Expired NOT-MH-21-090: Notice of Special Interest (NOSI) in Reducing Suicide Risk in Young People in Low- and Middle-Income Countries and Low-Resource Settings

Notice of Special Interest (NOSI) in Reducing Suicide Risk in Young People in Low- and Middle-Income Countries and Low-Resource Settings

Notice Number:

NOT-MH-21-090

Key Dates

Release Date:

March 2, 2021

First Available Due Date:

June 05, 2021

Expiration Date:

May 08, 2024

Related Announcements

RFA-MH-23-260 - Suicide Prevention Across the Life Span in Low- and Middle-Income Countries (R34 Clinical Trial Optional)

NOT-MH-21-305 - Notice of Change to NOT-MH-21-090

PAR-21-131 - Pilot Effectiveness Trials for Treatment, Preventive and Services Interventions (R34 Clinical Trial Required)

PAR-21-129 Clinical Trials to Test the Effectiveness of Treatment, Preventive, and Services Interventions (Collaborative R01 Clinical Trial Required)

PAR-21-130 Clinical Trials to Test the Effectiveness of Treatment, Preventive, and Services Interventions (R01 Clinical Trial Required)

PAR-21-132 Confirmatory Efficacy Clinical Trials of Non-Pharmacological Interventions for Mental Disorders (R01 Clinical Trial Required)

PAR-21-134 Development of Psychosocial Therapeutic and Preventive Interventions for Mental Disorders (R33 Clinical Trial Required)

PAR-21-135 Development of Psychosocial Therapeutic and Preventive Interventions for Mental Disorders (R61/R33 Clinical Trial Required)

PAR-19-189 Pilot Services Research Grants Not Involving Clinical Trials (R34 Clinical Trial Not Allowed)

PA-20-185 NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed)

PA-20-183 Research Project Grant (Parent R01 Clinical Trial Required)

PA-18-350 NIMH Exploratory/Developmental Research Grant (R21 Clinical Trial Not Allowed)

PAR-19-384 Research on Biopsychosocial Factors of Social Connectedness and Isolation on Health, Wellbeing, Illness, and Recovery (R01 Basic Experimental Studies with Humans Required)

PAR-19-373 Research on Biopsychosocial Factors of Social Connectedness and Isolation on Health, Wellbeing, Illness, and Recovery (R01 Clinical Trials Not Allowed)

PAR-19-274 Dissemination and Implementation Research in Health (R01 Clinical Trial Optional)

PAR-19-275 Dissemination and Implementation Research in Health (R21 Clinical Trial Optional)

Issued by

National Institute of Mental Health (NIMH)

Purpose

Purpose

The National Institute of Mental Health is issuing this Notice of Special Interest (NOSI) to highlight interest in developing and implementing prevention strategies to reduce suicide risk (suicide ideation and behavior, including acts of self-harm/suicide) and promote resilience among young people, age 10-24 years, in low-and middle-income countries (LMICs)and low-resources settings. NIMH welcomes applicants from LMICs and strongly encourages applicants from the United States or upper middle-income countries to partner with sites in LMICs.

Background

Suicide is a significant global public health problem and a major contributor to the total burden of disease and mortality. Nearly 800,000 people die by suicide each year with a global age-standardized suicide rate of 10.5 per 100,000 population (see WHO statistics). It is estimated that 79% of the world’s suicides occur in LMICs. The overall suicide rate in LMICs might actually be higher than estimated since many LMICs lack a national suicide surveillance system and a systematic reporting system. Local and cultural factors may also contribute to under-reported statistics on suicide and suicide behavior, such as stigma, religious beliefs, and judicial and legal practices. Globally, the suicide rate among men is higher than women, although the male-to-female ratio also varies by country. In general, the male-to-female ratio is much higher in high-income countries (HIC) (ratio 3.5 per 100.000) compared to in LMICs (ratio 1.6 per 100.000). More research is needed to better understand the sex and gender influences on susceptibility to suicidality in different contexts.

Young People (10-24 years)

Although suicide occurs throughout the lifespan, globally nearly one-third of all suicides occur among young people and suicidal thoughts and behaviors are common among college-age students. Suicide is the leading cause of death for females aged 15 19 years, and the second leading cause of death among individuals aged 15-29 years. In LMICs, where up to 90% of adolescents (10-19 years) reside, suicide rates for the total population are higher than rates in HICs. There is limited information about the prevalence of suicide ideation and behaviors (SIB) specifically among young people (10-24 years) across the globe, defining a need to better understand the mechanisms of risk, effective protective factors, and improved strategies for prevention.

Risk and Protective Factors

Although some data are emerging from LMICs, the majority of data regarding risk factors for youth suicide come from HICs, including, the United States, Canada, and the European Union. The risk factors derived from this body of knowledge include intrapersonal/interpersonal factors such as the presence of psychiatric disorders or limited education, family/peer factors including parental support and/or conflict, and school and community factors such as stigma, bullying, and exposure to suicide. Mental illnesses are strong predictors of suicide attempts, and mental health disorders are equally predictive in HICs and LMICs, but there are differences in the specific mental illnesses that are most predictive. In HICs, mood disorders are the strongest diagnostic risk factor for adult suicide attempts. In LMICs, PTSD, substance use disorders, and impulse control disorders are strong predictors of suicide attempts. Risk and protective factors have not been adequately studied in LMICs and gaps in our knowledge remain.

Suicide Risk Prevention Approaches

Programs designed to minimize risk factors for suicide globally have typically involved primary prevention efforts. Within this framework, universal interventions aim to target the general population, such as reducing access to lethal means or promoting effective mental health policies and ensuring education through media. Selective prevention strategies focus on subgroups with substantial risk for suicide, such as people with mental disorders. These include school and community- based-prevention programs, or crisis intervention and management of SIB with individuals with mental health disorders, including alcohol and/or substance use.

Currently, interventions/strategies are primarily designed to target individuals who have attempted suicide (indicated interventions), but very few strategies target young people for early identification and prevention interventions. While some programs have begun to introduce prevention and screening strategies in community and primary care settings and community-level platforms, there is a need to develop culturally adapted preventive strategies for young people with a focus on multiple risk factors across multiple settings, such as primary care, education, employment, social welfare, and justice settings.

Areas of Research Interest

To address the gaps in our knowledge about suicide risk and prevention in young people age 10-24 years in LMIC and low-resource settings (see definitions below), NIMH is particularly interested in research on the following topics:

Epidemiology, Etiology and Trajectories

Research is needed to better understand risk and protective factors specific to young people as well as to build and sustain local research capacity. Studies are encouraged to improve or implement surveillance systems of suicide-related behaviors, suicide deaths, and treatment outcomes in LMICs and low-resource settings with an emphasis on promoting linkage to care, including:

Studies that seek to identify protective and risk factors at the level of the individual, family, peer social networks, and community, which might serve as targets for preventive interventions for young people. The use of research domain criteria (RDoC) framework and constructs are also encouraged, if applicable, as is the use of longitudinal designs. Research evaluating the impact of social drivers, mediators, or population-level factors, such as economic declines, changing social structures, and/or health epidemics/pandemics, on suicidal behaviors in young people.
Studies to evaluate the role of adverse childhood experiences in contributing to mental health difficulties, suicide, and SIB. Adverse childhood experiences can include exposure to physical/emotional/sexual trauma and abuse, poverty, economic insecurity, neighborhood violence, family loss and grief, racism, and discrimination based on religion, ethnicity, race, sexual or gender identity.
Studies that examine the influence of social media, mass media, and communication channels on suicide ideation and behaviors.
Studies that test the use of risk algorithms in different settings, such as primary care clinics, community health centers, schools and universities, and on social media to identify individuals at high risk and improve suicide prevention outcomes among young people.

Preventive, Treatment, Services Intervention and Implementation

NIMH encourages research approaches that specify the conceptual model(s) and address the mediators, moderators, and mechanisms of interventions or implementation of services that prevent suicide, consistent with the NIMH experimental therapeutics approach (defined in Clinical Trials - Applicant FAQs, Q1). Topics of interest to NIMH include:

Studies that develop and test relevant preventive interventions that take into account mechanisms of culturally relevant risk and/or resilience factors, including social determinants of health and comorbid factors related to alcohol and drug use for young people.
Effectiveness trials that identify and/or intervene on mechanisms through which empirically identified moderators result in differential effectiveness of research-supported preventive interventions among young people.
Studies to determine how to improve the adoption, fidelity of dissemination and implementation, sustainability, and economic evaluation of effective suicide prevention programs for young people, including strengths-based and resilience-focused approaches.
Studies to test implementation strategies to integrate screening for SIB and delivery of suicide prevention strategies within existing community-level platforms, such as child welfare, social care services, and school/university-based programs.
Studies to develop innovative models to integrate suicide screening for SIB prevention and treatment into existing healthcare platforms in LMICs, for example, integrating into primary care and HIV clinics, and community health care services for non-communicable diseases.
Studies to examine the impact of changes in policy/regulations (e.g., access to lethal means, financing and reimbursement of public and private health care and other services) on rates of suicide of young people in LMICs and low-resource settings.
Studies focused on developing, testing, and implementing strategies to reduce access to lethal means at the national level (e.g., national and local action plans and programs), local level (e.g., reducing risk environments), and community level (e.g., training community health workers for recognition and management of suicide behavior; providing community storage facility to reduce access to lethal means), and to measure the impact of these strategies on suicide-related outcomes in young people in LMICs and low-resource settings.

Methodological Considerations

Applicants are encouraged to provide information on the country, region, or local community where the study is being proposed with relevant information related to available suicide rates. This should include demographics with gender, age, ethnicity, or geographical location; most common means of suicide or suicide attempt; risk factors; availability of helpful resources; social cultural context of target population and settings; and public health impact of the proposed suicide prevention strategies. NIMH also strongly encourages collaboration with in-country government agencies, non-governmental organizations, health care institutions and organizations, and other sectors such as education, employment, social welfare, and justice settings in order to be responsive to local needs and interests and to increase the likelihood of long-term sustainability, generalizability, and scalability. Proposed applications are expected to include multiple stakeholders, including young people and people with lived experience, in the development of the research plan.

For the purposes of this NOSI, NIMH uses the following definitions:

Under-resourced settings are settings in which limited capital and human resources create barriers to meeting the mental health care needs of the population being served
LMICs designated by World Bank

LMICs and low-resource settings present several challenges to delivering mental health care that should be taken into account and addressed in the proposed research plan, including participation of in-country suicide experts, trained and specialized mental health workers, mental health stigma among care providers, task sharing approaches and challenges, high staff turn-over, strategies to improve quality of care, delivery system challenges, lack of government investment for mental health, cost-effective and /or budgetary impact to delivery of evidence-based interventions, and inadequate protection services and human rights for young people and others.

It is strongly recommended that applicants review the NIMH Center for Global Mental Health website and consult with a Program Officer before application submission. Applicants should also consult NOT-MH-19-027 for NIMH policies on oversight and monitoring of clinical research.

Application and Submission Information

This notice applies to due dates on or after June 5, 2021 and subsequent receipt dates through May 7, 2024.

Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcements through the expiration date of this notice.