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Background: Little is known about when youth may be at greatest risk for attempting suicide, which is critically important information for the parents, caregivers, and professionals who care for youth at risk. This study used adolescent and parent reports, and a case-crossover, within-subject design to identify 24-hour warning signs (WS) for suicide attempts. Methods: Adolescents (N = 1094, ages 13 to 18) with one or more suicide risk factors were enrolled and invited to complete bi-weekly, 8–10 item text message surveys for 18 months. Adolescents who reported a suicide attempt (survey item) were invited to participate in an interview regarding their thoughts, feelings/emotions, and behaviors/events during the 24-hours prior to their attempt (case period) and a prior 24-hour period (control period). Their parents participated in an interview regarding the adolescents' behaviors/events during these same periods. Adolescent or adolescent and parent interviews were completed for 105 adolescents (81.9% female; 66.7% White, 19.0% Black, 14.3% other). Results: Both parent and adolescent reports of suicidal communications and withdrawal from social and other activities differentiated case and control periods. Adolescent reports also identified feelings (self-hate, emotional pain, rush of feelings, lower levels of rage toward others), cognitions (suicidal rumination, perceived burdensomeness, anger/hostility), and serious conflict with parents as WS in multi-variable models. Conclusions: This study identified 24-hour WS in the domains of cognitions, feelings, and behaviors/events, providing an evidence base for the dissemination of information about signs of proximal risk for adolescent suicide attempts. [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]

Objective: Suicide is the second leading cause of death among college students in the United States, and the percentage of students reporting suicidal thoughts is increasing. Nevertheless, many students at risk do not seek mental health (MH) services. This randomized controlled trial (RCT) examined the efficacy of Electronic Bridge to Mental Health for College Students (eBridge) for increasing at-risk students' linkage to MH services. Method: Students from four universities were recruited via email; 40,347 (22.6%) completed the online suicide risk screen; and 3,363 (8.3%) met criteria for randomization based on suicide risk factors and lack of current treatment (62.2% female, 35.0% male, 2.8% transgender/nonbinary; 73.2% White, 7.0% Black, 19.9% Asian, 11.7% other; 12.4% Hispanic, 76.2% undergraduate). These students were randomized to eBridge [personalized feedback (PF) with option of online counseling] or Control (PF). The primary outcome was linkage to MH services within 6 months. Results: Among students assigned to eBridge, 355 students (21.0%) posted ≥1 message, and 168 (10.0%) posted ≥2 messages to the counselor. In intent-to-treat analyses, there was no eBridge effect on obtaining MH services. However, within the eBridge group, students who posted ≥1 message were significantly more likely to link to MH services. Conclusions: eBridge shows promise for reaching a relatively small subset of college students at risk for suicide; however, engagement in eBridge was low. This study underscores the urgent need for more effective strategies to engage young adults in online mental health interventions. What is the public health significance of this article?: Suicide is the second leading cause of death among college students. Moreover, recent national surveys indicate that more than 10% of college students have seriously considered attempting suicide within the past year. In keeping with recommendations in the National Strategy for Suicide Prevention (Office of the Surgeon General & National Action Alliance for Suicide Prevention, 2012), this project examined the efficacy of eBridge, an online intervention that identifies students at elevated suicide risk and facilitates their linkage to mental health services, in a multiuniversity randomized controlled trial. [ABSTRACT FROM AUTHOR]

This study examined the effectiveness of LET's CONNECT (LC), a community mentorship program based on the positive youth development model. Participants were 218 youth (66.5% girls), ages 12 to 15, who reported peer victimization, bullying perpetration, and/or low social connectedness. These youth were randomized to LC or the control group (community resource information). The LC program linked youth to community mentors who connected with youth and facilitated their involvement in social growth activities across a 16‐month period. Outcomes were assessed at 6 and 16 months with self‐report measures of social and community connectedness, thwarted belongingness, depression, self‐esteem, and suicidal ideation and behavior. In intent‐to‐treat analyses, LC was associated with modest positive effects for social connectedness, self‐esteem, and depression. It had no effects on suicidal ideation or behavior. Results suggest that LC has the potential to positively impact the developmental trajectories of youth dealing with the interpersonal challenges of victimization, bullying perpetration, or low social connectedness. LC implementation challenges and directions for further research are also discussed. Highlights: LET's CONNECT (LC) is a community mentorship program for youth with peer social problems.We examined the effectiveness of LC in a randomized intervention trial.LC was associated with modest benefits, including improved social connectedness and self‐esteem.LC may positively impact the developmental trajectories of youth with peer social problems. [ABSTRACT FROM AUTHOR]

Background: The need for effective interventions for psychiatrically hospitalized adolescents who have varying levels of postdischarge suicide risk calls for personalized approaches, such as adaptive interventions (AIs). We conducted a nonrestricted pilot Sequential, Multiple Assignment, Randomized Trial (SMART) to guide the development of an AI targeting suicide risk after hospitalization. Methods: Adolescent inpatients (N = 80; ages 13–17; 67.5% female) were randomized in Phase 1 to a Motivational Interview‐Enhanced Safety Plan (MI‐SP), delivered during hospitalization, alone or in combination with postdischarge text‐based support (Texts). Two weeks after discharge, participants were re‐randomized in Phase 2 to added telephone booster calls or to no calls. Mechanisms of change were assessed with daily diaries for four weeks and over a 1‐ and 3‐month follow‐up. This trial is registered with clinicaltrials.gov (identifier: NCT03838198). Results: Procedures were feasible and acceptable. Mixed effects models indicate that adolescents randomized to MI‐SP + Texts (Phase 1) and those randomized to booster calls (Phase 2) experienced significant improvement in daily‐level mechanisms, including safety plan use, self‐efficacy to refrain from suicidal action, and coping by support seeking. Those randomized to MI‐SP + Texts also reported significantly higher coping self‐efficacy at 1 and 3 months. Although exploratory, results were in the expected direction for MI‐SP + Texts, versus MI‐SP alone, in terms of lower risk of suicide attempts (Hazard ratio = 0.30; 95% CI = 0.06, 1.48) and suicidal behavior (Hazard ratio = 0.36; 95% CI = 0.10, 1.37) three months after discharge. Moreover, augmentation with booster calls did not have an overall meaningful impact on suicide attempts (Hazard ratio = 0.65; 95% CI = 0.17, 3.05) or suicidal behavior (Hazard ratio = 0.78; 95% CI = 0.23, 2.67); however, boosters benefited most those initially assigned to MI‐SP + Texts. Conclusions: The current SMART was feasible and acceptable for the purpose of informing an AI for suicidal adolescents, warranting additional study. Findings also indicate that postdischarge text‐based support offers a promising augmentation to safety planning delivered during hospitalization. [ABSTRACT FROM AUTHOR]

Objective: This study examines the feasibility of a risk-management protocol for adolescent research participants at risk for suicide that relies on engagement with telephone crisis counselors. The study also examines whether engagement is moderated by adolescent demographics and clinical characteristics.Method: Participants were 234 adolescents (83% female; 63% White) ages 12-18 (M = 15.3 years) drawn from the national study, Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) Study One sample of adolescents randomized for 3-month telephone follow-up (n = 2,850). This study's sample was comprised of adolescents who completed the follow-up (69% retention), met study risk criteria, and were transferred to a crisis hotline for risk management. Engagement with a counselor was assessed by successful call connection, call duration, and information sharing.Results: Ninety-four percent of calls resulted in a successful call transfer, and the majority of youth (84%) shared information with counselor about one or more coping strategies. Average call length was 12.6 min (SD = 9.9). Engagement did not vary by gender, race, age, ethnicity, or clinical characteristics.Conclusions: Adolescents' engagement with telephone risk-management services was strong, suggesting that this strategy can address safety. Further, findings suggest telephone risk-management services effectively engage youth across demographic and clinical subgroups. [ABSTRACT FROM AUTHOR]

Background: The incidence of adolescent suicide is rising in the United States, yet we have limited information regarding short‐term prediction of suicide attempts. Our aim was to identify predictors of suicide attempts within 3‐months of an emergency department (ED) visit. Methods: Adolescents, ages 12–17, seeking health care at 13 pediatric EDs (Pediatric Emergency Care Applied Research Network) and one Indian Health Service Hospital in the United States were consecutively recruited. Among 10,664 approached patients, 6,448 (60%) were enrolled and completed a suicide risk survey. A subset of participants (n = 2,897) was assigned to a 3‐month telephone follow‐up, and 2,104 participants completed this follow‐up (73% retention). Our primary outcome was a suicide attempt between the ED visit and 3‐month follow‐up. Results: One hundred four adolescents (4.9%) made a suicide attempt between enrollment and 3‐month follow‐up. A large number of baseline predictors of suicide attempt were identified in bivariate analyses. The final multivariable model for the full sample included the presence of suicidal ideation during the past week, lifetime severity of suicidal ideation, lifetime history of suicidal behavior, and school connectedness. For the subgroup of adolescents who did not report recent suicidal ideation at baseline, the final model included only lifetime severity of suicidal ideation and social connectedness. Among males, the final model included only lifetime severity of suicidal ideation and past week suicidal ideation. For females, the final model included past week suicidal ideation, lifetime severity of suicidal ideation, number of past‐year nonsuicidal self‐injury (NSSI) incidents, and social connectedness. Conclusions: Results indicate that the key risk factors for adolescent suicide attempts differ for subgroups of adolescents defined by sex and whether or not they report recent suicidal thoughts. Results also point to the importance of school and social connectedness as protective factors against suicide attempts. [ABSTRACT FROM AUTHOR]

Abstract: This study examined the effectiveness of LET's CONNECT (LC), a community mentorship program for youths who report peer social problems, which is based on a positive youth development framework. Participants were 218 youths (66.5% girls), aged 12 to 15 years, who were recruited from an urban medical emergency department and screened positive for bullying victimization, bullying perpetration, and/or low social connectedness. Youths were randomized to LC (n = 106) or the control condition (n = 112). Six‐month outcomes were assessed with self‐report measures of youth social connectedness, community connectedness, thwarted belongingness, depression, self‐esteem, and suicidal ideation. LC was associated with a significant increase in only one of these outcomes, social connectedness (effect size = 0.4). It was associated consistently with trend‐level positive changes for thwarted belongingness (decreased), depression (decreased), community connectedness, and self‐esteem (effect sizes = 0.2). There was no effect on suicidal ideation (effect size = 0.0), and although not a primary outcome, eight youths in the LC condition and seven youths in the control condition engaged in suicidal behavior between baseline and follow‐up. Although LC effect sizes are consistent with those from previous studies of community mentorship, there were multiple challenges to LC implementation that affected dosage and intervention fidelity, and that may account for the lack of stronger positive effects. [ABSTRACT FROM AUTHOR]

Non-suicidal self-injury (NSSI) has been associated with an array of difficulties such as childhood abuse, interpersonal conflict, and mental health concerns ranging from emotional distress to suicidal thoughts and urges. To improve our understanding of NSSI and its relation to suicide risk, this study assessed the demographic (age, sex) and clinical (anxiety, depression, suicidal ideation, suicide attempt history) characteristics associated with NSSI methods ('how') and functions ('why'). The study sample ( N = 193) included youth and young adults, ages 13 to 25, who were seeking emergency psychiatric services and endorsed a lifetime history of NSSI. Study participants completed questionnaires assessing depression, anxiety, suicidal ideation, history of suicide attempt, and characteristics of NSSI engagement. Data were analyzed using Pearson, Spearman, and point-biserial correlation, Mann-Whitney U test, chi-square, t-test, and regression analyses (Poisson, binary-logistic, and ordinal). Female sex, the most prominent correlate in this study, was associated with number of lifetime NSSI incidents, quantity of NSSI methods used, and frequency of NSSI function engagement. Lifetime history of suicide attempt and suicidal ideation were positively associated with numbers of NSSI methods and functions, respectively. Regression analysis indicated that number of NSSI methods was associated with suicide attempt history, whereas total number of NSSI incidents was not. A greater understanding of the demographic and clinical factors associated with NSSI may ultimately advance the assessment and treatment of this behavior, especially in relation to suicide risk. [ABSTRACT FROM AUTHOR]

Suicide is the tenth leading cause of death in the United States, accounting for more than 42,000 deaths in 2014. Although this tragedy cuts across groups defined by age, gender, race/ethnicity, and geographic location, it is striking that nearly four times as many males as females die by suicide in the U.S. We describe the current regulations and recommendations for suicide risk screening in healthcare systems and also describe the aspirational goal of 'Zero Suicide,' put forth by the National Action Alliance for Suicide Prevention. We then provide information about suicide risk screening tools and steps to take when a patient screens positive for suicide risk. Given the substantially higher suicide rate among males than females, we argue that it is important to consider how we could optimize suicide risk screening strategies to identify males at risk and females at risk. Further research is needed to accomplish this goal. It is recommended that we consider multi-factorial suicide risk screens that incorporate risk factors known to be particularly important for males as well as computerized, adaptive screens that are tailored for the specific risk considerations of the individual patient, male or female. These strategies are not mutually exclusive. Finally, universal suicide risk screening in healthcare settings, especially primary care, specialty medical care, and emergency department settings, is recommended. [ABSTRACT FROM AUTHOR]

Objective: This pilot randomized controlled trial examined the effect of an online intervention for college students at risk for suicide. Electronic Bridge to Mental Health Services (eBridge), which included personalized feedback and optional online counseling delivered in accordance with motivational interviewing principles. Primary outcomes were readiness to seek information or talk with family and friends about mental health treatment, readiness to seek mental health treatment, and actual treatment linkage. Method: Participants were 76 college students (45 women, 31 men; mean age = 22.9 years, SD = 5.0 years) at a large public university who screened positive for suicide risk, defined by at least 2 of the following; suicidal thoughts, history of suicide attempt, depression, and alcohol abuse. Racial/ethnic self-identifications were primarily Caucasian (n = 54) and Asian (n = 21). Students were randomized to Bridge or the control condition (personalized feedback only, offered in plain report format). Outcomes were measured at 2-month follow-up. Results: Despite relatively modest engagement in online counseling (29% of students posted ≤ 1 message), students assigned to eBridge reported significantly higher readiness for help-seeking scores, especially readiness to talk to family, talk to friends, and see a mental health professional. Students assigned to eBridge also reported lower stigma levels and were more likely to link to mental health treatment. Conclusions: Findings suggest that offering students personalized feedback and the option of online counseling, using motivational interviewing principles, has a positive impact on students' readiness to consider and engage in mental health treatment. Further research is warranted to determine the robustness of this effect, the mechanism by which improved readiness and treatment linkage occurs, and the longer term impact on student mental health outcomes. [ABSTRACT FROM AUTHOR]

Objective: The feasibility and concurrent validity of adolescent suicide risk screening in medical emergency departments (EDs) has been documented. The objectives of this short-term prospective study of adolescents who screened positive for suicide risk in the ED were: 1) to examine adolescents' rate of suicidal behavior during the 2 months following their ED visits and compare it with reported rates for psychiatric samples; and 2) to identify possible predictors of acute risk for suicidal behavior in this at-risk sample. Method: Participants were 81 adolescents, ages 14-19 years, seeking services for psychiatric and nonpsychiatric chief complaints, who screened positive for suicide risk because of recent suicidal ideation, a suicide attempt, and/or depression plus alcohol or substance misuse. A comprehensive assessment of suicidal behavior, using the Columbia-Suicide Severity Rating Scale, was conducted at baseline and 2 month follow-up. Results: Six adolescents (7.4%) reported a suicide attempt and 15 (18.5%) engaged in some type of suicidal behavior (actual, aborted, or interrupted suicide attempt; preparatory behavior) during the 2 months following their ED visit. These rates suggest that this screen identified a high-risk sample. Furthermore, adolescents who screened positive for suicidal ideation and/or attempt plus depression and alcohol/substance misuse were most likely to engage in future suicidal behavior (38.9%). Conclusions: In this study, use of a higher screen threshold (multiple suicide risk factors) showed promise for identifying highly elevated acute risk for suicidal behavior. [ABSTRACT FROM AUTHOR]

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]

Clinicians commonly incorporate adolescents' self-reported suicidal ideation into formulations regarding adolescents' risk for suicide. Data are limited, however, regarding the extent to which adolescent boys' and girls' reports of suicidal ideation have clinically significant predictive validity in terms of subsequent suicidal behavior. This study examined psychiatrically hospitalized adolescent boys' and girls' self-reported suicidal ideation as a predictor of suicide attempts during the first year following hospitalization. A total of 354 adolescents (97 boys; 257 girls; ages 13-17 years) hospitalized for acute suicide risk were evaluated at the time of hospitalization as well as 3, 6, and 12 months later. Study measures included the Suicidal Ideation Questionnaire-Junior, Multidimensional Anxiety Scale for Children, Children's Depression Rating Scale-Revised, Beck Hopelessness Scale, Youth Self-Report, and Personal Experiences Screen Questionnaire. The main study outcome was presence and number of suicide attempt(s) in the year after hospitalization, measured by the Diagnostic Interview Schedule for Children. Results indicated a significant interaction between suicidal ideation, assessed during first week of hospitalization, and gender for the prediction of subsequent suicide attempts. Suicidal ideation was a significant predictor of subsequent suicide attempts for girls, but not boys. Baseline history of multiple suicide attempts was a significant predictor of subsequent suicide attempts across genders. Results support the importance of empirically validating suicide risk assessment strategies separately for adolescent boys and girls. Among adolescent boys who have been hospitalized due to acute suicide risk, low levels of self-reported suicidal ideation may not be indicative of low risk for suicidal behavior following hospitalization. [ABSTRACT FROM AUTHOR]

This article revisits the thesis of our 2005 book Transformational Public Service and responds to the question of what it takes to change the discipline by applying Emile Durkheim's notion of "collective effervescence" through means of empathy and transformational practices of institutions. We can enlarge the field of public administration to overcome its continued fixation on a narrowly managerial approach and find new ways to transform an otherwise languishing body of practice. [ABSTRACT FROM AUTHOR]

An essay is presented on the diverse and confusing way of using governance. It offers a review of how governance is used in the last chapter of the book "Democratic Governance," by Mark Bevir when referring to the work of the state. It examines the focus on governance in theory and examines interactions and processes that connect the state to civil society. The author relates the need to exercise care in using the term governance to avoid inauthentic participation.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: Background: Major Depressive Disorder (MDD) becomes increasingly prevalent during adolescence and is associated with substantial psychiatric comorbidity and psychosocial impairment. The marked behavioral heterogeneity evident among adolescents with MDD suggests the possibility of distinct subtypes. This study was designed to determine whether family psychiatric histories differ between groups of MDD adolescents defined by the presence or absence of severe behavioral disinhibition. Methods: Adolescents with MDD (n =71) completed the Buss–Durkee Hostility Inventory—Adapted, Adolescent Aggressive Incidents Interview (AAII), Measure of Aggression, Violence, and Rage in Children, Diagnostic Interview Schedule for Children, Suicidal Ideation Questionnaire-JR., Suicidal Behavior Inventory, and Reynolds Adolescent Depression Scale. Parents completed the Family Informant Schedule and Criteria, Children''s Affective Liability Scale, AAII, and a partial DISC. Behavioral disinhibition (BD) measures were used to assign adolescents to MDD+BD (n =41) and MDD−BD (n =30) groups. Results: The MDD+BD group had a higher prevalence of drug use disorders in biological fathers than the MDD−BD group. The MDD+BD group also had higher proportions of paternal second degree relatives with alcohol use disorders, drug use disorders, and psychiatric hospitalizations, and a higher proportion of maternal second degree relatives with antisocial personality disorder. Limitations: Limitations include reliance on single informants for family psychiatric histories and the failure to distinguish between child- and adolescent-onset depression. Conclusions: Family psychiatric histories differentiated MDD adolescents grouped by the presence or absence of behavioral disinhibition, suggesting possible etiologic mechanisms. Further research on subtypes or comorbid presentations may assist in the development of targeted treatment strategies. [Copyright &y& Elsevier]

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-l 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. [ABSTRACT FROM AUTHOR]

Discusses the nature and practice of public reason. Impact of the book "Postmodern Public Administration: Toward Discourse," by Chuck Fox and Hugh Miller, on the study of public administration theory; Difference between postmodernity and postmodernism; Implications of the postmodern moment on U.S. culture.

Women are underrepresented on the faculties and within the senior leadership ranks of academic health systems. Nevertheless, despite the continuing existence of career development challenges related to gender, it is possible for women to thrive professionally in these settings. Mentorship is extremely important, and it is argued that effective mentorship is facilitated by an understanding of both gender differences in social behaviors and the culture of academic health systems. Furthermore, a systems’ level emphasis on faculty diversity and the career development of women faculty is recommended. [ABSTRACT FROM AUTHOR]

The project described in this chapter was designed to maintain the social, recreational and task functioning of psychiatric outpatients impacted by the events of September 11th. A literature review determined that the research done on predicting the risk of psychiatric sequelae to the September 11th terrorist attacks focused on the development of psychiatric illness either in direct survivors or the population at large. No literature was found addressing functional outcomes, yet functional decompensation was the major concern of a group of occupational, recreational and creative arts therapists treating seriously mentally ill patients in The St. Luke 's/Roosevelt Hospital psychiatric outpatient programs in Manhattan. By comparing demographic patient data to risk factors identified in the research, we found a moderate amount of population risk. We then hypothesized, utilizing the stress diathesis model of serious mental illness, that major mental illness itself was a risk factor for decreased functioning in the aftermath of a disaster We designed a three-part program geared to the outpatient psychiatry population at large, utilizing an active coping model. The program is described and its potential as a prevention program utilizing the treatment setting's role as a support system is discussed. [ABSTRACT FROM AUTHOR]

Sloan and Marx (this issue) provide a comprehensive and thoughtful review of the written exposure paradigm, noting that it is a promising psychosocial intervention. They focus on possible explanatory theories and close their review by advocating for research aimed at understanding mechanisms of action. While this critically important research is being conducted by some investigators, it will be important for others to consider modifications or enhancements that might improve the efficacy and effectiveness of the written exposure paradigm and still others to consider the myriad of related intervention possibilities raised by the promising findings. That is, the emerging data on the written exposure paradigm have substantial heuristic value. There is insufficient psychosocial intervention research being conducted, and we have barely scratched the surface of possibilities related to this strategy. [ABSTRACT FROM AUTHOR]

Psychologists in academic health systems are in a unique position to impact the dynamic interplay among research, clinical practice, and policy domains. In addition to their specialty expertise in psychopathology, particular types of physical illness and disease, and health promotion, psychologists have substantial knowledge of human behavior, refined scientific skills, knowledge and experience in the effective delivery of clinical services, strengths in written expression, and a collaborative orientation. This combination of strengths makes psychologists extremely well-suited for (a) interdisciplinary efforts to develop and implement evidence-based assessment and intervention strategies with biological, psychological, behavioral, and social components, and (b) leadership and advocacy efforts that impact the quality and availability of health care services. [ABSTRACT FROM AUTHOR]

Examines a proposed pathway to mental health service use among depressed adolescents. Influences on parental identification; Parental identification of depression; Clinical implications.

Presents several reflections on the 2001 PAT-Net conference held in Leiden, the Netherlands, which deals with public administration. "Too Much of a Good Thing Is... Wonderful," by Vera Vogelsang-Coombs; "Inclusion and Relevance: The 2001 PAT-Net Conference Leiden University, the Netherlands," by Richard Huff; "Reflections on Leiden," by Steven E. Aufrecht.

This essay begins by deconstructing the basic question of how the present is defined in traditional historical explanation or analysis. It is our contention that to "rewrite" the present, one must be critical, examining the assumptions and methods behind historical "data" to identify what might be missed--whose stories are silenced--when theorists rely upon only the "great stories" of past events or "great men,"and to reveal metanarratives of history that support dominant regimes, hegemonies, and power structures. We then examine theoretical approaches to the use of theory, pointing out examples relevant to public administration. [ABSTRACT FROM AUTHOR]

Several studies have suggested a positive association between anxiety symptoms and suicidality in adults. However, relatively little is known about this topic in adolescents. To investigate this issue, we examined a group of adolescents admitted to our psychiatric inpatient unit. Fifty-six adolescents (mean age = 14.8 +/- 1.4; females = 34, males = 22; race = 95% Caucasians) participated in the study. Diagnoses were made using the DSM-III-R criteria and a diagnostic interview. Anxiety was found to significantly correlate with depression (r = .60; P = < .05) and suicidality (r = .72; P < .05). A multiple regression analysis revealed that anxiety and depression together accounted for more than half (55%) of the variance in suicidal ideation [F(2,46) = 28.4; P < .0001]. In addition, anxiety had an independent ability to predict suicidality (t = 5.01; P < .0001). Self-rated but not clinician-rated suicidality was positively correlated with both anxiety and depression. Clinical and research implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Presents a study which investigated the prevalence and characteristics of aggressive behavior in adolescent inpatients and outpatients with major depressive disorder. Analysis of the differences between males and females in prevalence and type of aggression; Level of parent-child agreement in report of aggression; Effect of the presence of psychopathology to the risk for aggressive behavior in adolescents; Measurement of aggressive behavior in youths.

Background: Despite evidence of the importance of interpersonal connectedness to our understanding of suicide risk, relatively little research has examined the protective and buffering effects of connectedness among adolescents. The aims of this study were to determine: (a) whether overall connectedness (composite of family, peer, and school) and specific domains of connectedness were related to a lower likelihood of suicide attempts, and (b) whether these factors buffer the prospective risk of suicide attempt for high‐risk subgroups (i.e., recent suicidal ideation and/or lifetime history of suicide attempt, peer victimization, or sexual and gender minority status). Methods: Participants were 2,897 adolescents (64.7% biological female), ages 12 to 17 (M = 14.6, SD = 1.6), recruited in collaboration with the Pediatric Emergency Care Applied Research Network (PECARN) from 14 emergency departments for the Emergency Department Screen for Teens at Risk for Suicide Study (ED‐STARS). Suicide risk and protective factors were assessed at baseline; 3‐ and 6‐month follow‐ups were completed (79.5% retention). Multivariable logistic regressions were conducted, adjusting for established suicide risk factors. Results: Higher overall connectedness and, specifically, school connectedness were associated with decreased likelihood of a suicide attempt across 6 months. Overall connectedness and connectedness domains did not function as buffers for future suicide attempts among certain high‐risk subgroups. The protective effect of overall connectedness was lower for youth with recent suicidal ideation or a suicide attempt history than for those without this history. Similarly, overall connectedness was protective for youth without peer victimization but not those with this history. Regarding specific domains, family connectedness was protective for youth without recent suicidal ideation or a suicide attempt history and peer connectedness was protective for youth without peer victimization but not youth with these histories. Conclusions: In this large and geographically diverse sample, overall and school connectedness were related prospectively to lower likelihood of suicide attempts, and connectedness was more protective for youth not in certain high‐risk subgroups. Results inform preventive efforts aimed at improving youth connectedness and reducing suicide risk. [ABSTRACT FROM AUTHOR]

The purpose of the study was to estimate prevalence of medication non-compliance among adolescents, following discharge from hospital. A second purpose was to identify predictors of such noncompliance. Seventy-one adolescents, who had been prescribed a medication during psychiatric hospitalization, were interviewed by telephone, 6–8 months post-hospitalization. Medication noncompliance was defined as discontinuing medication without the recommendation of the treating physician. Twenty-four subjects (33.8%) were noncompliant with medication. Age, race, gender, SES, diagnosis, type and number of medications, severity of depression, and family living arrangement did not predict noncompliance. We concluded that noncompliance with psychotropic medications was relatively common and difficult to predict in adolescents who had been hospitalized to a psychiatric inpatient unit; the majority of them suffered from depression. Clinicians should be aware that medication noncompliance may be common and a relatively unpredictable phenomenon. [ABSTRACT FROM AUTHOR]

Illustrates the central implications that a developmental perspective has for suicide prevention, with emphasis on the need to consider multiple pathways to prevention. Developmental or life-span considerations of substantial importance to development of a strategic plan and identification of possible pathways to suicide prevention; Goal of suicide prevention strategies.

Investigates predictors of self-reported depressive symptoms within groups of middle school students from the United States and Japan. Findings from multiple regression analyses; Factors contributing to self-reported depression; Critical relations between specific domains of perceived competence and depression; Implications for preventive interventions.

Presents two studies to investigate marital functioning and adolescent psychopathology in psychiatrically hospitalized adolescents. Methods and results of the two studies.

Summarizes findings from community-based studies that have explored suicide and risk factors among immigrant and Mexican-American groups. Reference to the increase in Mexican-American immigration since 1995; Information on suicidality within immigrant populations; Details on the existence of depression and psychiatric symptomatology among Mexican Americans.

Examines psychiatrically disturbed adolescents' history of exposures to suicide attempts and deaths in general. Identification of risk factors in the study of suicidal behavior; Effects of childhood experiences with suicide; Effects of exposures to death and suicidal behavior; Suicidality and attitudes toward death.

Presents a study on the identification of factors associated with adolescent suicidal behavior following psychiatric hospitalization. Facilitating effective aftercare interventions; Conducting of standardized baseline assessments and structured follow-up telephone interviews.

Presents information on the studied development and revision of depressive disorders, in relation to the diagnostic interview schedule for children, with the involvement of the National Institute of Mental Health (NIMH). What was the purpose of the study; Limitation of available information; Analysis of data; Results of analysis; Future research implications.

Focuses on adolescent psychiatric inpatients six months after discharge from psychiatric hospitalization, while identifying the individual, family-related, and treatment follow-through factors of prediction for outcome social functioning. Information on the method and subjects used; Details on the results, highlighting baseline depression; Statistical information supporting the results.

Presents a study suggesting that some acculturating Latino-American adolescents experience high levels of acculturative stress. Suicidality and depression among Latinos; Family support within the Latino population; Predictors of acculturative stress.

Presents a study which aims to identify clinical profiles discriminating depressed adolescents on the basis of comorbid alcohol/substance use disorders and to determine whether profiles with high predictive power are gender-specific. Comprehensive diagnostic evaluation of subjects; Importance of sensitivity in case identification; Increased risk of self-harm.

Presents a study to determine the nature of comorbid psychopathology and suicidality associated with a history of sexual abuse in depressed adolescents. Method of study; Higher prevalence of comorbid posttraumatic stress disorder (PTSD) among depressed adolescents with a history of sexual abuse; Need for thorough assessment of depression and PTSD.

Examines the family and parental characteristics related to suicidal behavior among adolescent inpatients with mood disorders. Family functioning and adolescent suicidal behavior; Measures used; Caregiving among mood disordered inpatients; Dynamics within families of suicide adolescents with mood disorders; Limitations and future research; Clinical implications.

Studies the effects of sleep deprivation on depression severity and level of arousal in psychiatrically disturbed adolescents. Sleep deprivation experiment on 17 patients; Findings; Suggestion of common psychophysiology between adult and adolescent depression.

Studies adolescent depression severity in relation to global self-worth and specific self-perceptions of competence. Determination of effect of improvement in depression during hospitalization; Research method; Study subjects; Importance of considering global self-worth and self-perceptions when assessing and treating adolescents.