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Background: teen Mental Health First Aid (tMHFA) is an Australian school-based universal program for grade 10 to 12 students. tMHFA teaches teens how to recognize and respond to a peer in crisis or experiencing mental health concerns. Methods: Schools implementing tMHFA in 2019 and 2020 were propensity score matched, yielding a sample of instructors (n = 130) and students (n = 1915) in 44 high schools in 24 American states. Effectiveness and acceptability were assessed with student surveys at baseline and after implementation. Results: There were significant findings for primary outcomes, including improved helpful first aid intentions (Cohen ds = 0.57 to 0.58), confidence supporting a peer (ds = 0.19 to 0.31); the number of adults rated as helpful (ds = 0.37 to 0.44); and reductions in stigmatizing beliefs (ds = 0.21 to 0.40) and "harmful first aid intentions" (ds = 0.11 to 0.42). Instructors and students rated the program favorably with students sharing improvements on their recognition and responses to mental health problems and crises. Conclusion: tMHFA is an effective, feasible, and scalable training program for increasing mental health literacy and decreasing mental health stigma in adolescents in the short term, consistent with trials of tMHFA in Australian adolescents.

The aim of this study was to identify independent risk and protective factors associated with self-reported suicidal thoughts and behaviors (STB) among young adolescents by examining self-report data on mental health, substance abuse, violence involvement, social and economic challenges and supports, physical health and demographics in relation to STB. Data from nearly 27,000 students who completed the 2018-19 Maryland Middle School Youth Risk Behavior Survey/Youth Tobacco Survey (YRBS/YTS) were used to identify independent risk and protective factors associated with STB among middle school students (grades 6-8; ages 11-14). Twenty-three percent of students reported lifetime suicidal ideation and nine percent reported lifetime attempt(s). Independent risk factors associated with STB include depression, substance abuse or misuse, violence involvement, bullying victimization at school or electronically, sexual activity, and sleep deprivation. Protective factors include having an adult outside of school to confide in and feeling that teachers care and provide encouragement. Interactive effects by gender and/or race/ethnicity were observed for some factors in relation to STB. These results suggest that evidence-based programs and policies at the universal and selective/indicated levels in school settings are needed and should be introduced earlier on to address the widespread prevalence of STB in young adolescents. Program planners should take into consideration social, cultural and language needs when implementing and developing intervention strategies.

Three generations of developmental epidemiologically based randomized field trials of the Good Behavior Game (GBG) have been delivered to Baltimore elementary schools. With the collaboration of family and community partners, all three trials were directed at decreasing proximal targets of aggressive behavior and improving learning in first-grade classrooms with distal mental health and substance abuse outcomes. GBG is a group-contingent classroom behavior management strategy that promotes classmate/peer concern for each child's positive behavior by rewarding teams with below-criterion levels of aggressive, disruptive behavior. GBG targets early risk factors for the above distal outcomes: aggressive, disruptive behavior, family/school relationships, and school failure. Here, we report on the third-generation randomized prevention trial of the GBG (whole-day first grade program (WD)), including 12 elementary schools. WD enhanced the standard curriculum in the areas of classroom behavior management; academic instruction, particularly reading; and family-classroom partnerships. Using a within-school classroom randomized trial design, we: 1) evaluate the effectiveness of the WD program by sex and cohort and 2) measure variation in WD impact by the quality of teachers' behavior management practices. Data from 961 first graders were used in general growth mixture modeling that accounts for classroom randomization to identify distinct developmental trajectories of aggressive, disruptive behavior and GBG impact on these trajectories. In the chronic high aggression trajectory of males, ratings of aggression after WD implementation and to the end of third grade were significantly lower in the WD condition than in controls in classrooms with a higher WD dosage (Cohort 2) and especially in classrooms with higher quality of WD implementation. For females, we found a modest but significant benefit of GBG in the low trajectory class when cohorts were combined. Regarding policy implications, embedding GBG into the curricula in teacher's colleges could better support student learning and behavior.

Objectives: To evaluate whether a history of incarceration was associated with increased odds of suicidal ideation and suicide attempts, and to determine if this association was further strengthened when combined with a history of solitary confinement. Methods: We collected cross-sectional data from a general population sample in New York City and Baltimore in March 2017. Participants were categorized based on their history of incarceration and solitary confinement: (1) no incarceration, (2) incarceration-only, and (3) incarceration plus solitary confinement. We compared these three groups, utilizing hierarchical adjustments for sociodemographic factors and adverse childhood experiences. Missing data were accounted for utilizing multiple imputation via chained equation. Results: A total of 1221 individuals were analyzed. Those who experienced both incarceration and solitary confinement consistently had higher odds of suicidal ideation (OR, 2.80; 95% CI, 1.43 to 5.48) and suicide attempts (OR, 6.98; 95% CI, 2.77 to 17.61) than never incarcerated individuals. Those who experienced incarceration without solitary confinement had higher odds of suicide attempts (OR, 3.77; 95% CI, 1.35 to 10.56) than never incarcerated individuals, whereas this association was not evident for suicidal ideation. Solitary confinement increased the odds of suicidal ideation even compared to incarceration without solitary confinement (OR, 2.71; 95% CI, 1.09 to 6.74). Conclusions: Our findings support the need to address the higher likelihood of suicide-related outcomes among those in contact with the criminal justice system, and to consider alternatives to solitary confinement. HIGHLIGHTS: Those who experienced both incarceration and solitary confinement had higher odds of suicidal ideation and suicide attempts than never incarcerated individuals. Solitary confinement increased the likelihood of suicidal ideation, even more so than incarceration without solitary confinement. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether collegiate athletes and nonathlete college students differ in nonsuicidal self-injury (NSSI), suicidal ideation, suicide attempt, and help-seeking behaviors. Participants: 165,210 respondents to the American College Health Association's National College Health Assessment (NCHA), a survey administered to college students by participating institutions during Fall 2011 to Spring 2015. Methods: Single-level binary logistic regression with equality of coefficients tests and chi-square analyses. Results: The models for NSSI and suicide attempt differed slightly between student-athletes and nonathletes. Most notably, stress is a stronger correlate of NSSI (Z=3.03, p < 0.01) for nonathletes while difficulties with social relationships is a stronger correlate of suicide attempt for student-athletes (Z=-3.13, p < 0.01). Conclusion: Our findings highlight the salience of relationship problems as a correlate with suicide attempts in student-athletes. Difficulty in romantic or other social relationships could be a marker of risk or an identifiable, actionable target for preventing future suicidal behaviors among collegiate athletes.

Objectives: Providing personal demographic information is routine practice in the United States, and yet, little is known about the impacts of this process. This study aims to examine the experiences and perspectives of Multiracial/ethnic adults in the United States when disclosing racial/ethnic identity. Methods: Seventeen semistructured interviews were conducted with adults identifying as Multiracial/ethnic. The Multiracial/ethnic identities of participants included Black or African American and White; Black or African American, American Indian or Alaska Native (AI/AN) and Hispanic or Latino; Black or African American and Hispanic or Latino; Black or African American and AI/AN; AI/AN and White and Asian, Native Hawaiian or Pacific Islander and White. Multiple participants reported identifying with multiple ethnic groups for any single broad category. Three identified as sexual minorities. Nine were Millennials; six were Gen X; one was Gen Z; one was Baby Boomer. Qualitative data were analyzed using staged hybrid inductive–deductive thematic analysis. Results: Disclosure of racial and ethnic identities presents a unique stressor for Multiracial/ethnic populations due to methods used to obtain data, perceived mismatch of identity and phenotype and exposure to prejudice. Social norms, constructs and movements impact the categories that a Multiracial/ethnic person indicates to external parties. Conclusions: The stress and negative feelings that Multiracial/ethnic adults face when identifying their race/ethnicity underscore the broader implications of standard demographic questions on feelings of inclusivity and visibility within a population. Patient or Public Contribution: Gathering data on individuals' racial and ethnic backgrounds is a standard practice, and yet, it can pose challenges for those who identify with multiple groups or do not see their identities reflected in the options provided. Such individuals may feel excluded or experience unfair treatment when disclosing their identity, leading to significant stress. As the frequency of this data collection increases, it is essential that the questions are posed empathetically and equitably, with a strong commitment to enhancing inclusivity throughout the process. [ABSTRACT FROM AUTHOR]

This cohort study investigates the characteristics of adolescents with a history of depression who do not endorse risk on the Patient Health Questionnaire before self-harm or suicide. Key Points: Question: What are characteristics of adolescents with a history of depression who do not endorse risk via the Patient Health Questionnaire (PHQ) item 9 before self-harm or suicide? Findings: This cohort study including 691 and 1024 adolescents in 30- and 90-day cohorts, respectively, found that being screened in primary care or having a history of an inpatient encounter with a mental health diagnosis were associated with significantly greater odds of not endorsing risk before self-harm or suicide. Meaning: At-risk adolescents with depression screened in primary care or those with prior inpatient mental health encounters have an increased likelihood of not endorsing risk via the PHQ item 9. Importance: Given that the Patient Health Questionnaire (PHQ) item 9 is commonly used to screen for risk of self-harm and suicide, it is important that clinicians recognize circumstances when at-risk adolescents may go undetected. Objective: To understand characteristics of adolescents with a history of depression who do not endorse the PHQ item 9 before a near-term intentional self-harm event or suicide. Design, Setting, and Participants: This was a retrospective cohort study design using electronic health record and claims data from January 2009 through September 2017. Settings included primary care and mental health specialty clinics across 7 integrated US health care systems. Included in the study were adolescents aged 13 to 17 years with history of depression who completed the PHQ item 9 within 30 or 90 days before self-harm or suicide. Study data were analyzed September 2022 to April 2023. Exposures: Demographic, diagnostic, treatment, and health care utilization characteristics. Main Outcome(s) and Measure(s): Responded "not at all" (score = 0) to PHQ item 9 regarding thoughts of death or self-harm within 30 or 90 days before self-harm or suicide. Results: The study included 691 adolescents (mean [SD] age, 15.3 [1.3] years; 541 female [78.3%]) in the 30-day cohort and 1024 adolescents (mean [SD] age, 15.3 [1.3] years; 791 female [77.2%]) in the 90-day cohort. A total of 197 of 691 adolescents (29%) and 330 of 1024 adolescents (32%), respectively, scored 0 before self-harm or suicide on the PHQ item 9 in the 30- and 90-day cohorts. Adolescents seen in primary care (odds ratio [OR], 1.5; 95% CI, 1.0-2.1; P =.03) and older adolescents (OR, 1.2; 95% CI, 1.0-1.3; P =.02) had increased odds of scoring 0 within 90 days of a self-harm event or suicide, and adolescents with a history of inpatient hospitalization and a mental health diagnosis had twice the odds (OR, 2.0; 95% CI, 1.3-3.0; P =.001) of scoring 0 within 30 days. Conversely, adolescents with diagnoses of eating disorders were significantly less likely to score 0 on item 9 (OR, 0.4; 95% CI, 0.2-0.8; P =.007) within 90 days. Conclusions and Relevance: Study results suggest that older age, history of an inpatient mental health encounter, or being screened in primary care were associated with at-risk adolescents being less likely to endorse having thoughts of death and self-harm on the PHQ item 9 before a self-harm event or suicide death. As use of the PHQ becomes more widespread in practice, additional research is needed for understanding reasons why many at-risk adolescents do not endorse thoughts of death and self-harm. [ABSTRACT FROM AUTHOR]

Increasing rates of depression, anxiety, substance use, and suicidal thoughts and behaviors among college students were exacerbated by the COVID-19 pandemic. This report describes how components of the Johns Hopkins Suicide Prevention Awareness, Response and Coordination (JH-SPARC) Project aligned with a multi-faceted strategy for suicide prevention. Key programs included suicide screening, gatekeeper trainings, and the use of third-party mental health services. Regarding suicide screening outcomes, staff sent 36,148 individual emails inviting students and trainees to participate in stress and depression screening. This approach garnered 2,634 responses and connected 130 students to care, 66 of whom (50.8%) indicated suicidal thoughts, plans, or behaviors. We estimate this screening cost $2.97 per student. Important lessons included the reliance on virtual platforms and the need to coordinate efforts across multiple campuses. Our manuscript provides an example of a transferable strategy for suicide prevention on college campuses in the pandemic era. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. Participants: Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. Methods: Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified. Results: Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization. Conclusions: Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.

Involvement of opioids in suicides has doubled during the past two decades, worsening a major public health concern. This study examined the characteristics of opioid-involved suicides. The sample of decedents (N = 12,038) in Maryland between 2006 and 2020 was used to compare the characteristics of opioid-involved suicides (n = 947) with suicides not involving opioids (n = 6,896) and accidental opioid deaths (n = 4,125). Direct comparisons were then made between opioid-involved suicides with and without the additional presence of non-opioid substances. Opioid-involved suicides were significantly more likely than suicides not involving opioids to occur among those aged 18–64 years, non-Hispanic Whites, and unemployed or disabled individuals. Opioid-involved suicides were more likely than accidental opioid deaths to occur among females, those aged <18 years, non-Hispanic Whites, and employed individuals. Of all suicides involved opioids, 45% involved other non-opioid substances. Polysubstance opioid suicides were significantly more likely than suicides involving opioids only to occur among non-Hispanic Whites. Significant differences were observed in the demographic groups most at risk for opioid-involved suicide than other suicide or accidental opioid death. Among opioid-involved suicides, polysubstance involvement also represents a distinct group. These findings may enhance the targeting of prevention efforts. Opioid-involved suicides differ from other suicides or accidental opioid deaths. In opioid-involved suicides, polysubstance involvement represents a distinct group. These findings may enhance the targeting of prevention efforts. [ABSTRACT FROM AUTHOR]