Dr. Elizabeth Ballard, Director of Psychology and Behavioral Research and Director of Pre-Doctoral Training at the National Institute of Mental Health's Experimental Therapeutics and Pathophysiology Branch, joins the JCP Podcast to trace the full arc of suicide risk assessment and treatment. Dr. Ballard helped develop the Ask Suicide Screening Questionnaire (ASQ) and was first co-author on the individual patient data meta-analysis establishing ketamine's rapid antisuicidal effect.

Suicide risk is assessed in some form during nearly every patient encounter, yet the tools clinicians use and the evidence behind current treatments remain works in progress. Dr. Ballard discusses the sensitivity-specificity trade-offs built into screening instruments, what ketamine research reveals about suicidality as distinct from depression, emerging biomarkers such as nocturnal wakefulness and electrophysiological signatures of hopelessness, and the ethical case for including suicidal patients in clinical research rather than excluding the population clinicians most need evidence for.

🎯 KEY EPISODE HIGHLIGHTS:

🩺 SCREENING IS A LIFE-OR-DEATH TRADE-OFF [11:00]

“This is literally a life or death situation, and so you don't want people slipping through the cracks that aren't getting identified.”

Ballard frames the sensitivity-specificity trade-off built into suicide screening tools like the ASQ as a stakes-defining design choice, not just a statistical one.

🎯 SUICIDE RISK IS MULTIFACTORIAL, SO WHERE DO YOU START [39:00]

“There's so many factors that lead somebody in a moment of crisis to think about ending their lives.”

Ballard argues clinicians can't treat every contributing factor at once, which is why her research isolates modifiable targets like hopelessness rather than suicide risk as a whole.

❤️ WHEN IN DOUBT, ASK [52:30]

“When in doubt, ask. There's no harm in asking.”

Ballard's single most actionable takeaway: approach suicide risk assessment with curiosity rather than treating it as a documentation exercise.

CHAPTERS:

00:00 – Introduction: Dr. Elizabeth Ballard's Path to Suicide Research

05:30 – Building and Calibrating the ASQ Screening Tool

12:30 – The 2018 AJP Ketamine Meta-Analysis: Pooling Individual Patient Data

17:30 – Disentangling Ketamine's Effect on Suicidality from Depression

20:30 – Ketamine's Response Trajectory and IV vs. Esketamine Comparison

25:30 – Nocturnal Wakefulness as a Warning Sign for Suicidal Ideation

31:00 – MEG and Electrophysiological Signatures of Suicide Risk

34:00 – Concordance Across Suicide Risk Assessment Scales

38:00 – Hopelessness as a Distinct, Modifiable Treatment Target

41:00 – Neurofeedback and Episodic Future Thinking at Neu Hope

45:00 – Ethically Including Suicidal Patients in Clinical Research

52:00 – Closing Clinical Takeaway: Asking with Curiosity

LINKS:

Full transcript and show notes:

https://www.psychiatrist.com/jcp/ep21-rethinking-suicide-risk-screening-treatment-elizabeth-ballard/

Journal of Clinical Psychiatry

https://www.psychiatrist.com/jcp/

Publisher of peer-reviewed research discussed in this episode.

Ask Suicide-Screening Questions (ASQ) Toolkit – NIMH

https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials

Free NIMH toolkit for the screening instrument Dr. Ballard helped develop, discussed at length in this episode.

Dr. Elizabeth Ballard – LinkedIn

https://www.linkedin.com/in/elizabeth-ballard-943245350/

#SuicideRiskAssessment #Ketamine #SuicidePrevention #ClinicalResearchEthics #Hopelessness