that suicide research is ethical because its potential harms appear to be consistent with minimal risk and may be outweighed by its potential benefits (e.g., advancing knowledge, reducing suicidality).…”

“…Moreover, the mechanisms commonly considered to lead to increased risk for suicide after exposure to suicide stimuli (e.g., habituation, sensitization, and priming) typically exert the strongest influence immediately after exposure. Prior studies did not detect increased suicide risk or related harms within session or within days of exposure 13 , 18 . Given that it is possible that effects on relatively rare phenomena such as suicide ideation and attempt may require a longer period to evidence, the present study extends prior research by examining short- and long-term effects.…”

“…Evidence does not support this belief. A plethora of studies have demonstrated that exposing participants to suicide-related content does not cause negative impacts on self-injurious or suicidal urges 18 , suicide risk 13 , suicide ideation 19 , 53 , or depressive symptoms 54 . Moreover, multiple studies have shown potential benefits of exposure to suicide-related stimuli, such as reduction in distress, suicide ideation, and depressive symptoms 16 , 17 , 55 .…”

Participant Reactions to Suicide-Focused Research

“…Per the protocol, if a participant rated their current intent to kill themselves at a 4 or higher, mood induction tasks were employed to reduce distress or a provider was alerted. UWRAP score changes have been used in previous research to assess distress following research participation (Poindexter et al., 2019; Reynolds et al., 2006).…”

“…Notably, a recent meta-analysis found that exposure to suicide-related research content may actually be associated with small reductions in distress (Blades, Stritzke, Page, & Brown, 2018). Recent studies have sought to explicitly assess potential distress following participation in suicide-focused research, finding no significant increases in distress following completion of suicide-related self-report measures, clinical interviews, or in-lab tasks (Ammerman, Sorgi, Berman, Coccaro, & McCloskey, 2018; Eynan et al., 2014; Gibson, Boden, Benson, & Brand, 2014; Poindexter, Nazem, Barnes, Hostetter, & Smith, 2019; Reynolds, Lindenboim, Comtois, Murray, & Linehan, 2006). Studies exploring the effects of participating in suicide-related research have predominately utilized online study designs or included participants with remote risk histories (see review by Dazzi et al., 2014).…”