INSPIRE: Innovations in Suicide Prevention Research

About This Grant

ABSTRACT Despite intensive prevention efforts from federal and state agencies, suicide remains a leading cause of mortality in the United States (US), increasing by 36% between 2000-2022. In 2023 alone, 49,303 Americans lost their lives to suicide. The impact of suicide is particularly high among vulnerable populations such as adolescents and formerly incarcerated individuals. Although much research has focused on causes and predictors of death from suicide, progress in suicide prevention has been hampered by data linkage and methodological challenges. While national mortality rates are known, entities with the potential to implement large suicide prevention initiatives – insurers, health systems, and departments of corrections – lack the linked data to monitor suicide mortality in their populations, establish benchmarks, and create an evaluation framework for prevention efforts. Many individuals who die from suicide have had recent contact with a health insurance, health care, or correctional system, representing critical missed opportunities to implement suicide prevention measures. Funded from 2020-2025, our original “INSPIRE” grant (R01MH124752) established a living suicide mortality surveillance system in North Carolina (NC) by securing all necessary data approvals and completing individual-level linkages between state death records and large datasets on four key populations covering 10-22 years depending on the data source: the publicly insured (NC Medicaid), privately insured (large single private insurer), a large integrated health system (UNC Health), and releasees from the Department of Adult Corrections. We have updated these linkages annually and have used this surveillance system to define benchmarks of suicide mortality in each population; evaluate policy impacts; identify risk factors for suicide mortality, attempts, self-harm, and suicidal ideation; and predict short and long term risk of suicide outcomes . Having invested the expertise, resources, and time to establish the INSPIRE living surveillance system and demonstrate its potential, RFA-MH-25-135 now provides an opportunity to untap the full potential of this surveillance infrastructure and further advance suicide prevention efforts. Over the next five years, we will enhance the surveillance system by continuing annual updates, including additional important populations (older adults), and performing enhanced cross-population linkages. We will utilize the established system to evaluate the impact of several recent suicide prevention efforts in NC and build risk assessment tools tailored to specific sub-populations and suicide mortality subtypes. Finally, we will move this research beyond Big Data as we engage end users (clinicians and health administrators) to plan implementation of the risk assessment tools into health care settings where they can be best utilized to connect people in mental health crisis with the help they need to prevent suicide-related outcomes.