Targeting Social Networks May Help Prevent Suicide In Young People At High Risk for Psychosis

The pattern of relationships in which a person is embedded—their social network structure—may offer an avenue for targeted suicide prevention efforts, argues Anna Defayette, PhD, a senior instructor with the department of Psychiatry and a Career Development K Award (KL2) scholar. Defayette is the first author alongside Steven Silverstein, PhD, and Anthony R. Pisani, PhD, exploring this opportunity in “Social network structure as a biopsychosocial suicide prevention target for young people at clinical high-risk for psychosis” published in Schizophrenia Research.

Although young people at clinical high-risk for psychosis experience suicidal thoughts and are more likely to take suicidal action than their peers, there are no specialized, targeted interventions developed for this group. In their paper, Defayette and her research partners argue that social network structure is a potential target for intervention efforts that may serve this vulnerable group.

Making A Career of Suicide Prevention Research

Defayette first began investigating suicide prevention as a research assistant at the Mt. Hope Family Center, where she assisted with a clinical trial for a psychotherapy for teen girls with depression.

“After hearing how frequently these young girls were having thoughts of suicide, I decided to pursue a career in suicide prevention,” Defayette said. “Mt. Hope uses a developmental psychopathology lens, which emphasizes the importance of conducting research using multiple levels of analysis. This includes integrating biological metrics to understand how things happening in our environment ‘get under the skin.’”

This philosophy shaped how Defayette thought about and approached suicide prevention research.

“As a PhD student, I primarily studied social-contextual factors like interpersonal conflict, cognitive processes, and family factors related to suicide risk, but wanted to better understand the underlying biological processes that may help inform suicide prevention,” Defayette said. “The focus on social network structure as a suicide prevention target grew out of research conducted at the Center for the Study and Prevention of Suicide [CSPS].”

Mentorship as Key to Research Success

Defayette first began working with Pisani and Silverstein during her National Institute of Mental Health-funded T32 postdoctoral fellowship in Suicide Prevention Research at CSPS in 2022. Pisani, a professor of Psychiatry and Pediatrics at CSPS, a researcher of young people and suicide, and a former KL2 scholar himself, encouraged her to incorporate an individual’s social network structure into her conceptualization of the processes she was already studying. Many of the themes in their new publication originate in the work that began at CSPS with Pisani and others.

“Team science is the pathway to discovery,” Pisani said. “Anna’s work is at the nexus of two specialty areas: suicide prevention and treatment of young people at risk for psychosis, so she wisely sought out mentors in each of these areas. It has been a pleasure to team up with Dr. Silverstein to support this outstanding early career investigator.”

Pisani spoke to the personal passion that drives Defayette’s research in this field.

“This article is Anna’s scientific ‘fight song’—her clarion call to the field about unexplored opportunities for improving and saving young lives,” he said. “Thanks to support from UR CTSI, she will now roll up her sleeves and put her ideas to the test.”

Second author Steven Silverstein, PhD, is a professor in Neuroscience and Ophthalmology, and is associate chair of research in Psychiatry.

“Anna started doing research on young people at high risk for developing psychotic disorders when she was a postdoc,” Silverstein said. “She did this work in the clinic I run for this population at URMC: Interventions for Changes in Emotion, Perception and Thinking—INTERCEPT. There is an elevated risk for suicide in this population, but almost no research on methods to reduce suicide risk.”

INTERCEPT focuses on young people of ages 15 to 28 years old, making it one of the few such specialized clinics in the country.

“I’m impressed by Anna’s important ideas, and her drive to conduct original research in the high-risk for psychosis population,” Silverstein said.

Defayette credits the encouragement of Silverstein as influential on her decision to focus on young people at clinical high-risk for psychosis.

“When I was first meeting Dr. Silverstein, he sent me research that highlighted how high the rates of suicidal ideation and behaviors are for this young group,” Defayette said. “It made me realize how little attention they received in the suicide prevention literature—including whether what we know about suicide risk more broadly applies to them.”

Next Steps

This publication directly ties into Defayette’s work as KL2 scholar, as she plans to conduct a study that will seek to develop a better understanding of the biopsychosocial context of the lives of clinically high-risk young people, with the long-term goal of developing tangible suicide prevention interventions.

“We will use the data from my KL2 project to describe patterns in how clinically high-risk young people engage with the people in their lives as it occurs in real time and how this fluctuates with indicators of suicide risk,” Defayette said. “We will capture changes in social network structure and underlying inflammatory processes across three months of specialized mental health treatment.”

Jonathan Raab | 8/8/2024