Youth Suicide Prevention Research Articles

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.

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.

Gatekeeper training for youth suicide prevention: A mixed method comparative analysis of two online programs

AbstractThe overriding aim of this study was to conduct a side‐by‐side comparative evaluation of two online suicide prevention gatekeeper‐training programs: Question, Persuade, Refer (QPR) and Making Educators Partners in Youth Suicide Prevention (MEP). Specific aims included identifying program components, instructional methods, and technology elements that are well received by school personnel and that increase knowledge and self‐efficacy. QPR and MEP were directly assessed following levels one and two of Kirkpatrick's Model (i.e., reactions to training, program efficacy), and indirectly assessed at levels three and four (i.e., future gatekeeper behaviors, potential school community impact). QPR and MEP produced positive outcomes with respect to reactions, knowledge, and self‐efficacy (i.e., Kirkpatrick levels one and two). MEP and QPR also produced partial support with respect to behavior and impact (i.e., Kirkpatrick levels three and four), given the limited objective data demonstrating consistent application of gatekeeper skills that reduce community suicidal behaviors. Taken together, future research should evaluate inclusion of innovative pedagogical approaches and strategic online classroom design, which may enhance learning motivation, attitudes, and self‐efficacy. Research should also objectively evaluate intermediate and longer‐term behavioral outcomes to identify population‐level impact.

Project Yarn Circle: development and pilot evaluation of a cultural connection suicide prevention program for Aboriginal and Torres Strait Islander young people

ABSTRACT Background Aboriginal and Torres Strait Islander young people experience markedly higher suicide mortality than non-Indigenous youth in Australia, yet there is little evidence of effective preventative strategies. Many are misaligned to the needs of First Nations young people due to a lack of consideration of protective factors such as community and cultural connection. Objective To date no research has examined whether increasing cultural connectedness may reduce Aboriginal and Torres Strait Islander youth suicidality. The current study outlines the development, implementation, and pilot evaluation of Project Yarn Circle, a school-based suicide prevention initiative utilising cultural education and connection. Method Project Yarn Circle was piloted by an Indigenous owned and managed youth mental health organisation, delivering 5 weekly sessions to 276 young people at 9 schools in Southeast Queensland, Australia, between 2019 and 2023. Sessions connected students to cultural knowledge and practices (stories, painting, dance, Indigenous languages) with Elders and local cultural knowledge facilitators. Results Pre- and post-program evaluation questionnaires completed 6–8 weeks apart found that participants had significantly lower suicidal ideation (GHQ-18-SS), pre 7.16, post 6.61, p = .043 higher positive ideation/reasons for living (PANSI-PI) pre 22.44, post 23.60, p = .009, and higher self-esteem (RSES) pre 16.55, post 23.60, p = .005. Analyses of cultural connectedness items co-designed for this evaluation study and validated using Exploratory Factor Analysis found that students demonstrated greater cultural identity clarity, peer cultural competence, strength from culture, salience of cultural continuity and sense of belonging. Conclusions These findings provide new evidence towards utilising cultural connectedness as an intervention mechanism in Indigenous youth suicide prevention.

Retrospective evaluation of implementation of caring contacts for youth suicide prevention in an emergency department.

Caring Contacts are brief caring messages sent to patients with suicidal thoughts or behaviors after an emergency department (ED) visit or hospitalization, which may decrease subsequent suicide attempts. We aimed to retrospectively evaluate the implementation of Caring Contacts in a children's hospital ED. We conducted a retrospective observational study to evaluate the implementation of Caring Contacts within routine clinical care at an academic children's hospital ED from May 2020 to April 2023. Patients 5‒18 years old presenting for suicidal thoughts or behaviors were eligible to receive six handwritten cards with individualized caring messages, mailed over 12 months. We assessed enrollment rates (the percentage of patients offered Caring Contacts who agreed to receive them), fidelity to the intended schedule and card writer, return visits for suicidal ideation or behaviors while receiving Caring Contacts, and program costs. Of 627 encounters eligible for and offered Caring Contacts, 614 (98%) resulted in enrollment. Among instances of enrollment, 587 (96%) had cards sent per the intended schedule and 541 (88%) had cards written by the intended writer. A return ED visit for suicidal ideation or behaviors occurred for 168 (27%) during program participation. Costs per participant were $4.54 in materials and 0.9h of personnel time. In a children's hospital ED, Caring Contacts were feasible to implement with low costs and high fidelity to the intended schedule and card writer. Prospective studies are needed to assess Caring Contacts' effectiveness in reducing suicide risk among adolescents following an ED visit.

Sleep Disturbance and Subsequent Suicidal Behaviors in Preadolescence

Suicide is a leading cause of death among adolescents, who demonstrate high rates of sleep disturbance. Poor sleep appears to confer risk for suicide, but longitudinal investigation of suicidal behaviors remains rare, particularly in the transition from childhood to early adolescence. To evaluate sleep disturbances in preadolescent children (aged 9 and 10 years) in association with longitudinal risk for suicidal ideation and suicide attempts at the 2-year follow-up. This cohort study used data from the Adolescent Brain Cognitive Development Study between June 2016 and January 2021. This dataset included children aged 9 or 10 years at baseline and their parents or caregivers who were recruited at 21 sites across the US. Data were analyzed July 2023 to June 2024. The Sleep Disturbance Scale for Children, a 26-item parent-reported inventory, was administered at baseline, generating a total score and 6 subscales. Central covariates included the Child Behavior Checklist Anxiety and Depression subscale and demographic variables. The computerized Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-COMP) assessed parent- and youth-reported suicidal behaviors and outcomes (none; passive, active nonspecific, and active specific suicidal ideation; and suicide attempt) at the 2-year follow-up. Sleep disturbance was further grouped by symptom severity (minimal, moderate, elevated, high, and severe). Of the 10 136 youths who reported no baseline suicidal ideation or behavior, 8807 youths (mean [SD] age, 9.9 [0.6] years; 4507 males [51.2%]; 197 Asian individuals [2.2%], 1273 Black individuals [14.5%], and 5775 White individuals [65.6%]) completed the K-SADS-COMP assessment at the 2-year follow-up and were included in the analysis. At the follow-up, 8044 participants (91.3%) had no suicidal behavior, 317 (3.6%) had passive suicidal ideation, 258 (2.9%) had active nonspecific suicidal ideation, 130 (1.5%) had active specific suicidal ideation, and 58 (0.7%) had a first-time suicide attempt. Baseline sleep disturbance was associated with increased incidence risk for suicidal behavior at age 12 years (odds ratio, 2.68; 95% CI, 1.44-4.98; P = .002), adjusting for covariates. Individual subscales or items demonstrating associations with risk included disorders of excessive somnolence and frequency of nightmares. Results of this longitudinal cohort study revealed that disturbed sleep at age 10 years was associated with risk for suicidal thoughts and behaviors in the next 2 years. The findings highlight the potential importance of sleep as a visible risk factor and intervention target in the prevention of youth suicide.

Experiences of Young People in Ireland with the Mental Health of Youth Story (MYSTORY) Photovoice Study

ABSTRACT The Mental Health of Youth Story (MYSTORY) study is a community-university partnership study which involved photovoice and consultation with young people. The MYSTORY study aimed to: (1) better understand adolescents’ perspectives on youth and school mental health and suicide prevention, and (2) communicate insights to schools and the wider community. In this article, we explored adolescents’ experiences of engaging with the MYSTORY study. Reflexive thematic analysis supports the MYSTORY study as a youth-centered study, which involved reflection, discussion and sharing of mental health perspectives and experiences within the study and community contexts. Study engagement was associated with feelings of pride, accomplishment, and connection. This study makes a novel contribution to understanding adolescents’ engagement in photovoice research exploring youth and school mental health, from the perspective of adolescents. Findings are relevant to researchers in wider mental health fields and practitioners interested in mental health promotion and suicide prevention in applied settings.

Preventing Youth Suicide.

Preventing Youth Suicide.

School-Based Suicide Prevention Efforts: The Impact of School Nurse Exclusivity on Moral Distress.

School nurses are well-positioned to assess, identify, and refer children and adolescents who are at risk of suicide. This multiple-case study examined the personal, behavioral, and environmental factors that influence the role of the school nurse in youth suicide prevention and intervention. Purposive sampling was used to recruit two school nurses who were identified as unique cases. Data from interviews, surveys, and documents generated a cross-case analysis. Findings indicate that school-level exclusive practices, such as a lack of communication and collaboration, greatly influence the role and reach of school nurses. Further, dilemmas arising from environmental barriers hinder school nurse capacity to promote student safety and affect moral distress levels. Leveraging data to demonstrate the pivotal role of school nurses to support mental health equity and reduce disparities in youth suicide is crucial to developing inclusive and responsive suicide prevention programs.

Incorporating the Emergency Department in the Blueprint for Youth Suicide Prevention

Incorporating the Emergency Department in the Blueprint for Youth Suicide Prevention

Youth Suicide and Preceding Mental Health Diagnosis

Suicide is a leading cause of death among US youths, and mental health disorders are a known factor associated with increased suicide risk. Knowledge about potential sociodemographic differences in documented mental health diagnoses may guide prevention efforts. To examine the association of documented mental health diagnosis with (1) sociodemographic and clinical characteristics, (2) precipitating circumstances, and (3) mechanism among youth suicide decedents. This retrospective, cross-sectional study of youth suicide decedents aged 10 to 24 years used data from the Centers for Disease Control and Prevention National Violent Death Reporting System from 2010 to 2021. Data analysis was conducted from January to November 2023. Sociodemographic characteristics, clinical characteristics, precipitating circumstances, and suicide mechanism. The primary outcome was previously documented presence of a mental health diagnosis. Associations were evaluated by multivariable logistic regression. Among 40 618 youth suicide decedents (23 602 aged 20 to 24 years [58.1%]; 32 167 male [79.2%]; 1190 American Indian or Alaska Native [2.9%]; 1680 Asian, Native Hawaiian, or Other Pacific Islander [4.2%]; 5118 Black [12.7%]; 5334 Hispanic [13.2%]; 35 034 non-Hispanic; 30 756 White [76.1%]), 16 426 (40.4%) had a documented mental health diagnosis and 19 027 (46.8%) died by firearms. The adjusted odds of having a mental health diagnosis were lower among youths who were American Indian or Alaska Native (adjusted odds ratio [aOR], 0.45; 95% CI, 0.39-0.51); Asian, Native Hawaiian, or Other Pacific Islander (aOR, 0.58; 95% CI, 0.52-0.64); and Black (aOR, 0.62; 95% CI, 0.58-0.66) compared with White youths; lower among Hispanic youths (aOR, 0.76; 95% CI, 0.72-0.82) compared with non-Hispanic youths; lower among youths aged 10 to 14 years (aOR, 0.70; 95% CI, 0.65-0.76) compared with youths aged 20 to 24 years; and higher for females (aOR, 1.64; 95% CI, 1.56-1.73) than males. A mental health diagnosis was documented for 6308 of 19 027 youths who died by firearms (33.2%); 1691 of 2743 youths who died by poisonings (61.6%); 7017 of 15 331 youths who died by hanging, strangulation, or suffocation (45.8%); and 1407 of 3181 youths who died by other mechanisms (44.2%). Compared with firearm suicides, the adjusted odds of having a documented mental health diagnosis were higher for suicides by poisoning (aOR, 1.70; 95% CI, 1.62-1.78); hanging, strangulation, and suffocation (aOR, 2.78; 95% CI, 2.55-3.03); and other mechanisms (aOR, 1.59; 95% CI, 1.47-1.72). In this cross-sectional study, 3 of 5 youth suicide decedents did not have a documented preceding mental health diagnosis; the odds of having a mental health diagnosis were lower among racially and ethnically minoritized youths than White youths and among firearm suicides compared with other mechanisms. These findings underscore the need for equitable identification of mental health needs and universal lethal means counseling as strategies to prevent youth suicide.

A Systematic Review of Resilience, Anxiety, and Suicidal Ideation in Adolescents

Suicide is a big challenge in India. Adolescents frequently experience anxiety and suicidal ideation worldwide. Resilience is the capacity to bounce back from adversity and adjust to challenging circumstances. The purpose of this research is to understand the relationship between anxiety and resilience in suicidal ideation. We studied 54 citations of which 13 were found to be relevant and included in this study. The finding of the study is that there is a significant relationship between the level of anxiety with suicidal ideation. It is also found that resilience is negatively correlated with suicidal ideation. Internal elements (personal traits, positive self-esteem and coping abilities) and external factors (inclusive environments and social support systems) all contribute to youth resilience, with age, gender, and indigenous identity playing crucial intersecting roles. Throughout the result, it can be concluded that a significant positive correlation was found between suicidal ideation and anxiety in adolescents. Adolescent suicide ideation decreases with decreasing anxiety levels. Suicidal ideation and resilience were discovered to be strongly and negatively associated to each other. The main strategy to prevent youth suicide is to foster resilience, however it's unclear how exactly these factors could shield young people from suicidality. From the conclusion, it is suggested that more intervention techniques be introduced that promote resilience among adolescents specifically, should be taken into consideration and incorporated into the school, and college curriculum.

Changes in State Laws on Suicide Prevention Training for School Staff, 2002-2022.

Youth suicide is an urgent public health problem. Gatekeeper training aims to prevent suicide by training people to identify warning signs and make referrals to appropriate services. Many states in the United States have enacted gatekeeper training laws (GTLs) to train school staff in suicide prevention. The objectives of this study were to describe the development of a dataset on GTLs and use the dataset to summarize trends in uptake of GTLs from 2002 through 2022 as well as differences in characteristics (eg, frequency and duration of training) of GTLs. We used publicly available legal databases from all 50 states and the District of Columbia to conduct a policy surveillance assessment of GTLs. We cross-checked data with the American Foundation for Suicide Prevention's 2022 Suicide Prevention in Schools (K-12) issue brief and used Westlaw Edge to conduct a sensitivity analysis. We included the following data in the full dataset: type of laws (encouraged, mandatory, or conditional mandatory), date passed, effective date, frequency of training, and length of training. In 2022, 49 states and the District of Columbia had GTLs, 31 of which were mandatory laws. In 2002, only 6 states had such laws, and none were mandatory. The growing proliferation of laws on suicide prevention training for school staff warrants evaluation of the laws' effectiveness. Our policy surveillance data may be used to better understand the role of these laws in a school-based approach to youth suicide prevention.

Firearm Access and Socio-Structural Factors Related to Suicidality Among Youth With Diverse Sexual, Gender, and Racial Identities

Objective Elevated rates of suicidal ideation (SI) and suicide attempts (SA) among youth, particularly multiply marginalized youth, are occurring in the context of youths’ access to household firearms. Research examining how perceived access to firearms is related to SI and SA among youth with marginalized identities is limited and often neglects to consider intersectionality. This study explored how intersecting social identities and positions, access to firearms, and socio-structural factors were associated with SI and SA for youth. Method The analytic sample (N = 17,794) included 7-12th grade students who participated in the 2021 Dane County Youth Assessment. Exhaustive CHAID – a decision tree matrix approach – examined all possible combinations of self-reported sociodemographic characteristics (gender identity, sexual identity, racial identity, grade, and firearm access) and socio-structural variables (bias-based bullying, school belongingness, and social pressure) to predict mutually exclusive groups of youth based on past-year SI and SA. Results SI and SA was most prevalent among intersectional groups with multiply marginalized identities and access to firearms. Socio-structural factors, including bias-based bullying victimization, lack of school belongingness, and social pressure, were characteristic of groups with higher prevalence of SI and SA. Conclusions While the marginalized youth in this sample have lower access to firearms, the prevalence of SI and SA was highest among multiply marginalized youth who reported access to firearms in the context of bias-based bullying, social pressure, and a lack of school belongingness. Youth suicide prevention efforts would be strengthened by policies that address firearm access and improve the school environment.

Youth Suicide Prevention Programming among the Mississippi Band of Choctaw Indians: Effects of the Lifelines Student Curriculum.

Suicide continues to be a leading cause of mortality for young people. Given persistent intersecting forms of disadvantage, Native American adolescents are especially vulnerable to mental health adversities and other suicide risk factors. The Mississippi Band of Choctaw Indians (MBCI) implemented the Choctaw Youth Resilience Initiative (CYRI), a five-year SAMHSA-funded project that began in 2019. This study uses Choctaw student pre-test/post-test survey data to examine the effectiveness of the Hazelden Lifelines Suicide Prevention Training curriculum for youth. A lagged post-test design was used, whereby post-surveys were administered at least one month after program completion. Several intriguing results were observed. First, the lagged post-test model was subject to some pre-to-post attrition, although such attrition was comparable to a standard pre/post design. Second, analyses of completed surveys using means indicated various beneficial effects associated with the Lifelines curriculum implementation. The greatest benefit of the program was a significant change in student perceptions concerning school readiness in response to a suicidal event. Some opportunities for program improvement were also observed. Our study sheds new light on suicide prevention training programs that can be adapted according to Native American youth culture. Program implementation and evaluation implications are discussed in light of these findings.

Expanding the Question-Persuade-Refer (QPR) Evidence Base: Youth Suicide Prevention among the Mississippi Band of Choctaw Indians.

Youth suicide risks have been on the rise or persistently elevated for decades, and Native American communities are especially vulnerable. This study provides a promising framework for suicide prevention among underserved populations in the U.S., especially Native American communities in states lacking strong suicide prevention supports. Our investigation reports the evaluation results of the Question-Persuade-Refer (QPR) gatekeeper training program, a key component of the SAMHSA-funded Choctaw Youth Resilience Initiative (CYRI) implemented by the Mississippi Band of Choctaw Indians (MBCI). QPR trains adult gatekeepers to identify youth at risk of suicide and refer them to certified mental health service providers. Standardized QPR pre-test and post-test training surveys were administered at in-person trainings delivered to youth-serving MBCI organization leaders and staff. Statistical analyses of all survey items indicate that QPR gatekeeper trainings significantly enhanced the knowledge of prevention practices and risk identification skills for the MBCI trainees. The robust evidence of positive changes revealed in this study suggests that QPR can be an effective suicide prevention program for underserved minority communities, especially Native American populations in rural states where suicide is a persistent and leading cause of mortality.

Text4Hope: An e-Mental Health Tool for Mitigating Psychological Symptoms among Young Adults

IntroductionChronic stress, anxiety, and depression can interfere with young adults’ everyday function, academic achievement, and interpersonal relationships. Interventions aimed at preventing the deterioration or possibly onset of these mental disorders among young people are timely.ObjectivesTo assess the impact of a supportive text messaging program (Text4Hope) on the psychological well-being of young adults.MethodsThis study adopted both longitudinal and naturalistic controlled trial designs. Longitudinal study: compared baseline and 6th week outcomes in the same group of young adult subscribers. Naturalistic controlled study: compared clinical parameters in two groups of Text4Hope young adult subscribers: (i) intervention group (IG), subscribers who received once-daily supportive text messages for 6-weeks and completed 6th-week evaluation between 26 April and 12 July 2020, and (ii) control group (CG), subscribers who joined Text4Hope the same time frame, completed a baseline survey and were yet to receive text messages. The prevalence and severity of moderate-high stress, anxiety, and depression was measured using standardized scales. Inferential statistics, including the t-test, McNemar test, chi-square, and binary logistic regression analyses, were used to evaluate the differences in the prevalence and severity of the psychological symptoms.ResultsLongitudinal study: subscribers who completed both the baseline and 6th-week surveys, had significant reduction in the prevalence of moderate-high stress (8%) and likely GAD (20%) from baseline to six weeks. The largest reduction in mean scores was for the GAD-7 scale (18.4%). Naturalistic study: significantly lower prevalence for likely Moderate Depressive Disorder (25.2%) and suicidal thoughts/thoughts of self-harm (48.4%), with a small effect size in the IG compared to CG.Image:ConclusionsTheText4Hope program has been demonstrated as an effective e-mental health tool for mental health support for young adult subscribers. This is particularly encouraging, as young adults have already adapted to SMS text messaging and texting. Therefore, this mode of intervention can be used to supplement existing treatments for psychological problems impacting young adults. In addition, the cost effectiveness and easy scalability of supportive text message interventions mean that policymakers and governments can quickly implement similar programs as part of national youth suicide prevention strategies.Disclosure of InterestNone Declared

Adapting a youth suicide prevention program for rural communities in the United States: a feasibility study

Rural youth suicide represents a major source of mental health inequity in the United States (US). School-based suicide prevention programs may provide an effective avenue to address this mental health crisis among rural youth. This study’s primary goal is to demonstrate the feasibility and acceptability of a novel implementation approach (utilizing teachers from a neighboring school) for delivering the Youth Aware of Mental Health (YAM) program, an evidence-based, universal youth suicide prevention curriculum, to high school students in rural Montana. We will recruit approximately 1300 9th grade student in four Montana schools. Using a non-inferiority design, we will randomize classrooms in each school to be instructed by a teacher from another school (YAM-TE; experimental) or a traditional external instructor (YAM-EXT; control). We will assess program fidelity of both YAM training and implementation via independent observer and instructor-reporter ratings. Youth will complete measures of acceptability at post-YAM and outcome measures at pre-YAM, post-YAM, and 12 month follow-up. Standard and mixed linear and logistic regression models will be used to test the main hypothesis that the YAM-TE does not differ from YAM-EXT regarding fidelity (teachers) and acceptability (teachers and youth). Exploratory analyses will test moderation of the intervention effect (e.g., sex, poverty) and the mediating effect of mental health literacy, belongingness, and perceived burdensomeness on the intervention effect. Results of this pilot study will inform the development of subsequent, fully powered noninferiority trials. Our long-term goal is to scale YAM-TE for implementation across rural US communities or, if culturally appropriate, more globally.

Identifying Subgroups of Youth Suicide Decedents Based on Clinical Profiles of Psychiatric and Medical Diagnoses: A Latent Class Analysis

PurposeTo identify risk subgroups of youth suicide decedents using demographic and clinical psychiatric and medical diagnostic profiles to inform tailored youth suicide prevention efforts. MethodsThis study linked Ohio Medicaid and death certificate data for Medicaid enrolled youth aged 8–25 years who died by suicide between January 1, 2010, and December 31, 2020 (N = 511). Latent class analysis was used to identify distinct clinical risk subgroups. ResultsThree latent classes were identified. Internalizing problems were common across all classes, but especially prevalent in class 1, the High Internalizing + Multiple Comorbidities group (n = 152, 30%). A prior history of suicidal behavior was confined to class 1 decedents, who were otherwise characterized by substance misuse, and multiple psychiatric and medical comorbidities. Class 2 decedents, the Internalizing + Externalizing group (n = 176, 34%), were more often younger, male, Black, and unlikely to have a history of substance misuse. Decedents in class 3, the Internalizing + Substance Misuse group (n = 183, 36%), were more often older and likely to have a history of substance misuse, but unlikely to exhibit other externalizing problems. DiscussionInternalizing psychopathology is particularly common among youth who die by suicide, with comorbid externalizing psychopathology, substance misuse, and medical problems contributing to youth suicide risk. Because less than a third of youth who die by suicide have a prior history of recognized suicidal thinking or behavior, universal screening for youth suicide risk should be considered, particularly in younger children, and efforts to integrate suicide prevention in traditional health care settings should be prioritized.

A conceptual framework for mobile-based cyberbullying-related youth suicide risk screening and intervention

ABSTRACT The prevalence of cyberbullying and related suicide rate increases among youth demand a proactive and systematic response. This paper proposes a mobile-based Framework for Youth Suicide Screening and intervention (YSSI) to address the issue of youth suicide within the cyber environment. It draws on Vygotsky’s sociocultural theory to understand the developmental stages of youth and employs Durkheim’s concept of anomic suicide to frame suicide due to cyberbullying as a social fact that extends beyond individual problems. Additionally, the framework invokes Friedrich Engels’ concept of social murder to highlight the urgent social responsibility of preventing youth suicide. The YSSI framework is designed for early detection and intervention, with mobile technology as a primary tool. It encompasses four stages: Stage 1 (Warning Signs), Stage 2 (Assessment), Stage 3 (Intervention), and Stage 4 (Follow-up). This framework emphasizes the critical role of community and family engagement in addressing youth suicide in the digital era. This engagement aims to provide support and guidance to youth, thereby strengthening their resilience to adversity associated with cyberbullying. In alignment with the objectives of the Grand Challenge for Social Work Initiative (GCSWI), the YSSI framework is dedicated to mitigating the negative effects of cyberbullying through collaborative social engagement and fostering a critical discourse on youth mental health and cyber well-being.