At the beginning of his career, Matthew K. Nock, Ph.D., a clinical psychologist, wanted to focus on research that could prevent suicide. The problem was that there wasn’t enough known about what motivated people to harm themselves to start testing ways to intervene.
But Dr. Nock, along with his research team at Harvard University, Cambridge, Mass., has been chipping away at some of those unanswered questions over the last several years, finding links between anxiety and suicidal behavior, and developing a predictive tool that could someday help clinicians identify people with suicidal thoughts.
Dr. Matthew K. Nock
Earlier this year, Dr. Nock, who at age 38 is a professor of psychology at Harvard, was named as one of 22 fellows by the John D. and Catherine T. MacArthur Foundation. The prestigious award was given to a range of people from across the fields of sports, science, and the arts who were selected for their "creativity, originality, and potential to make important contributions in the future."
The award also comes with a $500,000 "no-strings-attached" grant for the next 5 years. Dr. Nock said he plans to put that money right back into his Harvard lab, where he will seed some pilot projects aimed at attaining a better understanding of suicidal behavior.
He is also continuing work on the suicide implicit association test, a brief, computer-based test that he and his research team developed. It uses a person’s reaction time to measure the extent to which they identify with the concepts of death and suicide. The predictive test has had success in the laboratory and in early tests in the emergency department at Massachusetts General Hospital in Boston (Psychol. Sci. 2010;21:511-7).
The researchers found that the test could distinguish between people with psychiatric distress and those who had made a suicide attempt. It also improved the prediction of future suicide attempts better than with clinician prediction, patient prediction, or chart diagnosis. Dr. Nock said he and his colleagues are now trying to replicate the early results and assessing different versions of the test.
"I think we have promising early findings and now we really want to first try to improve on our predictive accuracy," Dr. Nock said.
The next step will be to determine whether the test can be useful in clinical decision making. "We’re hesitant as a research team to make it widely available and get it out into the hands of clinicians until we know we have the best possible tool," Dr. Nock said.
Dr. Nock’s research also has uncovered new linkages between suicidal behavior and anxiety that could help clinicians identify people who are more likely to act on suicidal thoughts.
After analyzing a data set from the World Health Organization with information from 21 countries, Dr. Nock and a team of researchers found that depression is the strongest predictor of suicidal thoughts. While that finding is not a surprise, they also discovered that depression doesn’t predict which people will act on those thoughts. Disorders characterized by anxiety, agitation, and poor impulse control are what drive people to actually go through with their plans for suicide, Dr. Nock said (PLoS One. 2010;5:e10574).
"We think this work is important, because it helps us tease apart how it is that some disorders are differentially associated with different parts of the pathway to suicide," he said.
Both through his analysis of the World Health Organization data and the development of the suicide implicit association test, Dr. Nock has helped to give clinicians and researchers a better sense of who is at risk, said Dr. Morton Silverman, senior adviser to the Suicide Prevention Resource Center in Newton, Mass., and a clinical associate professor of psychiatry at the University of Chicago.
"This is an incredible advance," he said.
And Dr. Nock’s MacArthur Foundation award also has helped to advance the field, Dr. Silverman said. By including Dr. Nock among its fellows this year, the organization has recognized the study of self-injury and suicide as a "legitimate" scientific endeavor, he said.
"It’s been a tremendous boost, I think, to putting the s-word on the kitchen table and making the topic something that deserves attention," Dr. Silverman said.
But along with attention, the field also needs increased funding, Dr. Silverman and Dr. Nock both agreed.
Funding for self-injury and suicide research lags tremendously behind other disease areas like HIV and breast cancer, even though deaths from suicide outpace those other diseases. But Dr. Silverman said he’s optimistic that the field will get some much-needed funding in the future, in part because of a new public-private effort known as the National Action Alliance for Suicide Prevention. The group, which is supported by the federal government, has been meeting for about a year. It is a public-private partnership aimed at addressing suicide and suicide prevention on a national level. The group is currently working on a prioritized research agenda for suicide prevention that is expected to be released in April 2012.