71 - Suicide Risk Management in the Context of Human Subjects Research: A Critical Illustrative Review

Background: Participants at elevated suicide risk are often excluded from research studies, limiting the generalizability of research findings for this vulnerable subgroup. This presentation provides a historical overview of the literature on the inclusion and safety of participants at risk for suicide in healthcare-focused research.

Methods: We conducted a literature search using PsycInfo and PubMed to identify published manuscripts pertaining to suicide risk in research, using relevant keywords (e.g., suicide risk, human subjects research, protection) in the title and/or abstract fields. Abstracts were reviewed by the first author to determine applicability to the topic under investigation, and relevant full-text articles were obtained and included in this review. Note that this review is meant to be illustrative rather than systematic or exhaustive.

Conclusion: Despite calls from prominent suicidology researchers to collect data from participants considered to be at high risk for suicide (Nock et al., 2021), people who display suicide risk are routinely excluded from research across a broad swathe of disciplines. Research regarding or potentially involving people at risk for suicide often spurs concerns among ethics committees (Andriessen et al., 2019). Not surprisingly, our literature review highlighted a historical pattern of concerns associated with participant suicide risk, conveyed by members of ethics and IRBs. While some of these concerns are reasonable and valid, others are largely based on misinformation and a lack of understanding of the suicide prevention literature. Furthermore, we found that some studies do not consistently delineate a clear set of inclusion and exclusion criteria pertaining to participant suicide risk (Bakalar et al., 2016). Finally, based on the review, a variety of suicide risk management strategies were found to be used in research conducted with participants at risk for suicide. Despite the breadth of these risk management strategies, to our knowledge, there is no standard by which to identify the components necessary for a rigorous suicide risk management protocol (Stevens et al., 2021). Despite substantial agreement among researchers regarding the importance of ethical practices to protect those at risk for suicide, there is little consistency in practice or education available to researchers concerning suicide risk management strategies.

Limitations: This review has several limitations. First, published work in languages other than English was excluded; therefore, only a subset of international publications was included. Second, the search was limited to only two databases in psychology and medicine; as a result, published work in other disciplines may not be adequately represented in this work. Finally, this review was meant to be illustrative, rather than exhaustive, and therefore did not adhere to systematic review standards (e.g., PRISMA).

Discussion: While researchers have historically employed a variety of strategies for suicide risk identification, mitigation, and management in the context of human subjects research, we continue to lack a standardized set of practices for the safe and responsible conduct of research with participants identified at risk for suicide. Standardized approaches can embolden researchers to include participants who may be at elevated suicide risk, even when suicide is not the focus of research.