The Role of Perceived Burdensomeness in the Link Between Functional Impairment and Suicidal Ideation in Clinically-Referred Youth.

Negative peer social interactions and oxytocin levels linked to suicidal ideation in anxious youth

There is a critical need to better understand the factors underlying the increased suicide risk for youth with bipolar disorder (BD) in order to develop targeted prevention efforts. This study aimed to examine differences in characteristics of suicide ideation (SI) in youth with BD compared to youth with major depressive disorder (MDD) that may be associated with increased suicide risk. One hundred and fifty-one participants (92 MDD and 59 BD), ages 13-21, completed a diagnostic interview and clinical assessments. Lifetime symptoms of SI and SA were assessed using the Columbia Suicide Severity Rating Scale. Ordinal logistic regression models were used to investigate whether the diagnostic group predicted the severity and intensity of the most severe or most common SI with the age of onset, age, and gender as covariates. Compared to MDD youth, BD youth were more likely to report experiencing more severe SI, p= 0.039, experiencing the most severe SI more frequently, p= 0.002, having less control of the most severe SI, p= 0.012, and that deterrents were less likely to stop them from acting on the most severe SI, p= 0.006. This study highlights differences in the severity and intensity of SI in youth with BD and suggests that youth with BD have greater difficulty inhibiting thoughts of SI which may lead to less resistance to suicide action. Findings underscore the need for a more detailed assessment of SI in youth with BD to better understand SI as a proximal risk factor for future SA and a potential target for intervention.

This study examines how relationship quality in family and peer domains are associated with suicidal ideation (SI) in youth with bipolar disorder (BP). We assessed 404 Course and Outcome of Bipolar Youth study participants for psychiatric disorders and SI at intake and for family/peer relationships the month after intake. Multivariate logistic regression examined associations between relationships and SI, controlling for significant covariates. There were 144 youth (36%) who reported SI at intake; bivariate analyses indicated they had significantly worse family/peer relationships. Multivariate analyses showed that family/peer relationships were associated with current SI, controlling for significant covariates. Results support associations between poor relationships and SI in BP youth, regardless of current mood symptom severity. Clinicians should assess relationships when completing risk assessments with BP youth.

Suicidal ideation in youth with tic disorders

Introduction Sleeping too little or too much has been linked to adverse mental health outcomes in youth. Most studies that described the link between sleep duration and suicide risk in youth, however, relied on a single assessment of sleep and suicidal ideation, with considerable temporal gaps in between. Characterizing the proximal link between sleep duration and suicide risk in children and adolescents is essential for developing informative, early mobile interventions. We examined the association between ecologically assessed suicidal ideation (SI) and sleep duration in youth recruited after a partial hospitalization program. We also examined contextual factors in relation to sleep duration that are particularly salient for youth, including nighttime social media use and social media use-related self-referential cognitions. Methods We used ecological momentary assessment (EMA) 3 times/day over two weeks in discharged partial hospital patients to assess their levels of SI at home (n=79; 62% assigned F at birth; ages 12-15; mean 13.52; sd 1.14 yr). We also asked youth to report their bedtimes and waketimes every morning for two weeks. Social media use was assessed once via a questionnaire. Results Using generalized linear mixed models, we showed a significant quadratic effect of sleep duration on next-day SI (B=–0.04, SE =0.01, p< 0.001). The turning point of the quadratic function was the sleep duration of 10 hours. Specifically, longer sleep was linked to lower next-day SI, with this association reversing at 10 hours of sleep. Nighttime social media use (B=–0.18, SE =0.05, p< 0.001) and engaging in social media use-related self-criticism (B=–0.10, SE =0.05, p< 0.05) were both linked to shorter sleep duration, whereas daytime social media use was not associated with sleep duration (p>0.05). Conclusion These preliminary findings point to a curvilinear association between how long children and adolescents sleep and how much they think about suicide the following day and highlight the significance of social media use at bedtime. The findings emphasize the potential clinical relevance of daily assessment of sleep duration in developing adaptive, just-in-time interventions to decrease suicide risk in youth. Support (if any) NIMH Career Development (K23MH122587) Award; Bradley Hospital COBRE Center (P20GM139743).

Reduced positive future thinking has been associated with suicidal ideation and behavior in adults, and appears to be exacerbated by negative affect. Yet, this has received little attention in youth. Prior research has also focused on longer-term future thinking, e.g., months and years, and relied on lab-based assessments. Using the experience sampling method (ESM), we investigated whether short-term future thinking in daily life was associated with suicidal ideation in youth and explored the role of affect in the future thinking–suicidal ideation relationship. A community sample of N = 722 adolescent twins and their non-twin siblings completed ESM as part of the TwinssCan study (n = 55 with, and n = 667 without, past-week suicidal ideation). Participants completed self-report questionnaires, including on past-week suicidal ideation as part of the SCL-90. Subsequently, daily future thinking was assessed each morning for six days with ESM. To investigate the relationship between daily positive future thinking and past-week suicidal ideation, we estimated a mixed-effects linear regression model with a random intercept for participant, including age and sex as covariates. The relationship between daily positive future thinking, past-week suicidal ideation, and average positive and negative affect from the previous day was investigated by estimating two separate mixed-effects linear regression models (one for negative affect, one for positive affect), with a random intercept for participant, and random slopes for average positive and negative affect. Our results showed that participants reporting higher past-week suicidal ideation also reported significantly less daily positive future thinking during the ESM period, and this association remained significant when controlling for previous-day average positive and negative affect. Higher average positive affect from the previous day was significantly associated with higher positive future thinking. Although average negative affect from the previous day was associated with lower positive future thinking, this association was not statistically significant. Our findings indicate that short-term future thinking relates to suicidal ideation among a non-clinical sample of adolescents. Future research should investigate the directionality of the future thinking–suicidal ideation relationship, in order to investigate whether impaired future thinking may be an early warning signal for escalating suicidal ideation in youth.

Predicting risk of suicidal ideation in youth using a multigene panel for impulsive aggression

Recent decades have seen an alarming increase in rates of suicide among young people, including children and adolescents (“youth”). Although child maltreatment constitutes a well-established risk factor for suicidal ideation in youth, few efforts have focused on identifying factors associated with maltreated youths’ increased risk for suicidal ideation, especially across development. The present study examined the relations between maltreated youths' (N = 279, M = 12.06 years, 52% female, 53% Latinx) perceptions of their social status and suicidal ideation and compared those relations between pre-adolescents and adolescents. Findings revealed unique developmental patterns: Perceived social status was associated with suicidal ideation, but only in adolescents, who showed greater risk for suicidal ideation if they viewed themselves as lower ranked in society and lower risk for suicidal ideation if they viewed themselves as higher ranked in society. Findings have implications for scientific and practical efforts aimed at better understanding and preventing suicide in a high-risk developmental population.

BackgroundPrevious studies demonstrated positive relations between various forms of maltreatment and suicidal ideation in youth; however, mechanisms underlying these relationships are not well understood. We propose that the experience of maltreatment in childhood may lead to high levels of generalized guilt and shame, resulting in an increase of depressive symptoms and suicidal thoughts in adolescents. The aim of the current study was to test our model of relations between these constructs using path analysis. Methods112 inpatient adolescents aged 12-17 years completed the Childhood Trauma Questionnaire to measure various types of maltreatment, the Personal Feelings Questionnaire to evaluate generalized guilt and shame, the Beck Depression Inventory-II to assess depressive symptoms, and the Columbia-Suicide Severity Rating Scale to assess suicidal ideation. ResultsFindings partly confirmed the theoretical model. Indirect positive effects of sexual and emotional abuse, as well as emotional and physical neglect on suicidal ideation via generalized self-conscious emotion and/or depression were demonstrated. In contrast to our predictions, indirect negative effects of physical abuse on suicidal thoughts via generalized guilt and shame and depression were found. LimitationsSample characterized by predominately Caucasian inpatient adolescents from financially stable and well-educated environments, over-reliance on self-report measures and the lack of a longitudinal design were main limitations of the study. ConclusionsThe study provides novel information on the potential mechanisms underlying the association between childhood maltreatment and suicidal ideation in adolescents. Generalized guilt and/or shame could be possible targets for interventions for victims of some forms of maltreatment to reduce depressive symptoms and suicidal ideation.

National surveys indicate high rates of suicidal ideation in youth, especially among females. Coping skill training programs hold promise as a potential intervention that can help young people better manage stress and not consider suicide as a solution to life's problems. To assess the promise of this strategy, the present research examined which coping strategies (if any) predicted reduction in youth suicidal ideation over a 1-year follow-up, and explored the potential pathways through which their influence was channeled. Two waves of panel data from a nationally representative sample of youth, assessed 1 year apart (N = 710; Mean age = 18 years) were analyzed separately by gender using multiple group path analytic procedures. Four coping strategies, namely problem solving, emotional regulation, support seeking and acceptance were found to predict reduction in suicidal ideation among both males and females. However, the influence of these strategies (at baseline) was channeled through distinct pathways. The effect of emotional regulation (and acceptance) was channeled through its use at follow-up and was mediated by reductions in perceived stress and depressive symptoms, leading to reduction in suicidal ideation. The influence of support seeking was also channeled through its more recent use at follow-up, but directly predicted reduction in suicidal ideation, with no effect on perceived stress or depressive symptoms. The effect of problem solving on suicidal ideation was mediated by reduction in depressive symptoms, but was not channeled through its use at follow-up, suggesting a longer time course for the protective influence of this strategy. Finally, acceptance had a direct risk-enhancing effect on suicidal ideation. Coping strategies commonly used by youth can be effective in reducing suicidal ideation and therefore universal training in the effective use of these strategies should be considered. An understanding of the distinct pathways through which their effect on suicidal ideation is transmitted can better inform the design of youth suicide prevention interventions.

Social anxiety disorder typically emerges in adolescence and its symptoms often co-occur with depression and suicidal ideation. It is important to understand whether social anxiety symptoms precede depression and suicidal ideation in youth. This study aimed to investigate the temporal associations between baseline social anxiety and later suicidal ideation and depressive symptoms in a community youth sample. The Wellcome Trust NSPN (Neuroscience in Psychiatry Network) study recruited 2397 youth aged 14-24 in the United Kingdom to participate in a prospective observational study. Participants were assessed for symptoms of social anxiety, generalised anxiety, depression and suicidal ideation at baseline, 1-year follow-up, and 2-year follow-up. We conducted multiple linear regression analyses and mediation analyses to examine whether baseline social anxiety was associated with 2-year suicidal ideation and depressive symptoms (excluding suicide-related items), and whether these associations were mediated by 1-year depressive symptoms. The study was preregistered on the Open Science Framework. Results from multiple linear regression analyses indicated that baseline social anxiety symptoms were associated with 2-year suicidal ideation (β=0.07, p<0.05, 95% CI [0.02, 0.12]) and 2-year depressive symptoms (β=0.08, p<0.05, 95% CI [0.02, 0.13]), after controlling for baseline predicted variable. Furthermore, 1-year depressive symptoms significantly mediated the relationship between baseline social anxiety symptoms and 2-year suicidal ideation (β=0.04, 95% CI [0.02, 0.05]), and the relationship between baseline social anxiety symptoms and 2-year depressive symptoms (β=0.06, 95% CI [0.03, 0.08]) after adjusting for age, sex, and other covariates. We found evidence that baseline social anxiety symptoms were associated with 2-year suicidal ideation and 2-year depressive symptoms via 1-year depressive symptoms in non-clinical adolescents. These results may have important implications for targeted psychological interventions.

ABSTRACTSuicidal ideation is a serious mental health concern reported by adolescents. Despite understanding of increased suicidal ideation in patients with eating disorders (EDs) and obesity, few studies have compared how disordered eating (bingeing, vomiting and over exercising) is associated with suicidal ideation in clinical and non-clinical samples of youth across the ED and weight spectrum. The present study aimed to 1) comparatively examine rates of suicidal ideation and disordered eating behaviors in clinical samples of youth with EDs, complex obesity, or from the community, and 2) examine whether disordered eating was associated with suicidal ideation above and beyond age, body mass index, diagnosis, treatment-seeking status, and depressive symptoms in large samples of males vs. females in an attempt to understand whether these behaviors should lead to concern regarding suicidal ideation. Data from charts on treatment-seeking adolescents diagnosed with either an ED (N = 315), severe complex obesity (N = 212), and from the community (N = 3036) were pooled together for comparative purposes. Results showed that suicidal ideation was higher in youth seeking treatment for an ED (50.2%) and obesity (23.7%) as compared to youth from the community (13%). Binary logistic regression analyses revealed that vomiting (OR = 1.73 for females, 8.17 for males) and over-exercising (OR = 1.47 for females, 1.68 for males) was significantly associated with suicidal ideation in both males and females. Findings underscore the importance of screening for suicidal ideation in youth who report vomiting or over-exercising despite diagnostic presentation, age, weight, or treatment setting.

Childhood trauma has been found to be associated with suicidal ideation among youth. However, the underlying processes that link childhood trauma and suicidal ideation are unclear. This study investigates the role of nightmare frequency in the association between childhood trauma and suicidal ideation, and the potential moderating effect of sex. Youths were recruited from Fujian Province, China. Childhood trauma was assessed using the Childhood Trauma Questionnaire, and the frequency of nightmares and suicidal ideation were also evaluated. Moderated mediation analyses were conducted with childhood trauma as the independent variable, suicidal ideation as the dependent variable, nightmare frequency as the mediator variable, and sex as the moderator. All statistical analyses were performed in R (version 4.2.3). A total of 3431 individuals completed all the questions assessing childhood trauma, nightmare frequency, and suicidal ideation. Among them, 28.6% reported having experienced suicidal ideation in the past 12 months. Additionally, 25.9% of participants reported frequent nightmares. The association between childhood trauma and suicidal ideation was significantly mediated by nightmare frequency, with an effect size of 0.003 (bootstrap 95%CI: 0.001, 0.005). The indirect effects accounted for approximately 4.11% of the overall effect. However, there was no statistically significant moderating effect of sex on the association between childhood trauma and nightmare frequency. The findings of this study suggest that treating nightmares may serve as a promising intervention target for addressing suicidal ideation in youth with a history of childhood trauma, irrespective of sex.

Although widely studied in adults, the link between lifetime adversities and suicidal ideation in youth is poorly understood. The purpose of this study was to explore this link in adolescents. The analyses used a sample of 740 16-year-old youth in the LONGSCAN sample, and distinguished between childhood (before the age of 12) and adolescent (between age 12 and age 16) adversities. There was a significant link between cumulative lifetime adversities and suicidal ideation. There was no evidence that this link was moderated by gender. Childhood adversities moderated the effects of adolescent adversities on suicidal ideation; effects of adolescent adversities were strongest at low levels of childhood adversities. There was also some evidence supporting a specific cumulative model of the effects of adversities on suicidal ideation; the most predictive model included the sum of the following adversities: childhood physical abuse, childhood neglect, childhood family violence, childhood residential instability, adolescent physical abuse, adolescent sexual abuse, adolescent psychological maltreatment, and adolescent community violence. The timing and nature of adversities are important in understanding youth suicidal ideation risk; in particular, adolescent maltreatment and community violence appear to be strong predictors. Preventing and appropriately responding to the abuse of adolescents has the potential to reduce the risk of suicidal ideation.

Displaced youth face numerous stressors and are at high risk of experiencing suicidal ideation. Sport-for-protection programs offer a potentially effective strategy to reduce this risk; however, randomized controlled trials (RCTs) evaluating interventions in displacement contexts are lacking. Displaced youth and youth from host communities in five humanitarian settings across Uganda, aged 15 to 24 years, with at least mild symptoms of anxiety and/or depression and suicidal ideation, were randomized to a 13-session sport-for-protection program or a wait-list control. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9, adolescent version (PHQ-9-A) were assessed pre- and post-intervention. Logistic and linear regression modeling were conducted. In total, 542 of 817 young people (66.3%) reported suicidal ideation (PHQ-9-A ≥1) in the past 2 weeks. Of these 542, 277 were randomized to the experimental group and 265 to the control group. The median age was 19.0 years, 45.6% were boys, 13.1% had a self-reported or observed disability, 25.8% were from host communities, and 74.2% were displaced youth. The prevalence of suicidal ideation dropped to 11.5% following the sport-for-protection intervention, compared to 53.2% in the control group (Cohen's h = 0.94, P<0.001, indicating a large difference; odds ratio for no suicidal ideation following sport-for-protection vs the control condition = 8.7, 95% confidence interval = 5.6-13.5). Sport-for-protection is an effective stand-alone or adjunctive intervention to reduce suicidal ideation among young people affected by displacement in humanitarian settings.