Adolescent Suicide Prevention Research Articles

Sleep disturbance and suicidal ideation mediated by psychotic-like experiences in adolescents: a two-wave longitudinal study.

Sleep disturbance may cause suicidal ideation (SI). This study aimed to examine their co-occurrence rate among adolescents and investigate whether psychotic-like experiences (PLEs) mediate this association. A total of 17 722 Chinese adolescents were included in this two-wave longitudinal study. The baseline survey (time 1, T1) was conducted between April 21 and May 12, 2021, and the follow-up survey (time 2, T2) was implemented between December 17 and 26, 2021. At T1, participants completed questionnaires to assess their sleep disturbance, sleep duration, PLEs, SI, depressive symptoms, and sociodemographic characteristics. At T2, participants reported their PLEs, SI, and negative life events. The SI prevalence decreased from 20.2% (T1) to 18.4% (T2). Participants with SI showed significantly higher prevalence of sleep disturbance and short sleep duration compared to those without SI. Baseline sleep disturbance and short sleep duration were both associated with the increased risk of SI 6 months later. These longitudinal links were mediated by PLEs, independent of baseline covariates and negative life events. These findings provide a novel insight into the mechanism linking sleep problems and suicidality, and stress the significance of assessing and addressing sleep problems and PLEs for adolescent suicide prevention and intervention.

A profound absence of counseling interventions for suicide prevention among youth in Africa: A call to action based on an empty scoping review.

One-third of all global suicide deaths occur among adolescents and young adults, making suicide the second leading cause of death among young people. Nearly 80% of suicide deaths occur in low- and middle-income countries, and many African nations have higher rates of suicide than global averages. However, interventions are scarce. We conducted a scoping review of counseling interventions for suicide prevention among youth in Africa. We performed structured searches of the Medline, Embase, PyscINFO, African Index Medicus, Global Heath Database, and Proquest Dissertations and Theses Global databases. Studies were eligible for inclusion if they described a counseling intervention conducted in Africa, focused on participants under age 22, and included a suicide-related outcome. After removal of duplicates, 1808 titles and abstracts were screened and 10 studies were identified for full-text review. Of these, six included adult participants and did not disaggregate results for youth, two did not describe an intervention, and two did not include a relevant outcome. Thus, no studies were eligible for inclusion. This empty review highlights the striking absence of published research on a life-threatening public health challenge, representing a distinct call to action for improved efforts in adolescent suicide prevention in Africa.

Exploring the Potential of Artificial Intelligence in Adolescent Suicide Prevention: Current Applications, Challenges, and Future Directions

Objective The global surge in adolescent suicide necessitates the development of innovative and efficacious preventive measures. Traditionally, various approaches have been used, but with limited success. However, with the rapid advancements in artificial intelligence (AI), new possibilities have emerged. This paper reviews the potentials and challenges of integrating AI into suicide prevention strategies, focusing on adolescents. Method: This narrative review assesses the impact of AI on suicide prevention strategies, the strategies and cases of AI applications in adolescent suicide prevention, as well as the challenges faced. Through searches on the PubMed, web of science, PsycINFO, and EMBASE databases, 19 relevant articles were included in the review. Results: AI has significantly improved risk assessment and predictive modeling for identifying suicidal behavior. It has enabled the analysis of textual data through natural language processing and fostered novel intervention strategies. Although AI applications, such as chatbots and monitoring systems, show promise, they must navigate challenges like data privacy and ethical considerations. The research underscores the potential of AI to enhance future suicide prevention efforts through personalized interventions and integration with emerging technologies. Conclusion: AI possesses transformative potential for adolescent suicide prevention by offering targeted and adaptive solutions, while they also raise crucial ethical and practical considerations. Looking forward, AI can play a critical role in mitigating adolescent suicide rates, marking a new frontier in mental health care.

Suicide Prevention and Management in Children and Adolescents: In Contemplation of a Philosophical Approach

Suicide Prevention and Management in Children and Adolescents: In Contemplation of a Philosophical Approach

Guest Editor’s Introduction: The Need for a Broader, More Inclusive Approach to Child and Adolescent Suicide Prevention

Guest Editor’s Introduction: The Need for a Broader, More Inclusive Approach to Child and Adolescent Suicide Prevention

일반교사가 지각한 학생 자살 예방 및 위기 개입 과정에서의 어려움과 개선방향에 대한 질적 연구

Purpose: This study was conducted to explore the experiences of teachers regarding adolescent suicide prevention and crisis intervention at school.
 Methods: An online survey using open-ended questions was administered to teachers currently working in elementary, middle, and high schools in South Korea. A total of one hundred responses were collected and analyzed using a Consensual Qualitative Research-Modified method.
 Results: As a result, concerning ways that teachers employ in response to student suicidal behavior and crises, five categories of in-school interventions (e.g., student counseling, prevention-focused education, and referral to Wee-class) and two categories of external interventions (e.g., collaboration with relevant organizations, parent counseling, and cooperation requests) were emerged. Secondly, four areas of difficulties perceived by teachers were identified. These areas include administrative challenges(e.g., complex procedures, unclear responsibility, and delegation of responsibility), difficulties arising from counseling capabilities (e.g., lack of professional knowledge and experience, limitations in teachers' roles and authority), challenges related to parents or guardians (e.g., uncooperative attitudes of parents), and student-related difficulties (e.g., difficulties in self-disclosure). These areas were further broken down into a total of 18 categories. Thirdly, teachers' perspectives on improving the process of student suicide prevention and crisis intervention led to the identification of four areas and 18 categories. The areas were administrative (e.g., simplification of procedures, manual development),counseling-related (e.g., workforce expansion, teacher training support to enhance capabilities), student-related (e.g., strengthening psychological education and activities), and parents orguardians-related (e.g., improving parental awareness).
 Conclusion: Based on the findings of this study, we discussed the implications for education and policies aimed at enhancing the suicide prevention and crisis response capacity of teachers, including mental health literacy education for teachers and students, alleviating the mental health-related workload of general teachers, and enhancing the clarity of their directions.

1.78 Evaluation of Resilience in an Adolescent Suicide Prevention Intensive Outpatient Program

1.78 Evaluation of Resilience in an Adolescent Suicide Prevention Intensive Outpatient Program

Evidence for Altered Electroencephalography Coherence in Depressed Adolescents with Suicidal Ideation and Behaviors.

Introduction: Major depressive disorder (MDD) is a primary risk factor for suicide, which is one of the leading causes of death among adolescents worldwide. Understanding the heterogeneity of suicidality in adolescents with MDD is critical for suicide prevention and intervention discovery. Quantitative electroencephalography (EEG) is a promising tool to address the knowledge gaps related to the neurophysiological characteristics of depression and suicidality. This study sought to examine resting-state EEG coherence differences in adolescents with MDD and suicidal ideation (SI)/behaviors (SB) and healthy controls (HC) to assess the utility of coherence as a biomarker of suicide. Methods: Twenty-six adolescents with MDD who were hospitalized for suicidality and 30 HC were recruited. The clinical sample was divided into SI (n = 9) and SB (n = 19) subgroups. Eyes closed resting-state EEG were recorded, and coherence was calculated. Depression severity and suicidality were assessed with the Children's Depression Rating Scale Revised and the Columbia Suicide Severity Rating Scale, respectively. Results: There were intrahemispheric differences in the right hemisphere across multiple electrode pairs. Delta, alpha, and beta coherence were higher in the SB group over the right prefrontofrontal and left parietooccipital electrode pairs, while alpha coherence was higher in the HC group over the right centroparietal electrode pair. There were no significant differences between HC and SI groups in any electrode pair. Conclusions: Patients with recent SB showed increased coherence in right frontal regions compared with patients with SI, suggesting altered cognitive states between those with SB and SI. These findings may have implications for suicide prevention in adolescents and could serve as useful biomarkers in clinical settings, but larger studies are needed to confirm the results.

Adolescent suicide prevention program recommendations from Latina immigrant mothers: “Starting with the word”.

Adolescent suicide prevention program recommendations from Latina immigrant mothers: “Starting with the word”.

Socio-psychological prevention of suicide among minors

Socio-psychological prevention is aimed at creating psychological, pedagogical, and socio-psychological conditions for optimal provision of the process of the individual’s socialization and the organization of psychological socio-pedagogical assistance to families and adolescents. Prevention of adolescent suicide in the educational environment is carried out on the basis of such principles as strategic integrity, which defines a single prevention strategy (directions, methodological approaches, and specific measures), priority of social issues prevention, and accessibility and efficiency of assistance and support. In the process of socio-psychological prevention, it is crucial for a teenager with a suicidal risk to have changes in the perception of his/ her own «I» and the surrounding reality.

Comparative effectiveness of safety planning intervention with instrumental support calls (ISC) versus safety planning intervention with two-way text message caring contacts (CC) in adolescents and adults screening positive for suicide risk in emergency departments and primary care clinics: Protocol for a pragmatic randomized controlled trial

BackgroundSuicide is a leading cause of death in adolescents and adults in the US. Follow-up support delivered when patients return home after an emergency department (ED) or primary care encounter can significantly reduce suicidal ideation and attempts. Two follow-up models to augment usual care including the Safety Planning Intervention have high efficacy: Instrumental Support Calls (ISC) and Caring Contacts (CC) two-way text messages, but they have never been compared to assess which works best. This protocol for the Suicide Prevention Among Recipients of Care (SPARC) Trial aims to determine which model is most effective for adolescents and adults with suicide risk. MethodsThe SPARC Trial is a pragmatic randomized controlled trial comparing the effectiveness of ISC versus CC. The sample includes 720 adolescents (12–17 years) and 790 adults (18+ years) who screen positive for suicide risk during an ED or primary care encounter. All participants receive usual care and are randomized 1:1 to ISC or CC. The state suicide hotline delivers both follow-up interventions. The trial is single-masked, with participants unaware of the alternative treatment, and is stratified by adolescents/adults. The primary outcome is suicidal ideation and behavior, measured using the Columbia Suicide Severity Rating Scale (C-SSRS) screener at 6 months. Secondary outcomes include C-SSRS at 12 months, and loneliness, return to crisis care for suicidality, and utilization of outpatient mental health services at 6 and 12 months. DiscussionDirectly comparing ISC and CC will determine which follow-up intervention is most effective for suicide prevention in adolescents and adults.

A Comparative Analysis of Mechanisms for Preventing Adolescent Suicide in China and Japan

China and Japan are both Asian countries that are geographically adjacent and share a common cultural heritage. Suicide is a significant public health concern in both countries. While Japan has established a relatively mature framework for suicide prevention, China lacks national suicide prevention mechanisms. This paper analyzes the disparity in adolescent suicide prevention between China and Japan so that China can learn from Japan’s experience in this area and develop effective, systematic mechanisms for the prevention and intervention of adolescent suicide.

Systematic Review of Interventions to Reduce Suicide Risk in Transgender and Gender Diverse Youth.

Transgender youth experience high rates of suicidal ideation and suicide attempts. This systematic review sought to examine interventions for suicide prevention in transgender children and adolescents. Literature related to suicide in the transgender population was systematically collected in accordance with PRISMA criteria. Searches identified studies with at least one suicide prevention method for participants ages 24years or younger with gender identity and sex clearly defined. Primary outcomes include suicide-related thoughts and behaviors. A total of 1558 citations were identified with 17 articles meeting inclusion criteria. Interventions with potential effectiveness included a gender-affirming crisis hotline, medical care via interdisciplinary gender clinics, online media-based outreach, safety and connectedness in schools, and family system-based interventions. In the included studies, the overall quality of evidence was low and the risk of bias high. Further high-quality studies are needed.

Implementation strategies and outcomes of school-based programs for adolescent suicide prevention: A scoping review protocol.

This scoping review aims to identify and map the empirical literature on the implementation strategies and outcomes of school-based programs for adolescent suicide prevention (SBASP). School-based programs are preferred interventions for preventing suicide in adolescents, and their effectiveness has been well-systematized in several reviews. Implementation research is a growing field for prevention programs, making it possible to understand the nature of success or failure outcomes and maximize intervention benefits. However, there is a knowledge gap in the implementation research applied to adolescent suicide prevention in the educational context. We conduct a scoping review to provide the first overview of the scope of implementation research applied to adolescent suicide prevention programs in the school setting to know what implementation strategies and outcomes are reported by these programs and how they are evaluated. The proposed scoping review will be conducted following six stages, including the definition of objectives. Studies must be empirical and address implementation strategies or implementation outcomes of school-based programs for adolescent suicide prevention. Studies that focused exclusively on clinical efficacy or effectiveness evaluation will be excluded. A preliminary search of PubMed was conducted to refine the initial search strings, followed by a final search of several other electronic databases. Finally, a gray literature search will identify unpublished literature and reduce location bias. There will be no limits to a specific date. Two independent reviewers will screen, select, and extract the retrieved records. The results will be presented using tabular forms and a narrative summary with attention to the review objectives and research questions and their implications for research and practice of school-based programs for adolescent suicide prevention.

Examining Latino Immigrant Caregiver’s Self-Efficacy to Support the Prevention of Adolescent Suicide

Examining Latino Immigrant Caregiver’s Self-Efficacy to Support the Prevention of Adolescent Suicide

Universal School-Based Screenings for Depression and Suicide: Identifying Students at Risk of Suicide

AbstractSchools have an important role to play in adolescent suicide prevention. This article describes universal screenings for depression and suicidality as one component of the Signs of Suicide (SOS) program in middle and high schools following the suicide death of a student in the past few years. Of the students screened (N = 7,429), 11.0 percent of youth were identified as at risk by the screening tool; 17.3 percent received a same-day secondary screen with a mental health professional. (Students without an at-risk screen could request a meeting with a mental health professional, so more students received secondary screenings than screened at risk.) Characteristics associated with an at-risk screen on the screening tool were identified. Girls were twice as likely to be identified as at risk than boys, and students exposed to a suicide death in the past year were 1.3 times more likely to have an at-risk screen. There was no difference in at-risk screens for middle versus high school students, but middle schoolers were more likely to receive a secondary screening due to help seeking from school staff. The article concludes with a discussion of the implications for school administrators at middle and high schools, including recommendations to screen with both a screening tool and an option to speak to an adult, strategies for planning for secondary screenings, and advantages to universal screening following the suicide death of a student.

The Relationship of Family Functioning and Suicidal Ideation among Adolescents: The Mediating Role of Defeat and the Moderating Role of Meaning in Life

To investigate the relationship between family functioning and suicidal ideation among adolescents. A total of 4515 junior and senior high school students were assessed using the Family APGAR, the Depressive Symptom Index-Suicidality Subscale, the Defeat Scale, and the Chinese Meaning in Life Questionnaire. This study found pairwise correlations between suicidal ideation, family functioning, defeat, and meaning in life. Specifically, family functioning was an influencing factor of adolescent suicidal ideation, and defeat was a mediator of the relationship between family functioning and adolescent suicidal ideation; meaning in life was found to be a moderator of the first half of the mediation process by defeat, that is, it moderated the influence of family functioning on adolescent defeat. This study demonstrated that the relationship between family functioning and adolescent suicidal ideation, as well as the influence of defeat and meaning in life on this relationship, constituted a moderated intermediary model. This finding has both theoretical and practical value for the implementation of a psychosocial model of adolescent suicide prevention and intervention.

The importance of recognizing worthlessness for suicide prevention in adolescents with Attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric diagnoses among children and adolescents. Depression and general anxiety disorder (GAD) are often co-occurring with ADHD among children and adolescents. Previous studies have found that ADHD, depression and GAD are all strongly correlated with suicidal thoughts and planning. The current study aimed to further explore the association between ADHD, GAD and depressive symptoms as well as their association with suicidal thoughts and planning among adolescents. Adolescents with ADHD diagnosis were involved from child psychiatry outpatient clinics and adolescents without a psychiatric treatment or diagnosis were enrolled from high schools in Hungary. The Mini International Neuropsychiatric Interview for Children and Adolescents was used to evaluate psychiatric symptoms and disorders as well as suicidal thoughts and planning. Regularized psychological networks were used to investigate the associations. Altogether 185 adolescents (58 females and 127 males; mean age 14.79 years, SD = 1.48), 89 with ADHD and 96 without ADHD were enrolled. Depression symptom worthlessness was directly related to suicidal thoughts and planning, CI95 of the logit B between worthlessness and suicidal thought (0.72, 1.66). Both ADHD and anxiety were indirectly related to suicidal thoughts and planning through depression: CI95 of the logit B between being disorganized and feeling worthless is (0.38, 3.02), and CI95 of the logit B between being distressed and feeling worthless is (0.57, 2.52). This study draws the attention of clinicians to the importance of recognizing "worthlessness" for suicide prevention in adolescents with ADHD. Furthermore, the results support previous studies, whereby symptoms of depression and anxiety mediate the relationship between ADHD and suicidal thoughts and planning. These results highlight the importance of ADHD comorbidities with depression and GAD and their effect on suicidal thoughts and planning.

Excessive daytime sleepiness mediates the relationship between insomnia symptoms and suicidal behavior in adolescents.

Insomnia symptoms, excessive daytime sleepiness (EDS), and suicidal behavior are prevalent among adolescents. Growing studies have shown that both insomnia symptoms and EDS are associated with suicidal behavior. However, little is known about the pathways between insomnia symptoms, EDS, and suicidal behavior. This study aimed to examine the longitudinal mediating effect of EDS on insomnia-suicidal behavior link in a large sample of Chinese adolescents. Participants were 7072 adolescents (Mean age = 14.58 years, 50.0% males) who were surveyed at baseline and were followed up 1 year later in the Shandong Adolescent Behavior and Health Cohort study. A self-administered questionnaire was used to measure insomnia symptoms, daytime sleepiness, sleep duration, social jetlag, suicidal behavior, and adolescent and family demographics. The prevalence of insomnia symptoms and EDS at baseline were 14.3% and 21.1%, respectively. Adolescents with insomnia symptoms or EDS at baseline were more likely to report suicidal behavior at 1-year follow-up compared to adolescents without insomnia symptoms or EDS. Path analyses showed that EDS played a significant mediation role between insomnia symptoms and suicidal behavior (including any suicidal behavior, suicidal thought, suicide plan, and suicide attempt) before and after adjusting for adolescent and family factors, sleep duration, social jetlag, and prior suicidal behavior. Insomnia symptoms and EDS were associated with increased risk of subsequent suicidal behavior. The association between insomnia symptoms and suicidal behavior was mediated by EDS. These findings highlight the importance of assessment and treatment of insomnia and daytime sleepiness for suicide prevention in adolescents.

Association of Cyberbullying Experiences and Perpetration With Suicidality in Early Adolescence

Adolescent suicidality (ie, suicidal ideation or attempts) is a major public health concern. Cyberbullying experiences and perpetration have become increasingly prevalent and are associated with mental health burden, but their roles as independent suicidality risk factors remain unclear. Data are needed to clarify their contribution to teen suicidality to inform suicide prevention efforts. To examine whether cyberbullying experiences and perpetration are distinct stressors divergent from other forms of peer aggression experiences in their association with suicidality in early adolescence. This cross-sectional analysis used data collected between July 2018 and January 2021 from the Adolescent Brain Cognitive Development (ABCD) study, a large, diverse sample of US children aged 10 to 13 years. Youth reports of cyberbullying experiences or perpetration. The main outcome was youth-reported suicidality (past or present, as reported in the ABCD 2-year follow-up assessment). Covariates included demographics, established environmental risk and protective factors for youth suicidality, psychopathology, and experiences or perpetration of offline peer aggression. A total of 10 414 ABCD participants were included in this study. Participants had a mean (SD) age of 12.0 (0.7) years and 4962 (47.6%) were female; 796 (7.6%) endorsed suicidality. A total of 930 (8.9%) reported experiencing cyberbullying and 96 (0.9%) reported perpetrating cyberbullying. Of the perpetrators, 66 (69.0%) also endorsed experiencing cyberbullying. Controlling for demographics, experiencing cyberbullying was associated with suicidality (odds ratio [OR], 4.2 [95% CI, 3.5-5.1]; P < .001), whereas perpetrating cyberbullying was not (OR, 1.3 [95% CI, 0.8-2.3]; P = .30). Experiencing cyberbullying remained associated with suicidality when accounting for negative life events, family conflict, parental monitoring, school environment, and racial and ethnic discrimination (OR, 2.5 [95% CI, 2.0-3.0]; P < .001) and when further covarying for internalizing and externalizing psychopathology (OR, 1.8 [95% CI, 1.4-2.4]; P < .001). Both being a target and being a perpetrator of offline peer aggression were associated with suicidality (OR, 1.5 [95% CI, 1.1-2.0] for both), controlling for all covariates described earlier. Cyberbullying experiences remained associated with suicidality (OR, 1.7 [95% CI, 1.3-2.2]; P < .001, controlling for all covariates) when included with offline peer aggression experiences and perpetration. In this cross-sectional study, experiencing-but not perpetrating-cyberbullying was associated with suicidality in early adolescence. This association was significant over and above other suicidality risk factors, including offline peer aggression experiences or perpetration. These findings can inform adolescent suicide prevention strategies, and they suggest that clinicians and educational staff working with this population should routinely evaluate for adolescents' experience with cyberbullying.