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Introduction: Suicidality in youth is a serious public health problem. The Texas Youth Depression and Suicide Research Network (TX‐YDSRN) was initiated in 2020 to create a research registry for youth with depression and/or suicidality in Texas. This report presents baseline clinical/demographic characteristics of the first 1000 participants, focusing on suicidal thoughts and behaviors. Methods: The registry includes 8–20‐year‐old youth receiving treatment for depression, or who screen positive for depression and/or suicidal ideation/behavior. Baseline data include diagnosis, depression/anxiety severity, suicidal ideation/behavior, trauma history, and measures of resilience. Results: We present baseline data on the first 1000 participants. Most (79.6%) of the sample had a primary depressive disorder. The sample had moderate to severe depression (Patient Health Questionnaire for Adolescents, PHQ‐A; 12.9 ± 6.4) and anxiety (Generalized Anxiety Disorder, GAD‐7; 11.3 ± 5.9). Nearly half reported ≥1 lifetime suicide attempts and 90% reported lifetime or current suicidal ideation. Participants with past/current suicidality (attempts and/or ideation) had greater illness severity (depression, anxiety, and suicidal thoughts/behaviors), lower resilience, and higher rates of trauma exposure than those without suicidality. Conclusions: Baseline data indicate moderate levels of depression, anxiety, and suicidality and their correlates in this cohort. Future reports will determine trajectories of outcomes and predictors, moderators, and social determinants related to these outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to better understand the sociocultural and logistical treatment needs and barriers of low-income Latinx suicidal youth; and to solicit feedback and identify best practices to adapt and implement a suicide treatment program for this population in a community mental health clinic. Working with the largest mental health care provider for urban area under- and uninsured patients, we conducted semi-structured interviews with Latinx suicidal youth (n = 6), their parents (n = 6), and clinical staff (n = 8). Interviews were audio-recorded, transcribed, and analyzed thematically using a deductively-driven codebook corresponding to interview domains. We supplemented semi-structured interview findings with knowledge gleaned from an exhaustive literature search, including best practice findings from other studies. We also conducted a brief provider survey to ensure a diverse sample. Many parents and providers focused on several unmet mental health needs and multiple barriers to accessing treatment that are common among uninsured populations: a need to prioritize parent and adolescent work schedules, lack of transportation, unstable housing, and unmet childcare needs. Additionally, participants described several factors that play a critical role in treatment: stigma, religion, fear related to immigration, gender roles, and acculturation. We mapped these findings, along with literature-identified best practices, to create components of a culturally-tailored adaptation. We combined primary and secondary evidence of Latinx suicidal youth and families' mental health needs and barriers to treatment to propose a tailored adaption of an intensive outpatient program that provides transdiagnostic, suicide-specific care to Latinx adolescents and families in a community setting. Highlights: Rates of suicidal behavior in Latinx youth are high. Access to culturally tailored treatment programs are limited for Latinx youth. Cultural adaptations are feasible, acceptable, and enhance care in this population. [ABSTRACT FROM AUTHOR]

Suicide is the second leading cause of death among youth and has become a serious public health problem. There has been limited research on strategies to decrease the likelihood of reattempt in adolescents. As phase one of a treatment development study, clinicians, parents, and adolescents participated in qualitative interviews in order to gain new perspectives on developing a targeted intervention and a safety plan phone application for suicide prevention. Participants indicated that transition of care, specific treatment targets, and safety planning were important parts of treatment. In addition, all participants endorsed the use of a smartphone application for these purposes. [ABSTRACT FROM AUTHOR]

Objective: The authors compared fluoxetine and placebo in continuation treatment to prevent relapse of major depressive disorder in children and adolescents. Method: After a detailed evaluation, children and adolescents 7-18 years of age with major depressive disorder were treated openly with fluoxetine. Those who had an adequate response after 12 weeks, as indicated by a Clinical Global Impression improvement score of 1 or 2 and a decrease of at least 50% in Children's Depression Rating Scale-Revised score, were randomly assigned to receive fluoxetine or placebo for an additional 6 months. The primary outcome measures were relapse and time to relapse. Relapse was defined as either a score of 40 or higher on the Children's Depression Rating Scale with a history of 2 weeks of clinical deterioration, or clinical deterioration as judged by the clinician. Additional analyses were conducted with relapse defined only as a score of 40 or higher on the Children's Depression Rating Scale. Results: Of 168 participants enrolled in acute fluoxetine treatment, 102 were randomly assigned to continuation treatment with fluoxetine (N=50) or placebo (N=52). Of these, 21 participants (42.0%) in the fluoxetine group relapsed, com- pared with 36 (69.2%) in the placebo group, a significant difference. Similarly, under the stricter definition of relapse, fewer participants in the fluoxetine group relapsed (N=11; 22.0%) than in the placebo group (N=25; 48.1%). Time to relapse was significantly shorter in the placebo group. Conclusions: Continuation treatment with fluoxetine was superior to placebo in preventing relapse and in increasing time to relapse in children and adolescents with major depression. [ABSTRACT FROM AUTHOR]

Published nonadherence rates in the adolescent oncology population range from 33 to 60% though little is known about the psychological factors that contribute to adherence and the relationship between outcome and nonadherence. Our study was designed to investigate psychological and family factors related to adherence and the relationship between adherence and survival in this population. We evaluated 44 (27 males, 17 females) patients with cancer (13–17 years) who were at least 6-months postdiagnosis. Adherence with trimethoprim/sulfamethoxazole (TMP/SMX) was determined at one point in time, using serum assay. Twelve of the patients (27%) had no detectable TMP/SMX. Patients without detectable drug had higher levels of depression, lower self-esteem, and higher levels of parent–child incongruence. Survival rates, 6 years after the initiation of the study, were lower in the group of participants categorized as nonadherent. These findings, if confirmed, have implications for the management of nonadherence and mood in this population. [ABSTRACT FROM AUTHOR]

American youth are seriously impacted by depression and suicide. The Texas Youth Depression and Suicide Research Network (TX-YDSRN) Participant Registry Study was initiated in 2020 to develop predictive models for treatment outcomes in youth with depression and/or suicidality. This report presents the study rationale, design and baseline characteristics of the first 1000 participants. TX-YDSRN consists of the Network Hub (coordinating center), 12 medical school "Nodes" (manage/implement study), each with 1–5 primary care, inpatient, and/or outpatient Sub-Sites (recruitment, data collection). Participants are 8–20-year-olds who receive treatment or screen positive for depression and/or suicidality. Baseline data include mood and suicidality symptoms, associated comorbidities, treatment history, services used, and social determinants of health. Subsequent assessments occur every two months for 24 months. Among 1000 participants, 68.7 % were 12–17 years, 24.6 % were ≥ 18 years, and 6.7 % were < 12. Overall, 36.8 % were non-Hispanic Caucasian, 73.4 % were female, and 79.9 % had a primary depressive disorder. Nearly half of the sample reported ≥1 suicide attempt, with rates similar in youth 12–17 years old (49.9 %) and those 18 years and older (45.5 %); 29.9 % of children <12 reported at least one suicide attempt. Depression and anxiety scores were in the moderate-severe range for all age groups (Patient Health Questionnaire for Adolescents [PHQ-A]: 12.9 ± 6.4; Generalized Anxiety Disorder [GAD-7]: 11.3 ± 5.9). The sample includes youth who are receiving depression care at enrollment and may not be representative of non-diagnosed, non-treatment seeking youth. The TX-YDSRN is one of the largest prospective longitudinal cohort registries designed to develop predictive models for outcome trajectories based on disorder heterogeneity, social determinants of health, and treatment availability. • TX-YDSRN will improve understanding of youth with depression and suicidal behaviors. • TX-YDSRN consists of the UT Southwestern Network Hub and 12 medical school "Nodes". • The Research Registry will follow 2500 Texas youth for 2 years. • This report includes the first 1000 youth enrolled in the Research Registry study. [ABSTRACT FROM AUTHOR]

This study evaluated the psychometric properties of the 9-item Concise Health Risk Tracking Self-Report (CHRT-SR 9), a measure of suicidality, in adolescent psychiatric outpatients. Altogether, 933 depressed or suicidal adolescents (12–20 years of age), receiving treatment at psychiatric outpatient clinics in Texas, completed the 16-item CHRT-SR at baseline and one month later. CHRT-SR 9 was extracted from CHRT-SR 16 using multigroup confirmatory factor analysis. Sex and age measurement invariance, classical test theory, item response theory (IRT), and concurrent validity analyses (against the suicidal ideation Item 9 of Patient Health Questionnaire-Adolescent (PHQ-A)) were conducted. The CHRT-SR 9 demonstrated excellent model fit with four factors (pessimism, helplessness, despair, and suicidal thoughts). Measurement invariance was upheld. Acceptable item-total correlations (0.56–0.80) and internal consistency (Spearman-Brown 0.78–0.89) were revealed. IRT analyses showed a unidimensional instrument with excellent item performance. Using the CHRT-SR 9 total score as a measure of overall suicidality and comparing it against levels of PHQ-A Item 9, the mean (standard deviation) of CHRT-SR 9 total score was 8.64 (SD = 5.97) for no-risk (0 on Item 9), 17.05 (SD = 5.00) for mild, 23.16 (SD = 5.05) for moderate, and 26.96 (SD = 5.24) for severe-risk (3 on Item 9). Significant differences (p-value<0.0001) indicated that CHRT-SR 9 total score distinguished between levels of suicidal risk. Furthermore, CHRT-SR 9 was sensitive to change over a one-month period. Whether CHRT-SR 9 predicts actual suicidal attempts in adolescents is not well defined. The CHRT-SR 9 is an easy-to-administer, user-friendly self-report with good psychometric qualities which makes it an excellent screening measure of suicidal risk in adolescent psychiatric outpatients. • CHRT-SR 9 is a measure of suicidal risk in adolescent psychiatric outpatients. • It is brief, easy to comprehend, and simple to score. • It has excellent psychometric qualities and stable subscales. • It has high reliability, validity and is sensitive to change in suicidality over time. • It can be useful as a screening tool for suicide or to assess treatment outcomes. [ABSTRACT FROM AUTHOR]

Symptoms of irritability, anxiety, panic, and insomnia are common in patients with depression, and their worsening after antidepressant treatment initiation is associated with poorer long-term outcomes. The Concise Associated Symptom Tracking (CAST) scale was developed to measure these symptoms in adults with major depressive disorder (MDD). Here, we evaluate the psychometric properties of CAST in an ongoing community-based observational study involving children, adolescents, and young adults. Individuals from the ongoing Texas Youth Depression and Suicide Research Network (TX-YDSRN; N = 952) with CAST data available were included. Fit statistics [Goodness of Fit Index (GFI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA)] from confirmatory factor analyses were used to evaluate the five- and four-domain structure of CAST. Item response theory (IRT) analyses were also used. Individuals were grouped based on age (in years) as youths (8–17) and young adults (18–20). Correlations with other clinical measures were used to inform construct validity. Four-domain (irritability, anxiety, panic, and insomnia) 12-item structure of CAST (CAST-12) was optimal for youths (N = 709, GFI = 0.906, CFI = 0.919, RMSEA = 0.095) and young adults (N = 243, GFI = 0.921, CFI = 0.938, RMSEA = 0.0797) with Cronbach's alpha of 0.87 and 0.88, respectively. Slope of each item exceeded 1.0 on IRT analyses suggesting adequate discrimination for each item. Scores on irritability, anxiety, panic, and insomnia were significantly correlated with similar items on other scales. Together these findings suggest that CAST-12 is a valid self-report measure of irritability, anxiety, insomnia, and panic in youths and young adults. • Study of Concise Associated Symptom Tracking (CAST) in youths and young adults. • Self-report measure of anxiety, irritability, insomnia and panic using 12 items. • Psychometric tests support four-domain structure of CAST-12. • Cronbach's alpha of 0.87 and 0.88 suggest strong internal consistency. • Strong association of domain score with other measures support construct validity. [ABSTRACT FROM AUTHOR]

Sleep disturbance is a unique, yet understudied, risk factor for suicidal thoughts and behaviors (STBs). The present study sought to explore the relationship between suicidal ideation (SI) and self-reported sleep disturbance in a sample of adolescents in an intensive outpatient program targeting suicidality (N = 691). Analyses conducted include paired samples t tests, multiple linear regression, and analysis of variance to examine group differences in sleep disturbance over time. Sleep disturbance and SI were associated at each timepoint, and sleep disturbance at admission predicted SI at discharge. Those with the most severe SI at discharge indicated increased sleep disturbance relative to admission, whereas those reporting no SI at discharge nearly resolved all sleep difficulties. Future studies should utilize objective sleep measures, longitudinal assessments, and include a more diverse sample to better inform the relationship of sleep and SI. These findings suggest that directly managing sleep disturbance during treatment could decrease the risk of STBs. [ABSTRACT FROM AUTHOR]

While prior research has investigated trajectories of depressive symptom change throughout psychotherapy, such work has not been conducted exclusively among underserved patients receiving brief Behavioral Activation (BA) teletherapy, intervention modifications that should reduce barriers to therapy initiation and engagement. The current project used cluster analysis to determine discrete groups of symptom change among patients receiving an 8-session BA teletherapy intervention, and analyzed whether demographic and clinical characteristics were associated with group membership. Data from 105 patients referred from charity primary care clinics and receiving at least two therapy sessions were analyzed. Patients were predominantly female and Latina. The 9-item Patient Health Questionnaire (PHQ-9) was the outcome. Two categories were determined: a larger group (N = 61) demonstrating initially less severe symptoms and experiencing a gradual recovery, and a smaller group beginning with more severe symptoms, and experiencing a steeper recovery. In both groups, a majority of participants experienced at least a 5-point drop in depressive symptoms, while in the latter group, a majority of patients achieved depressive symptom remission (PHQ-9 < 5). Monolingual Spanish speakers were more likely to be in the former group, but no other demographic or clinical characteristics were associated with group membership. In both groups, a majority of the symptom reduction occurred by sessions 4-6. Therefore, two categories of depressive symptom change, slow responders and rapid responders, occur among patients receiving a brief BA teletherapy intervention. No demographic differences aside from primary language, nor any clinical characteristics, distinguish group membership, suggesting similar patterns of symptom reduction among a primarily underserved sample. [ABSTRACT FROM AUTHOR]

We examined hopelessness as a predictor of suicide ideation in depressed youth after acute medication treatment. A total of 158 depressed adolescents were administered the Children's Depression Rating Scale-Revised (CDRS-R) and Columbia Suicide Severity Rating Scale (C-SSRS) as part of a larger battery at baseline and at weekly visits across 6 weeks of acute fluoxetine treatment. The Beck Hopelessness Scale (BHS) was administered at baseline and week 6. A negative binomial regression model via a generalized estimating equation analysis of repeated measures was used to estimate suicide ideation over the 6 weeks of acute treatment from baseline measure of hopelessness. Depression severity and gender were included as covariates in the model. The negative binomial analysis was also conducted separately for the sample of males and females (in a gender-stratified analysis). Mean CDRS-R total scores were 60.30 ± 8.93 at baseline and 34.65 ± 10.41 at week 6. Mean baseline and week 6 BHS scores were 9.57 ± 5.51 and 5.59 ± 5.38, respectively. Per the C-SSRS, 43.04% and 83.54% reported having no suicide ideation at baseline and at week 6, respectively. The analyses revealed that baseline hopelessness was positively related to suicide ideation over treatment (p = .0027), independent of changes in depression severity. This significant finding persisted only for females (p = .0024). These results indicate the importance of early identification of hopelessness. [ABSTRACT FROM AUTHOR]

• CHRT-SR 9 and C-SSRS predicted suicidal events and attempts in adolescents at risk. • CHRT-SR 9 and C-SSRS had similar sensitivity at detecting these events in our sample. • CHRT and C-SSRS have good negative predictive value (low rate of false negatives). • CHRT-SR 9 and C-SSRS are effective and can help assess suicidal risk in adolescents. This report examines the predictive capabilities of two scales of suicidality in high-risk adolescents. Charts of adolescents with severe suicidality participating in an intensive outpatient program were reviewed. Self-report data from the 9-item Concise Health Risk Tracking Self-Report (CHRT-SR 9) and clinician-completed data from the Columbia Suicide Severity Risk Scale (C-SSRS) were obtained at entry. Scales' performances in predicting suicide attempts and suicidal events were evaluated using logistic regression models and ROC analyses. Of 539 adolescents, 53 had events of which 19 were attempts. The CHRT-SR 9 total score predicted events (OR =1.05) and attempts (OR =1.09), as did the C-SSRS Suicide Ideation (SI) Intensity Composite for events (OR =1.10) and attempts (OR =1.16). The CHRT-SR 9 AUC was 0.70 (84.2% sensitivity; 41.7% specificity; PPV=5.0%; NPV=98.6%) for attempts. The C-SSRS Intensity Composite AUC was 0.62 (89.5% sensitivity; 24.1% specificity; PPV=4.2%; NPV=98.4%) for attempts. Both the CHRT-SR 9 and C-SSRS capture important parameters related to suicidal events or attempts that can help assess suicidal risk in adolescents. [ABSTRACT FROM AUTHOR]

Adolescence, when suicidal ideation and behaviors often begin, might offer an important window to understand the causes and prevent the progression of suicide phenomena. The need for frameworks to organize the fragmented field has been noted, but few studies are theoretically driven. An important recent contribution to understanding suicidality is Joiner's (2005) Interpersonal-Psychological Theory of Suicide (IPTS). This article reviews the evidence for the applicability of the IPTS in adolescence. Seventeen studies of adolescents that specifically tested or interpreted findings in the light of Joiner's theory or the IPTS were located. In addition, several recent reviews of the literature on suicidality in adolescence covered information relevant to the IPTS. There is some support for the theory in adolescence, particularly with regard to its most novel component, the association between acquired capability and suicide attempt. In summary, we find this theory to be a promising heuristic to organize the disparate studies in suicide research. Future challenges and directions for researchers seeking to test and elaborate the applicability of the IPTS in adolescence include: adaptations of instruments to the developmental stage, capturing of imminent risk, and consideration of whether the current model is underspecified. Age might moderate adult findings that give impulsivity an indirect role in suicide attempts. [ABSTRACT FROM PUBLISHER]

Study Design: Cross-sequential study design that used data from Texas Scottish Rite Hospital for Children (TSRHC).Objective: Examine anxiety symptoms and family experiences subsequent to school scoliosis screening (SSS) referrals.Summary Of Background Data: Use of SSS remains controversial. Prior research suggested that SSS programs may result in anxiety for both children and parents. Unfortunately, no study has examined the SSS referral processes and anxiety in families.Methods: Study consisted of 2 groups-patients/parents from TSRHC evaluated for Adolescent Idiopathic Scoliosis (AIS) (n = 27) and control participants/parents (n = 27) between ages 9 and 17. All participants completed the primary outcome measure (State-Trait Anxiety Inventory) before and after the scoliosis evaluation or controlled wait time. Parents also rated experience and satisfaction with SSS.Results: Compared with the control group, children/parents in patient group experienced significantly elevated levels of state-anxiety at preappointment. Children/parents in the patient group not diagnosed with AIS experienced a significant decline in state-anxiety. Children/parents in the patient group diagnosed with AIS continued to report elevated levels of anxiety. The control group remained consistent, reporting of low levels of anxiety pre to post. More than half (55.5%) of families indicated they received no information from the school about scoliosis. A third of the families who received information indicated it did not adequately address their concerns. Nonetheless, most families reported overall satisfaction with SSS.Conclusion: This study suggested that children and parents referred through the SSS program experienced significantly elevated levels of state-anxiety. This supports the subjective concerns of anxiety experiences in families voiced by researchers previously. However, families deemed the costs of the SSS referral process as worth the benefits. Though challengers of SSS programs were accurate in observing anxiety in families, it may not constitute significant burden to eliminate SSS programs altogether. Improvements to the current system may be warranted.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

The present investigation examined neurocognitive functioning, focusing on executive functioning (EF), in 39 children and adolescents with Major Depressive Disorder (MDD) and 24 healthy control subjects all ages 8 to 17 years. The Wechsler Intelligence Scale for Children-Third Edition along with several measures of executive functioning including the Wisconsin Card Sorting Task, Trail Making Test, Controlled Oral Word Association Test, and the Stroop Color Word Test were administered. The neurocognitive profiles for the group of depressed children and adolescents were grossly intact as most scores on intellectual and EF measures fell within the average range and did not differ from the comparison group. Mental processing speed was decreased in the MDD versus normal control group and 27% of the depressed group performed below average on the Trail Making Test. This investigation provided a good base from which to compare future literature on EF in outpatients with early-onset MDD. [ABSTRACT FROM AUTHOR]