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. 2025 Aug 29;20(4):233–240. doi: 10.1177/15562646251372240

‘Consider a Less Risky Alternative’: Navigating Ethics Approval in Suicide Research

Joanna Brooke 1, Caroline Lenette 1,✉, Jack Shipway 2
PMCID: PMC12480609  PMID: 40879427

Abstract

This paper discusses key themes from the literature on navigating institutional ethics approval for suicide research. We used a narrative review approach to identify recurring issues that Research Ethics Committees (RECs) commonly raise as concerns and the strategies that might be effective to manage the intricacies of institutional processes. Six dominant themes were: risk aversion overshadowing benefits of suicide research; participant agency and informed consent; ethically reflexive practice is not supported through current processes; dominance of quantitative research tradition; lack of standardisation in RECs decision-making; and lack of evidence on risk in suicide research. Four strategies to navigate institutional ethics approval were: relationship-building and dialogue between researchers and RECs; researcher safeguarding strategies; supporting ethically reflexive practice of the researcher; and RECs processes are evidence-based and provide ethical justification. We suggest how to improve institutional ethics processes specifically for suicide research and highlight the need for more insight into REC members’ perspectives.

Keywords: Suicidality, risks, emotional labour, vulnerability, reflexive practice

Introduction

Suicide research is essential to advance and broaden understandings of suicidality in a range of contexts. This topic is especially sensitive in nature, due to researchers’ and institutions’ concerns about the risks it might pose to participants with lived experience of suicide (Andriessen et al., 2019; Lakeman & FitzGerald, 2009; Mozaffor et al., 2020). Here, lived experience of suicide refers to personal experiences of suicidal thoughts or attempts, caring for suicidal persons, or being bereaved or affected by suicide in any way. Research Ethics Committees (RECs, known as Human Research Ethics Committees in Australia, or Institutional Review Boards in North America) review proposals involving participants to ensure they are compliant with national guidelines (Lenette et al., 2018). The primary concern of RECs is to protect participants against potential harm (Bhasin et al., 2022; DeCou & Schumann, 2018). In suicide research, RECs often require minor or major revisions to research proposals, the impact of which can be either positive (e.g., clarified procedures) or negative (e.g., lengthy delays and design limitations) (Andriessen et al., 2021)

While there is no internationally agreed-upon definition of suicidal ideation (Andriessen et al., 2021), a recurring concern from RECs is that discussing suicidality in research contexts might cause individuals to overly focus on suicidal thoughts and potentially result in them acting on their ideation. However, a growing body of evidence suggests that discussing suicide in and of itself does not lead to increased risk of suicidal behaviours and attempts and can instead generate benefits in terms of improved wellbeing (Blades et al., 2018; Nugent et al., 2019; Omerov et al., 2014). Overwhelmingly, researchers argue that such benefits outweigh potential risks due to the unique insights that individuals with lived experience of suicide might share (Blades et al., 2018; Holland, 2007). Recent literature suggests that being asked suicide-related questions could even reduce the probability of suicidal ideation, but RECs tend to disagree with this perspective in their assessment of how researchers balance the risks and benefits of discussing suicidality (see Andriessen et al., 2021). Consequently, the bulk of the literature on ethics and ethics approval in suicide research details how researchers have faced and addressed concerns from RECs so that this crucial research area can continue to expand.

As the phrase in the title of this paper suggests (a REC feedback point to Lenette's application), it is common for RECs to impose a lengthy list of amendments for proposals to minimise risks to participants in suicide research. Concerns from RECs might be especially pronounced in qualitative, participatory research that does not involve clinical measurements or assessments and instead focusses on lived experience-led explorations and sociocultural aspects. To some extent, this tendency reflects an over-reliance on colonial notions and western examinations and understandings of suicidality (see X & polanco, 2022) and a disproportionate preoccupation with participants’ ‘vulnerability’ in this research context (Jaworski, 2022).

Obtaining institutional ethics approval for suicide research can involve additional complexities that researchers should anticipate and be prepared for. This laborious process generates emotional labour (Hochschild, 2003), which refers to forms of labour (typically invisible and performed by women) that require emotional energy (Beck, 2018). Emotional labour is a useful concept to describe the discrepancy between how an individual portrays their emotions (especially in professional contexts) and their authentic emotional response. Emotional labour demands ‘surface acting’ and ‘deep acting’ (Carroll, 2012, p. 549). Surface acting is performative and involves carefully presenting emotions that are not actually felt (e.g., agreeing and complying with RECs’ concerns about a research project), while deep acting means actively suppressing emotions to align with expectations (e.g., hiding frustration about amendments RECs’ request to meet requirements and gain approval). These strategies are common across disciplines (e.g., in the social sciences, see Wadds et al., 2020). Such emotional labour can become exhausting because delays in gaining ethics approval for suicide research and project redesigns can sometimes affect project feasibility.

This paper provides a narrative review of a selection from the literature on ethics approval in suicide research to determine what issues are discussed and what key strategies might be effective to manage the intricacies of institutional processes – and in so doing, reduce the amount of emotional labour involved. Such strategies can support suicide researchers to minimise detrimental impacts on participants and on themselves. Our aim is to synthesise current knowledge on the topic as a basis for further research. We map six dominant themes from the literature before synthesising four strategies for researchers to navigate ethics approval. We also suggest how to improve institutional processes specifically in relation to suicide research. The overall aim is to demystify and address the complexities of ethics approval processes to continue to produce quality, meaningful, and ethical research on suicidality.

Materials and Methods

Based on the research question we sought to answer (What are the key issues researchers encounter when applying for ethics approval in suicide research?), we developed a list of key word search terms (institut*, ethic*, approv*, suicid*, research, university). Search strings included variations of ‘suicid*,’ ‘research,’ and ‘ethic*,’ alternating ‘institut*’ with more context specific terms (e.g., university, committee). We used the same process and keyword combinations in large databases (Google Scholar, University of New South Wales Library). We then shifted to a snowball search by scanning the reference lists of relevant articles for titles related to the search terms. To manage the large volume of results returned from databases, we conducted the search iteratively, screening papers by title and abstract. When the titles of new results consistently were no longer relevant to the research question, we stopped scanning. We excluded: literature published before 2005 to keep our findings relevant to current research and RECs processes; focused on genetic or scientific research rather than social research; and without reference to institutional ethics approval processes. Through this process, we selected and thematically analysed 19 articles in total.

Our aim was to avoid a rigid, systematic search approach. We conducted our review over a short period of time (November 2024 – March 2025), favouring a narrative synthesis to get a general sense of the issues discussed in the literature that could answer our research question. This approach was more appropriate to capture the broad trends we were interested to synthesise as a basis for future research. As such, we might not have identified all articles linked to our research question, but we felt that reviewing 19 articles for this paper was enough to establish a broad understanding of the literature.

Results

We identified six themes from scholarly discussions on navigating institutional ethics review processes in suicide research:

  1. Risk aversion overshadowing benefits of suicide research;

  2. Participant agency and informed consent;

  3. Ethically reflexive practice is not supported through current processes;

  4. Dominance of quantitative research tradition;

  5. Lack of standardisation in RECs decision-making; and

  6. Lack of evidence on risk in suicide research.

1. Risk Aversion Overshadowing Benefits of Suicide Research

As stated in the introduction, a widely held perception across RECs is that asking participants about suicide may induce suicidality (Blades et al., 2018; Nugent et al., 2019; Omerov et al., 2014). A survey of REC members found that all respondents were concerned about the potential for suicide research to be harmful, with a majority fearing suicidality might be exacerbated or reinforced (Lakeman & FitzGerald, 2009). Some researchers share this concern and experience apprehension and reluctance to engage in suicide-related research out of fear that exploring questions on suicide might make a person more likely to engage in suicidal thoughts or behaviours (see Bhasin et al., 2022; Blades et al., 2018).

Yet, concerns over the iatrogenic (i.e., induced by the words or actions of health care providers or researchers) risk of suicide-related research is widely contested across the literature. The mere act of asking research participants about suicide does not seem to increase the risk of suicidality or cause long-term harm (Blades et al., 2018; Nugent et al., 2019; Omerov et al., 2014). For instance, a quantitative meta-analysis of research on the risks of assessing suicidality found no significant iatrogenic effects in relation to increased suicidal ideation (DeCou & Schumann, 2018). Instead, there were direct benefits for research participants, such as decreased distress and suicidal ideation.

Nevertheless, there is widespread agreement that such concerns over iatrogenic risk have hampered suicide research, particularly in terms of gaining institutional ethics approval (Blades et al., 2018; Nugent et al., 2019; Omerov et al., 2014). This can impede progress in suicidology, as ‘decisions which are overly cautious and restrictive when approving research proposals will hinder important research in this area’ (Blades et al., 2018, p. 1). As a result, suicidal people are often excluded from, for instance, randomised control trials of new therapies for suicidality (Nugent et al., 2019). Thus, an overemphasis on risk may deprive participants from potential benefits.

2. Participant Agency and Informed Consent

The concept of participant agency is deprioritised in RECs’ assessments of suicide-related research. REC members tend to assert that determining the competency of suicidal people to consent to involvement in research is ethically problematic (Lakeman & FitzGerald, 2009; Nugent et al., 2019). Some researchers reject this concern, arguing that, as long as informed consent has been given, such individuals should be treated the same as non-suicidal participants (see Nugent et al., 2019). Further, Jaworski (2022) states that individuals experiencing suicidal ideation are not without agency and have the capacity to ask for help. In fact, there is little empirical evidence to support denying their access to research opportunities (Nugent et al., 2019). Framing suicidal individuals participating in suicide studies solely as vulnerable or at risk rather than recognising that they can also be agentic can diminish their personhood (see Jaworski, 2022).

Further, research involving ethnic minorities and other systemically marginalised communities faces additional scrutiny in ethics approval for suicide research (Andriessen et al., 2019; Mishara & Weisstub, 2024). For Juritzen et al. (2011), this poses an ethical issue of excluding marginalised communities from research that could directly address the very health inequalities they disproportionately experience. The issue of maintaining confidentiality is also linked to participant agency and RECs’ tendency to frame people experiencing suicidality solely as ‘vulnerable’. Mishara and Weisstub (2024) assert that studies with high-risk vulnerable individuals cannot guarantee complete confidentiality (see also Bhasin et al., 2022; Lakeman & FitzGerald, 2009; Mozaffor et al., 2020).

3. Ethically Reflexive Practice is not Supported in Current Processes

Jaworski (2022) argues that institutions’ procedural focus does not prepare researchers for the ethical challenges they may encounter in practice (see Guillemin & Gillam, 2004, for an extended discussion). The researcher's role in monitoring arrangements as per institutional ethics approval can transform them from an active agent and exerciser of power into a compliant subject exercising self-regulation and self-control, which can at times restrict their ability to engage fully in ethically reflexive practice (Juritzen et al., 2011). A common ethical dilemma researchers have documented in the literature is the expectation to establish a deep personal connection with participants (especially in qualitative research), while refraining from providing them with support or counselling, especially when participants might expect it (Bhasin et al., 2022). As Nugent et al. (2019) suggest, given the broader issues with access to appropriate care, it is understandable that individuals with suicidal ideation might want to participate in research in the hope that this will somewhat bridge the service gap. Not having access to adequate support to assist participants in suicide-related research can be anxiety-inducing for researchers (Nock et al., 2021).

Since current ethics review processes do not tend to facilitate ethically reflexive research practice, researchers’ focus can shift to the factors that will get an application through the deliberations of RECs rather than what constitutes ethical practice in suicide-related research (Juritzen et al., 2011). Institutional ethics review processes should pay more careful attention to critical reflexivity, which includes tuning into ethically important moments (Guillemin & Gillam, 2004) and being skilled in responding to ethical challenges as they arise in projects (Jaworski, 2022). In relation to informed consent processes in suicide research, Juritzen et al. (2011) warn against rule-bounded, routinised, and mechanical processes that do not foster ethically reflexive practice and ongoing critical self-evaluation of researcher positionality.

Ethically reflexive practice also extends to REC members. Their subjective perspectives play a key role in decision-making, and ethical or moral views may differ among stakeholders (Barnard et al., 2021; Mozaffor et al., 2020). While researchers and RECs may value the same ethical principles when it comes to suicide research, they may (and often do) interpret them differently (Andriessen et al., 2019). How RECs fulfil their overarching purpose of protecting participants and ensure ethical research is, to a certain extent, at the discretion of panels (Hom et al., 2017).

Interestingly, REC members feel that researchers attribute power to them, whereas the former perceive their role as primarily following regulations and ensuring suicide-related projects meet national guidelines (Andriessen et al., 2019). In Australia, for instance, RECs generally see their role as facilitative but are aware that this institutional structure is often perceived as hindering or obstructing suicide research (Barnard et al., 2021). Blades et al. (2018, p. 2) argue that ethics approval can be a barrier as RECs can be ‘overly conservative and restrictive in evaluating any potential harm that asking about suicide may have on participants’. There is a common experience of inconsistencies across researcher and REC member views on suicide-related research, which some researchers perceive is due to RECs being too risk-adverse or lacking knowledge about the safety of conducting research with individuals with suicidal ideation (Bailey et al., 2020). To our knowledge, there are no formal guidelines regarding ethical practices for assessing and conducting research on suicide (Nock et al., 2020), although anecdotal evidence suggests that research institutions are developing their own guidelines to fill this gap.

It is critical for researchers and REC members to be aware of their own moral attitudes and power, as they directly influence decision-making processes related to participants, informed consent, and safeguarding (Andriessen et al., 2019). Ethics review processes in suicide research require ethical literacy, and researchers and REC members have a shared responsibility in the ethical design of suicide-related research (Andriessen et al., 2019). However, RECs’ emphasis on harm minimisation is arguably less an ethical principle directed at participants but increasingly out of concern for protecting the interests of research institutions and preventing loss of reputation as well as obtaining financial support for future research (Holland, 2007; Juritzen et al., 2011).

4. Dominance of Quantitative Research Tradition

Current ethics review processes carry an epistemological bias (Holland, 2007), whereby quantitative, evidence-based research is perceived as ‘good’ science and superior to other kinds of research (Juritzen et al., 2011). RECs commonly base their decisions on a biomedical paradigm ill-suited to make decisions about qualitative research (Flicker et al., 2007; Halse & Honey, 2007; Lenette et al., 2018; Wadds et al., 2020), including in suicidology. Holding a quantitative, biomedical research tradition as the gold standard means that other research approaches (e.g., participatory research) face more scrutiny because they can be perceived as less ethical. For example, in qualitative projects, researcher-participant relationships do not resemble the unequal power dynamics typically seen in biomedical or quantitative research (Holland, 2007), and so standardised procedures for obtaining consent do not account for the nature of ethical challenges specific to qualitative research (Jaworski, 2022). The problematic quantitative ‘logic’ of knowledge production is particularly pertinent to suicide-related research, as conceptualisations of suicide are reduced to pathologised, individualist mental health framings, which Chandler et al. (2022) argue robs suicide of its contextual meaning and limits efforts to understand suicidal experiences fully (see also Lenette, 2023).

5. Lack of Standardisation in RECs Decision-Making

There is no standardised system across RECs for decision-making in suicide-related research. Such a decentralised system can result in different assessments of similar applications for suicide research across RECs (Andriessen et al., 2019; Mozaffor et al., 2020). Another challenge might arise when RECs diverge within institutions (Hom et al., 2017). Inconsistent decision-making frameworks can result in multi-site studies receiving conflicting recommendations that result in standstills for approval.

Even though national frameworks can help to support consistency (such as the National Statement on Ethical Conduct in Human Research (NHMRC, 2023) in Australia, which is guided by four principles of respect for human beings, research merit and integrity, justice, and beneficence), RECs place different emphases on how such statements are interpreted and used in decision-making (Barnard et al., 2021; Lenette et al., 2018; Wadds et al., 2020). The lack of standardised guidelines for identifying and managing risks in suicide-related research has led to individual researchers and RECs making decisions that are ‘idiosyncratically based’ (Schatten et al., 2020, p. 64).

6. Lack of Evidence on Risk in Suicide Research

RECs require evidence from researchers that the proposed project will not cause harm or distress (e.g., Andriessen et al., 2021), but there is limited available research to help evaluate these concerns (Blade et al., 2019). This is because it is difficult to accurately quantify significant risk for suicidality (Mishara & Weisstub, 2024; Nugent et al., 2019) as researchers and clinicians are not able to accurately identify all people at significant risk of suicidal thoughts or behaviours (Lakeman & FitzGerald, 2009). Thus, researchers can be uncertain about plausible (even if unintended) harm to participants in suicide-related research (Bhasin et al., 2022). There are no accepted safety practices for such studies, although recent advances such as digital monitoring technologies represent new opportunities to advance understandings on suicidal behaviours (see Nock et al., 2020).

Acknowledgements

As uninvited settlers, we pay our respects to the Traditional Owners of the Lands where our collaborative writing took place. We acknowledge that we live and work on Aboriginal land and that sovereignty was never ceded.

Author Biographies

Ms Joanna Brooke is a PhD candidate at the University of Melbourne, and research assistant in the School of Social Sciences and at the Big Anxiety Research Centre, University of New South Wales. She researches reconceptualisations of the role of the therapeutic practitioner in community-based singing workshops.

Dr Caroline Lenette is Professor of Anti-Colonial Research, School of Social Sciences, and Deputy Director of the Big Anxiety Research Centre. She is a leading interdisciplinary researcher in refugee studies and uses participatory, creative methods with community partners and co-researchers. Caroline is interested in sociocultural approaches to understanding and addressing suicide based on refugee perspectives, as part of critical suicide studies.

Mr Jack Shipway is Project Administrator at the Big Anxiety Research Centre, University of New South Wales. He researches Indigenous-led models of research.

Strategies for Researchers Navigating Institutional Ethics Approval: The literature offers practical advice and recommendations from researchers’ perspectives to better navigate ethics review processes in suicide-related research. We identified four main strategies in our search:
  1. Relationship-building and dialogue between researchers and RECs;
  2. Researcher safeguarding strategies;
  3. Supporting ethically reflexive practice of the researcher; and
  4. RECs processes are evidence-based and provide ethical justification.

Discussion: The themes outlined in this paper suggest that the literature on ethics and ethics approval in suicide research is dynamic. It details several interconnected issues and outlines important recommendations for how researchers can address concerns from RECs. Discussions on the ethical implications pertinent to suicidology are now more common (Andriessen et al., 2021) and are likely to continue to expand, which is promising to advance suicidology.

Clearly, there are several implications to consider more carefully – without resorting to simplistic solutions – to conduct suicide research ethically. For instance, Omerov et al. (2014) suggest that participants can experience temporary distress from their involvement in suicide-related research, but that alone should not exclude them from research projects. While individuals experiencing suicidality are generally considered vulnerable (Mishara & Weisstub, 2024), it is important for RECs to acknowledge this vulnerability alongside their resourcefulness, resilience, and sense of agency in research contexts (Jaworski, 2022). As Andriessen et al. (2021, p. 47) posit, ‘research and research ethics committees share a common goal of conducting ethically sound and safe research to the benefit of humankind’. This commonality in aims warrants more attention to understanding how ethics approval processes can become less contentious and more supportive of suicide researchers’ endeavours.

While the literature overwhelmingly conveys researchers’ perspectives, a relatively neglected field of inquiry concerns the views and experiences of REC members who assess suicide-related proposals, which suggests that more research is warranted to expand the knowledge base on this topic. An important albeit outdated research project is Lakeman and FitzGerald (2009), who surveyed 125 REC members from Australia, Ireland, Aotearoa New Zealand, Canada, the United Kingdom and United States, and identified several benefits and concerns relating to potential risks. Benefits included a deepened understanding of suicidality in general and in relation to specific groups such as young men. Concerns included risk of harm to participants, accessing target populations ethically, and risk of harm to researchers (see also Andriessen et al., 2021). More recent research reveals that tensions between RECs and researchers are more likely to arise when reviewing proposals from novice researchers or researchers new to suicide as a research area (Barnard et al., 2021). Nevertheless, the willingness of RECs to broaden their understanding of suicide-related research and ethical issues means that there is ample opportunity for non-confrontational and collaborative approaches to achieve a common goal with researchers. Andriessen et al. (2019) agree that a clearer understanding of not just what RECs do but also how they do it, is necessary alongside continuing dialogue to ensure ethical and high-quality suicide research.

Best Practices: Alongside the main themes discussed above, there are two key recommendations to improve institutional ethics processes: (1) Develop guidelines and resources for ethical decision-making; and (2) Decolonise ethics review processes. Reliance on ethical guidelines is crucial in the assessment of suicide-related research (Barnard et al., 2021). The research community should strive toward a set of standardised guidelines for RECs and decision-making in suicide research (perhaps nationally or even globally), including creating new guidelines and resources to address the decentralised nature of institutional review processes (Hom et al., 2017). Existing examples include Omerov et al.'s (2014) ethical protocol for epidemiological surveys of suicide-bereaved persons, and Nock et al.'s (2021) consensus statement from REC members on safe and ethical practices for conducting digital monitoring studies with participants deemed at high risk of suicide.

A decolonial lens can address the over-reliance on biomedical and quantitative framings of suicide in ethics review processes (Brooke et al., 2025; Lenette, 2023; X & polanco, 2022). For instance, ethical guidelines used in research with Indigenous people to support informed consent and participation are now based on cultural expertise relevant to a wider research community (e.g., Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, 2025; Mishara & Weisstub, 2024). These guidelines interrogate who owns data and how co-design approaches value participants and their communities, and appreciate the contexts of participants’ lives and cultural knowledge. Such approaches to ethical suicide research better situate individual experiences of suicidal thoughts and behaviours in relation to wider cultural contexts and structures and, crucially, relations of power (Chandler et al., 2022). This suggestion is in line with Jaworski's (2022) call for an individual's suicidal journey to be viewed contextually rather than atomised into risk factors and behaviours. Similarly, Chandler et al. (2022) suggest applying a social justice lens to better understand how suicide is deeply related to socioeconomic disadvantage and structural inequalities, including colonialism and racism (see also Ansloos & Peltier, 2022).

The limitations of this paper include data being drawn from a small number of articles post 2005, and the use of narrative review over a systemic review or meta-analysis. We acknowledge that a broader scope and more systemic review may have yielded different results, but the intention was to use a narrative approach to gain an understanding of key themes as a basis for further research.

Research Agenda: This paper has not addressed the all-important topic of ethical considerations when researchers themselves have lived experience of suicide. Anecdotally, more researchers with lived experience of suicide (known to us) complete higher degree research programs on the topic, often with little support or expertise from supervisors on how to handle the difficulties associated with this process. This demands careful attention and a modified support structure. New research can document such researchers’ experiences and the solutions they suggest for improving institutional processes and relationships. This could include individuals with lived experience being supported to guide the development of study protocols in suicide research, prior to submission to RECs.

Our review points to the following future research directions:
  1. Collaborative national and international research to develop practical and contextual guidance documents for REC members and researchers, that clearly set standards for review processes and anticipate concerns raised in suicide-related research;
  2. A global survey to document established suicide researchers’ strategies to better support emerging researchers who must navigate lengthy delays and project redesigns due to several rounds of feedback from RECs, without compromising their methodology;
  3. Creative and participatory research with people with lived experience of suicide (both as researchers and as participants) to explore contextual views on institutional ethics approval and RECs and how they can be involved sensitively and constructively in improving processes.

Such research could expand knowledge on the best strategies to deal promptly with ethical concerns raised and reduce the emotional labour involved in gaining ethics approval. A deeper understanding of these ongoing issues can assist with navigating ethical challenges that are likely to remain contentious in suicidology.

Educational Implications: As this paper synthesised the main issues discussed in the literature on navigating ethics approval in suicide research – an at times onerous but always necessary process – it would be a useful conversation starter among established researchers, REC members, and research students. Discussing the main issues outlined here might be beneficial to develop more collaborative (rather than adversarial) relationships, especially given that there are already several suggestions (see above) to improve relationships between researchers and REC members in the literature.

ORCID iD: Caroline Lenette https://orcid.org/0000-0002-2317-0438

Funding: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work received funding from the 2024 Arts, Design and Architecture (ADA) Faculty Research Grants Scheme, University of New South Wales. No ethics approval was required.

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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