IUSM-developed suicide questionnaire nudges 90% accuracy
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Nearly 500 Hoosier patients in the emergency department at Sidney & Lois Eskenazi Hospital have helped validate a screening tool for suicide, “so we can start making a massive impact in preventing these needless tragedies,” says its creator. Dr. Alexander Niculescu, a professor of psychiatry at the Indiana University School of Medicine, has spent two decades researching how to predict suicide risk, and the recent study shows the new tool is right about 90% of the time. His passion for prevention is evident in his startup company MindX Sciences, which is seeing swift success in its mission to make precision mental health tools widely available.
“In most other areas of medicine, we’re making progress over the years; the rates of people suffering or dying from certain conditions goes down, because science advances, clinical practice advances and so on,” says Niculescu. “Not only has suicide unfortunately not gone down, it’s moving in the wrong direction due to a variety of medical and socioeconomic issues. We need to do something different. What we’ve been doing hasn’t bent the curve, so new, better, more quantitative approaches are needed.”
Niculescu says “prevention is the name of the game” for suicide. The study that recently concluded at Eskenazi tested the power of the new tool to accurately predict who is at risk. The yes/no questionnaire was given to patients in the ER and hones in on 22 risk factors in about five minutes. Patients score a zero or 1 based on each risk factor being present or absent, such as stress, addictions and various cultural factors.
Four years after giving the tests in the ER, the tool was more than 80% accurate in predicting who would have any subsequent suicidal ideation or behavior. The predictive ability jumped to 90% when researchers added in artificial intelligence and machine-learning approaches.
“The majority of these risk factors are innocuous things we all have, like stress, a recent loss or having a financial concern; it’s just when you add them all together, they put you over a threshold and you become high-risk and suicidal,” says Niculescu. “This ability to pick up risk factors early on before a lot of them accumulate—and address them then—is something we think is a gamechanger.”
Current screening standards ask directly about suicidal thoughts—something his test does not, because he says “those are delicate questions that people are hesitant to answer” out of fear of being hospitalized.
Niculescu believes the new tool is a paradigm shift in suicide screening because, based on the person’s unique score, it also provides a personalized treatment plan to reduce suicide risk, whereas current screenings do not. The quantitative score also helps clinicians track any changes over time.
“You can get a score and run with it and do great prevention,” says Niculescu. “We want to pick up [patients] early on who have some risk factors—before things become a crisis. Early on, things are also modifiable.”
The test, which downloadable, can be used in any clinical setting, such as primary care offices or the ER. The screening tool also has a strong connection to Niculescu’s startup, MindX Sciences, which he launched a few years ago to commercialize the discoveries of his research group.
MindX provides the suicide screening tool in a digital app format, but on a larger scale, the startup focuses on blood biomarkers. The young company has commercialized six blood tests doctors can use to help diagnose a variety of conditions, including suicide risk, mood disorders (depression/bipolar), PTSD and memory/Alzheimer’s. Niculescu says the biomarkers can also match the patient to the right treatments based on their biology, rather than the current trial-and-error method. He’s confident many of the tools will become standards of care in three to five years.
“I know people are suffering, and I take that very seriously,” says Niculescu, who is founder, chairman and chief executive officer of MindX Sciences. “[Before MindX], it was frustrating to not have an avenue for people to get tested. We wanted to move [our discoveries] outside the academic ‘ivory tower’ and into the real world where they can make an impact, so we did that with MindX.”
The startup’s leadership team includes Hoosier heavy-hitters Dr. Don Brown and Dr. Anantha Shekhar, and former U.S. Surgeon General Dr. Jerome Adams serves on the advisory board. The startup’s next pressing task is to deploy the suicide risk tool on a college campus in Indiana—most likely via an app—because college students are a high-risk population.
“We’re doing our best every single day on the academic side and the commercial side to make these tools available and make a difference. The more widely they’re used, the more we can make a dent in suicide prevention,” says Niculescu. “We wanted to see if we could develop something simpler, better and more powerful. That’s what we set out to do, and that’s what we achieved.”
Niculescu says the next challenge is doing “the missionary work” of spreading the word, so the test can be used widely in clinical practice.
Niculescu says his fellow researchers “rolled up their sleeves” three years ago to turn their discoveries into products and “having the stickability is what made the difference.”