Suicidal ideation (SI) and thoughts of death are often experienced as fluctuating; therefore a dynamic representation of this highly important indicator of suicide risk is warranted. Theoretical ...accounts have suggested that affective, behavioral, and interpersonal factors may influence the experience of thoughts of death/SI. This study aimed to examine the prospective and dynamic impact of these constructs in relation to thoughts of death and SI. We assessed adolescents with a recent hospitalization for elevated suicide risk over 6 months. Using the methodology of the Longitudinal Interval Follow-Up Evaluation, weekly ratings for SI, course of depressive illness, affect sensitivity, negative affect intensity, behavioral dysregulation, peer invalidation, and family invalidation were obtained. Using multilevel modeling, results indicated that (a) same-week ratings between these constructs and SI were highly correlated at baseline and throughout follow-up; (b) baseline ratings of affect sensitivity, behavioral dysregulation, and peer invalidation were positive prospective predictors of SI at any week of follow-up; (c) weekly ratings of each of these constructs had significant associations with next-week ratings of SI; and (d) ratings of SI had positive significant associations with next-week ratings on each of the constructs. These results suggest that affective sensitivity, behavioral dysregulation, peer invalidation, and SI are highly associated with SI levels both chronically (over months) and acutely (one week to the next), whereas depression, negative affect intensity, and family invalidation were more acutely predictive of SI. Elevated SI may then aggravate all these factors in a reciprocal manner.
The contract for safety is a procedure used in the management of suicidal patients and has significant patient care, risk management, and medicolegal implications. We conducted a literature review to ...assess empirical support for this procedure and reviewed legal cases in which this practice was employed, to examine its effect on outcome. Studies obtained from a PubMed search were reviewed and consisted mainly of opinion-based surveys of clinicians and patients and retrospective reviews. Overall, empirically based evidence to support the use of the contract for safety in any population is very limited, particularly in adolescent populations. A legal review revealed that contracting for safety is never enough to protect against legal liability and may lead to adverse consequences for the clinician and the patient. Contracts should be considered for use only in patients who are deemed capable of giving informed consent and, even in these circumstances, should be used with caution. A contract should never replace a thorough assessment of a patient's suicide risk factors. Further empirical research is needed to determine whether contracting for safety merits consideration as a future component of the suicide risk assessment.
Evidence-based treatment for Latinx/Hispanic (L/H) with suicidal behaviors (SB) is scarce. This study evaluated the acceptability and preliminary efficacy of a socio-cognitive-behavioral therapy ...protocol for SB (SCBT-SB) with L/H adolescents and the feasibility of conducting a randomized controlled trial (RCT) of SCBT-SB compared to treatment-as-usual (TAU). A pilot RCT was conducted with 46 L/H teens. The target outcomes included suicidal ideation (SI), suicide attempts (SAs), and depressive/internalizing symptoms. Results indicated that the SCBT-SB was acceptable and an RCT with diverse L/H families is feasible to implement. Within group analyses showed reductions over time for each group in SI and depressive/internalizing symptoms. Intent-to-treat between-group analyses showed a medium effect for the SCBT-SB at the twelve-month follow-up for depressive/internalizing symptoms and a large effect for SA. Although results must be interpreted cautiously given the small sample size, outcomes suggest that SCBT-SB may be a promising psychosocial treatment for depressive/internalizing symptoms, and SAs in L/H youth.
Introduction
This study examines suicidal ideation and behavior of youth in the 3 months following their initial diversion appointment in the juvenile justice system.
Method
Participants were 99 ...adolescents (72.7% female; 65% racial minority) between the ages of 12 and 18 (Mage = 15.06, SD = 1.35) and a parent/caregiver (80% female; 54% racial minority; Mage = 42.7 years, SD = 8.9 years). Participants were eligible if they endorsed two or more suicide items on a mental health screener (MAYSI‐2) and were able to be contacted 3 months following initial court appointment. Youth and parent/caregiver responded to questionnaires assessing SI/SA, psychiatric symptoms, treatment motivation and engagement.
Results
Three months post‐initial court appointment, more than half of youth (55.5%) continued to flag on the Suicide Ideation subscale of the MAYSI‐2, though mean scores decreased from baseline to 3‐months (t97 = 5.74, p < 0.000, 95% CI −0.79, 1.62 Cohen's d = 0.77). There were no significant differences in parent/youth treatment motivation or engagement regardless of SI at 3 months.
Conclusions
Persistence of suicidal thoughts and behaviors beyond initial legal involvement highlights the importance of targeted suicide prevention interventions (beyond screening and referral to treatment) with justice‐involved youth, even at first court contact.
This study examined the relationships among cognitive variables, family immigration history, negative life events, and depressive symptoms in a sample of 306 low-income, urban fifth- and sixth-grade ...children. Explanatory style and negative automatic thoughts were the cognitive variables examined. There were three key findings. First, children who were immigrants reported significantly more depressive symptoms, more negative life events, and more negative automatic thoughts than children who were not immigrants. Second, both explanatory style and negative automatic thoughts were significantly associated with depressive symptoms above and beyond the effects of child immigration history and negative life events. Finally, negative automatic thoughts mediated the relationship between child immigration history and depressive symptoms. We discuss the clinical and research implications of these findings.
Evaluating and Treating Adolescent Suicide Attempters provides a comprehensive overview of the emotional, behavioral and cognitive characteristics of adolescents who have attempted suicide. Each ...chapter opens with a case study vignette from the author's extensive clinical files followed by a summary of the empirical literature. Assessment and treatment practices close each chapter. While suicide is the third largest killer of adolescents, most suicide attempts do not result in death. Therefore the treatment of the suicide attempter following the attempt becomes a significant part of the clinician's work with these adolescents. Moreover, the precursors and behavioral markers for a suicide attempt become important signals for the school counselor, youth worker, or therapist. This book also include assessment measures to use when evaluating an adolescent who has attempted suicide. * Includes an outline form of an assessment battery for adolescents who have attempted suicide * Analyzes and discusses treatment and case studies * Presents detailed descriptions of specific therapy techniques useful with adolescents who attempt suicide * Includes succinct reviews of the literature, ways to measure relevant factors related to suicidal behavior, tips for clinicians, and reviews of pertinent assessment measures
Extant research has documented a relation between the quality of family communication and adolescent suicidal ideation. However, few studies have examined this relation longitudinally or explored ...potential mechanisms of this effect. In the present study, unhealthy family communication was hypothesized to be associated with suicidal ideation severity over 18 months via a serial mediation pathway through emotion regulation difficulties and depressive symptom severity.
The sample consisted of 147 adolescents (Mage = 14.91, SD = 1.51, range = 12–18 years; 76.2% female, 85.5% White) enrolled in a randomized clinical trial. Family communication quality was assessed at baseline using the Family Assessment Device. Emotion regulation difficulties and depressive symptoms were assessed using the Difficulties in Emotion Regulation Scale and Children's Depression Inventory-2, respectively, at baseline, 6-, and 12-months. Suicidal ideation was assessed using the Suicidal Ideation Questionnaire-JR at baseline and 18-months. Path analysis was used to analyze temporal relations between constructs.
After accounting for participant's age, sex, treatment condition, and baseline levels of variables of interest, analyses supported the indirect relation between baseline family communication and 18-month suicidal ideation severity through 6-month emotion regulation difficulties and 12-month depressive symptom severity.
Data were exclusively collected via self-report, and the sample was racially homogenous.
Treatment aimed at improving family communication may help bolster emotion regulation abilities, lower depressive symptoms, and subsequently, suicide risk.
•Dysfunctional family communication predicted emotion regulation difficulties.•Next, emotion regulation difficulties predicted depressive symptom severity.•Finally, depressive symptom severity predicted suicidal ideation severity.•Both serially mediated the relation between communication and suicidal ideation.•This indirect path was non-significant when temporal order of mediators was swapped.
Anxiety and suicidal ideation have been shown to be positively related in adolescents. However, less is known about the strength of this association across different types of anxiety or the ...mechanisms through which this relation exists. Joiner's interpersonal theory of suicide suggests that thwarted belongingness (TB) and perceived burdensomeness (PB) lead to suicidal ideation; these constructs may explain a pathway through which anxiety and suicidal ideation are related. It was hypothesized that TB would mediate the relation between social anxiety disorder (SAD) symptoms and suicidal ideation, and PB would mediate the relation between generalized anxiety disorder (GAD) symptoms and suicidal ideation.
These longitudinal mediation models were assessed using data collected from 147 depressed adolescents, who were recently hospitalized for suicidal ideation or behavior, enrolled in a randomized controlled trial (RCT).
Consistent with study hypotheses, PB mediated the relation between GAD symptoms and suicidal ideation severity. However, TB did not mediate the relation between SAD symptoms and suicidal ideation severity.
These results suggest that screening for and addressing PB among youth with GAD may help reduce risk for suicidal behavior.
Background
Suicide is the second leading cause of death among adolescents. The purpose of this study was to test a family‐focused outpatient cognitive behavioral treatment (F‐CBT) protocol for ...depressed adolescents following psychiatric hospitalization for a suicide attempt or suicidal ideation, and who had a co‐occurring risk factor (suicidal behavior prior to the index admission, nonsuicidal self‐injury, and/or a substance use disorder), in a randomized Phase 2 efficacy trial.
Method
One hundred forty‐seven adolescents (mean age = 14.91 years; 76.2% female, 85.5% White) and their families, recruited primarily from an inpatient psychiatric hospitalization program, were randomly assigned to F‐CBT or enhanced treatment‐as‐usual (E‐TAU). A suicide attempt was the primary outcome variable. Depression, suicidal ideation, and nonsuicidal self‐injury are also reported here. Assessments were completed at pretreatment as well as 6, 12, and 18‐months postrandomization (Trial Registration ClinicalTrials.gov Identifier: NCT01732601).
Results
In the sample as a whole, rates of attempts decreased from 20% at 6 months to 9% at 12 months to 7% at 18 months. There was no evidence of a significant difference between treatment arms in rates of suicide attempts, major depressive disorder, suicidal ideation, or nonsuicidal self‐injury at any of the postrandomization assessment points.
Conclusions
Though F‐CBT was associated with reductions in suicidality, depression, and nonsuicidal self‐injury, E‐TAU showed an equally strong effect. Greater frequency of F‐CBT treatment sessions, particularly at the start of care, and alternative approaches to transitioning to care at 12 months, may be necessary when using F‐CBT with this population.
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