Adolescent Suicide Research Articles

Mental health, risk behaviors, and social life factors in relation to adolescents' suicide ideation, plans and attempt.

This study investigated differences in mental health and well-being, risk behaviors, and social life factors among adolescents who experienced different forms of suicidality. We examined 18-years-olds in the Danish National Birth Cohort (N = 47,852). Suicidality was defined with mutually exclusive categories ranging from no suicidality, self-reported suicide ideation, plans, and attempt as well as hospital-recorded suicide attempt. The proportion of adolescents with self-reported poor mental health and well-being, risk behaviors, and social life factors were compared across forms of suicidality. Sample weights were applied. Depressive symptoms were reported by 14% (95% CI 13%;14%) of girls with no suicidality, 44% (95% CI 43%;45%) of girls with suicide ideation, and 68% (95% CI 65%;72%) 66% (95% CI 60%;72%) of girls with self-reported suicide attempt or hospital-recorded suicide attempt respectively. Among boys, depressive symptoms were reported by 5% (95% CI 4%;5%) of those with no suicidality, 27% (95% CI 26%;28%) of those with suicide ideation, and 51% (95% CI 45%;57%) and 40% (95% CI 22%;58%) of those with self-reported suicide attempt or hospital-recorded suicide attempt respectively. Likewise, other aspects of poor mental health and well-being gradually increased relative with more severe forms of suicidality, while no notable differences were identified between adolescents with self-reported and hospital-recorded suicide attempt. Similar tendencies were observed for risk behaviors and social life factors. These findings suggest that adolescents with suicidality, including the large proportion with suicide ideation only, faces challenges across several parameters of mental health and well-being, risk behavior, and social life factors. This emphasizes the need for community-based interventions to identify and support the large group of adolescents experiencing both more and less severe forms of suicidality. Clinicians should prioritize comprehensive psychiatric intervention to address the complex needs of suicidal adolescents effectively.

Risk and Protective Effects of Need for Approval on Self-Injury in Adolescent Girls.

The goal of this research was to expand theoretical models of adolescent suicide by exploring whether individual differences in adolescent girls' need for approval (NFAavoid and NFAapproach) contribute to risk for, or protection against, self-injurious thoughts and behaviors (SITBs). We examined these novel hypotheses in a series of concurrent and longitudinal analyses in two samples of adolescent girls (Study 1: N = 89, Mage = 16.31years, SD = 0.84, 67.4% White; Study 2: N = 229, Mage = 11.80, SD = 1.80, 49.8% White). Hierarchical linear and logistic regressions revealed that NFAavoid was generally associated with higher risk for SITBs, whereas NFAapproach generally had a protective effect against SITBs; moreover, the strength of these associations depended on the extent to which girls engaged in rumination. Together, these results suggest that encouraging girls to develop diverse foundations for their sense of self-worth beyond peer judgements may protect against SITBs.

Efficacy and Safety of Lithium for Suicide and Suicide-Related Behaviors in Youth: A Review of the Literature

Objectives: This systematic review evaluates the anti-suicidal properties of Lithium in children and adolescents with Bipolar Disorder (BD), addressing gaps in evidence regarding its efficacy and safety in reducing suicidality and self-harming behaviors. Methods: A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus up to February 2024. Eligible studies were those focusing on patients aged 25 years or younger, examining Lithium therapy and its impact on suicidal ideation and behaviors. The review included randomized controlled trials, longitudinal prospective and retrospective studies, and cross-sectional studies, while excluding expert opinions and case reports. Results: Evidence generally supports the efficacy of Lithium in reducing suicidal ideation and self-harming behaviors in youth with BD, though results are mixed. Randomized controlled trials demonstrated its effectiveness in mitigating suicidal thoughts during acute manic episodes, with effects persisting post-treatment. Longitudinal studies suggested that Lithium might offer superior outcomes compared to other mood stabilizers, although its specific impact on suicidality remains inconclusive. Cross-sectional studies and retrospective analyses reveal associations between Lithium use and reduced self-harming behaviors, but causality remains uncertain. While mood-stabilizing effects of Lithium offer potential benefits for reducing suicidality in youth, evidence on its direct impact on emotional dysregulation (ED) and long-term efficacy is limited. Variability in individual responses and adherence issues underscore the need for further research. Future studies should include larger, diverse samples, focus on ED symptoms, and explore Lithium mechanisms in suicidality prevention. Conclusions: Lithium remains a promising treatment for mood stabilization and reduction in suicidality in youth with BD.

Characteristics of Japanese teenage suicide attempters: a retrospective study comparing suicide attempters with young adults

BackgroundTeenage suicide-related behaviors have been highlighted in Japan in recent years, but the background factors and characteristics of these behaviors have not been clarified. Therefore, we investigated the characteristics of teenage suicide attempters who were admitted to an emergency room.MethodsThe subjects were suicide attempters in their teens and twenties who were admitted to the Critical Care Medical Center of Nippon Medical School Hospital between January 1, 2010 and December 31, 2021. The means of suicide attempt, sociodemographic data, psychiatric diagnoses, and causes and motives for suicide attempts were retrospectively examined from medical records. Teenage suicide attempters were compared to those in their twenties in regard to the acquired data, and logistic regression analysis was conducted to evaluate the influence on teenage suicide attempts by the aspects that have been shown to be closely associated with teenage suicides.ResultsAmong 860 suicide attempters between 2010 and 2021, 59 (6.9%) were teenage suicide attempters and 216 (25.1%) were suicide attempters in their twenties. The large number of females, the history of self-harm, the great number of drug overdoses as a means of attempting suicide, and the large number of individuals with psychiatric disorders, especially with mood disorders and personality disorders, were commonly shared by suicide attempters both in their teens and twenties. On the other hand, family problems, school problems and autism spectrum disorder significantly influenced mostly teenage suicide attempters.ConclusionsIt was suggested that teenage suicide attempters may have attempted suicide due to environmental difficulties and conflicts about not being able to escape from them. It has become clear that teenage suicide attempters have unique characteristics and background factors, and that it is important to take these into account when taking measures to prevent teenage suicides.

Worsening sleep predicts next-week suicidal ideation in a high-risk adolescent outpatient treatment sample.

Suicidal thoughts and behaviors often onset during adolescence, constituting a major public health concern. Despite rising rates in youth, psychotherapeutic and pharmacological treatment outcomes remain meager, indicating a need to identify modifiable risk factors. Experts suggest sleep may serve as a promising clinical indicator of risk and treatment progress, yet few studies have examined acute temporal associations between sleep and suicidal ideation. Participants were depressed and suicidal adolescents (age 13-19, n = 311) attending an intensive outpatient program (IOP). Patients completed weekly self-report assessments of sleep, depression, and suicidal ideation throughout IOP, with an average of 5 assessments over 30 days. Greater overall sleep difficulties, as well as within-person increases in sleep difficulties, were predictive of greater depression severity and suicidal ideation at subsequent assessments, above and beyond previous levels of symptoms. The reverse associations were not found. Inclusion of within-person changes in sleep difficulties significantly improved model fit compared to inclusion of overall sleep difficulties alone. This study provides additional evidence for a prospective relationship between worsening sleep difficulties and suicidal ideation in an IOP youth sample. Worsening sleep may be an important clinical indicator of subsequent depression and suicide risk among adolescents in treatment.

Factors Associated with Suicidal Behavior in Adolescents: An Umbrella Review Using the Socio-Ecological Model.

Adolescent suicide is a critical social issue with profound and lasting individual and collective consequences. This umbrella review examines factors associated with adolescent suicidal behavior through the socioecological framework of prevention and seeks to identify gaps in the existing literature. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included a comprehensive search of the of the Web of Science, Scopus, and Cochrane databases in both English and Spanish, covering the period from 2018 to 2024, using terms related to adolescence and suicidal behavior. Out of 6,138 articles identified, 37 met the quality criteria and were selected for analysis. The studies highlighted individual risk factors such as age, gender, belonging to ethnic or gender minorities, emotional disorders, self-destructive behavior, emotional regulation, and experience of physical or emotional pain. Interpersonal factors such as parental relationships, sexual abuse, social isolation, peer pressure, and loneliness were also found. However, the review revealed a worrying lack of studies on societal and community factors and a paucity of research focusing on protective factors. The study highlights the need to include factors related to the physical and social environments that influence health and behavior in future research, as well as to enhance the resources and strengths of adolescents.

Unravelling Suicide and Related Behaviours in Indigenous Youth and Young Adults in the Canadian Context.

Suicide, rooted in antiquity, is now identified as a global dilemma, particularly impacting Indigenous peoples. The backdrop for this non-systematic focused review is the worldwide challenges faced by vulnerable Indigenous peoples with untenable poverty, degraded life-quality conditions, and suicidality, while the focus, as a specific case, is on the complexity of suicidality in Canadian Indigenous high-risk age groups. The aim here is to present overt and covert intersecting factors underlying suicide in Indigenous youths and young adults in the vast Canadian context. Although living in a privileged geopolitical region, their physically remote and economically compromised communities meshed with a haunting history combined with authorities' ingrained attitudes of exclusion and neglect, spawned meager health and education resources, services, and consequent dire results. The article's guiding theoretical frameworks are Transcultural Psychiatry with its emphasis on context that explains health, illness, and recovery in groups and individuals, and the Interpersonal Psychological Theory of Suicide to identify individuals' suicidality triggers. The article highlights indigenous social determinants of health, identifies elements underlying the tragic suicidality trend in these groups, and addresses literacy and education as poverty driven issues and suicidality-contributing factors promoting attitudes of hopelessness. The discussion includes joint suicide combatting efforts by Indigenous communities and Canadian authorities, these authors' psychosocial-cognitive literacy acquisition plan to address all age-groups simultaneously, and a take-home message introducing employers' desirable worker competencies for effective future employment, thereby uplifting life-quality and prospects to help thwart the spectre of suicide. The Conclusion introduces current trends in suicidality science, confirming the authors' intervention plan is a good fit in the psychosocial intervention trend. Future directions include advice to examine the effectiveness of the plan in the Indigenous context, and tweak it accordingly. For ease of reader comprehension, the article flow is included at the start of the Introduction section.

Investigating the association between housing mobility and self-reported adolescent suicidality and mental health.

Suicide continues to be a public health crisis among adolescents in the United States. Suicide prevention requires a comprehensive understanding of the factors that lead to death from suicide. Housing stability is an important social determinant of health, and literature has begun to describe how housing instability can affect mental health, as well as suicidal behavior. The aim of the present study was to assess the relationship between lifetime housing mobility among adolescents and suicidal behavior (both ideation and attempt). This study examines disparities in housing mobility and suicidal behavior to determine whether certain population subgroups are disproportionately impacted. We undertook a cross-sectional study using data from Wisconsin's Youth Risk Behavior Survey administered during the Fall of 2019, which assessed Wisconsin middle and high school students. We find that housing mobility, as measured in the lifetime number of residences, was associated with an increased risk of suicidal ideation and behavior. We also demonstrate disparities by race, disability status, and sexual orientation. Findings from this study can be used to not only drive change to support students at the school or school district level but also to drive policy change at the societal level. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adolescent, caregivers, and therapists’ experiences of youth and family suicide intervention: A qualitative study

Objective This study explores the experience of an individual and family therapy youth suicide intervention from the perspectives of seven psychotherapy triads (young people aged 12–18, their parents/caregivers and therapists). Method Data were collected through semi-structured individual interviews and analyzed using consensual qualitative research methods. Results Four domains were identified: Focusing on the youth-parent relationship, individual therapy for young people and their parents, conjoint therapy, and public service structures and systemic practice that facilitated tailored treatment. All participant groups valued intervention that improved the youth-parent relationship; however, they held different views about its influence on suicidality and recovery. Separate youth and parent therapy was crucial for facilitating the tailoring of treatment and enhancing the reparative potential of conjoint therapy. Barriers to productive intervention included inaccessible, fragmented, and siloed treatment that excluded parents, stigmatizing clinician responses, and acute care that was not attuned to need or developmental context. Helpful intervention was systemically and attachment-informed, multi-disciplinary, individually tailored, and integrated freely available specialist therapy with crisis and inpatient care. Conclusion A relational, nuanced, and flexible approach is needed to tailor youth suicide treatment in the context of the complexity of youth-parent relationships.

The role of the United States in shaping youth mental health advocacy and suicide prevention through foreign policy and media in conflict zones

This article explores the significant role of the United States in shaping youth mental health advocacy and suicide prevention through its foreign policy and media initiatives in conflict zones such as Iraq, Syria, and the Israeli-Gaza War. The U.S. has actively contributed to improving mental health outcomes by supporting humanitarian programs, facilitating mental health services for displaced youth, and funding initiatives aimed at addressing trauma caused by war. The paper highlights how U.S. foreign policy, through diplomatic efforts and peace-building interventions, has promoted human rights and stability in these regions, providing essential aid to vulnerable populations. In addition, the United States remains a global leader in promoting peace and safety, advocating for the protection of civilians, and upholding international standards of human rights. By working with international organizations, the U.S. has played a key role in ensuring that mental health and suicide prevention programs are integrated into post-conflict recovery efforts, creating safer environments for youth affected by war. Media coverage of U.S. efforts has also helped raise global awareness of the mental health challenges faced by young people in these conflict zones, further amplifying the need for continued advocacy and international support. This paper aims to demonstrate the United States' commitment to fostering global peace and ensuring that young populations have the resources they need to recover from the impacts of conflict, thereby strengthening mental health advocacy on a global scale.

Valoración de los factores de riesgo y estrategias de intervención respecto del suicidio y sus tentativas en adolescentes de entre 15 y 24 años en la ciudad de San Francisco (Córdoba, Argentina)

The following article offers an exhaustive study on the problem of suicide in adolescents, assessing the most relevant risk indicators in the most vulnerable age group, considered between 15 and 24 years of age. This study has been carried out by students and teachers from the University of Social and Business Sciences (UCES) in the city of San Francisco (Córdoba, Argentina), and, also, it offers possible intervention strategies to facilitate detection and prevention in significant contexts, particularly, in social, family, and/or educational environments.

Adult mental health outcomes of adolescent depression and co-occurring alcohol use disorder: a longitudinal cohort study

AbstractDepression and alcohol use disorder (AUD) are frequently co-occurring in adolescence, which often goes undetected in routine care. While this may potentially compromise treatment effectiveness and lead to a less favourable long-term prognosis, few longitudinal studies have followed this group into adulthood. The aim of this study was to explore the risk for adult depression, anxiety disorders, suicidality, and AUD in adolescents with concurrent depression and AUD. The study was based on the Uppsala Longitudinal Adolescent Depression Study (ULADS), a Swedish prospective cohort study. Diagnostic interviews were conducted in adolescence (age 16-17) and adulthood (around age 30). Adolescents with concurrent depression and AUD (n = 38) were compared with peers having only depression (n = 189) or neither of the conditions (n = 144). Logistic regression was used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Adolescents with concurrent depression and AUD were more likely than their non-affected peers to experience adult depressive episodes (aOR, 5.33; 95% CI, 2.22–12.83), anxiety disorders (4.05; 1.77–9.27), suicidality (5.37; 2.28–12.66), and AUD (7.68; 2.59–22.81). Notably, 34% of adolescents with both depression and AUD subsequently experienced both these conditions as adults, compared to 7% of adolescents with only depression. Adolescents suffering only from depression were less likely than those with both conditions to experience suicidality (0.44; 0.21–0.95) and AUD in adulthood (0.18; 0.07–0.44). These findings underscore the clinical imperative to identify adolescents with this comorbidity. Recognition of the poor long-term prognosis can inform targeted interventions for this vulnerable group, ultimately improving health and well-being throughout the life course.

Electronic Health Record Phenotyping of Pediatric Suicide-Related Emergency Department Visits

Suicide is a leading cause of death among young people. Accurate detection of self-injurious thoughts and behaviors (SITB) underpins equity in youth suicide prevention. To compare methods of detecting SITB using structured electronic health information and measure algorithmic performance across demographics. This cross-sectional study used medical records among youths aged 6 to 17 years with at least 1 mental health-related emergency department (ED) visit in 2017 to 2019 to an academic health system in Southern California serving 787 000 unique individuals each year. Analyses were conducted between January and September 2023. Multiexpert electronic health record review ascertained the presence of SITB using the Columbia Classification Algorithm of Suicide Assessment. Random forest classifiers with nested cross-validation were developed using (1) International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for nonfatal suicide attempt and self-harm and chief concern and (2) all available structured data, including diagnoses, medications, and laboratory tests. Detection performance was assessed overall and stratified by age group, sex, and race and ethnicity. The sample comprised 2702 unique youths with an MH-related ED visit (1384 youths who identified as female [51.2%]; 131 Asian [4.8%], 266 Black [9.8%], 719 Hispanic [26.6%], 1319 White [48.8%], and 233 other race [8.6%]; median [IQR] age, 14 [12-16] years), including 898 children and 1804 adolescents. Approximately half of visits were related to SITB (1286 visits [47.6%]). Sensitivity of SITB detection using only codes and chief concern varied by age group and increased until age 15 years (6-9 years: 59.3% [95% CI, 48.5%-69.5%]; 10-12 years: 69.0% [95% CI, 63.8%-73.9%]; 13-15 years: 88.4% [95% CI, 85.1%-91.2%]; 16-17 years: 83.1% [95% CI, 79.1%-86.6%]), while specificity remained constant. The area under the receiver operating characteristic curve (AUROC) was lower among preadolescents (0.841 [95% CI, 0.815-0.867]) and male (0.869 [95% CI, 0.848-0.890]), Black (0.859 [95% CI, 0.813-0.905]), and Hispanic (0.861 [95% CI, 0.831-0.891]) youths compared with adolescents (0.925 [95% CI, 0.912-0.938]), female youths (0.923 [95% CI, 0.909-0.937]), and youths of other races and ethnicities (eg, White: 0.901 [95% CI, 0.884-0.918]). Augmented classification (ie, using all available structured data) outperformed classification with codes and chief concern alone (AUROC, 0.975 [95% CI, 0.968-0.980] vs 0.894 [95% CI, 0.882-0.905]; P < .001). In this study, diagnostic codes and chief concern underestimated SITB prevalence, particularly among minoritized youths. These results suggest that priority on algorithmic fairness in suicide prevention strategies must extend to accurate detection of youths with suicide-related emergencies.

Study on the Emergence and Intervention of Mental Health Problems among Chinese Adolescents

The mental health of Chinese adolescents has received widespread attention due to the rising rate of adolescent suicide. Although previous studies have focused on the causal analysis of such problems, there is still room for further improvement. This study examines the impact of mental health problems from four distinct perspectives in Chinese society. Specifically, cognitive, psychological, behavioral, and physical effects. Then, this study analyzes the causality of mental health problems from three different aspects of adolescents’ daily lives: school-related causality, family-related causality, and peer-related causality. On this basis, the paper makes the following recommendations: Students can develop time management and self-control skills to reduce stress in a high-pressure educational system. Parents and peers can provide emotional support and counseling to help students experiencing emotional distress. Parents, in particular, can aim to create a harmonious family environment to ensure the mental well-being of adolescents Schools can create a harmonious school environment and build healthy peer relationships to prevent bullying behavior.

The relationship between mindfulness and childhood trauma with suicide: The mediating role of cognitive bias

The purpose of this study is to investigate the relationship between mindfulness, childhood trauma, and suicide, specifically focusing on the mediating role of cognitive bias. Suicide is a pressing issue that poses a significant threat to public health in society, and understanding the factors that contribute to it is crucial. The research design employed in this study is a correlation-based structural equation model. A total of 370 students from the second level of secondary school in Iran city were selected as participants using an available sampling method during the academic year of 2023. To gather data, several questionnaires were utilized, including the Kentucky Mindfulness Questionnaire, Bernstein et al.'s Childhood Trauma Questionnaire (1994), Hammachi and Ozturk's Cognitive Bias Questionnaire (2004), and the Multi-attitude Suicidal Tendency Questionnaire (MAST). Data analysis was conducted using SPSS-23 and Amos software, encompassing both descriptive and inferential levels. The findings of this research revealed several significant relationships. Firstly, there is a positive and significant direct path from childhood trauma to cognitive bias. Secondly, mindfulness has a negative and significant direct path to cognitive bias. Thirdly, childhood trauma has a direct and significant path to suicide. Additionally, cognitive bias has a positive and significant path to suicidality, while mindfulness has a negative and significant path to suicide. Moreover, there are positive and significant indirect paths from suicide to childhood trauma and negative and significant indirect paths from suicide to mindfulness. In conclusion, this study highlights the importance of mindfulness and cognitive bias as variables related to adolescent suicide. Adolescents who have experienced childhood trauma are more likely to consider suicide as a solution when faced with life problems. These findings emphasize the need for interventions and support systems that address mindfulness, cognitive bias, and childhood trauma to prevent and mitigate the risk of suicide among adolescents.

Asking to thrive: structures supporting young men’s behavioural health in Belfast, Northern Ireland

Abstract Background Men in Northern Ireland are three times more likely to die by suicide and psychiatric morbidity is significantly higher than for the United Kingdom overall, in part due to the Troubles, a 30-year conflict during which there were 34,000 shootings, 14,000 bombings, and 3,500 deaths. Prior studies suggest strong friendships and high collective efficacy in communities are protective against suicide and self-harm in adolescents and that inquiring about supportive people and structures directly-rather than through parental intermediaries-yields more accurate responses. Methods Semi-structured interviews were conducted with 30 adolescent males aged 16-19 from working-class communities across Belfast. Participants were recruited via trusted community partners and often had experiences with sectarianism and restorative justice. A deductive thematic analysis was conducted of interview transcripts, supplemented by responses to the Self-Harm Inventory and a modified Collective Efficacy Scale. Analyses were completed in NVivo and RStudio. Results In addition to male peer friendships in which they could share confidences, participants strongly endorsed the value of youth work organisations as keystones in supporting not only their own behavioural health through positive modelling but also the reduction of antisocial and sectarian behaviours in their communities. Participants named specific aspects of these structures they found most useful, including demonstrating “masculine success” though community engagement and family life, providing a safe venue for socialising, and delivering restorative justice programming. Conclusions Findings from this study suggest that youth work programming is an important component of both adolescent behavioural health promotion and community safety through the reduction of sectarian and other antisocial behaviours. Participants expressed dismay at the reduction of these services and endorsed both their personal and wider community importance. Key messages • Youth workers may provide valuable positive modelling and behavioural health support to the young men. • Youth work programmes may function both for behavioural health promotion and community violence reduction in Belfast, Northern Ireland.

Co-occurrence of Intimate Partner Violence and Suicide Mortality Among Adolescents and Young Adults in the United States

PurposeSuicide is the second leading cause of death among people ages 10–24 in the United States (US). Intimate partner violence (IPV) is also prevalent, and studies suggest that IPV is associated with youth suicide risk. However, limited research has investigated such associations. We conducted an in-depth analysis of youth suicides that were preceded by or coincided with IPV (i.e., IPV-related) to characterize how decedents were involved in IPV, IPV types experienced, and prior legal systems involvement. MethodsUsing US National Violent Death Reporting System (2014–2018) data for suicide decedents aged 7–24 (n = 15,430 deaths), we manually reviewed case narratives for IPV-related suicides (n = 882) and coded details concerning IPV circumstances. We conducted bivariate analyses to compare IPV-related suicides to other (non-IPV) youth suicides and examined differences in antecedent circumstances between IPV perpetrators (n = 651) and victims (n = 81) using multivariable logistic regression. ResultsAmong IPV-related suicides, most decedents were male and were described as IPV perpetrators. Physical IPV was most frequently reported. Compared to decedents with a history of IPV perpetration, decedents with a history of IPV victimization were more often female and younger. Narratives of IPV victim decedents had higher odds of reporting physical IPV; narratives of IPV perpetrator decedents had higher odds of reporting psychological IPV. DiscussionFuture research should explore the relationship between IPV perpetration and suicide and potential impacts on surviving partners. Research and practice should seek to develop effective assessments and interventions for young people that address IPV and suicide risk simultaneously.

Potential Harms of Responding to Youth Suicide Risk in Schools.

The potential harms related to interventions for adults with suicide-related risk, particularly hospitalization, have been well documented. Much less work has focused on the potential harms related to interventions with youth struggling with suicidal thoughts and behaviors. Young people are most likely to receive mental health services in schools, which are recognized as meaningful sites for effective suicide prevention work. However, no overviews have conceptualized the potential harms to youth when schools engage in ineffective suicide prevention efforts. In this article, we discuss three prominent overlapping areas of potential harms: (1) privacy-related, (2) relationship-related, and (3) mental health-related. We then discuss key factors thought to influence the development and maintenance of these potential harms. We conclude by noting ways in which school-based mental health providers may attempt to reduce unintentional harms in this area, with an overarching goal of helping support school mental health providers and the youth they serve.

Implementing LEARN: Comprehensive Suicide Prevention Training for High School Students, Parents, and School Personnel.

Adolescent suicide is a public health issue, and school is an ideal setting for prevention activities. LEARN is a peer-led gatekeeper training for high school personnel, parents, and students. The purpose of this study was to evaluate the effectiveness of LEARN as a gatekeeper training. Paired t tests were used to compare pre- and post-training surveys for 4983 LEARN participants. Participants reported an increased likelihood of engaging in each LEARN step: looking for signs, empathizing and listening, asking about suicide thoughts and plans, reducing danger, and connecting the person with help. Most participants were highly satisfied with the peer trainer's delivery of content. LEARN gatekeeper training was successfully implemented in high schools with students, parents, and school personnel. All groups reported increases in likelihood of approaching and providing support and connections for at-risk individuals and rated the trainer as effective, indicating satisfaction with the peer-led training format.

Youth suicidality risk relative to ambient temperature and heatwaves across climate zones: A time series analysis of emergency department presentations in New South Wales, Australia.

Youth suicidality prevalence continues to rise alongside hot weather severity. Links between these two variables are underexplored. We examined associations between daily temperature and emergency department suicidality presentations by young people. We assessed these associations for five regions covering New South Wales as determined by 'climate zone' and analysed for heatwave effects as well as based on demographic subgroups. Daily emergency department presentations for suicidality by people aged 12-24 years across New South Wales, Australia, during warmer months (November to March) from 2012 to 2019 were examined in relation to daily mean temperature and heatwaves (⩾3 consecutive days ⩾ 95th percentile of long-term daily mean temperature) and by climate zone, using a generalised additive model with negative binomial distribution. Risks for age- and sex-based subgroups were also calculated. New South Wales youth suicidality presentation rates were significantly higher on hotter days. For every 1°C rise above average daily mean temperature, youth suicidality presentations to New South Wales emergency departments increased by 1.3%. Heatwaves did not increase presentation rates beyond single-day daily mean temperature effects. These findings were predominantly replicated across climate zones and demographic subgroups, though the association between suicidality and ambient temperature was weaker in coastal regions including Eastern Sydney. There is a positive linear association between ambient temperature and youth suicidality presentations to emergency departments. Risks are increased on single hot days, not only during heatwaves. Public health, broader societal approaches to heat and health system planning should consider impacts on youth suicidality of predicted increases in hot weather severity and frequency.