Editor’s Note: This story talks about suicide. If you or someone you know needs immediate help, you can call the National Suicide Prevention Hotline at 1-800-273-8255.
INDIANAPOLIS — After a several-year process, Indiana University researchers have validated a screening tool that can detect suicidality risk, which can save countless lives.
The assessment, called the Convergent Functional Information for Suicidality, is up to 80 percent predictive of future suicidality and is increased to 90 percent with the use of artificial intelligence and machine learning.
The project was led by Alexander Niculescu, MD, PhD, who is a professor of psychiatry and medical neuroscience at the IU School of Medicine.
There were numerous experts involved in the process and collaboration with colleagues at the University of Southern California in developing the AI. Niculescu emphasizes it was a “team effort” in finding and developing this study.
Niculescu has been trying to make a dent in this problem for about 15 years now and conducted multiple studies on the topic. His previous work examined genetic markers they were able to identify linked to suicide and they are rolling out those tests in clinics.
However, they wanted to find something broad, inexpensive, simple and easy to deploy quickly and with a widespread effect. This led to the development of CFI-S which focuses on unique risk markers.
“In genetics, you have a cumulative risk, where you have many mutations adding up and leading to you developing a disorder,” Niculescu said. “So, we felt suicide is the same way, you can have a number of risk factors that when they come together and add up, they put you over a threshold, and you have a risk. So, we developed and validated a simple instrument.”
The study found that top risk factors are based on social factors and things that can be changed. This means it can be preventable and help those who need it by altering their environment and reducing those particular risks.
The top factors pinpointed in the study were feeling useless or unneeded, having a history of suicidality and social isolation.
CFI-S is only 22 yes/no questions and is non-invasive in nature. It takes only about 3-5 minutes to take and is available both on paper and digitally.
The questionnaire focuses on psychosocial risk factors rather than biological markers, distinguishing it from his previous study. It also does not ask about suicide intention.
“Patients do not always want to answer questions specifically about suicidal ideation, because they may be afraid of being hospitalized,” Niculescu said in an IU release. “Because this tool leaves out those -questions, it is easier to deploy in any setting and can be a complementary questionnaire to use with current standard clinical screenings.”
After patients take the screening, it is easy to use the quantitative tool to assess risk and it even provides a specific and personalized risk mitigation plan based on the results.
Niculescu compared its format and simplicity to getting your credit score.
“One way to think about it is like a suicidality credit report where it gives you a score, and it gives you a list of things you can do for that patient for that person to reduce that risk to reduce that score. And on purpose, we wanted to see can we develop something like this that's so simple and easy to use in any setting,” Niculescu said.
This can lead to a “game-changing” advancement in suicide prevention and can help “move the needle” on declining suicide rates. This is especially needed now with a steady incline in rates nationwide, according to Macrotrends’ data.
It has been about an eight-year process to get the study to this point. They started testing and validating the system initially and worked with veterans. Then they advanced it further five years ago by rolling it out in a real-world test.
They worked with colleagues at the Eskanazi emergency room and sampled 480 patients. All came in consecutively and were just random ER patients, they were not patients who necessarily had a psychiatric history or were identified to have any risk factors. They gave them a quick questionnaire during the screening and then followed up six months later.
At that point, they could already see some accuracy, but they gave the sample group time to see the full results. When final data was collected, they discovered the 80% accuracy of the assessment and the promising impact it had potential.
As of now, CFI-S is currently available to the public and is being rolled out to different organizations.
Niculescu said that they are looking to work with the Department of Defense and use it to help veterans and other service members because they are groups with higher suicide rates.
They are also working to get it to other high-risk groups like college and high school students.
“We're now working on an adolescent version because adolescents are at high risk for it,” Niculescu said. “All this effort is now leading to something that can directly help people. So, we're very happy about that.”
The current version of the screening has only 22 questions, but their study indicates that they are developing an expanded version that has 33 items, with more suicidality risk factors included. It has not yet been analyzed and compared to the original but could assist in future studies.
To reach more about their study they published their findings in the Springer Nature journal Discover Mental Health.
If you or someone you know needs immediate help, you can call the National Suicide Prevention Hotline at 1-800-273-8255.