Opportunities for suicide prevention integration into task-shifted mental health interventions in low-resourced contexts

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ABSTRACT Suicide is a leading contributor to global mortality and rates have remained steady, or increased, in low- resourced settings. Motherhood is both a protective and risk factor for suicidal thoughts and behaviors. In the perinatal period, women have increased risk for suicidal ideation and experience higher rates of violence and violent death. Given rising suicide rates, the importance of the perinatal period for both mother and child, and growing dissemination of task-shifting programs to treat common mental disorders, there is critical and urgent need to incorporate implementation strategies for suicide detection and referral within these programs. While task-shifted mental health interventions have trained peer community members to successfully deliver low intensity interventions where access to clinical care is limited, peers remain an untapped resource to provide suicide prevention support in settings where it is needed most. The goal of this award is to broaden the candidate’s expertise to conduct independent clinical trials related to suicide prevention research focused on the integration of community-delivered detection and response in low-resourced, high need, settings. Through structured mentorship from an expert team, coursework, workshop, and conference attendance, the candidate will develop new competencies in suicide prevention research, including: (1) quantitative training in longitudinal analysis for rare events (2) implementation science methods and research design to apply to suicide prevention interventions; and (3) clinical trial management skills, including ethical conduct of suicide prevention research in resource strained contexts, to become a NIH-funded independent investigator. Drs. Donna Spiegelman, Joanna Maselko, Atif Rahman, Paul Pfeiffer, and Byron Powell (alongside a Pakistani advisory committee) will mentor and advise the candidate to meet these objectives. The proposed research will (1) examine the epidemiology and health impacts of recurrent suicidal ideation on mothers over time, (2) characterize key features of suicidal ideation and finalize intervention package components for the study context, and (3) conduct a pilot clinical trial to assess the feasibility and acceptability of implementing a Suicide Prevention Package (SuPP) within an existing task-shifted depression intervention. This K01 lays the groundwork for a future R01 to scale a package for multi-level suicide prevention strategies that can be integrated into community based mental health programs, particularly targeting individuals living in low- resourced settings. As the model is designed to be easily adapted and integrated, we anticipate the findings will be valuable for all researchers looking to improve population health and mental health services in disadvantaged settings.