Clear Intent - Suicidology Data and Evidence

Tyler Black, MD

A psychiatrist and suicidologist walks through new research on suicide, psychiatric medications and mental health, looking closely at what the data actually show. Hosted by Dr. Tyler Black, with charts, references and a written version of every episode at suicidology.substack.com. suicidology.substack.com

Episodes

  1. 4h ago

    Episode 4 - Can we predict suicide?

    Can we predict who will die by suicide? In 1983, Alex Pokorny tried with 4,800 psychiatric inpatients and nearly every rating scale available. More than 96% of the men he flagged as high risk did not die by suicide, and more than half of those who did had been rated low risk. Four decades later, we have machine learning, health records on millions of people, and a Harvard smartphone study reported this year as a “weather app” for suicide risk, with accuracy figures as high as 94%. Dr. Tyler Black works through what those numbers mean, starting with a plain-language primer on sensitivity, specificity and positive predictive value, then looks at what happens to the Harvard model when it meets patients it hasn’t seen before. Along the way he covers the 2025 meta-analysis of 53 machine learning studies, the US Army’s 2026 algorithm, and the VA’s REACH VET program, which has been flagging veterans since 2017. He also argues for what clinicians should do instead: give everyone the basics that work, and build every assessment around the individual person’s own risk and protective factors. If you are struggling, in Canada and the US call or text 988. References for this podcast: Pokorny et al., (1983) Prediction of suicide in psychiatric patients. Report of a prospective study, Archives of General Psychiatry. Large et al., (2016) Meta-analysis of longitudinal cohort studies of suicide risk assessment among psychiatric patients: heterogeneity in results and lack of improvement over time, PLOS ONE. Belsher et al., (2019) Prediction models for suicide attempts and deaths: a systematic review and simulation, JAMA Psychiatry. Spittal et al., (2025) Machine learning algorithms and their predictive accuracy for suicide and self-harm: systematic review and meta-analysis, PLOS Medicine. Nock et al., (2026) Using smartphone surveys to predict next-week suicide attempts, Journal of Psychopathology and Clinical Science. Get full access to Suicidology Data and Evidence at suicidology.substack.com/subscribe

    Episode 4 - Can we predict suicide?

  2. Oct 6

    Episode 3: Can Suicide Spread? The Evidence on Media and Contagion

    In the five months after Robin Williams' death in 2014, the US recorded about 1,800 more suicides than expected, most of them by the same method that was widely reported. Dr. Tyler Black goes through the history and evidence on suicide contagion, from Goethe's Werther to Vienna's subway, shares his own analyses of Robin Williams and 13 Reasons Why, and covers what clinicians, journalists and all of us can do when a famous person dies by suicide. Corrections: In the opening, the roughly 1,800 excess deaths include all methods; about 1,150–1,400 were by the method that was reported. Physicians can self-claim time spent listening to this episode or reading this post under Royal College MOC Section 2 (Personal Learning) or as non-certified Mainpro+ credits. Other health professionals should follow their own college's CPD rules. Get full access to Suicidology Data and Evidence at suicidology.substack.com/subscribe

  3. Sep 29

    Pollution and Suicide - A huge meta-analysis makes huge errors

    Thanks to everyone listening so far. Please share and consider subscribing to the substack (suicidology.substack.com) to support this. Resource list: Our paper today: Jones SM, Garcia L, Cleland CL, et al. Environmental exposure and risk of death by suicide, attempted suicide and suicide ideation: a systematic review and meta-analysis .J Epidemiol Community Health Published Online First: 15 September 2026. doi: 10.1136/jech-2025-225491 * EurekAlert press release * Kim et al. (2010), Am J Psychiatry * Szyszkowicz et al. (2010), Environmental Health Insights * Braithwaite et al. (2019), Environmental Health Perspectives * Heo et al. (2021), IJERPH * Persico & Marcotte (2026), Journal of Health Economics * Frangione et al. (2022), Environmental Research * Burke et al. (2018), Nature Climate Change * Ro et al. (2026), Nature Mental Health Get full access to Suicidology Data and Evidence at suicidology.substack.com/subscribe

    Pollution and Suicide - A huge meta-analysis makes huge errors

  4. Sep 22

    Episode 1 - Crisis Lines at Hotspots May Harm more than they Help

    As always, please consider subscribing to this podcast, and supporting ime suicidology.substack.com, so I can continue to create content for suicidology education. References for this show: Bagley, C. (1968). The evaluation of a suicide prevention scheme by an ecological method. Social Science & Medicine, 2(1), 1–14. Garnett, M. F., et al. (2025). Changes in suicide rates in the United States from 2022 to 2023 (NCHS Data Brief No. 541). National Center for Health Statistics. Gould, M. S., et al. (2007). An evaluation of crisis hotline outcomes. Part 2: Suicidal callers. Suicide and Life-Threatening Behavior, 37(3), 338–352. Hoffberg, A. S., et al. (2020). The effectiveness of crisis line services: A systematic review. Frontiers in Public Health, 7, Article 399. Jennings, C., et al. (1978). Have the Samaritans lowered the suicide rate? A controlled study. Psychological Medicine, 8(3), 413–422. Miller, H. L., et al. (1984). An analysis of the effects of suicide prevention facilities on suicide rates in the United States. American Journal of Public Health, 74(4), 340–343. Pirkis, J., et al. (2015). Interventions to reduce suicides at suicide hotspots: A systematic review and meta-analysis. The Lancet Psychiatry, 2(11), 994–1001. Public Health Agency of Canada. (n.d.). Suicide and self-harm: Suicide mortality. Health Infobase. Retrieved September 21, 2026. Shin, S., et al. (2026). Effectiveness of fixed landline crisis phone boxes in preventing suicides: Evidence from Australia and the United States. Epidemiology and Psychiatric Sciences, 35, e59. Stack, S. (2015). Crisis phones – suicide prevention versus suggestion/contagion effects: Skyway Bridge, 1954–2012. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 36(3), 220–224. Too, L. S., et al. (2025). Impact of interventions at frequently used suicide locations on occurrence of suicides at other sites: A systematic review and meta-analysis. Psychological Medicine, 55, e168. Zarkowski, P. (2008). The Aurora Bridge. American Journal of Psychiatry, 165(9), 1126. Get full access to Suicidology Data and Evidence at suicidology.substack.com/subscribe

    Episode 1 - Crisis Lines at Hotspots May Harm more than they Help
  • 4 Episodes

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A psychiatrist and suicidologist walks through new research on suicide, psychiatric medications and mental health, looking closely at what the data actually show. Hosted by Dr. Tyler Black, with charts, references and a written version of every episode at suicidology.substack.com. suicidology.substack.com

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