For more than three decades, David Brian Goldston, PhD, Professor in Psychiatry and Behavioral Sciences at Duke University, has studied suicide risk and prevention, particularly among adolescents and young adults. His work spans suicide risk assessment, brief interventions, substance use, technology-based approaches, and the implementation of suicide prevention strategies across different settings.
Dr. Goldston also founded the Duke Center for the Study of Suicide Prevention & Intervention (CSSPI), a collaborative group of clinical research scientists working to advance understanding of suicidal behaviors and strengthen evidence-based prevention and intervention.
As part of Suicide Prevention Month, Dr. Goldston spoke about what drew him to suicide prevention research, the Center’s work, emerging approaches in the field, and why creating opportunities to talk openly about suicide remains so important.
What first drew you to suicide prevention research?
My work in suicide research began before I came to Duke. I spent 13 years at Wake Forest, where I initially worked in the area of childhood and adolescent depression. I had planned to develop a program of research on depression among young people receiving inpatient psychiatric care.
But I quickly realized that the clinicians working on the inpatient unit had a significant need: there was relatively little research available to guide them in addressing suicide risk among the young people they were treating.
That experience shifted the direction of my research. I began focusing more on suicidal behaviors and trying to understand risk among young people who were psychiatrically hospitalized.
We started with smaller follow-up studies and eventually received funding for larger longitudinal studies, allowing us to examine risk and the course of suicidal behavior over time. Much of my subsequent work—including research on substance use, families, and interventions—grew out of those studies.
What was the motivation behind creating the Duke Center for the Study of Suicide Prevention & Intervention?
The Center was developed as a way for researchers working in suicide prevention to connect with one another, share ideas and provide feedback on research projects and grant proposals. There are a number of researchers at Duke and neighboring institutions doing work in this area, and having a collaborative structure allows us to bring those perspectives together.
The Center gives researchers an opportunity to share ongoing and planned research, provide feedback on projects and grant proposals, and develop collaborations and partnerships. I thought it was important to have a space where people could regularly come together, ask questions, and strengthen their work based on the feedback they receive.
The Center brings together researchers working across many different areas. What are some of the approaches being explored?
There is a tremendous breadth of work. Some researchers are looking at ways to use machine learning to better predict suicidal behavior. Others are developing or adapting interventions for young people experiencing suicidality alongside depression, alcohol use or other substance use.
We are also looking at how interventions can be adapted for different settings. For example, we have studied brief suicide interventions in juvenile detention settings and explored ways to support young people as well as adults as they transition from psychiatric hospitalization back into their communities.
Technology is another growing area. Research within the Center includes mobile health interventions, virtual reality, smartphone-based assessments and other approaches that can provide support or collect information in real time.
Are there particular projects or initiatives that have been especially meaningful to you?
There are several. One that stands out is a 25-year follow-up study of adolescents who had been psychiatrically hospitalized. We followed them into adulthood to look at predictors and different developmental trajectories of suicidal thoughts and behaviors and to better understand individual differences over time.
That study actually began before I came to Duke, when I was at Wake Forest, and we continued following the participants. Because we followed people for such a long period, we really got to know some of the participants. That has provided a unique perspective on how suicidal thoughts and behaviors can develop and change across the lifespan.
We’ve also conducted research examining the experiences of parents whose children have engaged in suicidal behavior. That work highlighted how much impact a suicide attempt can have on the entire family and how important it is to think about supporting caregivers as well as young people.
More recently, I’ve been excited about intervention research—developing approaches that help young people who are at risk and determining how those interventions can be delivered effectively in real-world settings.
How do you see this research being translated into practice?
A major part of the work is figuring out how interventions that have evidence behind them can be implemented in different settings.
For example, we have developed and adapted the SAFETY-Acute (SAFETY-A) intervention, a brief intervention designed to foster safety, reduce risk, and reinforce connection to care for young people who are suicidal. We’ve adapted it for juvenile justice settings, schools, and other contexts.
We’re also involved in a large PCORI-funded multisite trial, Youth Partners in Care for Suicide Prevention, which is examining the comparative effectiveness of SAFETY-A alone versus SAFETY-A combined with follow-up caring contacts among adolescents and young adults presenting to emergency departments with suicidal thoughts and behaviors. An important part of that work is understanding not only whether an intervention works, but also for whom it works best and how we can connect young people to ongoing care.
Our work through the National Child Traumatic Stress Network Center allows us to take evidence-based approaches and train providers across the country in brief trauma-informed suicide interventions and in preventing secondary traumatic stress among professionals who work with young people experiencing crises. That allows us to take what we’ve learned through research and translate it into training for clinicians and providers, where it can have an impact on real patients and providers.
What emerging developments in suicide prevention are you most excited about?
There is a lot of innovative work happening in both intervention and understanding the mechanisms of suicide risk being led by the researchers in our group. Technology is one area that is particularly interesting. Virtual reality, smartphone applications including mobile phone interventions, and ecological momentary assessment allow us to think differently about both intervention and measurement.
For example, Marissa Marraccini’s work uses virtual reality to help young people who have been hospitalized for suicide attempts practice skills related to returning to school and social settings. Jeremy Grove is using smartphone applications to extend therapeutic work that begins in the hospital, helping people continue to use those skills after they leave.
Shayna Cheek’s work uses ecological momentary assessment, in which participants receive prompts on their phones several times a day. Rather than relying only on retrospective reports, researchers can learn in real time about people’s drinking behaviors, suicidal thoughts, and experiences of stress. This can help us better understand how changes in mood, stress, and other factors relate to suicidal thoughts and behaviors.
Nosa Osazuwa-Peters work has been examining suicide risk among cancer survivors, and the impact of suicide screening in clinics for head and neck cancer. Nate Kimbrel has been using machine learning approaches to improve our prediction of suicide in veteran populations.
I’m also excited about work being done in settings that have historically had fewer resources for suicide prevention. Brandon Knettel’s work in Tanzania, for example, is examining how a brief telehealth intervention can help reduce suicide risk while also supporting HIV care. If we can develop effective interventions in these settings, there may be opportunities to adapt and transport those approaches to other countries and contexts.
What have you learned about the role of communities in suicide prevention?
Duke has been partnering with ICF for years to help evaluate the Garrett Lee Smith Memorial Suicide Prevention program. This is a large congressionally authorized and nationally disseminated suicide prevention program which supports suicide prevention efforts in states, tribes and communities.
“What I find particularly interesting about the Garrett Lee Smith program is that different communities can develop suicide prevention programs that are a good fit for their own communities. It isn’t one identical program for everyone.”
The evaluation work has found that communities in which these suicide prevention programs were implemented had lower rates of suicide deaths and population-level rates of suicide attempts compared with communities without those programs. That provides encouraging evidence for the potential impact of community-based prevention.
You’ve been involved in this field for more than three decades. What continues to motivate you?
There are always new questions to explore. Understanding the mechanisms underlying suicide risk is fascinating because that knowledge can have implications for developing better interventions.
I’m also fortunate to work with and mentor researchers who are developing innovative approaches to suicide prevention. Supporting other faculty and students as they develop their own research programs and pursue new questions is incredibly rewarding.
It’s really interesting to help people along their journeys and collaborate with them as they take their research in different directions that are innovative and contribute to the field in their own ways.
Ultimately, I think the most exciting part is when we can take something we learn about risk and turn it into an intervention or approach that can actually help someone.
During Suicide Prevention Month, what is one conversation you think we need to have more often?
We need to continue increasing awareness and reducing the stigma around suicide. People don’t always feel comfortable talking about suicide, even when someone they care about may be struggling.
We need to become more comfortable having those conversations and understanding how to support people who may be at risk. That includes knowing how to ask about suicide, how to respond when someone is struggling, and how to help strengthen their connections with other people and with sources of support. Being willing to have these conversations is an important part of prevention.
“Suicide prevention isn’t just about reducing risk. It’s also about helping people recognize their strengths, build connections and find a path forward.”
Looking ahead, what gives you hope for the future of suicide prevention?
The breadth of work happening right now gives me a lot of hope. We’re developing interventions, studying how to implement them in different settings, using technology in new ways and learning more about which approaches work for different populations.
We’re also increasingly thinking about how research can be translated into practice and how interventions can reach communities and populations that have historically been underserved.
There is still a lot we don’t know, but we’re continuing to build the evidence base. The goal is to take what we learn and translate it into approaches that can make a meaningful difference in people’s lives.