Researchers must consider how to screen participants for suicidality

Researchers studying conditions that cause chronic pain often screen participants for signs of depression, since the two are connected.

Since depression can be linked to suicidal ideation, should researchers also ask participants if they have thoughts about harming themselves? And if the participant says yes, what is the researcher’s responsibility to act? Thinking about self-harm is not the same as having a plan to do so. If researchers alert doctors because a participant says they’ve thought about hurting themselves, it could violate the patient’s right to privacy and strain health resources.

These ethical questions were deliberated by a team led by Eric Swirsky, BHIS clinical associate professor, in a recent paper published in the journal Contemporary Clinical Trials Communications.

The discussion grew out of an ongoing National Institutes of Health-funded study, based at UIC, that is examining whether acupuncture or guided relaxation can help alleviate chronic pain from sickle cell disease. In the study, participants are screened remotely for a number of health indicators, including signs of depression and suicidality.

The ethics team agreed there’s an obligation to screen for suicidality when asking about depression. They proposed seven steps for researchers:

  • understand the responsibility to act
  • determine triggers for action
  • examine responsibilities for action
  • protect patient autonomy and privacy
  • identify indirect and collateral participants
  • mitigate risk of bias
  • manage sociotechnical considerations of integrating research data into clinical practice.

The key takeaway for researchers is to think about these issues and their interconnectedness, said Swirsky, who studies medical ethics.

“Deliberate decision-making requires taking steps,” he said. “They don’t necessarily have to go in that order. They may not all be relevant to every trial. But they should each be considered.”

Other UIC authors involved in the study include BHIS associate professor Andrew Boyd, Carol Gu ’23 MS HI and BHI doctoral candidate Jonathan Leigh.