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The long-term consequences of exposure to firearm injury—including suicide, assault, and mass shootings—on children's mental and physical health is unknown. Using PRISMA-ScR guidelines, we conducted a scoping review of four databases (PubMed, Scopus, PsychINFO, and CJ abstract) between January 1, 1985 and April 2, 2018 for articles describing long-term outcomes of child or adolescent firearm injury exposure (n = 3582). Among included studies (n = 31), most used retrospective cohorts or cross-sectional studies to describe the correlation between firearm injury and post-traumatic stress. A disproportionate number of studies examined the effect of mass shootings, although few of these studies were conducted in the United States and none described the impact of social media. Despite methodologic limitations, youth firearm injury exposure is clearly linked to high rates of post-traumatic stress symptoms and high rates of future injury. Evidence is lacking on best practices for prevention of mental health and behavioral sequelae among youth exposed to firearm injury. Future research should use rigorous methods to identify prevalence, correlates, and intervention strategies for these at-risk youth. [ABSTRACT FROM AUTHOR]

Peer violence and depressive symptoms are increasingly prevalent among adolescents, and for many, use the emergency department (ED) as their primary source of healthcare. Brief in-person interventions and longitudinal text-message-based interventions are feasible, acceptable, and may be effective in reducing peer violence and depressive symptoms when delivered in the ED setting. This paper presents the study design and protocol for an in-ED brief intervention (BI) and text messaging program (Text). This study will be conducted in a pediatric ED which serves over 50,000 pediatric patients per year. Recruitment of study participants began in August 2018 and anticipated to continue until October 2021. The study will enroll 800 adolescents (ages13–17) presenting to the ED for any reason who self-report past-year physical peer violence and past-two week mild-to-moderate depressive symptoms. The study will use a factorial randomized trial to test both overall intervention efficacy and determine the optimal combination of intervention components. A full 2 × 2 factorial design randomizes patients at baseline to 1) BI or no BI; and 2) Text or no Text. Peer violence and depressive symptoms improvements will be measured at 2, 4, and 8 months through self-report and medical record review. This study has important implications for the progress of the greater field of mobile health interventions, as well as for adolescent violence and depression prevention in general. This proposal has high clinical and public health significance with high potential scalability, acceptability, and impact. [ABSTRACT FROM AUTHOR]

A recommended component of suicide prevention is encouraging at-risk individuals to voluntarily and temporarily reduce access to firearms and other lethal methods. Yet delivering counseling on the topic can be difficult, given the political sensitivity of firearm discussions. To support such counseling, we sought to identify recommended framing and content of messages about reducing firearm access for suicide prevention. Through qualitative interviews with firearm owners and enthusiasts, we identified key points for use in framing (identity as a gun owner, trust, voluntary and temporary storage, and context and motivation) and specific content (preference for "firearm" over "gun," and legal issues such as background checks for transfers). These findings build on prior work and should enhance efforts to develop and deliver effective, acceptable counseling and-ultimately-prevent firearm suicide. [ABSTRACT FROM AUTHOR]

"Skills to Enhance Positivity" (STEP) is a two-part positive affect program designed to decrease recurrent suicidal behavior in adolescents hospitalized due to suicide risk. Here, we describe the initial pilot phase in which the intervention was developed and modified based on a sample of 20 adolescent participants, aged 12 to 18 years old (Mage = 15.9, SD = 1.5). STEP consisted of an in-person phase (four sessions) and a remote delivery phase (text messaging and phone calls). The inpatient sessions focused on psychoeducation of positive affect, mindfulness meditation, gratitude, and savoring. The remote delivery phase comprised of weekly phone calls and daily text messages to enhance mood monitoring and skills practice reminders. Average session attendance was 81%, and mean daily response rate to text messages was 73.6%, demonstrating high engagement. STEP was described as good or excellent by over 90% of parents and 100% of adolescents. Only one participant had a suicide attempt, and five were readmitted for suicidality in the following 6 months, fewer than comparable naturalistic studies. Although preliminary results are promising, larger randomized trials are needed to determine the efficacy of STEP in reducing suicidal behaviors. [ABSTRACT FROM AUTHOR]

At-risk adolescents' comprehension of, and preferences for, the content of a text-message (SMS) delivered, cognitive behavioral therapy (CBT)-based depression prevention intervention was investigated using two qualitative studies. Adolescents with depressive symptoms and a history of peer violence were recruited from an urban emergency department. Forty-one participants completed semi-structured qualitative interviews. Thematic analysis using deductive and inductive codes were used to capture a priori and emerging themes. Five major themes were identified: CBT-based messages resonated with at-risk adolescents; high levels of peer violence, comorbid symptoms, and prior exposure to the mental health system were variables affecting preferred content; participants endorsed emotional regulation messages, but found mindfulness content difficult to understand via SMS; cognitive awareness and restructuring content was most acceptable when framed by self-efficacy content; adolescent participants generated applicable CBT content in their own voices. Overall, CBT-informed content was able to be distilled into 160-character text messages without losing its comprehensibility. [ABSTRACT FROM AUTHOR]

Adolescent cyberbullying is increasingly prevalent. Depression and suicidal ideation are also common, particularly among minority adolescents and cyberbullied adolescents. Little data exists to establish whether minority cyberbullied adolescents are at greater risk of negative mental health outcomes associated with cyberbullying. This cross-sectional study of 1031 adolescents presenting to an emergency room examines the prevalence of cyberbullying in minority and non-minority populations. Using logistic regression, we compared mental health symptoms between minority and non-minority cyberbullying-involved adolescents (accounting for demographic factors), and examined the correlation between use of multiple forms of online technology, minority status, and prevalence of cyberbullying. Sexual orientation was the only demographic factor to strongly correlate with cyberbullying involvement or to correlate with negative mental health symptoms. Increased use of social media platforms also correlated with cyberbullying involvement. This analysis provides a baseline for future work around targeted cyberbullying interventions for minority adolescent populations. [ABSTRACT FROM AUTHOR]

Objectives In the United States, emergency medicine ( EM) researchers hold proportionately fewer federal career development awards than researchers in other specialties. Others hypothesize that this deficit may partly be attributed to lack of mentors, departmental resources, and qualified applicants. Our objectives were to examine the association between departmental and institutional resources and career development awards and to describe the barriers to conducting research and btaining grants in EM. Methods We conducted an online, cross-sectional survey study of vice chairs for research and research directors at academic emergency departments in the United States in January and February 2016. Participants provided quantitative information regarding their department's demographics, available research resources, number of funded independent investigators, and number of career development awards. They were also asked about the perceived adequacy of departmental and institutional resources and perceived barriers to research and grant success. Data were analyzed using descriptive statistics and multivariable linear regression, as appropriate. Results Of 178 eligible participants, 103 (58%) completed the survey. Most departments reported some infrastructure for research and grant submission, including research coordinator(s) ( n = 75/99; 76%, 95% confidence interval [ CI] = 66%-84%), research associates (69/99; 70%, 95% CI = 60%-79%), and administrative/secretarial research support (79/101; 78%, 95% CI = 69%-86%). The majority of departments (56/103; 49%, 95% CI = 44%-64%) had no R01-funded researchers, and only 15 (15%, 95% CI = 8%-23%) had three or more R01-funded researchers. The most frequently reported challenge to junior faculty applying for grants was low motivation for applying (62/103; 60%, 95% CI = 50%-70%), followed closely by insufficient mentorship (50/103; 49%, 95% CI = 39%-59%) and discouragement from low funding rates (50/103; 49%, 95% CI = 39%-59%). In the multivariable model, only the number of departmental R-level-funded researchers was associated with the number of departmental career development awards (coefficient = 0.75, 95% CI = 0.39-1.11; R2 = 0.57). Conclusions While more multiple departmental and institutional resources correlated with a greater number of funded career development awards, the single greatest predictor was the number of R-level-funded researchers in the department. Low motivation and insufficient mentorship were the most frequently reported barriers to junior faculty applying for career development awards. Further studies are needed to describe junior faculty perspectives on these issues and to explore strategies for overcoming these barriers. [ABSTRACT FROM AUTHOR]