How to anticipate suicide attempts among teenagers by using their cellphones, scientists begin study

Every Wednesday afternoon, an alert flashes on the cellphones of about 50 teenagers in New York and Pennsylvania. Its questions are blunt: “In the past week, how often have you thought of killing yourself?” “Did you make a plan to kill yourself?” “Did you make an attempt to kill yourself?”

The 13- to 18-year-olds tap their responses, which are fed to a secure server. They have agreed, with their parents’ support, to something that would make many adolescents cringe: an around-the-clock recording of their digital lives. For 6 months, an app will gobble up nearly every data point their phones can offer, capturing detail and nuance that a doctor’s questionnaire cannot: their text messages and social media posts, their tone of voice in phone calls and facial expression in selfies, the music they stream, how much they move around, how much time they spend at home.

Most of these young people have recently attempted suicide or are having suicidal thoughts. All have been diagnosed with a mental illness such as depression. The study they’re part of, Mobile Assessment for the Prediction of Suicide (MAPS), is one of several fledgling efforts to test whether streams of information from mobile devices can help answer a question that has long confounded scientists and clinicians: How do you predict when someone is at imminent risk of attempting suicide?
The goal is to combine machine learning with decades of evidence about what may trigger suicidal behavior to create an algorithm that detects spikes in risk. For adolescents, whose social and emotional lives are tightly bound to their phones, the approach could be especially powerful, says MAPS co-investigator Nicholas Allen, a clinical psychologist at the University of Oregon in Eugene. “If you looked at my phone, what you’d find out is that I run late a lot. I’m always just saying, ‘running late.’” Allen’s 18-year-old daughter, in contrast, “uses her phone to conduct all the most important and intimate and personally involving aspects of her life.” By monitoring that digital appendage, researchers hope to identify clues that foreshadow a crisis.

Randy Auerbach, a clinical psychologist at Columbia University and a MAPS coinvestigator, is used to hearing that the study sounds like an invasion of privacy. But Auerbach, who has interviewed thousands of teenagers to gauge their suicide risk and laid plans to try to keep them safe, has a response. “Kids are killing themselves in record numbers, and what we’ve traditionally tried to do isn’t working,” he says. “We really need to rethink this.”
Suicide rates have nudged upward in the United States in the past decade, but the rise among young people has been especially sharp. For 10- to 24-year-olds, the rate climbed to 10.57 per 100,000 in 2017, up from 6.75 per 100,000 a decade earlier. In 2017, more than 6700 young people took their lives, making suicide the second leading cause of death for teens and young adults, after unintentional injuries. And in a 2017 survey of 15,000 high school students by the Centers for Disease Control and Prevention, 7.4% said they had attempted suicide in the past 12 months.

Scientists are now playing catch-up. “For a long time, researchers have been unwilling to do research on suicide, particularly in youth,” Allen says, because they worry about their responsibility for participants’ safety. But those fears, he says, are keeping his field from helping young people in need. “Researchers need to be willing to take some risk, and to manage that risk, so that we can actually understand these important problems,” he says. “In the best possible scenario, we could save a life.”

MANY SUICIDE RISK FACTORS are well known. Among the strongest is a previous attempt. Mental illnesses—especially depression and substance abuse—can increase risk, as can chronic illness and access to lethal means. Much of that information appears in medical records, and some health care providers already use it to flag patients at potentially elevated suicide risk.

The problem is that those risk factors capture huge numbers of people, few of whom are in imminent danger. And they don’t change much day to day, whereas suicidal impulses do. A 2017 meta-analysis took a dim view of the current crystal ball: Three hundred and sixty-five suicide risk studies in the past 50 years have led to predictions only slightly better than chance.

“If I’m seeing a kid at school in a guidance counselor’s office, or in the hospital, one of the key questions is ‘Is this individual at risk over the next hours and days?’” says Catherine Glenn, a clinical psychologist who studies youth suicide at the University of Rochester in New York.

(First published on Science Mag. See concluding part of article there)