Suicide Research & Prevention Laboratory
At the Suicide Research and Prevention Lab, we conduct clinical research focused on understanding the Suicide Crisis Syndrome (SCS), which is 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.
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.
Funding & Awards
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.
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.
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.
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.
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”.
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.
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.
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.
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.
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)
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)
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)
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)
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)
Graduate Research Assistant Team
Sevval Aydin, M.A.
Nadia Yanez, M.A. candidate
Lauren McMullen, M.A. candidate
Ji Yoon Park, M.A. candidate
Allison Vespa, M.A. candidate
Gabriella Epshteyn, M.A. candidate
Erjia Cao, M.A. candidate
Olivia Lawrence, B.A.
Nazareth Perez, B.A.
Anohki Bafna, B.F.A.
In the Media
“Asking about suicidal thoughts leaves us to miss 75% of people who go on to die by suicide.”
Preventing Suicide: What Should Clinicians Do Differently?
Interview of Igor Galynker, MD by Clinical Psychiatry News.
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.
“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.
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.”
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.
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.”
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.”
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.
Galynker Suicide Research and Prevention Laboratory
1-9 Nathan D. Perlman Place, Floor 7
Phone # (212) 420-2302
Fax # (212) 420-4332