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BackgroundSuicide is the second leading cause of death among adolescents. A critical need exists for developing promising interventions for adolescents after psychiatric hospitalization who are at a high risk of experiencing repeated suicidal behaviors and related crises. The high-risk period following psychiatric hospitalization calls for cost-effective and scalable continuity of care approaches to support adolescents’ transition from inpatient care. Text messages have been used to improve a wide range of behavioral and health outcomes and may hold promise as an accessible continuity of care strategy for youth at risk of suicide. ObjectiveIn this study of 40 adolescents at elevated suicide risk, we report on the iterative development and acceptability of a text-based intervention designed to encourage adaptive coping and safety plan adherence in the high-risk period following psychiatric hospitalization. MethodsAdolescents (aged 13-17 years) who were hospitalized because of last-month suicide attempts or last-week suicidal ideation took part in either study phase 1 (n=25; 19/25, 76% female), wherein message content was developed and revised on the basis of feedback obtained during hospitalization, or study phase 2 (n=15; 11/15, 73% female), wherein text messages informed by phase 1 were further tested and refined based on feedback obtained daily over the course of a month after discharge (n=256 observations) and during an end-of-study phone interview. ResultsQuantitative and qualitative feedback across the 2 study phases pointed to the acceptability of text-based support. Messages were seen as having the potential to be helpful with the transition after hospitalization, with adolescents indicating that texts may serve as reminders to use coping strategies, contribute to improvement in mood, and provide them with a sense of encouragement and hope. At the same time, some adolescents expressed concerns that messages may be insufficient for all teens or circumstances. In phase 2, the passage of time did not influence adolescents’ perception of messages in the month after discharge (P=.74); however, there were notable daily level associations between the perception of messages and adolescents’ affect. Specifically, higher within-person (relative to adolescents’ own average) anger was negatively related to liking text messages (P=.005), whereas within-person positive affect was associated with the perception of messages as more helpful (P=.04). ConclusionsText-based support appears to be an acceptable continuity of care strategy to support adolescents’ transition after hospitalization. The implications of study findings are discussed. Future work is needed to evaluate the impact of text-based interventions on suicide-related outcomes.

Firearm-related injuries are the leading cause of death among youth in the United States, and rates of firearm-related suicide in rural youth are more than double those in urban youth. Although safe firearm storage has been shown to reduce firearm injuries, little is known about how to culturally tailor such interventions for rural families in the United States. Informed by community-based participatory methods, focus groups and key informant interviews were conducted to design a safe storage prevention strategy for rural families. Participants included a broad array of community stakeholders (n = 40; 60% male, 40% female; age 15–72, M = 36.9, SD = 18.9) who were asked to identify acceptable messengers, message content, and delivery mechanisms that were perceived as respectful to the strengths of rural culture. Independent coders analyzed qualitative data using an open coding technique. Emerging themes included (1) community norms, values, and beliefs about firearms; (2) reasons for ownership; (3) firearm safety; (4) storage practices; (5) barriers to safe storage; and (6) suggested intervention components. Firearms were described as a "way of life" and family tradition in rural areas. Owning firearms for hunting and protection influenced family storage decisions. Intervention strategies that use respected firearm experts as messengers, refer to locally derived data, and that reflect community pride in firearm safety and responsible ownership may improve the acceptability of prevention messages in rural areas. [ABSTRACT FROM AUTHOR]

This study explores behavioral health services for American Indians and Alaska Natives (AIANs) at six Urban Indian Health Programs (UIHPs). Interviews and focus groups with clinicians and staff inquired about behavioral health treatment available, service needs, client population, and financial and staffing challenges. Resulting site profiles were created based on focused coding and integrative memoing of site visit field notes and respondent transcripts. These six UIHPs evidenced diversity across multiple facets of service delivery even as they were united in their missions to provide accessible and effective behavioral health treatment to urban AIAN clients. Primary challenges to service provision included heterogenous client populations, low insurance coverage, limited provider knowledge, lack of resources, and incorporation of traditional healing. Collaborative research with UIHPs harbors the potential to recognize challenges, identify solutions, and share best practices across this crucial network of health care sites for improving urban AIAN well‐being. [ABSTRACT FROM AUTHOR]

ObjectiveHeavy alcohol use has been clearly linked to risk for suicidal behaviors and is also prevalent on many American college campuses. This report uses a large sample of college students to explore relationships between alcohol use, depressive symptoms, and suicidality. Methods: A brief suicide screen was completed by 40,335 university students at four pariticipating sites. Assessments quantified recent depressive symptoms, alcohol use, suicidal ideation, and suicide attempts. Results: Problems from alcohol use were consistently associated with suicidal thoughts and attempts in the previous month, and in the previous year, but the quantity of alcohol used was not. Alcohol related problems exerted effects on the likelihood of both suicide ideation and attempts beyond those explained by their relationship with depressive symptoms. Conclusions: Screens for individuals at increased risk for suicidal ideation and behavior should emphasize alcohol-related problems over quantification of alcohol intake. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to describe self-reported barriers to professional help seeking among college students who are at elevated suicide risk and determine if these barriers vary by demographic and clinical characteristics. Participants: Participants were 165 non-treatment seekers recruited as part of a Web-based treatment linkage intervention for college students at elevated suicide risk (from September 2010 through December 2011). Methods: Data were collected using Web-based questionnaires. Two coders coded students' responses to an open-ended question about reasons for not seeking professional help. Results: The most commonly reported barriers included perception that treatment is not needed (66%), lack of time (26.8%), and preference for self-management (18%). Stigma was mentioned by only 12% of students. There were notable differences based on gender, race, and severity of depression and alcohol abuse. Conclusions: Efforts aimed at reaching students at elevated risk for suicidal behavior should be particularly sensitive to these commonly described barriers.

Using a nationally representative sample of young adults, this study examines COVID-induced financial hardship and its association with suicide risk (N = 1,087). About 40% experienced one or more financial hardship, a third reported having suicidal ideation, and 1.57% reported suicide attempt. The association between financial hardship and suicide risk was cumulative: Those reporting four or more financial hardships were 2.61 times more likely to report suicidal ideation and 24.27 times more likely to report a suicide attempt. The finding that COVID-related financial insecurity was associated with drastically elevated suicide risks highlights the need to assess financial hardship for suicide risk. [ABSTRACT FROM AUTHOR]

Victims of bullying, dating violence, and child maltreatment are all more likely than their peers to contemplate and attempt suicide in adolescence and young adulthood. However, knowledge of the relationship between violence and suicide risk is primarily limited to studies that isolate certain forms of victimization or examine several forms in additive risk models. We aim to move beyond the findings of basic descriptive studies by investigating whether multiple types of victimization elevate risk for suicide and whether latent profiles of victimization are more strongly related to suicide-related outcomes than are others. Primary data are from the first National Survey on Polyvictimization and Suicide Risk, a cross-sectional, nationally representative survey of emerging adults 18–29 in the United States (N = 1,077). A total of 50.2% of participants identified as cisgender female, followed by 47.4% cisgender male, and 2.3% transgender or nonbinary. Latent class analysis (LCA) was used to establish profiles. Suicide-related variables were regressed onto victimization profiles. A four-class solution was determined to be the best fitting model: Interpersonal Violence (IV; 22%), Interpersonal + Structural Violence (I + STV; 7%), Emotional Victimization (EV; 28%), and Low/No Victimization (LV; 43%). Participants in I + STV had increased odds for high suicide risk (odds ratio = 42.05, 95% CI [15.45, 114.42]) compared to those in LV, followed by IV (odds ratio = 8.52, 95% CI [3.47, 20.94]) and EV (odds ratio = 5.17, 95% CI [2.08, 12.87]). Participants in I + STV reported significantly higher odds for nonsuicidal self-injury and suicide attempts compared to most classes. Public Policy Relevance Statement: Given that many young people experience varying forms of violence, identifying common patterns of experiences may help identify which groups of young adults are most at risk for suicidal behavior. This study found that young adults exposed to both interpersonal and structural forms of violence were at the greatest risk for suicide, including suicide attempts and nonsuicidal self-injury. Cross-cutting violence and suicide prevention policies are needed, which should specifically address structural forms of violence as it is often overlooked in intervention and prevention efforts. [ABSTRACT FROM AUTHOR]

Treatment linkage and adherence to psychotherapeutic interventions can be challenging with suicidal individuals. Health behavior theories, specifically the Health Belief Model, Stages of Change, and Theory of Planned Behavior, focus on individuals' beliefs, their readiness to change, their perceptions of illness severity and "threat," their perceptions of significant others' attitudes toward illness and treatment, and their behavioral intentions to change. These constructs have relevance both for understanding suicidal individuals' behaviors related to treatment utilization and for understanding cultural variations in these behaviors. Furthermore, these theories have implications for clinical practices aimed at facilitating improved treatment follow-through and adherence. After describing the theories and their constructs, clinical examples are provided to illustrate applications to practice with suicidal individuals. (Contains 1 table.)

This experimental study examined the effect of communication about type of screening follow-up (in-person follow-up vs. no in-person follow-up) on adolescents' responses to a self-report suicide risk screen. Participants were 245 adolescents (131 girls, 114 boys; ages 13-17; 80% White, 21.6% Black, 9.8% American Indian, 2.9% Asian) seeking medical emergency services. They were randomized to a screening follow-up condition. Screening measures assessed primary risk factors for suicidal behavior, including suicidal thoughts, depressive symptoms, alcohol use, and aggressive/delinquent behavior. There was no main effect of follow-up condition on adolescents' screening scores; however, significant interactions between follow-up condition and public assistance status were evident. Adolescents whose families received public assistance were less likely to report aggressive-delinquent behavior if assigned to in-person follow-up. Adolescents whose families did not receive public assistance reported significantly higher levels of suicidal ideation if assigned to in-person follow-up. Findings suggest that response biases impact some adolescents' responses to suicide risk screenings. Because national policy strongly recommends suicide risk screening in emergency settings, and because screening scores are used to make critical decisions regarding risk management and treatment recommendations, findings indicate the importance of improving the reliability and validity of suicide risk screening for adolescents. (Contains 2 tables.)

This study examined the extent to which posthospitalization "change" in connectedness with family, peers, and nonfamily adults predicted suicide attempts, severity of suicidal ideation, and depressive symptoms across a 12-month follow-up period among inpatient suicidal adolescents. Participants were 338 inpatient suicidal adolescents, ages 13 to 17, who were assessed at 3, 6, and 12 months posthospitalization. General liner models were fitted for depressive symptoms and suicidal ideation outcomes, and logistic regression was used for the dichotomous suicide attempt outcome. The moderating effects of gender and multiple attempt history were examined. Adolescents who reported greater improvements in peer connectedness were half as likely to attempt suicide during the 12-month period. Improved peer connectedness was also associated with less severe depressive symptoms for all adolescents and with less severe suicidal ideation for female individuals, but only at the 3-month assessment time point. Improved family connectedness was related to less severe depressive symptoms and suicidal ideation across the entire year; for suicidal ideation, this protective effect was limited to nonmultiple suicide attempters. Change in connectedness with nonfamily adults was not a significant predictor of any outcome when changes in family and peer connectedness were taken into account. These results pointing to improved posthospitalization connectedness being linked to improved outcomes following hospitalization have important treatment and prevention implications given inpatient suicidal adolescents' vulnerability to suicidal behavior. (Contains 5 tables.)

The coping strategies used by adolescents to deal with stress may have implications for the development of depression and suicidal ideation. This study examined coping categories and specific coping behaviors used by adolescents to assess the relation of coping to depression and suicidal ideation. In hierarchical regression models, the specific coping behaviors of behavioral disengagement and self-blame were predictive of higher levels of depression; depression and using emotional support were predictive of suicidal ideation. Results suggest that specific behaviors within the broad coping categories of emotion-focused coping (e.g., self-blame) and avoidant coping (e.g., behavioral disengagement) account for these categories' associations with depression and suicidal ideation. Specific problem-focused coping strategies did not independently predict lower levels of depression or suicidal ideation. It may be beneficial for interventions to focus on eliminating maladaptive coping behaviors in addition to introducing or enhancing positive coping behaviors. (Contains 4 tables.)

This longitudinal study of recently hospitalized suicidal youth examined parental mental health history in addition to several indices of adolescent functioning as risk factors for time-to-suicide attempt over a 1-year period. Participants were 352 adolescents (253 girls, 99 boys; ages 13-17 years) who participated in self-report and interview assessments within 1 week of hospitalization and 6 weeks, 3, 6, and 12 months post-hospitalization. Multivariable proportional hazards regression modeled time-to-suicide attempt. Results indicate that adolescents were almost twice as likely to make a suicide attempt if they had at least one biological parent with mental health problems. Risk was also increased for adolescents with baseline histories of multiple previous suicide attempts, more severe suicidal ideation and more severe functional impairment. Findings suggest the need to consider the family system when intervening with suicidal youth.

The purpose of this study was to examine the efficacy of the Youth-Nominated Support Team-Version II (YST-II) for suicidal adolescents, an intervention based on social support and health behavior models, which was designed to supplement standard treatments. Psychiatrically hospitalized and suicidal adolescents, 13-17 years of age, were randomly assigned to treatment-as-usual (TAU) + YST-II (n = 223) or TAU only (n = 225). YST-II provided tailored psychoeducation to youth-nominated adults in addition to weekly check-ins for 3 months following hospitalization. In turn, these adults had regular supportive contact with adolescents. Adolescents assigned to TAU + YST-II had an average of 3.43 (SD = 0.83) nominated adults. Measures included the Suicidal Ideation Questionnaire-Junior (SIQ-JR; W. M. Reynolds, 1988), Children's Depression Rating Scale-Revised (E. O. Poznanski & H. B. Mokros, 1996), Beck Hopelessness Scale (A. T. Beck & R. A. Steer, 1993), and Child and Adolescent Functional Assessment Scale (CAFAS; K. Hodges, 1996). YST-II had very limited positive effects, which were moderated by history of multiple suicide attempts, and no negative effects. It resulted in more rapid decreases in suicidal ideation (SIQ-JR) for multiple suicide attempters during the initial 6 weeks after hospitalization (small-to-moderate effect size). For nonmultiple attempters, it was associated with greater declines in functional impairment (CAFAS) at 3 and 12 months (small effect sizes). YST-II had no effects on suicide attempts and no enduring effects on SIQ-JR scores. (Contains 4 tables and 3 figures.)

Information on history of suicidal thoughts and behaviors is critical in risk assessment, and multi-informant assessment has been recommended. Despite this, relatively little is known about parent-adolescent agreement regarding adolescent suicidality. To examine the extent and predictors of such agreement, 448 psychiatrically hospitalized adolescents and their parents were administered structured interviews assessing suicidal thoughts, plans, and attempts and completed measures of youth internalizing and externalizing behaviors, perceived family social support, and parental distress and psychopathology. Adolescents reported significantly more suicidal ideation, plans, and attempts than parents. Parental history of depression and adolescent perceived family support were associated with significantly greater agreement about suicidality. History of multiple suicide attempts was associated with greater disagreement about suicidality. (Contains 6 tables and 1 figure.)

Intervention research with youths at elevated risk for suicidal behavior and suicide--a vulnerable and high risk population--presents investigators with numerous ethical challenges. This report specifically addresses those challenges involving the informed consent and assent process with parents/guardians and youths. The challenges are delineated in the context of pertinent laws and regulatory requirements, and guidelines are suggested for their practical resolution. These are illustrated with case examples from NIMH-funded intervention trials. Through the sharing of such methodological information, intervention researchers can support each other in conducting ethical research in a manner that does not unduly compromise scientific rigor.

Family functioning and parenting were hypothesized to mediate the relation between remission of maternal depression and children's psychosocial adjustment. Participants were 114 mother-child dyads participating in the Sequenced Treatment Alternatives to Relieve Depression Child 3-month follow-up. All mothers had been diagnosed with major depressive disorder and were treated initially with citalopram; 33% of mothers experienced remission of depressive symptoms. Youth ranged in age from 7 to 17. Remission of maternal depression was associated with changes in children's reports of their mothers' warmth/acceptance, which in turn partially mediated the relation between maternal depression remission and youth internalizing symptoms, accounting for 22.9% of the variance. (Contains 6 tables, 1 figure and 1 footnote.)

Objective: The validity and clinical utility of the Reynolds Adolescent Depression Scale, Beck Hopelessness Scale, Suicidal Ideation Questionnaire-Junior, and Suicide Probability Scale (SPS) were examined longitudinally among suicidal adolescents. Method: Between 1998 and 2000, 289 psychiatrically hospitalized, suicidal youth, ages 12 to 17 years, participated in this study. Self-report measures were completed at baseline. Clinician-rated suicidality and suicide attempt were collected at baseline and 6-month follow-up. Results: Baseline self-reports were internally consistent and strongly intercorrelated within male, female, white, and black subsamples. All of the measures predicted follow-up suicidality and suicide attempts. Using published cutoff scores, the Beck Hopelessness Scale and SPS were moderately to highly sensitive predictors of subsequent suicide attempts, as was the Suicidal Ideation Questionnaire-Junior for predicting suicide attempts and broad suicidality. Alternative cutoff scores that predicted outcomes with moderate and high sensitivity also were examined, with attention to resultant sacrifices in specificity. Conclusions: Baseline self-report scores predicted follow-up suicidality. SPS contributed uniquely to prediction of future suicidality and suicide attempt. SPS may supplement other sources of information when assessing suicide risk with this population. (Contains 4 tables.)

Perceptions of social support from family, non-family adults, and peers were examined in relation to the psychopathology reported by 220 suicidal adolescents (152 females) during a psychiatric hospitalization. Results of regression analyses showed that, among females, family support was negatively related to hopelessness, depressive symptoms, and suicidal ideation. Among males, peer support was positively associated with depressive symptoms and suicidal ideation. Across gender, more peer support was associated with more externalizing behavior problems; whereas, family support was negatively related to these problems and to alcohol/substance abuse. Paralleling normative findings, age was positively associated with peer support, and females perceived more peer support than did males. Findings extend previous research on social support to suicidal adolescents, and broaden the literature by examining extrafamilial support and a broader range of relevant psychopathology. That is, perceived social support relates to psychiatric impairment differentially by gender, and normative, age-related variations in perceptions of social support are detected even among highly impaired adolescents. Clinical implications and directions for future research are discussed.

In this study, the authors investigated the efficacy of the Youth-Nominated Support Team-Version 1 (YST-1), a psychoeducational social network intervention, with 289 suicidal, psychiatrically hospitalized adolescents (197 girls, 92 boys). Adolescents were randomly assigned to treatment-as-usual plus YST-1 or treatment-as-usual only. Assessments were completed pre- and postintervention (6 months). There were no main effects for YST-1 on suicide ideation or attempts, internalizing symptoms, or related functional impairment. Relative to other girls, however, those who received YST-1 reported greater decreases in self-reported suicidal ideation (actually treated analytic strategy) and significantly greater decreases in mood-related functional impairment reported by their parents (intent to treat and actually treated analytic strategies). This is the first randomized controlled clinical trial to investigate the efficacy of a social network intervention with suicidal youths.

Background: Bereavement during childhood is associated with elevated rates of suicide‐related behaviours among youth. However, no interventions explicitly address suicidal ideation among bereaved youth. The Supporting Grieving Teens (SGT) programme was created as a preventive intervention to reduce suicide risk among bereaved youth. Methods: This preliminary open trial evaluated the feasibility, acceptability and preliminary outcomes of the SGT intervention among a sample of bereaved adolescents. Participants were 32 adolescents, 12–17 years of age (M = 14.44, SD = 1.56; 87.5% female, 31.3% Hispanic, 31.3% African American/Black and 25.0% non‐Hispanic White), seeking bereavement‐related services at a trauma and grief speciality outpatient clinic. Participants completed a two‐session web‐assisted intervention prior to enrolling in standard outpatient therapy. Results: There was a high rate of completion of the intervention, with 93.8% of those who provided assent completing both intervention sessions. Youth reported high levels of satisfaction with the intervention. Preliminary evaluation of outcomes demonstrated that the intervention was associated with small but significant reductions in thwarted belongingness and suicide ideation over the course of treatment and follow‐up. However, reliable change indices indicated reliable improvements for only a subset of participants. Limitations: This study utilised an open trial design without a control group, and so causality cannot be inferred. Additional limitations include the small sample size and limited variability in suicidal ideation in the sample. Conclusions: The intervention shows promise as a brief, web‐assisted psychosocial intervention for activating youths' existing social support networks. Further research is needed to more rigorously evaluate the intervention. [ABSTRACT FROM AUTHOR]

Recent research and theory suggest narcissistic features contribute to aggression in adults. The present study examined the association of narcissistic features with aggression and internalizing symptoms in 233 students of 5th-8th grade at three inner-city schools. A factor analysis of the Narcissistic Personality Inventory in this sample revealed three factors: Adaptive Narcissism, Exploitativeness, and Exhibitionism. Regression analyses were used to predict the association of these three narcissistic features with self-, teacher-, and peer-reported aggression and self-reported internalizing symptoms. Results indicate narcissistic exploitativeness positively predicted self-reported proactive aggression, and narcissistic exhibitionism positively predicted internalizing symptoms. Narcissism and self-esteem interacted to predict teacher-reported aggression and self-reported internalizing symptoms. Results are discussed in the context of existing theories of narcissism, threatened egotism, and self-perception bias.KEY WORDS: narcissism; aggression; internalizing; urban African American adolescent.