Understanding factors related to suicidality leads to better therapeutic interventions

DENVER – Understanding biomechanisms and other factors related to trauma that lead to suicidality are crucial for better therapeutic outcomes, an expert said at the Anxiety and Depression Association of America annual conference.

“We have had a suicide epidemic and an opioid epidemic and that is really the baseline for our country before we found ourselves roughly two years into a global stressor like the pandemic,” Lynnette Averill, PhD, associate professor of psychology at Baylor College of Medicine, said during the presentation.

According to Averill, suicide is the tenth leading cause of death among all age groups. It is the second leading cause of death for those aged 10 to 34 years, and the fourth leading cause for those aged 35 to 54 years.

“We have an incredible opportunity to intervene,” she said.

Interventions may begin by attempting to assess factors related to stress and their resultant outcomes that affect behavior and mood. Averill outlined more than 30 individual symptoms related to suicidality across all populations. She highlighted current events and how those adversely affect certain moods, such as: isolation, chronic stress, tiredness/fatigue, powerlessness, a sense of overwhelming grief and desensitization.

In addition, she said that research suggests there are more than 600,000 ways to arrive at a PTSD diagnosis. Averill posited there may also be thousands of ways to find oneself experiencing suicidal thoughts or behaviors.

“And how do we treat such a complex phenomenon?” she asked.

Per the presentation, addressing chronic stress responses and gaps in neuroconnectivity are pathways toward treating illness and preventing worsening of symptoms and behaviors. Focusing on regions of the brain interconnected in regulation of stress and processing of trauma can be targeted to reduce suicidality as well.

In a study looking at 69 combat-exposed veterans to evaluate effects of combat on cortical thickness, Averill and colleagues found that the greater the combat exposure and the greater the effects of PTSD, the thinner the cortex, particularly the prefrontal cortex.

For all populations, the prefrontal cortex is involved in sleep regulation, and impaired sleep is a significant risk factor for suicidality, she said.

From a therapeutic perspective, recent changes in philosophy toward usage of mood-altering drugs or psychedelics like ketamine, MDMA and psilocybin have yielded positive results to reverse effects of trauma.

These interventions, as opposed to traditional selective serotonin reuptake inhibitors, are more rapid acting, and therefore progress, both cognitively and emotionally, and are likely to occur more quickly.

To date, Averill said, there are no specific studies to evaluate these drugs for their anti-suicidal effects, but studies have shown prescriptive ketamine increases neuroconnectivity in the short term.

“The ultimate goal is that we can better understand what leads people on the path to suicide, and that we can ultimately expand our interventions, and that we can open up a space and build a foundation where people can build lives that they really want to be living,” Averill said.