Duke Center for the Study of Suicide Prevention and Intervention (CSSPI)

The Duke Center for the Study of Suicide Prevention and Intervention (CSSPI) represents a collaborative effort among several research scientists at the Duke Child and Family Study Center to advance the knowledge base on suicide risk and prevention using innovative, multidisciplinary, and scientifically-sound research studies. The CSSPI partners with local, state, and national community organizations and foundations, as well as academic institutions.

Specifically, the faculty members affiliated with the CSSPI maintain active collaborations with several groups, including:

CSSPI faculty include:


The CSSPI has three key missions related to (1) research, (2) intervention, and (3) education.


The faculty members of the CSSPI have conducted research focused on understanding the emergence and maintenance of adolescent suicidal and self-harming behaviors, and on the prevention and treatment of suicidal behaviors. Studies have examined the course and risk for suicidal behavior from adolescence through young adulthood, the emotional and behavioral outcomes of high-risk youths, and the impact of adolescent suicidal behavior on parents’ well-being and involvement in youths’ treatment. Studies also have focused on the development and evaluation of a new intervention (Cognitive Behavioral Therapy – Relapse Prevention or CBT-RP) for suicidal young people with depression and alcohol-/substance abuse disorders, the evaluation of national suicide prevention efforts funded through the Garrett Lee Smith Memorial Suicide Prevention Act, and the evaluation of a new intensive cognitive behavioral intervention (Post Admission Cognitive Therapy or PACT) aimed at preventing the recurrence of suicidal behaviors among individuals in the military. As part of CSSPI’s focus on fostering collaboration, the CSSPI also hosts monthly research conference calls pertaining to research on suicide risk and interventions, with investigators from Duke University, University of North Carolina Greensboro, University of North Carolina Chapel Hill, George Mason University, Uniformed Services University of the Health Sciences, Johns Hopkins University, the University of Puerto Rico, Simmons School of Social Work/Harvard University, and other academic institutions.

Ongoing Studies and Collaborative Research and Evaluation Efforts
  • Cognitive and Affective Mechanisms of Risk for Suicidal Thoughts and Behavior (NIMH R01-MH48762) – In the context of a prospective (20 year), naturalistic, repeated assessment study of long-term psychological adjustment following adolescent psychiatric hospitalization, we are examining processes associated with risk, resilience, and developmental trajectories of suicidal thoughts and behavior. Consistent with NIMH strategic priorities, this study is examining mechanisms of risk across domains, including cognitive (decision-making), psychophysiological, and affective (automatic affective responses). This is one of the few longitudinal studies to follow individuals at risk for an extended period of time, through two developmental periods (adolescence and adulthood).
  • Cognitive/Affective Mechanisms of Risk among Suicidal Adults with and without Substance Abuse (AFSP Distinguished Investigator Grant 0-134-11) – In this study of mechanisms of risk associated with suicidal behavior, we are examining decision-making biases, psychophysiological patterns of response, and automatic affective responses to different types of stimulus cues among three groups of psychiatrically hospitalized adult patients with depression: (a) patients with no history of suicide attempts and no current substance abuse; (b) patients with suicide attempts but no substance abuse; and (c) patients with both suicide attempts and substance abuse. We are examining the relationship of these mechanisms to post-discharge levels of suicidal thoughts.
  • Post Admission Cognitive Therapy (PACT) for Treatment of Military Personnel with Suicidal Behaviors: A Multi-Site Randomized Trial. (DOD Contract W81XWH-11-2-0106) - This study is a randomized controlled trial of an augmenting intensive cognitive behavioral intervention and follow-up care for military personnel who have been hospitalized following suicide attempts. Via subcontract from the Henry Jackson Foundation, Duke University has collaborated in the development of this study and is providing follow-up assessments for military personnel participating in this study
  • The Garrett Lee Smith Memorial Suicide Prevention Cross-Site Evaluation (SAMHSA/CMHS Contract 280-03-1606) - Via a contract from SAMHSA to ICF, a cross-site evaluation is being conducted of the state, tribal, and campus suicide prevention programs funded via the Garrett Lee Smith Memorial Act. Duke University is participating in this project as part of the cross-site evaluation team. As part of this effort, Duke University recently took the lead in preparing a white paper regarding policies and protocols for youths at risk for suicide, and youths who have attempted suicide that are identified through suicide prevention programs or present in emergency settings. In a recent finding from the cross-site evaluation, communities in which Garrett Lee Smith Suicide Prevention programs had been implemented were found to have reduced rates of suicide deaths when compared to communities without these suicide prevention programs.
Past Studies
  • Impact of Adolescent Suicide Attempts on Parents (NIMH R01-MH081947) - The study was designed to help us learn more about the impact of adolescent suicidal behavior and psychiatric hospitalization on families, and the needs of families working with suicidal youths. In this study, mothers of 144 teenagers who were hospitalized for suicide attempts and mothers of 144 teenagers who were hospitalized for other reasons participated in assessments at 1, 3, 6, and 12 months after hospital discharge. We are studying the treatment and support needs for mothers, the differences among mothers in their reactions to suicidal behavior, factors related to differences among families in how they cope with adolescent difficulties, and how differences among families are related to treatment participation and parenting after hospitalization. In two supplements to this study from NIMH, we are examining racial and ethnic differences among mothers in the impact of suicidal behavior, and the impact of suicidal behavior on fathers.
  • Relapse Prevention for Suicidal Dually Diagnosed Youths (NIMH R34-MH67904) - An augmenting motivational interviewing and cognitive behavioral relapse prevention intervention (CBT-RP) for suicidal, depressed, and alcohol or substance abusing/dependent adolescents was developed, refined, and compared to treatment as usual in a pilot randomized controlled trial. There was preliminary evidence that youths receiving CBT-RP as an augmenting intervention had larger improvements in depressive symptoms and suicide ideation, and were less likely to need intensive intervention (e.g., hospitalization, day treatment, intensive outpatient care, residential treatment) relative to youths without the intervention.


The CSSPI faculty members and trainees, including clinical psychology interns and child psychiatry fellows, provide clinical services through the Duke Child and Family Study Center. Services are available for children, adolescents, adults, and families seeking evidence-based assessment, diagnosis, and treatment services for a range of psychological or adjustment difficulties, including suicide-related thoughts and behaviors and self-harm. For more information, please contact the Referral Coordinator at 919-668-0038.


The CSSPI is involved in the provision of training opportunities for individuals interested in suicide- or self-harm-related research. Mentored research experiences are available for graduate students, postdoctoral fellows, and junior faculty. Opportunities also are available for clinical training in the assessment and treatment of suicide-related thoughts and behaviors. The CSSPI is involved in outreach and education in the community, including consultation with Durham Public Schools, collaboration with the NC Chapter of the American Foundation for Suicide Prevention and Duke Integrated Pediatric Mental Health.


American Foundation for Suicide Prevention

American Association of Suicidology

Depression and Bipolar Support Alliance

National Action Alliance for Suicide Prevention

National Institute of Mental Health

Substance Abuse and Mental Health Services Administration (SAMHSA)

Suicide Prevention Resource Center

The Jed Foundation

The Trevor Project

The National Suicide Prevention Lifeline - 1-800-273-TALK (8255) is a free, 24-hour hotline available to anyone in suicidal crisis or emotional distress.

Selected Recent Publications

Goldston, D. B. Daniel, S., Erkanli, A., Heilbron, N., Doyle, O., Weller, B., Sapyta, J., Mayfield, A., & Faulkner, M. (2015). Suicide attempts in a longitudinal sample of adolescents followed through adulthood: Evidence of escalation. Journal of Consulting and Clinical Psychology, 83(2), 253-264.

Walrath, C., Garraza, L., Reid, H., Goldston, D. B., & McKeon, R. (2015). Impact of the Garrett Lee Smith Youth Suicide Prevention program on suicide mortality. American Journal of Public Health, 105(5), 986-993.

Weller, B., Faulkner, M., Doyle, O., Daniel, S. S., & Goldston, D. B. (2015). Impact of patients’ psychiatric hospitalization on caregivers: A systematic review. Psychiatric Services, 66(5), 527-535.

Condron, D., Garraza, L., Walrath, C., McKeon, R., Goldston, D., & Heilbron, H. (2014). Identifying and referring youths at risk for suicide following participation in school-based gatekeeper training. Suicide and Life-Threatening Behavior, Advance Online Publication.

Conner, K. R., Wyman, P., Goldston, D. B., Bossarte, R. M., Lu, N., Kaukeinen, K., Tu, X., Houston, R. J., Lamis, D. A., Chan, G., Bucholz, K. K., & Hesselbrock, V. M. (2014). Two studies of connectedness to parents and suicidal thoughts and behavior in children and adolescents. Journal of Clinical Child and Adolescent Psychology. Advance Online Publication.

Conner, K., Bossarte, R., Lu, N., Kaukeinen, K., Chan, G., Wyman, P., Tu, X., Goldston, D., Houston, R., Bucholz, K., & Hesselbrock, V. (2014). Parent and child psychopathology and suicide attempts among children of parents with alcohol use disorder. Archives of Suicide Research, 18(2), 117-130.

Conner, K. R., Bagge, C. L., Goldston, D. B., & Ilgen, M. A. (2014). Alcohol and suicidal behavior: What is known and what can be done. American Journal of Preventive Medicine, 47(3), S204-S208.

Heilbron, N., Franklin, J. C., Guerry, J. D., & Prinstein, M. J. (2014). Social and ecological approaches to understanding suicidal behaviors and nonsuicidal self-injury. In M. Nock (Ed.), The Oxford Handbook of Suicide and Self-Injury, 206-234.

Goldston, D. B., Weller, B, & Doyle, O. (2013). Suicide. In G. Nagayama-Hall, L. Comas-Diaz, V. McLloyd & J. Trimble. APA Handbook of Multicultural Psychology. Washington, DC: American Psychological Association Press.

Pisani, A., Wyman, P., Petrova, M. Schmeelk-Cone, K., Goldston, D., Xia, Y., & Gould, M. (2013). Emotion regulation difficulties, youth-adult relationships, and suicide attempts among high school students in underserved communities. Journal of Youth and Adolescence, 42, 807-820.

Heilbron, N., Goldston, D., Walrath, C., Rodi, M., & McKeon, R. (2013). Suicide risk protocols: Addressing the needs of high-risk youths identified through suicide prevention efforts and in clinical settings. Suicide and Life-Threatening Behavior, 43, 150-160.

Sapyta, J., Goldston, D., Erkanli, A., Daniel, S., Heilbron, N., Mayfield, A., & Treadway, S. (2012). Evaluating the predictive validity of suicidal intent and medical lethality in youth. Journal of Consulting and Clinical Psychology, 80, 222-231.

Pisani, A., Schmeelk-Cone, K., Gunzer, D., Petrova, M., Goldston, D., Tu, X., & Wyman, P. (2012). Association between high school students’ help-seeking and their attitudes and perceptions of social environment. Journal of Youth and Adolescence, 41(10), 1312-1324.

Daniel, S. S., & Goldston, D. B. (2012). Hopelessness and lack of connectedness to others as risk factors for suicidal behavior across the lifespan: Implications for cognitive-behavioral treatment. Cognitive and Behavioral Practice, 19(2), 288-300.

Ellis, T., & Goldston, D. B. (2012). Working with suicidal clients: Not business as usual. Cognitive and Behavioral Practice, 19, 205-208.

Esposito-Smythers, C., Walsh, A., Spirito, A., Rizzo, Christie; Goldston, David, B., & Kaminer, Y. (2012). Working with the suicidal client who also abuses substances. Cognitive and Behavioral Practice, 19(2), 245-255.

Pisani, A., Schmeelk-Cone, K., Gunzler, D., Petrova, M., Goldston, D. B., Tu, X., & Wyman, P. A. (2012). Associations between suicidal high school students’ help-seeking and their attitudes and perceptions of social environment. Journal of Youth and Adolescence.

Wells, K. C., & Heilbron, N. (2012). Family-based cognitive-behavioral treatments for suicidal adolescents and their integration with individual treatment. Cognitive and Behavioral Practice, 19(2), 301-314.

Goldston, D. B., Curry, J. F., Wells, K. C., & Roley, M. (2011). Assessment and treatment of suicidal behavior. In Y. Kaminer and C. Winters (Eds.), Clinical manual of adolescent substance abuse treatment. Arlington, VA: American Psychiatric Publishing, Inc., 349-377.

Esposito-Smythers, C., Miller, A., Weismoore, J., Doyle, O., & Goldston, D. B. (2011). Suicide. In R. Brown & M. Prinstein (eds.), Encyclopedia of Adolescence, New York: Elsevier.

van Tilburg, M.A.,Spence, L., Naomi J., Whitehead, W.E., Bangdiwala, S., & Goldston, D. B. (2011). Chronic pain in adolescents is associated with suicidal thoughts and behaviors. The Journal of Pain, 12(10), 1032-1039.

Weller, B., & Goldston, D. B. (2011). Suicidal thoughts and behavior and non-adherence to medical regimen.. In A. Berman and M. Pompili (Eds.), Medical condition and suicide risk. Washington, DC: American Association of Suicidology.

Dew, R., Daniel, S. S., Goldston, D. B., McCall, W. V., Kuchibhatia, M., Schieffer, C., Triplett, M., & Koenig, H. (2010). A prospective study of religion/spirituality and depressive symptoms among adolescent psychiatric patients. Journal of Affective Disorders, 120,149-157.

Franklin, J. C., Hessel, E. T., Aaron, R. V., Arthur, M. S., Heilbron, N., & Prinstein, M. J. (2010). The functions of nonsuicidal self-injury: Support for cognitive–affective regulation and opponent processes from a novel psychophysiological paradigm. Journal of Abnormal Psychology, 119(4), 850-862.

Goldston, D. B., Walrath, C. M., McKeon, R., Puddy, R. W., Lubell, K. M., Potter, L. B., & Rodi, M. S. (2010). The Garrett Lee Smith Memorial Suicide Prevention programs. Suicide and Life-Threatening Behavior, 40(3), 245-256.

Heilbron, N., Compton, J. S., Daniel, S. S., & Goldston, D. B. (2010). The problematic label of suicide gesture: Alternatives for clinical research and practice. Professional Psychology: Research and Practice, 41(3), 221-227.

Heilbron, N., & Prinstein, M. J. (2010). Adolescent peer victimization, peer status, suicidal ideation, and nonsuicidal self-injury. Merrill-Palmer Quarterly: Journal of Developmental Psychology, 56(3), 388-419.

Prinstein, M. J., Heilbron, N., Guerry, J. D., Franklin, J. C., Rancourt, D., Simon, V., & Spirito, A. (2010). Peer influence and nonsuicidal self injury: Longitudinal results in community and clinically-referred adolescent samples. Journal of Abnormal Child Psychology, 38(5), 669-682.

Wilson, M. P., Castillo, E. M., Batey, A. M., Sapyta, J., & Aronson, S. (2010). Hepatitis C and depressive symptoms: Psychological and social factors matter more than liver injury. International Journal of Psychiatry in Medicine, 40(2), 199-215.

Barksdale, C., Walrath, C., Compton, J. S., & Goldston, D. B. (2009). Caregiver burden and suicide attempts: Are they related? Suicide and Life Threatening Behavior, 39,152-160.

Daniel, S., & Goldston, D. (2009). Interventions for suicidal youths: A review of the literature and developmental considerations. Suicide and Life Threatening Behavior, 39, 252-268.

Daniel, S., Goldston, D., Erkanli, A., Franklin, J., & Mayfield, A. (2009). Trait anger, anger expression, and suicide attempts among adolescents and young adults: A prospective study. Journal of Clinical Child and Adolescent Psychology, 38, 661-671.

Goldston, D. B., Daniel, S. S., Erkanli, A., Reboussin, B. A., Mayfield, A., Frazier, P., & Treadway, S. L. (2009). Psychiatric disorders as contemporaneous risk factors for suicide attempts among adolescents and young adults: Developmental changes. Journal of Consulting and Clinical Psychology, 77, 281-290.