Suicide Risk Research Articles

The hypothalamic-pituitary-thyroid axis, depression and risk of suicide: commentary, Luo et al.

There is a considerable literature on the relationship of thyroid function with risk of depression and responsiveness to depression treatment. This literature is briefly reviewed here, followed by a focus on the incremental advance provided by the findings of Luo et al on autoimmune thyroiditis and suicide attempts.

The relationship between intersectional discrimination and mental health outcomes among LGBTQ+ Asians in New York City: an exploratory, mixed-methods study

ABSTRACT LGBTQ+ Asians face increased mental health risks due to intersectional discrimination and minority stress. This mixed-methods study examined associations between minority stress, intersectional discrimination, and mental health outcomes among LGBTQ+ Asians. Between 2022 and 2023, 136 LGBTQ+ Asian residents of New York City were surveyed. Adjusted logistic regression models compared the odds of clinically-significant depressive symptoms, anxiety symptoms, and suicide risk by self-reported measures of discriminatory experiences towards LGBTQ+ Asians. A subsample of 24 individuals completed semi-structured interviews in English, and thematic content analysis was utilised to understand contextual factors and discriminatory experiences influencing mental health. Individuals experiencing higher levels of everyday discrimination had increased odds of reporting clinically-significant depressive symptoms, anxiety symptoms, and high suicide risk. Individuals experiencing higher levels of racialised and LGBTQ-related microaggressions had increased odds of reporting clinically-significant depressive and anxiety symptoms. Interviews revealed themes including social isolation, anticipated stigma attributed to discriminatory experiences within LGBTQ+ and Asian communities, and pervasive impacts of racial and LGBTQ+ discrimination on mental health. These findings underscore mental health disparities among LGBTQ+ Asians associated with varying levels of discrimination and targeted microaggressions. More research is needed to understand the causal mechanisms by which intersectional discrimination impacts LGBTQ+ Asians’ mental health.

Association of General Anesthesia for Cesarean Delivery with Postpartum Depression and Suicidality.

Compared to neuraxial anesthesia, general anesthesia (GA) for cesarean delivery is associated with an increased risk of postpartum depression (PPD) requiring hospitalization. However, obstetric complications occurring during childbirth (eg, stillbirth) are associated with both increased use of GA and increased risk of PPD, and may account for the reported association between GA and PPD. This study assessed the association of GA for cesarean delivery with PPD requiring hospitalization, outpatient visit, or emergency department (ED) visit, accounting for obstetric complications. This retrospective cohort study included women who underwent a cesarean delivery in New York State between January 2009 and December 2017. Women were followed for 1 year after discharge for readmission, outpatient visit, or ED visit. The primary outcome was PPD requiring readmission, outpatient visit, or ED visit. The 2 secondary outcomes were (1) PPD requiring readmission, and (2) suicidality. Obstetric complications included severe maternal morbidity, blood transfusion, postpartum hemorrhage, preterm birth, and stillbirth. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of PPD, PPD requiring readmission, and suicidality associated with GA were estimated using the propensity score matching and the overlap propensity score weighting methods. Of the 325,840 women included, 19,513 received GA (6.0%; 95% CI, 5.9-6.1). Complications occurred in 43,432 women (13.3%) and the GA rate for these women was 9.7% (95% CI, 9.4-10.0). The incidence rate of PPD was 12.8 per 1000 person-years, with 24.5% requiring hospital readmission, and was higher when an obstetric complication occurred (17.1 per 1000 person-years). After matching, the incidence rate of PPD was 15.5 per 1000 person-years for women who received neuraxial anesthesia and 17.5 per 1000 person-years for women who received GA, yielding an aHR of 1.12 (95% CI, 0.97-1.30). Use of GA was associated with a 38% increased risk of PPD requiring hospitalization (aHR: 1.38; 95% CI, 1.07-1.77) and with a 45% increased risk of suicidality (aHR 1.45; 95% CI, 1.02-2.05). Results were consistent when using the overlap propensity score weighting. Use of GA for cesarean delivery is independently associated with a significantly increased risk of PPD requiring hospitalization and suicidality. It underscores the need to avoid using GA whenever appropriate and to address the potential mental health issues of patients after GA use, specifically by screening for PPD and providing referrals to accessible mental health providers as needed.

The role of suicidal motivations in adolescence: implications for the psychotherapeutic treatment of suicidal risk.

The study of suicidal risk has increasingly emphasized the importance of assessing specific suicidal motivations. Motivations express an elaboration of the condition of psychache, representing an effective perspective on the management of suicidal risk in psychotherapy. This study explores suicidal motivations and personality pathology in a clinical sample of adolescents with suicidal ideation or a history of suicide attempts. We aim to investigate how specific motivational factors and personality disorders (PDs) contribute to the foreseeability of suicidal outcomes, such as the occurrence, number, and lethality of suicide attempts and their interaction with the impact of personality disorders. A sample of 134 adolescents aged 12-18, with active suicidal ideation or recent suicide attempts, was assessed using a combination of self-report measures and structured clinical interviews. Binomial logistic regressions and linear regressions were conducted to explore the predictive value of PDs and motivational factors on suicidal behaviors. The results indicate that specific suicidal motivations, such as interpersonal influence, escape fantasy, and absence of fear, provide an additional increase in the foreseeability value beyond personality disorder criteria alone. These findings suggest that assessing suicidal motivations can significantly enhance risk evaluation and inform more effective therapeutic interventions. Beyond identifying certain risk factors, the therapist's ability to diss and process specific suicidal motivations in the context of the therapeutic relationship can be a decisive factor in monitoring and directly intervening on the risk.

Assessment of Suicidal Risk through Clinical Scales: A Comparative Analysis of Measurement Tools and Their Effectiveness in Psychiatric Practice

<p dir="ltr"><span>Suicide risk assessment is one of the critical components of mental health care, necessitating accurate, reliable, and sensitive tools to identify at-risk individuals and guide interventions. This article provides a comprehensive analysis of various clinical scales used to assess suicidal risk, exploring their psychometric properties, target populations, and practical applications. Key scales discussed include BSS, C-SSRS, SBQ-R, and SS. </span></p><p dir="ltr"><span>The analysis highlights the importance of integrating these tools into clinical practice to enhance early detection and management of suicidal behaviors, particularly among high-risk groups such as individuals with depression, mood disorders, adolescents, and so on. </span></p><p dir="ltr"><span>The effective application of these assessment scales is crucial in improving mental health outcomes, emphasizing a multifaceted approach that includes mental health support, community engagement, and targeted interventions for high-risk groups. The article underscores the need for ongoing research and refinement of these tools to adapt to the evolving understanding of suicidal behavior and prevention strategies.</span></p><div><span><br /></span></div>

The problem of suicidality, personality disorder, and treatment: an alternative psycho-social perspective.

Suicidal behaviour, including both attempted and completed suicides, has been increasing globally, particularly in industrialized nations, making suicidality a significant public health concern. Despite the allocation of increasing resources by US, EU, and UK governmental and mental health bodies, the effectiveness of current strategies for the treatment, management, and prevention of suicide remains in question. This paper reviews evidence from epidemiological studies and national prevention policies, alongside research data from a London-based specialist personality disorder treatment centre and clinical case studies from private psychiatric/psychotherapy practice, to explore an alternative psychosocial approach to addressing suicidality. The dominant psychiatric model, which relies heavily on medication, hospitalization, and often coercive methods of control, may have iatrogenic effects, potentially exacerbating the risk of suicide. In contrast, a psychodynamic and psychosocial approach, focused on understanding the underlying psychological dimensions of suicidality, fostering a trusting therapeutic alliance, addressing both internal and external factors contributing to suicidal behaviour, and promoting open dialogue around suicidal thoughts, has shown promise in reducing suicide risk. The findings presented in this paper argue for a rethinking of traditional psychiatric approaches, advocating for a shift toward more personalized, collaborative, and psychologically informed interventions that can more effectively reduce the risk of suicide.

The role of childhood maltreatment and mental health disorders on suicidal behaviour in adolescents

BackgroundSuicide stands as a grave and pressing public health concern, ranking among the foremost causes of death in the youth demographics. While childhood maltreatment (CM) and mental disorders have garnered substantial attention as risk factors for suicide, there remains an enigmatic aspect concerning how these two elements interact, influencing the nature of suicidal ideation and suicidal behaviour, and the transition between them. ObjectiveThis study endeavours to shed light on the intricate interplay between CM, mental disorders, and suicide. Participants and settingWe gathered data from 289 adolescents aged 12–17 (87.2 % female) drawn from eight different hospitals across Spain, all of whom had attempted suicide within the past 10 days. MethodsWe assessed suicidal ideation severity and intensity, suicidal behaviour by attempts using the C-SSRS, and the presence of CM using CTQ and identified concurrent mental disorders according to the MINI. Regression analysis and moderation analysis were conducted by PROCESS macro. ResultsModeration analysis revealed that higher scores of CM were associated with a higher number of suicide attempts with the presence of a mental disorder. Additionally, we found that those with higher scores of CM reported less severe characteristics of suicidal ideation, when presenting along with an anxiety disorder. ConclusionsThese findings revealed CM increased risk of suicidal behaviour among young individuals. Additionally, the results suggest that adolescents with CM and anxiety disorder might under-report suicidal ideation. Hence, these findings offer a potential key to identifying and preventing suicide risk among young individuals.

Evaluating the adverse drug reactions to clozapine in populations of children and adolescents: insights from VigiBase data.

Pharmacovigilance findings have marked clozapine use. Prescribers and package inserts worldwide focus on clozapine-induced neutropenia. The literature on clozapine adverse drug reactions (ADRs) for those under age 18 and their associated fatal outcomes is limited. Reports to the World Health Organization's global pharmacovigilance database (VigiBase) were analyzed among patients under 18 years of age extending from clozapine's introduction to June 1, 2022. There were 2825 reports of clozapine, including 42 fatal outcomes (relative lethality = 1.5% vs. 11.7% in all ages). After 280 cases were excluded (clozapine exposure during pregnancy, accidental exposure or unclear age), 2455 were included with ADRs during therapeutic use. Decreased white blood cell (WBC) count provided the most frequent aggregated ADR, accounting for 934 cases (37% of 2545), with only 1 fatal outcome (0.01%, 1/934). Suicide explained 7 of 27 (26%) non-duplicated fatal outcomes. Next in importance was clozapine-induced gastrointestinal hypomotility (CIGH) with 3 cases (11% of 27) and neuroleptic malignant syndrome with 2 cases (7% of 27). Agranulocytosis, aspiration, myocarditis, myocardiopathy and ventricular arrythmia led to single fatal cases. Based on these new findings and recent literature in all ages, to prevent fatal outcomes, child and adolescent psychiatrists need to shift their focus from severe neutropenia to other ADRs including pneumonia, respiratory aspiration and CIGH. In spite of its potential toxicity during overdoses, clozapine may have specific and strong anti-suicidal effects when compared with other antipsychotics. Child and adolescent psychiatrists need to take extreme precautions to avoid intentional overdoses when prescribing clozapine to patients with suicide risk.

Measuring Psychological Strains: A Psychometric Study to Develop a Shortened Version of the Psychological Strain Scales

The Psychological Strain Scale (PSS) has been widely used in various populations to assess the risks of suicidality and mental disorders. The current study aims to shorten the original 40-item scale and test its psychometric properties. Data were derived from three samples in China: (1) undergraduate students (n = 10,742), (2) non-medical office employees (n = 1044), and (3) hospital workers (n = 949). A questionnaire was administered to the samples at about the same time of the year 2017. Data were randomly divided into Sub-study 1 (70% of the sample) and Sub-study 2 (30% of the sample). In Sub-study 1, principal component analyses were run and five items with the highest factor loadings within each subscale were retained, resulting in a 20-item PSS scale. Cronbach’s α estimates were above 0.70. In Sub-study 2, confirmatory factor analyses for the three samples revealed RMSEA values below 0.10, PNFI values below 0.50 for all samples, and CFI, TLI and NFI values above 0.90 for the student and non-medical office employee samples, but the hospital worker sample had a TLI of 0.88. The PSS-20 and its subscales were significantly associated with past-year suicidal ideation. The PSS-20 has acceptable psychometric properties but requires further testing in university students and hospital workers.

Comportamientos emocionalmente inteligentes docentes y su papel en la relación entre la cibervictimización y los factores de riesgo de suicidio en adolescentes

Psychological distress is an increasing concern among adolescents worldwide. Cybervictimization is considered one of the stressors that adolescents may face, and it significantly impacts various indicators of suicide risk (i.e., symptoms of depression, anxiety, and stress, and suicidal ideation). However, teacher emotionally intelligent behaviors (TEIB) might mitigate the links between cybervictimization experiences and suicide risk factors. This study aimed to examine the relationships between cybervictimization and several suicide risk indicators, as well as the potential moderating role of TEIB in these links. A sample of 1,866 (996 girls) adolescents (Mage=13.99, SD=1.44) participated in this study and completed widely validated measures. Moderation analyses revealed that TEIB moderated the positive associations between cybervictimization and symptoms of depression, anxiety, and stress, even after controlling for the effects of sociodemographic factors (i.e., age and gender) and emotional intelligence. However, TEIB did not moderate the link between cybervictimization and suicidal ideation. These novel findings both underscore the significance of students’ perceptions of TEIB in shaping their psychological well-being and highlight potential avenues for research aimed at mitigating the consequences of cybervictimization.

Suicide risk identification and mitigation in patients with chronic pain prescribed opioid medication

Abstract Managing suicidality in persons with chronic pain is a challenging clinical scenario with no treatment guidelines to inform clinical decision-making related to suicide risk mitigation. Applying appropriate risk mitigation strategies, such as opioid education and naloxone distribution, lethal means safety education, increased frequency of appointments, individualized opioid tapers, consideration of nonopioid pharmacotherapy, nonpharmacological treatment options, and addressing modifiable risk factors, can decrease suicide risk. Recommending a treatment plan for patients with chronic pain experiencing suicidality is explored through 3 patient cases.

Enhancing suicidal behavior detection in EHRs: A multi-label NLP framework with transformer models and semantic retrieval-based annotation

Background:Suicide is a leading cause of death worldwide, making early identification of suicidal behaviors crucial for clinicians. Current Natural Language Processing (NLP) approaches for identifying suicidal behaviors in Electronic Health Records (EHRs) rely on keyword searches, rule-based methods, and binary classification, which may not fully capture the complexity and spectrum of suicidal behaviors. This study aims to create a multi-class labeled dataset with annotation guidelines and develop a novel NLP approach for fine-grained, multi-label classification of suicidal behaviors, improving the efficiency of the annotation process and accuracy of the NLP methods. Methods:We develop a multi-class labeling system based on guidelines from FDA, CDC, and WHO, distinguishing between six categories of suicidal behaviors and allowing for multiple labels per data sample. To efficiently create an annotated dataset, we use an MPNet-based semantic retrieval framework to extract relevant sentences from a large EHR dataset, reducing annotation space while capturing diverse expressions. Experts annotate the extracted sentences using the multi-class system. We then formulate the task as a multi-label classification problem and fine-tune transformer-based models on the curated dataset to accurately classify suicidal behaviors in EHRs. Results:Lexical analysis revealed key themes in assessing suicide risk, considering an individual’s history, mental health, substance use, and family background. Fine-tuned transformer-based models effectively identified suicidal behaviors from EHRs, with Bio_ClinicalBERT, BioBERT, and XLNet achieving the F1 scores (0.81), outperforming BERT and RoBERTa. The proposed approach, based on a multi-label classification system, captures the complexity of suicidal behaviors effectively particularly “Suicide Attempt” and “Family History” instances. The proposed approach, using task-specific NLP models and a multi-label classification system, captures the complexity of suicidal behaviors more effectively than traditional binary classification. However, direct comparisons with existing studies are difficult due to varying metrics and label definitions. Conclusion:This study presents a robust NLP framework for detecting suicidal behaviors in EHRs, leveraging task-specific fine-tuning of transformer-based models and a semi-automated pipeline. Despite limitations, the approach demonstrates the potential of advanced NLP techniques in enhancing the identification of suicidal behaviors. Future work should focus on model expansion and integration to further improve patient care and clinical decision-making.

Abnormal ReHo and ALFF values in drug-naïve depressed patients with suicidal ideation or attempts: Evidence from the REST-meta-MDD consortium

BackgroundThe assessment of suicide risk in patients with major depressive disorder (MDD) is somewhat subjective in clinical diagnosis and may lead to diagnostic bias and serious consequences. Therefore, the aim of this study was to determine whether MDD patients with suicidal ideation or suicide attempts exhibited local brain functional synchrony and spontaneous activity intensity, thus providing certain imaging basis for suicide assessment. MethodsThis study was conducted using ReHo and ALFF analyses on 213 first episode drug-naïve MDD patients from the REST-meta-MDD consortium. All patients were categorized into MDD with SI or SA group and MDD without SI and SA. A voxel-based two-sample t-test was then used to identify brain regions with significant differences in ReHo or ALFF values. Finally, Reho or ALFF values of those brain regions in MDD with SI or SA group were extracted for correlation analysis with suicide severity. ResultsCompared with MDD patients without SI or SA, MDD patients with SI or SA had increased ReHo in the triangular part of left inferior frontal gyrus, orbital part of right inferior frontal gyrus and right precuneus gyrus, and increased ALFF in the middle occipital gyrus. All of these brain region characteristics were positively correlated with suicide severity on the HAMD 3th item score and HAMD 9th item score. ConclusionOur findings suggest that abnormalities of regional spontaneous brain activity were found in IFG, precuneus gyrus, and MOG among MDD patients with suicidal thoughts or attempts, which provides a reliable imaging basis for identifying and preventing suicide.

Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study

Introduction: Nearly three quarters of the suicides occur in developing world, however few evidenced-based health systems strategies exist to detect and prevent suicide in these contexts. This pilot study evaluates the feasibility of implementing a universal suicide risk screening program in a Nepalese emergency department. Methods: This study reports the preliminary training phases of a pilot implementation trial in the emergency department to evaluate the program. The approval was obtained from the Nepal Health Research Council (Approval no. 447/2021 P), and the Kathmandu University School of Medical Sciences Institutional Ethical Review Board (Approval no. 237/2021) and Yale University IRB (Protocol ID 2000029480). Implementation assessments included suicide screening acceptability, appropriateness, confidence, system priority, and myth knowledge of staff. Implementation strategies were selected, decolonized, and preliminarily trained followed by phased supportive coaching to initiate the screening package. We designed the implementation package through co-design staff focus groups and embedded ethnography. Results: Co-design focus groups (n=8) occurred with staff and leadership. We trained 26 (76.47%) the staff on the Nepali suicide screening tool followed by supported phased initial screening over two months. Implementation assessments demonstrated increased scores on appropriateness, confidence, system priority, and myth knowledge. The implementation package included key strategies to be deployed over six months. The embedded ethnographic observations revealed barriers to effective implementation, such as anticipated stigma, reluctance to engage families, and distrust in referral processes.Conclusions: The pilot study demonstrated that training improves staff appropriateness, confidence, system priority, and myth knowledge. Despite initial barriers, co-designed strategies and phased coaching facilitates screening uptake, highlighting the program's potential for sustainable implementation.

Association between receipt of a continuum of supportive housing services and mortality among Veterans with experience of housing instability

Veterans face elevated risk of suicide and homelessness, with housing instability being a significant, independent risk factor among this population. Addressing housing instability through primary, secondary, and tertiary prevention services is crucial for improving health and mortality outcomes, though research remains limited. The objective of this study is to assess the association between receipt of primary, secondary, and tertiary homelessness prevention services and risk of suicide and all-cause mortality among Veterans within 24 months of experiencing housing instability. Data were extracted from national U.S. Department of Veterans Affairs (VA) electronic health records (EHR), 2014-2019, and mortality data from National Death Index. Logistic regressions conducted in 2024 modeled suicide and all-cause mortality using a time-discreet survival framework with person-month as the unit of analysis. Cohort included 662,682 Veterans with indicators of housing instability in EHR. Veterans who received homeless services across the three levels of public health prevention had reduced odds of suicide compared to non-participants while Veterans exiting these programs had higher odds of suicide (p-value ranges <.001 - 0.05). Consistent results were found for all-cause mortality. Continued receipt of services to address housing instability is associated with reduced mortality risk. Exiting programs to address housing instability may be a vulnerable period for Veterans, and investment in homelessness prevention is crucial to reduce mortality and improve outcomes among Veterans. Ongoing support is essential to mitigate risks associated with program exit.

A Mixed-Methods Examination of Perceived Burdensomeness in Emerging Adults

ABSTRACT This mixed methods study aims to identify contexts within which young adults report perceptions of being a burden. Participants (N = 243) completed self-report measures of study variables and provided examples of times they felt like a burden. Seven major categories were developed from the qualitative analysis. Quantitative analyses indicated no significant differences across coding themes with respect to perceived burdensomeness. A significant association regarding intensity ratings of perceived burdensomeness was found when comparing categories of perception of failure and drain on resources. These results provide unique insight regarding the nature of how individuals describe the contexts within which they perceive themselves to be a burden. Since maladaptive cognitions of perceived burdensomeness may be related to suicide risk, identifying these contexts could inform avenues for adapting clinical interventions designed to target perceived burdensomeness.

Personality Disorders and Clinical Disorders: The Challenge of Comorbid Autism Spectrum Disorder (ASD), Eating Disorders (EDs), Posttraumatic Stress Disorder (PTSD), or Somatic Symptom Disorder (SSD).

The purpose of this review is to report on prevalence of co-occurrence, possible etiologic mechanisms, and course and treatment implications of each of these challenging clinical disorders (Autism Spectrum Disorder, Eating Disorders, Posttraumatic Stress Disorder) comorbid with Personality Disorders. These comorbidities often increase the symptom severity, worsen the course and outcome, and increase the risk of self-harm and suicidal behavior. For EDs and PTSD, existing therapies may prove somewhat helpful but novel approaches are needed and under investigation in the context of comorbid PDs and ASD, EDs and PTSD to address common underlying diatheses. Treatments for these comorbid disorders need to incorporate interventions addressing suicide risk, emotion dysregulation, be trauma-informed and attend to patient engagement. Future research should prioritize studying the course and outcome of ASD comorbid with PDs, novel therapies for EDs comorbid with PDs; refining the concept of Complex PTSD and commencing study of SSD comorbid with PDs.

Towards a Better Use of Safety Planning in Emergency Departments: An Exploratory Study of Patients and Clinicians' Perspectives.

Suicidality frequently leads to emergency department (ED) visits, yet few interventions are offered in EDs to mitigate suicide risk. This study uses a descriptive interpretative design to evaluate the key components for a successful use of such an intervention, the Stanley-Brown safety plan, in EDs. Semi-structured interviews were conducted with patients and ED clinicians and were analyzed using a thematic analysis approach. Participants' perspectives revealed 6 key recommendations for a successful use of the safety plan in EDs: (1) personalize the content of the safety plan, (2) offer a variety of formats, (3) avoid periods of high emotional intensity, (4) engage a broad range of professionals in safety planning, (5) use limited time to make meaningful interventions, (6) propose alternative interventions. A change in the ED culture is needed to ensure that the management of suicidal patients in EDs includes brief therapeutic interventions like safety planning, to mitigate suicide risk.

Diabetes and suicide: a nationwide longitudinal cohort study among the Japanese working-age population

BackgroundAlthough the mental health burden of diabetes has received substantial attention, there is limited evidence on whether the risk of suicide—a severe consequence of mental health problems—increases among individuals with...

Moderators of treatment outcomes for LGBTQ+ military veterans in the PRIDE in All Who Served health promotion group.

Veterans who identify as lesbian, gay, bisexual, transgender, queer, questioning, and related identities (LGBTQ+) have faced discrimination that puts them at increased risk for depression, anxiety, and suicide. Upstream interventions like the PRIDE in All Who Served program can improve internalized prejudice, suicidality, symptoms of depression, and symptoms of anxiety by addressing minority stress, facilitating social connection, and promoting engagement with the healthcare system. Yet, little is known about who benefits most from these types of services. Sixty-six US military veterans (Mean age = 47.06, SD = 13.74) provided outcome surveys before and after a 10-week health promotion group for LGBTQ+ individuals at one of 10 Veterans Health Administration (VA) Medical Centers. Subscales of a coping self-efficacy measure (e.g., problem-solving, social support, thought-stopping), and demographic factors were examined as moderators of treatment outcomes. Coping self-efficacy moderated effects across treatment outcomes with those lower in coping self-efficacy beliefs reporting the greatest benefit of the intervention. Reduction in anxiety symptoms was moderated only by problem-solving coping self-efficacy, while suicidality was moderated only by social support. Reduction of internalized prejudice and depression symptoms were moderated by both problem-solving and social support coping self-efficacy, while thought-stopping (a frequent target of traditional cognitive therapies) only moderated internalized prejudice, but not clinical symptom indicators. Most demographic factors (e.g., age, race, gender) did not impact treatment outcomes; however, sexual orientation was significant such that those who identified as bisexual, queer, or something else (e.g., pansexual) had greater reductions in internalized prejudice than their single gender-attracted peers. Individual differences like coping self-efficacy and sexual orientation are rarely considered in clinical care settings when shaping policy or implementing tailored programs. Understanding implications for who is most likely to improve could inform program refinement and implementation of affirming interventions for minoritized people.