Prior to reading this section, review Including a Risk-Sensitive Population for general guidelines about including risk-sensitive populations.
Studies can focus on individuals who are (or have been) suicidal, they can include individuals who are or have been suicidal but suicide is not the topic of the study, or the researcher inadvertently learns of suicidal thoughts or feelings during his interaction with the participant. For the first two scenarios, the Board will want to know:
- What is your recruitment and consent process?
- Is there a potential that the subject matter could be upsetting or trigger suicidal tendencies?
- If you obtain information about illegal behaviors, how will you handle that information?
- If you learn of a situation that is threatening to a participant, how will you handle reporting the incident?
The remaining pages in this section cover how to report a suicide threat if you encounter it while conducting your study. If your study involves at-risk participants, especially if you are working intimately with them, there is always the possibility that you could learn about a suicide threat. It is important to make yourself aware of the signs of suicidal tendencies, your reporting responsibilities, and where to report any suspicion. If you are working with an at-risk population, you will need to demonstrate that you are qualified and capable of working with this population.
In addition to reporting a suicide threat to the appropriate authorities, you may need to report the incident to the IRB-SBS as an Unexpected Adverse Event. Please see Unexpected Adverse Events for more information.
Loss of confidentiality is often the most serious risk for these types of studies. Understanding the participant’s situation will help you to anticipate how to protect his or her confidentiality. For someone who is suicidal or had previous attempts, they may be working towards healing and finding solutions for dealing with their suicidal triggers. The participant may not be ready to divulge to family, friends, coworkers, etc, that he or she had a suicide attempt or has suicidal thoughts, so keeping this information private is essential. It is important that you consider how to approach the victim about the study, where the study will take place, and how the data are collected and stored so that confidentiality will be protected.
There may be instances in which confidentiality has to be compromised. If you learn of new instances of a suicide attempt, the Board will want you to have a protocol in place so that you can help the individual find the assistance they need, which may result in a breach of confidentiality. If you will ask the victim questions about illegal behaviors, such as drug use, etc, you may need to obtain a certificate of confidentiality. If it is likely that they will tell you this information and it isn’t in the scope of your study, you need to have a procedure so that this information is not documented; for example, if you are conducting an interview, start the interview by instructing the participant not to include information about illegal behaviors in the interview. If it comes up anyway, you could stop the interview, remind the participant not to provide the information about illegal behaviors, and erase that part of the interview.
If the potential exists that you may have to compromise confidentiality, you should provide this information in the consent form in the “Confidentiality” section; provide the participants with specifics about what would prompt you to break confidentiality and what information will be shared. For example, see the sample text below:
Confidentiality (please modify so that it is appropriate for the participants’ reading level): I have ethical obligations to contact individuals to help you if you should threaten to harm yourself. If keeping information obtained in this study private would immediately put you in danger, I will release that information to protect you.
Please note that if your study involves a minor and/or an individual with diminished capacity to consent, you need to provide the participant with an assent form and the appropriate parent/surrogate with a consent form.
What are signs of a suicide threat?
The Surgeon General stated that there are far more suicides per year than homicides (over 50%), and suicide is the ninth leading cause of death. According to the Surgeon General, there are certain groups more likely to attempt suicide, specifically those with mental and/or substance abuse disorders, but suicide victims include the entire spectrum of population from children to the elderly. Some risk factors are:
- Previous suicide attempt
- Mental disorders—particularly mood disorders such as
depression and bipolar disorder - Co-occurring mental and alcohol and substance abuse disorders
- Family history of suicide
- Hopelessness
- Impulsive and/or aggressive tendencies
- Barriers to accessing mental health treatment
- Relational, social, work, or financial loss
- Physical illness
- Easy access to lethal methods, especially guns
- Unwillingness to seek help because of stigma attached to mental and substance abuse disorders and/or suicidal thoughts
- Influence of significant people—family members, celebrities, peers who have died by suicide—both through direct personal contact or inappropriate media representations
- Cultural and religious beliefs—for instance, the belief that suicide is a noble resolution of a personal dilemma
- Local epidemics of suicide that have a contagious influence
- Isolation, a feeling of being cut off from other people
What are my responsibilities to report a suicide threat?
As a researcher, you do not have specific legal responsibilities for reporting a suicide threat. However, you should consider the well-being of your participants and act in their best interests, as stated in the Belmont Report. Often these situations are delicate and require experienced clinicians to council the participant. If you do not have certified experience in helping a suicidal individual, do not council your participant or become involved in the situation. Inappropriate action may put the participant at greater risk. As you are working with an adult, the more appropriate step may be to refer the participant to resources that can help them, such as a hotline or mental health clinic (as the situation warrants) instead of simply calling the police. However, if you become aware of a specific and immediate threat of harm to your participant, you should contact the appropriate authorities.
If you are working in a public school system, there is specific protocol for reporting suicidal behavior. Please see the Education: Abuse section for more information.
How do I report a suicide threat?
If your participants are at-risk for expressing suicidal intentions, you will need to have protocol in place to provide immediate assistance. For example, should a participant express suicidal intentions, or discuss suicidal thoughts and feelings, an experienced clinician should be available to assess the individual’s state and refer them to the appropriate resources for help. Please note that some surveys and instruments, such as the BDI-II, ask participants if they have suicidal thoughts and feelings. Even though suicide may not be the topic of your research, if you are asking these questions of participants, you need to have a protocol in place for addressing affirmative answers.
If a participant has expressed suicidal intentions and you do not have the protocol or expertise to handle this situation, please refer the participant to qualified individuals. For example, if the participant is a UVA Student the Department of Student Health offers emergency services.