Understanding the Complexities of Suicide Risk: A Conversation With Jill Harkavy-Friedman, PhD, and Elizabeth Ballard, PhD

“Psychopharm Today” is a video-podcast series, created collaboratively with the American Society of Clinical Psychopharmacology (ASCP), in which members converse about the latest hot topics in psychopharmacology.

Suicide is the eleventh leading cause of death overall in the United States, claiming the lives of over 49,300 people.¹

In this inaugural episode of “Psychopharm Today,” host Jenessa Johnston, PhD, and guests Jill Harkavy-Friedman, PhD, and Elizabeth Ballard, PhD, discuss the limitations of current diagnosis-based frameworks in suicide research, emphasizing the need for more targeted interventions. They highlight that suicide is a leading cause of psychiatric-related death, affecting individuals across various mental health diagnoses. The discussion is based on a recent panel at the 2026 ASCP annual meeting about targeted interventions for suicide prevention.

The conversation covers the importance of including suicide-specific research, the challenges of powering and designing such studies, and the role of organizations like the American Foundation for Suicide Prevention (AFSP) in funding and supporting this research. Harkavy-Friedman specifically mentions the limitations of current research studies that focus on depression or bipolar disorder and exclude suicidal individuals; suicide has its own biology and psychosocial origins. Many clinicians falsely equate suicidal thoughts with depression. Harkavy-Friedman stated she frequently has to argue that they are distinct.

They group also discusses the impact of treatment on suicidal ideation, the significance of clinician-patient communication, and the potential for personalized treatment approaches based on individual risk factors and responses to interventions. Notably, treating mental health conditions does not necessarily reduce suicidal ideation and behavior. Ballard noted that 90% of people who die by suicide have experienced symptoms of a mental health condition²; however: “Suicide is more complex than that. It has to do with decision making, with weighing a risk, with emotion regulation, and an ability to control your behaviors. I think it is just much more complicated than diagnosis.”

Harkavy-Friedman conducted a 2-year study about suicide in individuals with schizophrenia, and found that having the opportunity to give back, to make a difference, was hugely important to individuals with suicidal ideation.³

“I have found if you are inquisitive about people and not just checking off a checklist, but you are really inquisitive, people want to understand, and so they want you to understand, and then you can help not just them, but everyone. If you are opening to listening to people's stories, they will tell you much more than you anticipate,” said Harkavy-Friedman.

Dr Johnston is a postdoctoral fellow at National Institute of Mental Health.

Dr Harkavy-Friedman is senior vice president of research at the American Foundation for Suicide Prevention.

Dr Ballard is an associate scientist, the director of Psychology and Behavior Research, and the director of Predoctoral Training in the Experimental Therapeutics and Pathophysiology Branch at the National Institute of Mental Health.

References

1. Suicide. NIMH. Accessed June 8, 2026. https://www.nimh.nih.gov/health/statistics/suicide

2. Isometsä ET. Psychological autopsy studies--a review. Eur Psychiatry. 2001;16(7):379-385.

3. Harkavy-Friedman JM, Restifo K, Malaspina D, et al. Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide. Am J Psychiatry. 1999;156(8):1276-1278.