Proximal Risk Factors Research Articles

Culturally-Relevant Predictors of Thwarted Belongingness Among College Students of Asian Descent

ABSTRACT Suicide is one of the most prevalent causes of death among college students in the United States, and the leading cause of death among Asian American college-aged adults. Given these concerning rates, further investigation is essential to understanding the current levels of suicide risk among this population, including culture-specific risk factors, to influence mental health interventions that support this population. This study aims to explore the impacts of Asian culture-specific factors on thwarted belongingness, a proximal risk factor of suicide desire, among college students of Asian descent guided by the Interpersonal Theory of Suicide. Participants (n = 218) completed a battery of validated measures to assess predictors of thwarted belongingness, which included shame, discrimination, ethnic identity, and perfectionism. Nearly half of participants met clinical cutoff criteria for suicide desire. Further, ethnic identity commitment, perfectionism discrepancy, and external shame were statistically significant predictors of thwarted belongingness among this population. These findings underscore the need for tailored interventions that address these culture-specific factors on college campuses to reduce the risk of suicide among students of Asian descent. Additional implications for college-student serving mental health professionals and future research directions are discussed.

Functional and effective connectivity between reward and inhibitory control networks underlying subclinical binge eating.

Knowledge is growing on the essential role of neural circuits involved in aberrant cognitive control and reward sensitivity for the onset and maintenance of binge eating. To investigate how the brain's reward (bottom-up) and inhibition control (top-down) systems potentially and dynamically interact to contribute to subclinical binge eating. Functional magnetic resonance imaging data were acquired from 30 binge eaters and 29 controls while participants performed a food reward Go/NoGo task. Dynamic causal modelling with the parametric empirical Bayes framework, a novel brain connectivity technique, was used to examine between-group differences in the directional influence between reward and executive control regions. We explored the proximal risk factors for binge eating and its neural basis, and assessed the predictive ability of neural indices on future disordered eating and body weight. The binge eating group relative to controls displayed fewer reward-inhibition undirectional and directional synchronisations (i.e. medial orbitofrontal cortex [mOFC]-superior parietal gyrus [SPG] connectivity, mOFC → SPG excitatory connectivity) during food reward_nogo condition. Trait impulsivity is a key proximal factor that could weaken the mOFC-SPG connectivity and exacerbate binge eating. Crucially, this core mOFC-SPG connectivity successfully predicted binge eating frequency 6 months later. These findings point to a particularly important role of the bottom-up interactions between cortical reward and frontoparietal control circuits in subclinical binge eating, which offers novel insights into the neural hierarchical mechanisms underlying problematic eating, and may have implications for the early identification of individuals suffering from strong binge eating-associated symptomatology in the general population.

What's the harm in starting early?: Daily and long-term risks of daytime drinking in young adults.

There is a robust body of work demonstrating that certain drinking practices, such as pregaming or playing drinking games, are linked to heavier, riskier patterns of drinking among college students. However, less attention has been paid to other drinking practices that are relatively common among undergraduates, such as daytime drinking (i.e., drinking before 4:00 PM). Using data from an intensive longitudinal study (bursts of daily data over the course of 12 months; 6,842 total days of data) collected from a high-risk sample of college students (N=403), the present study tested daytime drinking as both a proximal (daily level drinking outcomes) and distal (AUD symptoms) risk factor for hazardous drinking. Daytime drinking was reported by over 70% of the sample and on approximately 15% of drinking days. Daily-level findings indicated that compared to non-daytime drinking days, daytime drinking days were significantly associated with more drinks consumed, more high-risk drinking practices (i.e., heavy episodic or high intensity drinking), and greater subjective intoxication. Longitudinal analyses identified frequent daytime drinking as a risk factor for increased hazardous drinking behavior, particularly among individuals who were younger or reported lower hazardous drinking at baseline. Findings add to a sparse literature supporting daytime drinking as a risky drinking practice among college students. Future work should aim to further characterize contextual and psychosocial factors associated with daytime drinking practices.

MOMENTARY ASSESSMENT OF SOCIAL DISCONNECTION IN OLDER ADULTS AT HEIGHTENED RISK FOR SUICIDE

Abstract Social disconnection is a proximal and modifiable risk factor for suicide among older adults. Identifying periods of acute or intensified disconnection can inform just-in-time interventions for individuals at heightened risk for suicide. Ecological momentary assessment (EMA) using mobile devices is feasible and acceptable for older adults, and is a promising method for capturing daily changes in social disconnection. To assess preliminary validity of EMA for assessing social disconnection in older adults at heightened risk for suicide, we compare mobile EMA to paper-and-pencil assessments of social disconnection within a sample of older adults with subjective cognitive decline (n=27, mean age=69 years, 81% female). Participants completed baseline paper-and-pencil measures of social disconnection (INQ) and depression symptoms, then completed daily surveys (EMA) that were delivered to their smartphone up to 4 times a day for 14 days. Three EMA LIkert-type items items assessed aspects of social disconnection (burdensomeness, belonging, and disconnection). Participants completed a mean of 37.2 surveys with an average response rate of 67%. EMA items correlated strongly with INQ scores (r’s=.6-.7) and depression (r’s=.5-.7). Intercorrelations among EMA items were low to moderate (r’s=.3-.6), suggesting items assessed unique aspects of social disconnection. Among 19 participants who reported no perceived burden on the INQ, 63% reported daily variability in the EMA burden item. Additional analyses will examine within-person variations in EMA items using multilevel mixed models. Findings provide initial evidence of validity for mobile EMA to assess momentary changes in social disconnection among older adults at heightened risk for suicide.

Exploring the role of bridging nodes linking adverse childhood experiences and psychological risk factors in suicidal ideation among MSM

This study investigates the interplay between distal adverse childhood experiences (ACEs) and proximal psychological risk factors in predicting suicidal ideation among men who have sex with men (MSM) using network analysis. A total of 1138 MSM completed self-reported questionnaires on demographics, ACEs, depression, anxiety, interpersonal needs, and suicidal ideation. We employed Gaussian graphical models to perform a network analysis that mapped the relationships between ACEs and proximal psychological variables and identified bridge nodes. Additionally, suicidal ideation was incorporated to reevaluate the network and explore the association between the identified bridge nodes and suicidal ideation. The results show that approximately 88.3% of participants reported experiencing ACEs, with an average occurrence of 3.4 types of ACEs. Suicidal ideation was reported by 31.3% of participants. Key bridging nodes in the psychosocial network included perceived burdensomeness, thwarted belongingness, feeling tired/having little energy, and excessive worrying. Perceived burdensomeness exhibited the strongest correlation with suicidal ideation, followed by thwarted belongingness. Moreover, neglect is strongly associated with suicidal ideation. Our findings suggest that ACEs are associated with suicidal ideation and may be linked to specific proximal psychological factors that correlate with and potentially exacerbate suicidal ideation. These findings provide support to the Interpersonal Theory of Suicide, which suggests that perceived burdensomeness and thwarted belongingness are vital psychological factors in the onset of suicidal ideation. Addressing and intervening in these bridging nodes could help reduce the influence of ACEs on suicide ideation within the MSM community.

Incel Perpetrated Violence: Distal and Proximal Risk Factors and Pathways

ABSTRACT The current study sought to answer the research question, “what are the pathways and risk factors associated with misogynist incel-perpetrated violence against women?” using a novel root cause analysis methodology. Four (N = 4) cases were examined. Data collected included official records and investigations (e.g. police reports, autopsy records), personal communications (e.g. manifestos, online postings), and public sources (e.g. news reports, academic articles). Cases were initially reviewed, and risk factors and pathways were identified. These included: social isolation; alt-right/conservative views; significant online presence; narcissism; legally purchased firearms; history of psychotropic medication use; previous/current suicidal intent; bullying; history of mental illness; lack of familial engagement/concern; and law enforcement/legal involvement. Results indicate similarities between violent misogynist incels which may assist in the development of targeted violence prevention and deradicalization efforts, as well as further our understanding of the factors that lead one to identify with the misogynist incel subculture.

Urbanization and substance use in left-behind children and adolescents: a systematic review and meta-analysis.

Inequalities in job opportunities between urban and rural regions have driven many parents to move from rural to urban regions with aims to improve household income. Financial and political barriers prevent children from moving with their parents, meaning that their children become left-behind in rural regions. This study aims to meta-analyse the risk of drinking, smoking, illicit drug use and drunk experiences in left behind children (LBC) and non-LBC. Previous studies have indicated the negative effects of prolonged parental separation on children and adolescent mental health. Parental separation and poor mental health have both been identified as proximal risk factors for substance use in adolescence. The results indicated that LBC were at significantly greater risk of drinking, smoking, using illicit drugs, and having drunk experiences. Positive psychology interventions are required to help provide LBC with positive coping strategies against psychological distress. Policy changes to reduce inequalities in job opportunities between urban and rural regions are required to reduce the prevalence of LBC.

Meaningful Associations Between Motivation for Treatment and Interpersonal Needs Within a Residential Sample of Women With Eating Disorders.

Perceived burdensomeness (PB) and thwarted belongingness (TB), two proximal risk factors for suicide, may rise during residential eating disorder (ED) treatment when patients are separated from support and face exorbitant costs of care. In this setting, fostering motivation for treatment is challenging, and low motivation for treatment may exacerbate feelings of PB and TB. Simultaneously, PB and TB could reduce motivation for treatment, though no studies have explored this relationship longitudinally. Accordingly, this study examined associations between interpersonal needs (TB, PB) and motivation for treatment across the first 6 weeks of residential ED treatment. Participants (n = 98) completed the Interpersonal Needs Questionnaire (INQ) and rated treatment motivation weekly. Pearson bivariate correlations examined the relationship between motivation and interpersonal needs at each timepoint. Two autoregressive cross-lagged panel models (AR-CLPMs) tested reciprocal relationships between these constructs longitudinally across the first 6 weeks of treatment. Motivation was significantly negatively correlated with PB and TB at all timepoints. In AR-CLPM 1, Week 2 Motivation predicted Weeks 3 PB, then Week 3 PB predicted Week 4 Motivation. In AR-CLPM 2, Week 2 TB predicted Week 3 Motivation, but Motivation did not predict TB at any timepoint. This study is the first to examine longitudinal relations between interpersonal needs and treatment motivation in residential ED care. PB and TB may influence one's motivation for treatment, although motivation and PB had a stronger reciprocal relationship than motivation and TB. Interpersonal needs should be addressed early in residential treatment to mitigate negative cycling.

Adolescent mindfulness may buffer the longitudinal effect of parental work-family conflict and interparental conflict on adolescent affiliation with deviant peers

Parental work-family conflict undermines family functioning, which in turn may impair children’s peer functioning. Using a longitudinal design spanning across 2 years, the present study examined whether paternal/maternal work-family conflict could predict interparental conflict and, in turn, whether such conflict contributed to adolescent affiliation with deviant peers. Additionally, this study also explored the moderating role of adolescent mindfulness on these relationships. As part of a large longitudinal project, 1427 adolescents (773 boys and 654 girls; aged from 12 to 15 years, M = 12.66 years, SD = 0.63) completed questionnaires regarding perceived interparental conflict, deviant peer affiliation, and mindfulness, and both parents reported on questionnaires regarding their own work-family conflict at three-time points with 1-year intervals. Results indicated that paternal but not maternal work-family conflict positively predicted interparental conflict, which was further positively predictive of deviant peer affiliation for adolescents with low but not high mindfulness. Our study revealed the role of paternal work-family conflict as a seemingly distal but relatively proximal risk factor for adolescents’ affiliation with deviant peers, as well as the buffering role of mindfulness on the longitudinal relations.

Prevalence, severity and risk factors for mental disorders among sexual and gender minority young people: a systematic review of systematic reviews and meta-analyses.

Evidence suggests heightened prevalence and severity of mental disorders among sexual minority (SM) and gender minority (GM) young people. Several risk factors have been associated with these disparities. A systematic review of systematic reviews and meta-analysis was conducted to provide a comprehensive overview of the literature and to determine the field's current position. MEDLINE, PsycInfo, Scopus and Web of Science were searched in March 2022 and updated January 2024. Eligibility criteria were systematic reviews or meta-analyses assessing contemporaneous prevalence, severity and/or risk factors of mental disorders among SM or GM young people aged 25 and under. 42 reviews were included, all of which were low quality. The prevalence of depression among SM was 26% (95% CI 21-32%), and among GM was 46% (95% CI 36-56%). Greater depression severity was found among SM compared to heterosexual young people, with a significant albeit small effect size (Hedges' g = 0.38, 95% CI = 0.25 to 0.50); effect sizes were similar when separating by gender. GM also reported greater symptom severity compared to cisgender young people. Other mental disorders were more prevalent compared to those reported in the general population, and of greater severity compared to heterosexual/cisgender young people. Several proximal and distal risk factors were focused upon within the systematic reviews identified. Past systematic reviews consistently indicate a heightened risk of mental disorders among SM and GM young people. Services need to be aware of these disparities and adapt their care accordingly.

LFCI and knee morphological parameters as a risk factor in anterior cruciate ligament tear on magnetic resonance imaging- A case control analysis

The anterior cruciate ligament is commonly injured and multiple risk factors have been studied. But there is paucity of articles considering predictive risk factors of femoral condyle morphology in south Indian population. This study aims to assess distal femoral condyle sphericity as a risk factor in anterior cruciate ligament injury and to correlate it with proximal tibia morphological risk factors. This is a case control study including 80 patients with knee MRI aged between 18 and 60.They were grouped into cases (40) and controls (40). Cases being non-contact ACL injuries without multi ligamentous injuries and controls being MRI with ACL intact. Lateral femoral condyle index, posterior tibial slope, medial and lateral tibial depth were measured and compared. The risk factors were analysed with multiple logistic regression. The lateral femoral condyle index had a mean value of 0.79 with standard deviation of ± 0.05 in cases group. Control group had a mean value of 0.803 with standard deviation of±0.05. Medial tibial slope in cases (8°) was lesser than in control group (7.6°). Lateral tibial slope was found to more among cases group (9.1°) than in control group (7.5°). Medial tibial depth had a mean of 4.07mm among cases and 3.9mm among control group. There was a moderate positive correlation between LFCI and Medial Tibial slope among cases that was statistically significant (P=0.002). In addition, there was a weak negative correlation between LCFI and Medial Tibial Depth that was statistically significant. The lateral femoral condyle index was not found to be significant statistically among ACL injured patients. In our study we concluded that lateral tibial slope was more reliable risk factor in predicting ACL injury when compared to other parameters.

Identifying factors impacting missingness within smartphone-based research: Implications for intensive longitudinal studies of adolescent suicidal thoughts and behaviors.

Intensive longitudinal research-including experience sampling and smartphone sensor monitoring-has potential for identifying proximal risk factors for psychopathology, including suicidal thoughts and behaviors (STB). Yet, missing data can complicate analysis and interpretation. This study aimed to address whether clinical and study design factors are associated with missing data and whether missingness predicts changes in symptom severity or STB. Adolescents ages 13- to 18 years old (N = 179) reporting depressive, anxiety, and/or substance use disorders were enrolled; 65% reported current suicidal ideation and 29% indicated a past-year attempt. Passively acquired smartphone sensor data (e.g., global positioning system, accelerometer, and keyboard inputs), daily mood surveys, and weekly suicidal ideation surveys were collected during the 6-month study period using the effortless assessment research system smartphone app. First, acquisition of passive smartphone sensor data (with data on ∼80% of days across the whole sample) was strongly associated with survey data acquisition on the same day (∼44% of days). Second, STB and psychiatric symptoms were largely not associated with missing data. Rather, temporal features (e.g., length of time in study, weekends, and summer) explained more missingness of survey and passive smartphone sensor data. Last, within-participant changes in missing data over time neither followed nor predicted subsequent change in suicidal ideation and psychiatric symptoms. Findings indicate that considering technical and study design factors impacting missingness is critical and highlight several factors that should be addressed to maximize the validity of clinical interpretations in intensive longitudinal research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PARENTAL OVER-INDEBTEDNESS AND YOUTH CRIME IN SWEDEN: A NATIONWIDE REGISTER-BASED STUDY

Very little is known about whether a child’s delinquency can be related to a parent’s economic problems in terms of financial indebtedness. This would seem to be an important research gap, not least at a time when the repercussions of the 2008 global financial crisis are still being felt by many people. This study concerned boys and girls born in 2002 who had a parent with a registration date for a debt in the Swedish Enforcement Authority register between 2016 and 2017 (n = 3,284). We determined whether the adolescents had been convicted of a crime during the 3-year period when they were 15 to 17 years old, and compared their records with a sample from the general Swedish population (n = 16,435). Results from logistic regressions show that children who, at age 15 to 17, had a parent with debt problems were approximately one and a half times more likely to be convicted of a crime than children who were unexposed to registered debts of parents (OR = 1.55), irrespective of other well-established criminogenic risk factors observed prior to the parent’s date of registration at the Enforcement Authority. The results provide support for the notion that financial challenges and problems with creditors may be an important proximate risk factor of delinquency.

Gender-Specific Trajectories of Non-Suicidal Self-Injury among Adolescents: Predictive Roles of Distal and Proximal Risk Factors.

Non-suicidal self-injury (NSSI) is considered a strong risk factor for suicide. Although NSSI is prevalent among adolescents and varies by gender, few studies have examined the gender-specific trajectory of NSSI and its predictors. This study examined the trajectory of NSSI among Chinese adolescent boys and girls separately, and the roles of distal (i.e., childhood maltreatment and its specific subtypes) and proximal risk factors (i.e., emotional dysregulation, peer victimization) on their trajectories. A total of 3290 Chinese adolescents (Mage = 13.08; SD = 0.84; 57.6% boys) participated in assessments at three time points. Latent class growth models identified three trajectories for boys: Low stable (92.5%), moderate increasing (5.0%) and high decreasing (2.5%). Four trajectories were identified for girls: Low stable (87.9%), moderate increasing (7.6%), high decreasing (3.0%) and high stable (1.5%). Multinomial logistic regression analyses revealed that both emotional dysregulation and emotional abuse predicted the trajectories of moderate increasing, high decreasing and high stable for girls, as well as predicted moderate increasing and high decreasing trajectories for boys. Peer victimization served as a significant risk factor predicting the moderate increasing and high decreasing trajectories only for girls, while overall childhood maltreatment was a remarkable predictor for the moderate increasing and high decreasing trajectories of boys. The findings highlighted the importance of gender differences in understanding the progression of NSSI and the key predictors, informing effective strategies for prevention and intervention.

The association of microvascular disease and endothelial dysfunction with vertebral trabecular bone mineral density : The MESA study.

Microvascular diseases of the eye, kidney, and brain are associated with endothelial dysfunction and increased hip fracture risk. To explore the basis for higher hip fracture risk, we comprehensively examined whether markers of microvascular disease and/or endothelial dysfunction are related to trabecular bone mineral density (BMD), a proximate risk factor for osteoporotic fractures. Among 6814 participants in the Multi-Ethnic Study of Atherosclerosis study (MESA), we derived thoracic vertebral trabecular BMD from computed tomography of the chest and measured urine albumin to creatinine ratios (UACR), retinal arteriolar and venular widths, flow mediated dilation (FMD) of the brachial artery after 5min of ischemia; and levels of five soluble endothelial adhesion markers (ICAM-1, VCAM-1, L-selectin, P-selectin, and E-selectin). Linear regression models were used to examine the association of trabecular BMD with markers of microvascular disease and with markers of endothelial dysfunction. We observed no significant associations of UACR, retinal arteriolar or venular widths, or FMD with BMD. We also observed no statistically significant association of spine trabecular BMD with levels of endothelial adhesion markers. Men and women had largely similar results. We conclude that there is little evidence to connect thoracic spine trabecular BMD to microvascular disorders or to endothelial dysfunction among multi-ethnic middle-aged and older adults. Other factors beyond trabecular BMD (e.g., bone quality or predisposition to falling) may be responsible for the associations of microvascular disease with osteoporotic fractures.

A Qualitative Study on Understanding the Process of Nonsuicidal Self-injury

Background:Intentional self-harm presents a significant challenge within the mental health system, yet misconceptions persist regarding its nature, particularly the view that nonsuicidal self-injury (NSSI) serves as a mere call for attention and represents impulsive behavior. This study aimed to explore the process and experiences of self-harm among young adults in India to address this stigmatization.Methods:Semi-structured interviews were conducted with eight participants aged 21–24 years, encompassing diverse psychiatric diagnoses and a history of NSSI. These interviews aimed to delve into the nuanced experiences and perspectives surrounding self-harm in this demographic.Results:Thematic analysis of the interviews unveiled six overarching themes: distal risk factors, proximal risk factors, methods and conditions to self-harm, during the act, after the act, and considerations to be taken while planning intervention. These themes shed light on various factors influencing self-harm behaviors and the context in which they occur.Conclusion:The findings underscore the necessity of incorporating individuals’ unique processes of self-harm into intervention planning to effectively support those at risk of self-harm. By understanding the complex interplay of factors involved, mental health professionals can develop targeted and comprehensive interventions to address NSSI effectively.

Social media misuse explained by emotion dysregulation and self-concept: an ecological momentary assessment approach

ABSTRACT Studies suggested that emotion dysregulation and identity processes are involved in social media (SM) misuse, even if their proximal role has not been investigated. Previous studies rarely discriminated between specific activities or between types of SM. We recruited 50 young adults and implemented a momentary ecological assessment measurement. Four times by day, during seven days, we measured SM use, frequency of several activities on SM, emotion dysregulation, distress and clarity of self-concept. Daily time spent on Facebook, Instagram and TikTok were retrieved from devices. Intradaily changes in emotion dysregulation and clarity of self-concept predict changes in SM addiction symptoms and frequency of use according to the type of activity. Daily changes in time spent on SM were not predicted by emotion dysregulation, distress and self-concept clarity. Findings suggest that emotion dysregulation and poor self-concept clarity are proximal risk factors for SM misuse.

An examination of the mediating role of maladaptive emotion regulation strategies in the complex relationship between interpersonal needs and suicidal behavior.

Studies have shown that psychological factors, notably interpersonal needs and emotion regulation, play a significant role in suicidal behavior. Interpersonal needs are significant contextual components that affect emotion regulation and contribute to a wide range of dysfunctional behaviors, such as suicidal behavior. It has been postulated that emotion regulation mediates the associations between proximal and distal risk factors of suicidal behavior. The sample consisted of 340 community-dwelling individuals (62.5% women; SD = 0.48) with an age range of 18 through 55 (M = 30.23; SD = 8.54) who completed the interpersonal needs questionnaire, the suicide behaviors questionnaire-revised, and the cognitive emotion regulation questionnaire. The Structural Equation Modeling (SEM) approach was utilized to evaluate a mediation model. The findings indicate that interpersonal needs (i.e., perceived burdensomeness r = .55, p <.01 and thwarted belongingness r = .25, p <.01) and putatively maladaptive cognitive emotion regulation strategies (i.e., self-blame; r = .38, p <.01, catastrophizing; r = .55, p <.01, rumination; r = .40, p <.01, and other blame; r = .44, p <.01) have strong associations with suicidal behavior, and these strategies have a mediating effect on the association between interpersonal needs and suicidal behavior. Our findings show that contextual-interpersonal needs, which underpin suicidal behavior, are significantly influenced by maladaptive emotional processes. Thus, therapeutic outcomes might be enhanced by focusing on the content of the associated cognitions and trying to reduce maladaptive regulatory processes like rumination and catastrophization.

Proximal risk pathways of momentary alcohol urges and use: differences based on suicidal ideation history

Despite alcohol use being a proximal risk factor for suicidality, there have been limited examinations of alcohol use risk pathways at the momentary level among those at elevated suicide risk. Thus, we aimed to investigate risk factors relevant to predicting alcohol use experiences among those with and without a history of suicidal ideation. Data from 51 participants with a probable alcohol or substance use disorder across 21 days of ecological momentary assessment was utilized. Participants reported relevant risk factors (i.e., affect, thwarted belongingness, perceived burdensomeness) and alcohol use experiences (i.e., urges, use) four times per day. Group-level analyses examining differences in momentary associations between risk factors and alcohol use experiences based on suicidal ideation history did not detect group differences in predicting alcohol use, but group differences emerged for concurrent and prospective prediction of alcohol urges. Individual-level analyses demonstrated heterogeneity in momentary associations between risk factors, alcohol urge, alcohol use, and suicidal thinking. Together, results demonstrate the role of negative emotion, thwarted belongingness, and perceived burdensomeness in understanding momentary alcohol use experiences. Findings also highlight the complexity of, and significant heterogeneity in, the alcohol use experience among those who have experienced suicidal ideation.

Weekly links among irritability and suicidal thoughts and behaviors in high-risk youth.

Previous studies demonstrate a link between irritability and suicidal thoughts and behaviors (STBs) in youth samples. However, they have mostly assessed irritability in community samples and as a largely dispositional (i.e. trait-like) construct. Thus, it remains unclear to what extent links between irritability and STBs reflect within-person processes of elevated risk in clinically meaningful time periods. The present study used clinical data from 689 adolescents aged 12-19 years attending a total of 6,128 visits at a specialty Intensive Outpatient Program for depressed and suicidal youth to examine patterns in weekly assessments of irritability and STBs throughout treatment, including associations among trends and fluctuations departing from these trends via multilevel structural equation modeling. Youth completed self-report measures of irritability, depression, and STBs weekly as part of standard IOP clinical care. Overall, two-thirds of variance in weekly irritable mood was accounted for by between-person differences and the remaining portion by weekly fluctuations. After controlling for depression, during weeks when youth were more irritable they experienced increased STBs. Rates of change in irritability and STBs tended to track together at early stages of treatment, but these effects were generally accounted for by depression severity. Our results suggest that although changes in STBs are best accounted for by depression, irritability can be understood as a specific, proximal risk factor for youth STBs that exacerbates youth STBs in clinically informative timeframes above and beyond depression.