Including Questions About Suicidal Ideation in Research with Undergraduates

Responding to Undergraduate Students at Risk for Suicide

All members of the Duke community who interact with undergraduate students are obligated to respond to students who appear to be at risk of suicide. DukeReach, an office within the Dean of Students Office, provides a mechanism for responding to students who express suicidal ideation. DukeReach directs students, faculty, staff, parents, and others to the resources available to help a student in need. DukeReach staff are available during regular business hours and refer after hours concerns to the Dean-on-Call. The Dean-on-Call is available 24 hours a day, seven days a week. The Dean-on-Call serves as a consultant to the university community to address concerns about a Duke student.

More information about DukeReach can be found here:
http://studentaffairs.duke.edu/dos/dukereach

Because researchers use measures to assess depression and suicidality in students, they must be prepared to contact DukeReach, and in some cases interact with students while the contact is made.

Administering measures about depression and suicidality is not known to increase depression or suicidal ideation; therefore the measures don’t increase risks of harm to research subjects. However, the IRB, in collaboration with Student Affairs, has developed guidelines for using these measures in research with human subjects. The IRB is particularly concerned that students are informed that they may be contacted based on concerns about their well-being.

IRB Guidelines

Researchers are obligated to contact undergraduate students and refer them to DukeReach if they endorse suicidality (for example, in Section 9 of the Beck Depression Inventory).

During business hours contact DukeReach at 919-681-2455. After hours the Dean-on-Call can be reached at 984-287-0300. The deans will consult with the Counseling and Psychological (CAPS) on-call team for students expressing suicidal ideation. If a researcher is concerned about the immediate safety of a student or those around a student dial 911 or call Duke Police at 919-684-2444.

There are three scenarios in which the measures of depression and suicidality are used.

1. They are administered in a lab setting in which researchers have face-to-face contact with the students.
2. They are administered on-line, there is no face-to-face contact, but the students are identifiable. For example, the Psychology and Neuroscience Subject Pool often includes the Beck Depression Inventory (BDI) in the prescreen instrument.
3. They are administered on-line as part of a battery of measures and undergraduate students are one of multiple subject populations completing the measures. 

Scenario 1: Face-to-face contact with students

If researchers are using a depression inventory that includes questions about suicidality ideation in the lab setting, the following procedures should be implemented.

The relevant scores must be calculated before the students leave the lab. For example, if the BDI is used, Section 9 is the relevant item (see below). If students endorse No. 2 or No. 3, they have expressed suicidal ideation. Although the BDI is not diagnostic, some research indicates that it is predictive.

BDI Section 9: Suicidal Thought or Wishes

0. I don’t have any thoughts of killing myself

1. I have thought of killing myself

2. I would like to kill myself

3. I would kill myself if I had the chance

The research faculty should contact DukeReach (or Dean-on-Call) and maintain contact with the student while the referral is made, serving as the link between the student and DukeReach until a determination is made about what steps need to be taken.  DukeReach (or Dean-on-Call) will advise on the appropriate course of action.  This role may not be filled by lab managers, graduate, or undergraduate students.  If researchers do not feel comfortable serving in this role, they may arrange to have a mental health professional serve as the link. Measures of depression and suicidality must be administered and scored early in the study so that the individual intervening with the student can be present before the student leaves the lab.

The initial contact with the student and the subsequent conversation should be handled in a way that does not violate the student’s privacy.

With regard to the informed consent process, subjects should be told that if the researcher has concerns about their well-being, based on their responses to the questionnaires, someone will want to speak with them before they leave the lab.

DukeReach provides training about responding to students in distress on an as-requested basis. If interested, please contact DukeReach at 919-681-2455 or dukereach@duke.edu.

Scenario 2: There is no face-to-face contact, but the students are identifiable

If there is no face-to-face contact with students, but their scores are identifiable, a member of the research team should contact DukeReach and let them know that there is a concern about the student. When measures of depression and suicide are administered to undergraduate students and the researchers intend to make referrals to DukeReach, informed consent documents must explain that this may happen. Sample language:

“If we have any concerns about your well-being based on your responses, someone from DukeReach will contact you to find out if you need support or assistance.”

The scores must be calculated and the referral made within 8 hours of the administration of the measures.  The referral may be made through the DukeReach on-line reporting system.

Scenario 3: There is no face-to-face contact and the students are not identifiable

If undergraduate students are among the research subjects completing measures of depression and suicidality, but they are not identifiable, there should be a link at the end of the last measure that says:

“Duke Students: One (or some) of the questionnaires you just completed asked you to reflect on how badly you might be feeling. In case this raised some concerns for you, we are providing all subjects a link to a list of campus resources.”

Recording Contacts

The IRB should be informed about all contacts to DukeReach.  The information provided should not include any identifiable information, but the date and type of the contact and basic information about the outcome.

Responding to More than Moderately Depressed Undergraduate Students

It is not required to respond to students whose BDI scores indicate that they are more than moderately depressed.