Research

Dr. Barzilay’s current research focuses on innovative assessment methods and advanced suicide research and prevention strategies. She has authored over 40 papers in major journals and has received research grants and fellowships, including the Shamir fellowship by the Ministry of Science and Technology, a Young Investigator research grant by the American Foundation for Suicide Prevention, and an NIMH R-34 grant. Dr. Barzilay’s extensive work has led to significant advancements in the field of suicide prevention, particularly among youth, and her insights have been published in leading journals such as Depression and Anxiety, Journal of Child Psychology and Psychiatry, Psychotherapy, Suicide and Life‐Threatening Behavior, and Journal of Affective Disorders.

Projects:

Psychological Models of Suicide

Understanding the factors that lead individuals to harm themselves is crucial. In order to gain insight into these factors, psychological models of suicide have been developed. Among the leading theories related to suicide risk and behavior is the interpersonal theory of suicide by Joiner. This theory suggests that thwarted belongingness and perceived burdensomeness can lead to suicidal ideation and attempts. By investigating such theories, we can gain a better understanding of the psychological processes that underlie suicidal behavior and develop effective interventions to prevent it.

Barzilay, S., & Apter, A. (2014). Psychological Models of Suicide. In Archives of Suicide Research (Vol. 18, Issue 4, pp. 295–312). https://doi.org/10.1080/13811118.2013.824825

Barzilay, S., Feldman, D., Snir, A., Apter, A., Carli, V., Hoven, C. W., Wasserman, C., Sarchiapone, M., & Wasserman, D. (2015). The interpersonal theory of suicide and adolescent suicidal behavior. Journal of Affective Disorders, 183, 68–74. https://doi.org/10.1016/j.jad.2015.04.047

Barzilay, S., Apter, A., Snir, A., Carli, V., Hoven, C. W., Sarchiapone, M., Hadlaczky, G., Balazs, J., Kereszteny, A., Brunner, R., Kaess, M., Bobes, J., Saiz, P. A., Cosman, D., Haring, C., Banzer, R., McMahon, E., Keeley, H., Kahn, J.-P., … Wasserman, D. (2019). A longitudinal examination of the interpersonal theory of suicide and effects of school-based suicide prevention interventions in a multinational study of adolescents. Journal of Child Psychology and Psychiatry and Allied Disciplines, 60(10). https://doi.org/10.1111/jcpp.13119

Bloch-Elkouby, S., Gorman, B., Lloveras, L., Wilkerson, T., Schuck, A., Barzilay, S., Calati, R., Schnur, D., & Galynker, I. (2020). How do distal and proximal risk factors combine to predict suicidal ideation and behaviors? A prospective study of the narrative crisis model of suicide. Journal of Affective Disorders, 277. https://doi.org/10.1016/j.jad.2020.08.088

 

Health Risk Behaviors, Bullying and Self-Injury in Youth

The project investigated the prevalence and risk factors associated with health risk behaviors, bullying, and self-injury among youth in Europe. The study included a series of surveys conducted between 2012 and 2020, with a focus on different aspects of adolescent mental health. The surveys explored the prevalence of pathological internet use, direct self-injurious behavior, and suicide ideation and behavior. The study also examined the correlation between bullying victimization and suicide ideation and behavior. The findings of the study provide valuable insights into the factors associated with adolescent mental health and could inform interventions to promote mental health and prevent mental health problems among youth.

Durkee, T., Kaess, M., Carli, V., Parzer, P., Wasserman, C., Floderus, B., Apter, A., Balazs, J., Barzilay, S., Bobes, J., Brunner, R., Corcoran, P., Cosman, D., Cotter, P., Despalins, R., Graber, N., Guillemin, F., Haring, C., Kahn, J. P., … Wasserman, D. (2012). Prevalence of pathological internet use among adolescents in Europe: Demographic and social factors. Addiction, 107(12), 2210–2222. https://doi.org/10.1111/j.1360-0443.2012.03946.x

Brunner, R., Kaess, M., Parzer, P., Fischer, G., Carli, V., Hoven, C. W., Wasserman, C., Sarchiapone, M., Resch, F., Apter, A., Balazs, J., Barzilay, S., Bobes, J., Corcoran, P., Cosmanm, D., Haring, C., Iosuec, M., Kahn, J. P., Keeley, H., … Wasserman, D. (2014). Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: A comparative study of findings in 11 European countries. Journal of Child Psychology and Psychiatry and Allied Disciplines, 55(4), 337–348. https://doi.org/10.1111/jcpp.12166

Barzilay, S., Brunstein Klomek, A., Apter, A., Carli, V., Wasserman, C., Hadlaczky, G., Hoven, C. W., Sarchiapone, M., Balazs, J., Kereszteny, A., Brunner, R., Kaess, M., Bobes, J., Saiz, P., Cosman, D., Haring, C., Banzer, R., Corcoran, P., Kahn, J.-P., … Wasserman, D. (2017). Bullying Victimization and Suicide Ideation and Behavior Among Adolescents in Europe: A 10-Country Study. Journal of Adolescent Health, 61(2). https://doi.org/10.1016/j.jadohealth.2017.02.002

Snir, A., Apter, A., Barzilay, S., Feldman, D., Rafaeli, E., Carli, V., Wasserman, C., Hadlaczky, G., Hoven, C. W., Sarchiapone, M., & Wasserman, D. (2018). Explicit Motives, Antecedents, and Consequences of Direct Self-Injurious Behaviors: A Longitudinal Study in a Community Sample of Adolescents. Crisis, 39(4). https://doi.org/10.1027/0227-5910/a000493

Brunstein Klomek, A., Barzilay, S., Apter, A., Carli, V., Hoven, C. W., Sarchiapone, M., Hadlaczky, G., Balazs, J., Kereszteny, A., Brunner, R., Kaess, M., Bobes, J., Saiz, P. A., Cosman, D., Haring, C., Banzer, R., McMahon, E., Keeley, H., Kahn, J.-P., … Wasserman, D. (2019). Bi-directional longitudinal associations between different types of bullying victimization, suicide ideation/attempts, and depression among a large sample of European adolescents. Journal of Child Psychology and Psychiatry and Allied Disciplines, 60(2). https://doi.org/10.1111/jcpp.12951

Barzilay, S., & Apter, A. (2020). Perspectives on cross-diagnostic trajectories and outcomes in children’s mental health. European Child and Adolescent Psychiatry, 29(8). https://doi.org/10.1007/s00787-020-01584-7

Benatov, J., Klomek, A. B., Shira, B., Apter, A., Carli, V., Wasserman, C., Hoven, C. W., Sarchiapone, M., Balazs, J., Bobes, J., Brunner, R., Corcoran, P., Cosman, D., Haring, C., Kahn, J.-P., Keeley, H., Kereszteny, A., Podlogar, T., Postuvan, V., … Wasserman, D. (2020). Doing Nothing is Sometimes Worse: Comparing Avoidant versus Approach Coping Strategies with Peer Victimization and Their Association to Depression and Suicide Ideation. Journal of School Violence, 19(4). https://doi.org/10.1080/15388220.2020.1738941

Lustig, S., Kaess, M., Schnyder, N., Michel, C., Brunner, R., Tubiana, A., Kahn, J.-P., Sarchiapone, M., Hoven, C. W., Barzilay, S., Apter, A., Balazs, J., Bobes, J., Saiz, P. A., Cozman, D., Cotter, P., Kereszteny, A., Podlogar, T., Postuvan, V., … Wasserman, D. (2022). The impact of school-based screening on service use in adolescents at risk for mental health problems and risk-behaviour. European Child and Adolescent Psychiatry. https://doi.org/10.1007/s00787-022-01990-z

Kaess, M., Klar, J., Kindler, J., Parzer, P., Brunner, R., Carli, V., Sarchiapone, M., Hoven, C. W., Apter, A., Balazs, J., Barzilay, S., Bobes, J., Cozman, D., Gomboc, V., Haring, C., Kahn, J.-P., Keeley, H., Meszaros, G., Musa, G. J., … Wasserman, D. (2021). Excessive and pathological Internet use – Risk-behavior or psychopathology? Addictive Behaviors, 123. https://doi.org/10.1016/j.addbeh.2021.107045

 

Therapeutic Alliance and Countertransference with Suicidal Patients

This research project investigates various aspects of working with suicidal patients, including therapist responses, emotional self-awareness, clinician assessment of short-term suicide risk, therapeutic alliance, and suicide risk management. The studies highlight the importance of emotional regulation, therapist self-awareness, and effective communication in suicide risk assessment and management. The findings also underscore the need for further research and training in suicide prevention and intervention for mental health professionals to improve patient care.

Barzilay, S., Yaseen, Z. S., Hawes, M., Gorman, B., Altman, R., Foster, A., Apter, A., Rosenfield, P., & Galynker, I. (2018). Emotional responses to suicidal patients: Factor structure, construct, and predictive validity of the therapist response questionnaire-suicide form. Frontiers in Psychiatry, 9(APR). https://doi.org/10.3389/fpsyt.2018.00104

Yaseen, Z. S., Bloch-Elkouby, S., & Barzilay, S. (2019). Teaching emotional self-awareness and what to do with it in patient encounters. In Teaching Empathy in Healthcare: Building a New Core Competency. https://doi.org/10.1007/978-3-030-29876-0_6

Barzilay, S., Yaseen, Z. S., Hawes, M., Kopeykina, I., Ardalan, F., Rosenfield, P., Murrough, J., & Galynker, I. (2019). Determinants and Predictive Value of Clinician Assessment of Short-Term Suicide Risk. Suicide and Life-Threatening Behavior, 49(2). https://doi.org/10.1111/sltb.12462

Barzilay, S., Schuck, A., Bloch-Elkouby, S., Yaseen, Z. S., Hawes, M., Rosenfield, P., Foster, A., & Galynker, I. (2020). Associations between clinicians’ emotional responses, therapeutic alliance, and patient suicidal ideation. Depression and Anxiety, 37(3). https://doi.org/10.1002/da.22973

Levi-Belz, Y., Barzilay, S., Levy, D., & David, O. (2020). To Treat or Not to Treat: The Effect of Hypothetical Patients’ Suicidal Severity on Therapists’ Willingness to Treat. Archives of Suicide Research, 24(3). https://doi.org/10.1080/13811118.2019.1632233

Bloch-Elkouby, S., & Barzilay, S. (2022). Alliance-Focused Safety Planning and Suicide Risk Management. Psychotherapy, 59(2). https://doi.org/10.1037/pst0000416

Yunik, N. P., Schiff, M., Barzilay, S., Yavnai, N., Ben Yehuda, A., & Shelef, L. (2022). Military mental health professionals’ suicide risk assessment and management before and after experiencing a patient’s suicide. Suicide and Life-Threatening Behavior, 52(3). https://doi.org/10.1111/sltb.12829

Barzilay, S., Gagnon, A., Yaseen, Z. S., Chennapragada, L., Lloveras, L., Bloch-Elkouby, S., & Galynker, I. (2022). Associations between clinicians’ emotion regulation, treatment recommendations, and patient suicidal ideation. Suicide and Life-Threatening Behavior, 52(2). https://doi.org/10.1111/sltb.12824

Suicide Risk Assessment and Prediction

Identifying individuals at risk of suicide is crucial for preventing suicide. Suicide is a complex phenomenon influenced by multiple factors, including psychiatric and psychological disorders, life events, and individual characteristics. The studies in this field aim to identify risk factors associated with suicide, develop effective screening and assessment tools, and improve suicide prevention strategies. Overall, studying suicide risk assessment and prediction can help reduce the incidence of suicide and improve mental health outcomes for individuals at risk.

Barzilay, S., & Apter, A. (2014). Predictors of suicide in adolescents and adults with mood and common comorbid disorders. In Neuropsychiatry (Vol. 4, Issue 1, pp. 81–93). https://doi.org/10.2217/npy.13.86

Hawes, M., Galynker, I., Barzilay, S., & Yaseen, Z. S. (2018). Anhedonia and suicidal thoughts and behaviors in psychiatric outpatients: The role of acuity. Depression and Anxiety, 35(12). https://doi.org/10.1002/da.22814

Levi-Belz, Y., Gavish-Marom, T., Barzilay, S., Apter, A., Carli, V., Hoven, C., Sarchiapone, M., & Wasserman, D. (2019). Psychosocial Factors Correlated with Undisclosed Suicide Attempts to Significant Others: Findings from the Adolescence SEYLE Study. Suicide and Life-Threatening Behavior, 49(3). https://doi.org/10.1111/sltb.12475

Yaseen, Z. S., Molina, N., Hawes, M., Barzilay, S., & Galynker, I. (2019). Suicide Risk and Emotional Responses to Thoughts of Death: The Response to Morbid Ideations Questionnaire. Suicide and Life-Threatening Behavior, 49(5). https://doi.org/10.1111/sltb.12520

Barzilay, S., Assounga, K., Kim, H.-J., Rudner, E., Yaseen, Z., & Galynker, I. (2019). Psychotic symptoms predict suicidal behavior postdischarge in high risk psychiatric inpatients. Journal of Psychiatric Practice, 25(6). https://doi.org/10.1097/PRA.0000000000000421

Kaess, M., Eppelmann, L., Brunner, R., Parzer, P., Resch, F., Carli, V., Wasserman, C., Sarchiapone, M., Hoven, C. W., Apter, A., Balazs, J., Barzilay, S., Bobes, J., Cosman, D., Horvath, L. O., Kahn, J.-P., Keeley, H., McMahon, E., Podlogar, T., … Wasserman, D. (2020). Life Events Predicting the First Onset of Adolescent Direct Self-Injurious Behavior—A Prospective Multicenter Study. Journal of Adolescent Health, 66(2). https://doi.org/10.1016/j.jadohealth.2019.08.018

Barzilay, S., & Apter, A. (2022). Recent research advances in identification and prevention of youth suicide risk. Current Opinion in Psychiatry, 35(6). https://doi.org/10.1097/YCO.0000000000000816

Mevorach, T., Zur, G., Benaroya-Milshtein, N., Apter, A., Fennig, S., & Barzilay, S. (2023). A Following Wave Pattern of Suicide-Related Pediatric Emergancy Room Admissions during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 20(2). https://doi.org/10.3390/ijerph20021619

Toukhy, N., Barzilay, S., Hamdan, S., Grisaru-Hergas, D., Haruvi-Catalan, L., Levis Frenk, M., Apter, A., Benaroya-Milshtein, N., Fennig, S., & Gvion, Y. (2023). Implicit identification with death detects and predicts short-term suicide risk among adolescents discharged from the emergency room. Suicide and Life-Threatening Behavior. https://doi.org/10.1111/sltb.12958

Shahnovsky, O., Pirogovsky, L., Toukhy, N., Hergas, D. G., Apter, A., Haruvi-Catalan, L., Benaroya, N., Fennig, S., & Barzilay, S. (2022). Psychosocial Correlates of Suicidal Ideation and Behavior in Adolescents and Preadolescent Children Discharged from Emergency Department. In ResearchSquare. https://doi.org/10.21203/rs.3.rs-2413093

Suicide Crisis Syndrome

Suicide Crisis Syndrome (SCS) is a framework proposed by Dr. Igor Galynker and his colleagues for understanding the suicidal process as a syndrome, rather than a single event. The SCS model suggests that suicidal behavior is the result of an interaction between predisposing factors, triggering events, and emotional and cognitive states that result in a suicidal crisis. The goal of studying SCS is better to understand the complex and dynamic nature of suicidal behavior. Assessment of SCS involves evaluating the presence of various factors, such as psychiatric disorders, stressors, protective factors, and warning signs of suicidal behavior. This can be done through clinical interviews, self-report questionnaires, and other assessment tools. By understanding the factors that contribute to suicidal crises, healthcare professionals can develop more effective prevention and intervention strategies. Research in this area has focused on identifying reliable predictors of suicide risk, developing and testing assessment tools for SCS. Overall,

Yaseen, Z. S., Hawes, M., Barzilay, S., & Galynker, I. (2019). Predictive Validity of Proposed Diagnostic Criteria for the Suicide Crisis Syndrome: An Acute Presuicidal State. Suicide and Life-Threatening Behavior, 49(4). https://doi.org/10.1111/sltb.12495

Schuck, A., Calati, R., Barzilay, S., Bloch-Elkouby, S., & Galynker, I. (2019). Suicide Crisis Syndrome: A review of supporting evidence for a new suicide-specific diagnosis. Behavioral Sciences and the Law, 37(3). https://doi.org/10.1002/bsl.2397

Calati, R., Cohen, L. J., Schuck, A., Levy, D., Bloch-Elkouby, S., Barzilay, S., Rosenfield, P. J., & Galynker, I. (2020). The Modular Assessment of Risk for Imminent Suicide (MARIS): A validation study of a novel tool for suicide risk assessment. Journal of Affective Disorders, 263. https://doi.org/10.1016/j.jad.2019.12.001

Ying, G., Cohen, L. J., Lloveras, L., Barzilay, S., & Galynker, I. (2020). Multi-informant prediction of near-term suicidal behavior independent of suicidal ideation. Psychiatry Research, 291. https://doi.org/10.1016/j.psychres.2020.113169

Bloch-Elkouby, S., Gorman, B., Schuck, A., Barzilay, S., Calati, R., Cohen, L. J., Begum, F., & Galynker, I. (2020). The suicide crisis syndrome: A network analysis. Journal of Counseling Psychology, 67(5). https://doi.org/10.1037/cou0000423

Barzilay, S., Assounga, K., Veras, J., Beaubian, C., Bloch-Elkouby, S., & Galynker, I. (2020). Assessment of near-term risk for suicide attempts using the suicide crisis inventory. Journal of Affective Disorders, 276. https://doi.org/10.1016/j.jad.2020.06.053

Parghi, N., Chennapragada, L., Barzilay, S., Newkirk, S., Ahmedani, B., Lok, B., & Galynker, I. (2021). Assessing the predictive ability of the Suicide Crisis Inventory for near-term suicidal behavior using machine learning approaches. International Journal of Methods in Psychiatric Research, 30(1). https://doi.org/10.1002/mpr.1863

Bloch-Elkouby, S., Barzilay, S., Gorman, B. S., Lawrence, O. C., Rogers, M. L., Richards, J., Cohen, L. J., Johnson, B. N., & Galynker, I. (2021). The revised suicide crisis inventory (SCI-2): Validation and assessment of prospective suicidal outcomes at one month follow-up. Journal of Affective Disorders, 295. https://doi.org/10.1016/j.jad.2021.08.048

Rogers, M. L., Richards, J. A., Cao, E., Krumerman, M., Barzilay, S., Blum, Y., Chistopolskaya, K., Çinka, E., Dudeck, M., Husain, M. I., Yilmaz, F. K., Kravtsova, N. A., Kuśmirek, O., Menon, V., Peper-Nascimento, J., Pilecka, B., Titze, L., Valvassori, S. S., You, S., & Galynker, I. (2023). Associations Between Long-Term and Near-Term Stressful Life Events, Suicide Crisis Syndrome, and Suicidal Ideation. International Journal of Stress Management. https://doi.org/10.1037/str0000272

Rogers, M. L., McMullen, L., Liang, Y., Perez, N., Richards, J. A., Akülker, G., Barzilay, S., Bilici, R., Blum, Y., Chistopolskaya, K., Dudeck, M., Husain, M. I., Kuśmirek, O., Luiz, J. M., Menon, V., Pilecka, B., Sadovnichaya, V., Titze, L., Valvassori, S. S., … Galynker, I. (2023). Cross-national presence and sociodemographic correlates of the suicide crisis syndrome. Journal of Affective Disorders, 329. https://doi.org/10.1016/j.jad.2023.02.076

Suicide Prevention Interventions

The ongoing study aims to assess the effectiveness of a brief intervention based on Interpersonal Psychotherapy-Adolescent for suicidal children and adolescents. The need for such a brief intervention arises due to the increasing numbers of children and adolescents presenting to emergency departments with suicidal ideation and behaviors. The intervention focuses on improving communication, problem-solving, and coping skills among the participants.

Haruvi Catalan, L., Levis Frenk, M., Adini Spigelman, E., Engelberg, Y., Barzilay, S., Mufson, L., Apter, A., Benaroya Milshtein, N., Fennig, S., & Klomek, A. B. (2020). Ultra-Brief Crisis IPT-A Based Intervention for Suicidal Children and Adolescents (IPT-A-SCI) Pilot Study Results. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.553422