Suicide risk detection and mitigation in patients with head and neck cancer

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PROJECT SUMMARY/ABSTRACT The goal of this K01 proposal is to provide the candidate with formal training and mentoring in psychiatric epidemiology, psycho-oncology and implementation science; training needed to pursue an independent career in implementing interventions to detect and mitigate suicide risks among head and neck (HNC) cancer patients. Suicide is the 10th leading cause of death, and 1 person dies by suicide every 11 minutes in the US. Among individuals at higher risk of suicide are chronic disease sufferers, including cancer survivors. The suicide mortality rate for HNC patients is 63.4 per 100,000 person-years, which is four times more than the general US population. Clearly, suicide is an important public health crisis in the US and is considered a leading health indicator by the Healthy People initiative. Screening for suicidal ideation is an evidence-based suicide prevention and mitigation strategy. Several studies have demonstrated that it is feasible and effective to screen patients for suicidal ideation and behavior in various clinical settings, including general, non-psychiatric emergency room settings. The Food and Drug Administration (FDA) has endorsed the Columbia Suicide Severity Rating Scale (C-SSRS) as the tool of choice for screening for suicidal ideation and behavior. However, suicide screening interventions among HNC patients are lacking, in part due to the gaps in our understanding of the multilevel barriers associated with screening HNC patients for risks of suicide. To address this gap, the candidate will utilize the C-SSRS to characterize suicide risk among HNC patients, and test effectiveness and potential implementability of the C- SSRS as a routine suicide screening tool in HNC care. Using informant interviews with key stakeholders, candidate will identify patient, provider and other barriers that could underlie the suboptimal investigation of suicidal ideation among HNC patients in Aim 1. In Aim 2, candidate will administer the C-SSRS to a group of HNC patients, providing insights on suicidal ideation and severity among HNC patients in the US. In addition, a risk management/triage system will be developed to provide follow-up care when suicide risk is detected. Aim 3 will involve a mixed-method evaluation with a subset of patients who received the C-SSRS from Aim 2 to elicit feedback on the administration of the C-SSRS, and a debrief with providers to assess future implementability of the C-SSRS as routine part of HNC care. This research will have scientific impact by enhancing our enhancing our knowledge of the barriers to screening for suicide in the HNC setting. It will have significant clinical impact through the novel utilization of the C-SSRS in HNC care. Lessons learned will be adopted for future studies in HNC and across the cancer continuum. The training objective is to address the candidate’s scientific gaps in psychiatric epidemiology, psycho-oncology, qualitative/mixed methods research design, and implementation science. Completion of this proposal and training will position the candidate as a transdisciplinary, independent investigator in implementing interventions to decrease psychosocial morbidity in the HNC population.