Suicide Research and Prevention Laboratory

WELCOME TO THE MOUNT SINAI SUICIDE RESEARCH AND PREVENTION LAB

Directed by Dr. Igor Galynker, the Suicide Research and Prevention Lab at Mount Sinai conducts clinical research focused on understanding the Suicide Crisis Syndrome (SCS): a negative cognitive-affective state associated with imminent suicidal behavior in those who are already at high risk for suicide. We also investigate the mechanisms by which traditional long-term risk factors such as mental illness or histories of past attempts interact with the SCS to increase risk of suicide in the immediate future. Our hypothesis is that long term vulnerability factors make it likely for some individuals in stressful life situations to conceptualize their live stories and Suicidal Narratives, which make the future unimaginable, and bring on the Suicidal Crisis.

OUR MISSION

To research, implement, and teach new methods of suicide prevention through treatment of the acute pre-suicidal mental state as a serious mental illness, including increasing the quality of communication between clinician and patient

The lab is actively investigating the Narrative-Crisis Model of suicide, which is based on this premise. Finally, we are studying how clinicians could use their own emotional responses to identify those at the highest risk for imminent suicide.

Contact Us

Dr. Igor Galynker, MD, PhD
Professor in Department of Psychiatry, Icahn School of Medicine at Mount Sinai
Director of the Suicide Research and Prevention Lab and Zirinsky Center for Bipolar Disorder
Associate Chairman for Research, Mount Sinai Beth Israel Department of Psychiatry
igor.galynker@mountsinai.org

Funding & Awards

Active funding:

AFSP Grant Galynker (PI) 03/01/20-02/28/22

The goal of this project is to create and test the feasibility and efficacy of the first multi-modal virtual human patient interaction (VHI) Emotional Self-Awareness (ESA) training program for clinicians working with patients at risk for suicide.

Role: PI

R34-NIMH Grant Galynker & Foster (Co-PI’s) 04/04/2019 – 03/31/2021

The goal of this project is to evaluate the impact of clinicians’ training in emotional self-awareness (ESA) on their patients’ suicidal outcomes, as assessed by the severity of patient suicidal ideation and of the suicide crisis syndrome.

Role: Co-PI

Completed funding:

AFSP Focus Grant Galynker (PI) 10/01/15-9/30/18 Modular Assessment of Risk for Imminent Suicide (MARIS) – a Novel Tool for Suicide Prediction

The goal of this study is to assess the predictive validity of MARIS for short-term suicidal behavior in psychiatric outpatients and to establish the diagnostic value of clinicians’ emotional responses to suicidal individuals.

Role: PI

Zirinsky Foundation Galynker (PI) 08/01/15-7/30/18 Richard and Cynthia Zirinsky Center for Bipolar Disorder.

The goal of this project is to establish the feasibility of a family-inclusive approach for treatment of bipolar disorder.

Role: PI

Research Studies

**The MARIS Project:** The Modular Assessment of Risk for Imminent Suicide

Our lab is actively examining a multi-informant model, the MARIS-NCM, or, the Modular Assessment of Risk for Imminent Suicide (MARIS) and the Narrative-Crisis Model of suicidal behavior (NCM). The effectiveness of the MARIS-NCM approach is described in multiple peer-reviewed publications, and in the book The Suicidal Crisis by Galynker (2017; Oxford University Press), now a recommended resource by the American Foundation for Suicide Prevention.

Throughout the course of MARIS, we have identified the Suicide Crisis Syndrome (SCS), which is comprised of several factors predictive of imminent suicidal behavior (SB). Our aim now is to propose and substantiate this SCS. What precipitates this syndrome is a suicidal narrative; the concept of such a narrative postulates that individuals each possess a story of self, and a suicidal narrative is the coherent cognitive structure in which the representation of self becomes sufficiently distressing, such that suicide becomes a viable option. Overall, the narrative-crisis model comprises enduring characteristics that make an individual susceptible to suicide.

Study: Emotional Safety Course

Inpatients meeting the proposed DSM criteria for the SCS at discharge and denying suicidal ideation were seven times more likely to attempt suicide within one month. The MARIS and assessment of the SCS as well as clinician responses to same, has even higher predictive validity. There is a notable contrast between outcome and self-reported intention, and the SCS appears to capture a specific moment of suicidal crisis predictive of imminent behavior.

In this context, we have now initiated several studies of suicide prevention in high-risk patients who meet the proposed DSM SCS criteria but may deny suicidal ideation.

Currently, the lab has and is conducting multisite studies, in Trondheim (Norway) and New York City, examining the implementation and efficacy of an Emotional Safety Course for Suicide Prevention (ESC-SP).

The study aims to answer the following research questions: (1) is the SCS-C a test with higher sensitivity than suicidal intention assessment – can we detect suicide earlier? (2) Will the MiniMARIS measure have incremental predictive validity over the DSM SCS? (3) Is treatment inclusive of the ESC-SP a better intervention that the original safety plan in preventing short-term suicidal behaviors?

Study: The Y-MARIS (Young MARIS) and MARIS in Adolescents

In collaboration with an AFSP award recipient Dr. Alan Apter in Israel, we have initiated a prospective bi-national imminent risk assessment study in high-risk Israeli and American adolescents. We have modified the MARIS to make it appropriate for children and adolescents. The study is ongoing and the interim data will be ready in 2020. Colleague Dr. Gennadiy Bannikov in Moscow has initiated suicide screening of children and adolescents in Russian schools. In interim analysis, MARIS was predictive of suicidal ideation and behavior. Notably, a child’s crisis syndrome differs from an adult’s – social isolation seems a stronger predictor than feelings of entrapment and frantic hopelessness.

Study: Virtual Interaction Training in Emotional Self-Awareness for Working with Suicidal Patients

MARIS has also revealed a need for clinician training in the effective management of negative emotions towards suicidal patients, which can yield improved suicidal outcomes. This training should be accessible and easy to disseminate, for clinicians everywhere. Therefore, in an effort to address the need for emotional awareness and emotional management training, we have established collaborations with AFSP grant recipient Dr. Adriana Foster of Florida International University and Dr. Benjamin Lock of Florida State University. We have two running projects, “Impact of Clinician Virtual Human Interaction Training in Emotional Self-Awareness on Patients’ Suicidal Ideation and Suicide Crisis Syndrome: a Randomized Controlled Trial” and “Virtual Interaction Training in Emotional Self-Awareness for Working with Suicidal Patients”.

The MARIS Project: The Modular Assessment of Risk for Imminent Suicide

Narrative Crisis Model (NCM) of Suicidal Behavior

RESOURCES

Selected Publications

Calati, R., Cohen, L. J., Schuck, A., Levy, D., Bloch-Elkouby, S., Barzilay, S., . . . Galynker, I. (2020). The Modular Assessment of Risk for Imminent Suicide (MARIS): A validation study of a novel tool for suicide risk assessment. Journal of Affective Disorders, 263, 121-128.

Bloch-Elkouby, S., Gorman, B., Schuck, A., Barzilay, S., Calati, R., Cohen, L. J., . . . Galynker, I. (2020). The suicide crisis syndrome: A network analysis. Journal of Counseling Psychology, 67(5), 595-607.

Calati, R., Nemeroff, C. B., Lopez-Castroman, J., Cohen, L. J., & Galynker, I. (2020). Candidate Biomarkers of Suicide Crisis Syndrome: What to Test Next? A Concept Paper. International Journal of Neuropsychopharmacology, 23(3), 192-205.

Bloch-Elkouby, S., Gorman, B., Lloveras, L., Wilkerson, T., Schuck, A., Barzilay, S., . . . Galynker, I. (2020). How do distal and proximal risk factors combine to predict suicidal ideation and behaviors? A prospective study of the narrative crisis model of suicide. Journal of Affective Disorders, 277, 914-926.

Schuck, A., Calati, R., Barzilay, S., Bloch‐Elkouby, S., & Galynker, I. (2019). Suicide Crisis Syndrome: A review of supporting evidence for a new suicide‐specific diagnosis. Behavioral Sciences & the Law, 37(3), 223-239.

Cohen, L. J., Gorman, B., Briggs, J., Jeon, M. E., Ginsburg, T., & Galynker, I. (2018). The Suicidal Narrative and Its Relationship to the Suicide Crisis Syndrome and Recent Suicidal Behavior. Suicide and Life-Threatening Behavior, 49(2), 413-422.

2021

McMullen, L., Parghi, N., Rogers, M. L., Yao, H., Block-Elkouby, S., & Galynker, I. (2021). The Role of Suicide Ideation in Assessing Near-Term Suicide Risk: A Machine Learning Approach. Psychiatry Research, 114118.

Foster, A., Alderman, M., Safin, D., Aponte, X., McCoy, K., Caughey, M., & Galynker, I. (2021). Teaching suicide risk assessment: spotlight on the therapeutic relationship. Academic Psychiatry, 45(3), 257-261.

Parghi, N., Chennapragada, L., Barzilay, S., Newkirk, S., Ahmedani, B., Lok, B., & Galynker, I. (2021). Assessing the predictive ability of the Suicide Crisis Inventory for near‐term suicidal behavior using machine learning approaches. International journal of methods in psychiatric research, 30(1), e1863.

Høyen, K. S., Solem, S., Cohen, L. J., Prestmo, A., Hjemdal, O., Vaaler, A. E., … & Torgersen, T. (2021). Non-disclosure of suicidal ideation in psychiatric inpatients: Rates and correlates. Death studies, 1-9.

Ying, G., Chennapragada, L., Musser, E. D., & Galynker, I. (2021). Behind therapists’ emotional responses to suicidal patients: A study of the narrative crisis model of suicide and clinicians’ emotions. Suicide and Life‐Threatening Behavior.

Moazen-Zadeh, E., & Galynker, I. I. (2021). Suicidality and cannabidiol: opportunities and challenges. Current neuropharmacology, 19(6), 733-735.

2020

Pia, T., Galynker, I., Schuck, A., Sinclair, C., Ying, G., & Calati, R. (2020). Perfectionism and Prospective Near-Term Suicidal Thoughts and Behaviors: The Mediation of Fear of Humiliation and Suicide Crisis Syndrome. International Journal of Environmental Research and Public Health, 17(4), 1424.

Bannikov, G., Vihristyuk, O., & Galynker, I. (2020). A New Approach to Suicidal Behavior Diagnostics: A Review of Foreign Sources. Counseling Psychology and Psychotherapy, 28(1), 8-24.

Barzilay, S., Assounga, K., Veras, J., Beaubian, C., Bloch-Elkouby, S., & Galynker, I. (2020). Assessment of near-term risk for suicide attempts using the suicide crisis inventory. Journal of Affective Disorders, 276, 183-190.

Ying, G., Cohen, L. J., Lloveras, L., Barzilay, S., & Galynker, I. (2020). Multi-informant prediction of near-term suicidal behavior independent of suicidal ideation. Psychiatry Research, 291, 113169.

Otte, S., Lutz, M., Streb, J., Cohen, L. J., Galynker, I., Dudeck, M., & Büsselmann, M. (2020). Analyzing suicidality in German forensic patients by means of the German version of the suicide crisis inventory (SCI-G). The Journal of Forensic Psychiatry & Psychology, 31(5), 731–746.

Moazen-Zadeh, E., & Galynker, I. I. (2020). Suicidality and Cannabidiol: Opportunities and Challenges. Current Neuropharmacology. Advance Online Publication.

Parghi, N., Chennapragada, L., Barzilay, S., Newkirk, S., Ahmedani, B., Lok, B., & Galynker, I. (2020). Assessing the predictive ability of the Suicide Crisis Inventory for near‐term suicidal behavior using machine learning approaches. International Journal of Methods in Psychiatric Research.

Yao, H., Siqueira, A. G., Foster, A., Galynker, I., & Lok, B. (2020). Toward Automated Evaluation of Empathetic Responses in Virtual Human Interaction Systems for Mental Health Scenarios. Proceedings of the 20th ACM International Conference on Intelligent Virtual Agents, Article 57,1-8.

Cohen, L. J., Wilman-Depena, S., Barzilay, S., Hawes, M., Yaseen, Z., & Galynker, I. (2020). Correlates of chronic suicidal ideation among community-based minor-attracted persons. Sexual Abuse, 32(3), 273-300.

Barzilay, S., Schuck, A., Bloch‐Elkouby, S., Yaseen, Z. S., Hawes, M., Rosenfield, P., … & Galynker, I. (2020). Associations between clinicians’ emotional responses, therapeutic alliance, and patient suicidal ideation. Depression and anxiety, 37(3), 214-223.

2019

Cohen, L. J., Wilman-Depena, S., Barzilay, S., Hawes, M., Yaseen, Z., & Galynker, I. (2019). Correlates of Chronic Suicidal Ideation Among Community-Based Minor-Attracted Persons. Sexual Abuse: A Journal of Research and Treatment, 32(3), 273-300.

Molaie, A. M., Chiu, C., Habib, Z., Galynker, I., Briggs, J., Rosenfield, P. J., . . . Yaseen, Z. S. (2019). Emotional Pain Mediates the Link Between Preoccupied Attachment and Non-suicidal Self-Injury in High Suicide Risk Psychiatric Inpatients. Frontiers in Psychology, 10, 289.

Hannan, J., Sanchez, G., Musser, E. D., Ward-Peterson, M., Azutillo, E., Goldin, D., Galynker, I., Foster, A. (2019). Role of empathy in the perception of medical errors in patient encounters: A preliminary study. BMC Research Notes, 12(1), 327.

Nia, A. B., Mann, C. L., Spriggs, S., Defrancisco, D. R., Carbonaro, S., Parvez, L., Galynker, I. I., Perkel, C. A., & Hurd, Y. L. (2019). The Relevance of Sex in the Association of Synthetic Cannabinoid Use With Psychosis and Agitation in an Inpatient Population. The Journal of Clinical Psychiatry, 80(4).

Barzilay, S., Assounga, K., Kim, H., Rudner, E., Yaseen, Z., & Galynker, I. (2019). Psychotic Symptoms Predict Suicidal Behavior Postdischarge in High Risk Psychiatric Inpatients. Journal of Psychiatric Practice, 25(6), 418-426.

2018

Li, S., Yaseen, Z. S., Kim, H., Briggs, J., Duffy, M., Frechette-Hagan, A., . . . Galynker, I. I. (2018). Entrapment as a mediator of suicide crises. BMC Psychiatry, 18(1), 4.

Barzilay, S., Yaseen, Z. S., Hawes, M., Gorman, B., Altman, R., Foster, A., . . . Galynker, I. (2018). Emotional Responses to Suicidal Patients: Factor Structure, Construct, and Predictive Validity of the Therapist Response Questionnaire-Suicide Form. Frontiers in Psychiatry, 9, 104.

Barzilay, S., Yaseen, Z. S., Hawes, M., Kopeykina, I., Ardalan, F., Rosenfield, P., . . . Galynker, I. (2018). Determinants and Predictive Value of Clinician Assessment of Short‐Term Suicide Risk. Suicide and Life-Threatening Behavior, 49(2), 614-626.

Spriggs, S. A., Cohen, L. J., Valencia, A., Yaseen, Z. S., & Galynker, I. I. (2018). Qualitative Analysis of Attitudes Toward Adult-Child Sexual Activity Among Minor-Attracted Persons. Journal of Sex & Marital Therapy, 44(8), 787-799.

Yaseen, Z. S., Hawes, M., Barzilay, S., & Galynker, I. (2018). Predictive Validity of Proposed Diagnostic Criteria for the Suicide Crisis Syndrome: An Acute Presuicidal State. Suicide and Life-Threatening Behavior, 49(4), 1124-1135.

Hawes, M., Galynker, I., Barzilay, S., & Yaseen, Z. S. (2018). Anhedonia and suicidal thoughts and behaviors in psychiatric outpatients: The role of acuity. Depression and Anxiety, 35(12), 1218-1227.

Cohen, L. J., Ndukwe, N., Siegfried, R., Kopeykina, I., Yaseen, Z. S., & Galynker, I. (2018). Attraction Versus Action in Pedophilic Desire. Journal of Psychiatric Practice, 24(6), 374-387.

Yaseen, Z. S., Molina, N., Hawes, M., Barzilay, S., & Galynker, I. (2018). Suicide Risk and Emotional Responses to Thoughts of Death: The Response to Morbid Ideations Questionnaire. Suicide and Life-Threatening Behavior, 49(5), 1209-1219.

2017

Galynker, I., Yaseen, Z. S., Cohen, A., Benhamou, O., Hawes, M., & Briggs, J. (2017). Prediction of suicidal behavior in high risk psychiatric patients using an assessment of acute suicidal state: the suicide crisis inventory. Depression and anxiety, 34(2), 147-158.

Cohen, L. J., Ardalan, F., Yaseen, Z., & Galynker, I. (2017). Suicide crisis syndrome mediates the relationship between long‐term risk factors and lifetime suicidal phenomena. Suicide and Life‐Threatening Behavior.

Li, S., Galynker, I. I., Briggs, J., Duffy, M., Frechette-Hagan, A., Kim, H. J., … & Yaseen, Z. S. (2017). Attachment style and suicide behaviors in high risk psychiatric inpatients following hospital discharge: The mediating role of entrapment. Psychiatry research, 257, 309-314.

Yaseen, Z. S., Galynker, I. I., Cohen, L. J., & Briggs, J. (2017). Clinicians’ conflicting emotional responses to high suicide-risk patients—Association with short-term suicide behaviors: A prospective pilot study. Comprehensive psychiatry, 76, 69-78.

Hawes, M., Yaseen, Z., Briggs, J., & Galynker, I. (2017). The Modular Assessment of Risk for Imminent Suicide (MARIS): a proof of concept for a multi-informant tool for evaluation of short-term suicide risk. Comprehensive psychiatry, 72, 88-96.

2016

Yaseen Z, Galynker I, Briggs J, Freed R, Gabbay V: Functional domains as correlates of suicidality among psychiatric inpatients. J Affect Disord. doi:10.1016/j.jad.2016.05.066. (2016)

2015

Zeng R, Yaseen Z, Lopatyuk Y, Tanis T, Tiara T, Galynker I. Cohen L: Assessing the contribution of borderline personality disorder and features to suicide risk in psychiatric in patients with bipolar disorder, major depression and schizoaffective disorder. Psychiatry Res. 2015 Jan 28. pii: S0165-1781(15)00062-1. doi: 10.1016/j.psychres.2015.01.020. [Epub ahead of print] (2015)

Galynker I, Yaseen Z, Briggs J, Hayashi F. Attitudes Toward Suicide May Predict Post-Discharge Suicide Attempts. BMC Psychiatry. 2015 Apr 16;15:87. doi: 10.1186/s12888-015-0462-5. (2015)

Bustamante F, Ramirez V, Urquidi C, Yaseen Z, Galynker I: Suicide rate trends in Chile: 2001-2010. Crisis. Dec 1 2015 DOI: http://dx.doi.org/10.1027/0227-5910/a000357 (2015)

2014

Yaseen Z, Kopeykina I, Gutkovich Z, Bassimina A, Cohen L, Galynker I: Predictive Validity of the Suicide Trigger Scale (STS-3) for Post-discharge Suicide Attempt in High-risk Psychiatric Inpatients. PLoS One. 2014 Jan 21;9(1):e86768. doi: 10.1371/journal.pone.0086768. eCollection (2014)

2013

Yaseen Z, Briggs, J, Kopeykina I, Galynker I. Distinctive clinician responses to suicidal patients – A Pilot comparative study. BMC Psychiatry.2013, 13:230. DOI: 10.1186/1471-244X-13-230 (2013)

Rappaport, LM, Moskowitz DS, Galynker I, Yaseen Z: Panic Symptom Clusters Differentially Predict Suicide Ideation and Attempt. Compr Psychiatry. 2013 Dec 17. pii: S0010-440X(13)00365-9. doi: 10.1016/j.comppsych.2013.10.017. [Epub ahead of print] (2013)

2012

Yaseen ZS, Fisher K, Morales E, Galynker II: Love and Suicide: The Structure of the Affective Intensity Rating Scale (AIRS) and Its Relation to Suicidal Behavior. PLoS ONE 7(8): e44069. doi:10.1371/journal.pone.0044069 (2012)

Yaseen Z, Gilmer E, Modi J, Cohen L, Galynker I: Confirmatory Factor Analysis of the Suicide Trigger Scale (STS-3): A Measure of a Hypothesized Suicide Trigger State (PLoS ONE: e45157. doi: 10.1371/journal.pone.0045157 (2012)

Yaseen Z, Chartrand H, Mojtabai R, Bolton J, Galynker I: Fear of dying in panic attacks predicts suicide attempt in comorbid depressive illness: Prospective evidence from the National Epidemiological Survey on Alcohol and Related Conditions. Depression and Anxiety DOI:10.1002/da.22039 (2012)

PubMed

Measures

Suicide Crisis Inventory-2 Short-Form

SCI-2 Measure

Suicide Crisis Syndrome Checklist

SCS Checklist

Team

Dr. Lisa J. Cohen, PhD
Clinical Professor of Psychiatry
LisaJ.Cohen@mountsinai.org

Megan Rogers, PhD
Postdoctoral Fellow
Megan.Rogers@mountsinai.org
Curriculum Vitae

Sarah Bloch-Elkouby, PhD
Postdoctoral Fellow
Sarah.Bloch-Elkouby@mountsinai.org

Olivia Lawrence B.A.
Clinical Research Coordinator
olivia.lawrence@mountsinai.org

Inna Goncearenco, B.A.
Clinical Research Coordinator
inna.goncearenco@mountsinai.org

Giuseppe Sarli, M.D.
Visiting Research Fellow
giuseppe.sarli@mountsinai.org

Rawad El Hayek, M.D.
Postdoctoral Fellow
rawad.elhayek@mssm.edu

Graduate Research Assistant Team

Sifan Zheng, M.A. candidate

Alexis Mitelman, B.A. candidate

Tanya Verma, M.A. candidate

Angelique Simeone, M.A. candidate

Jae Gabriella Citarella, B.A.

Frank Rappa, M. A. candidate

Shihui Wang, M.A. candidate

In the Media

“Asking about suicidal thoughts leaves us to miss 75% of people who go on to die by suicide.”

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Preventing Suicide: What Should Clinicians Do Differently?

Interview of Igor Galynker, MD by Clinical Psychiatry News.

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Lorenzo Norris, MD, editor in chief of MDedge Psychiatry, sits down with Igor Galynker, MD, PhD, for a podcast episode to talk about an evaluation model he and his team have created aimed at assessing the risk of imminent suicide. Dr. Galynker discusses ways clinicians can assess their own personal emotional responses to patients who are at risk.

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“In my opinion, the main reason to have a suicide-specific diagnosis in the DSM, introducing [one], is clinical…in our work, there is a very specific syndrome that precedes suicidal behavior that we described as the ‘suicide crisis syndrome’ that has very distinct criteria,” discusses Igor Galynker, MD in this episode of the MDedge Psychcast podcast.

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Reporting on the 2019 Anxiety and Depression Association of America Conference, Nancy A. Melville of MedScape Medical News explores the Galynker Laboratory’s MARIS study and the novel approach their work takes to suicide assessment. She writes, “in new research, a novel two-part assessment tool that includes both patient and clinician data may fit the bill.”

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A recent episode of the MDedge Psychcast features Igor Galynker, MD speaking about how to explore the kinds of “gut feelings” that clinicians can access to help them identify when a patient might have the suicide crisis syndrome.

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Online publication UnDark examines the merits of adding a new diagnosis to the DSM as proposed by the Galynker Lab at Mount Sinai Beth Israel. “The criteria include familiar symptoms of depression, but these symptoms occur in an acute state that is not currently obvious to clinicians. Proponents say it could spur more research and make it easier for suicidal patients to get the care they need.”

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Igor Galynker, MD explains to APA reporter Mark Moran in Psychiatric News that “nothing in medicine is 100%, and there is probably more than one pathway to suicide, but I believe the essential features of suicide crisis syndrome are present in the majority of suicides.”

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The American Psychiatric Association news examines the phenomenon of a “decision that may be made only in the minutes or hours before an attempt – and the almost complete lack of ‘suicidal ideation’ until a crisis reaches its most acute phase“, emphasizing the importance of a Suicidal Crisis Syndrome diagnosis for vulnerable persons in this acute emergency state.

Contact Us

Galynker Suicide Research and Prevention Laboratory
1-9 Nathan D. Perlman Place, Floor 7
Phone # (212) 420-2302
Fax # (212) 420-4332