Adapting suicide safety plans for youth with intellectual and developmental disabilities.

INTRODUCTION: Although risk for suicide appears elevated in individuals with intellectual and developmental disorders (I/DD), few interventions or tools addressing suicide prevention have been adapted for this population. Among evidence-based interventions for preventing suicide, safety planning interventions are an effective and commonly employed intervention for reducing suicide-related risk. METHODS: By drawing on Special Education praxis for supporting the learning needs of individuals with I/DD, we provide recommendations for adapting suicide safety planning interventions for youth with I/DD. RESULTS: Specific visual, content, teaching, and communication components of the safety plan intervention can be adapted to better meet the needs of youth with I/DD. DISCUSSION: Although future research is needed to evaluate these recommendations, these modifications may support clinicians serving youth with I/DD and suicide-related risk.

A Trauma- and Justice, Equity, Diversity, and Inclusion (JEDI)-Informed Approach to Suicide Prevention in School: Black Boys' Lives Matter.

Black boys have been dying by suicide at an increasing rate. Although the reasons for this increase are unknown, suicide in Black boys is likely influenced by multiple, intersecting risk factors, including historical and ongoing trauma. Schools can serve as an important mechanism of support for Black boys; however, without intentional anti-racist frameworks that acknowledge how intersecting identities can exacerbate risk for suicide, schools can overlook opportunities for care and perpetuate a cycle of racism that compromises the mental health of Black youth. By recognizing their own implicit biases, modeling anti-racist practices, listening to and recognizing the strengths and diversity of Black youth, and fostering school-family-community partnerships, school psychologists can help transform the school environment to be a safe and culturally affirming place for Black youth. This paper outlines how school psychologists can apply a trauma- and Justice, Equity, Diversity, and Inclusion (JEDI)-informed approach to suicide prevention in order to more holistically support Black boys, disrupt patterns of aggressive disciplinary procedures, and improve school-based suicide prevention programs. By applying this lens across a multitiered systems of support (MTSS) framework, school psychologists can help to prevent the deaths of Black boys and begin to prioritize the lives of Black boys.

School Supports for Reintegration Following a Suicide-Related Crisis: A Mixed Methods Study Informing Hospital Recommendations for Schools During Discharge.

The immediate period following psychiatric hospitalization is marked by increased risk for suicide behavior and rehospitalization. Because adolescents commonly return to school settings following hospital discharge, school-related stressors and supports are important considerations for psychiatric treatment and discharge planning. The current study aimed to inform recommendations provided by hospitals to schools to improve school reintegration practices by employing a concurrent, mixed-methods design. Specifically, we: (1) surveyed school professionals (n = 133) in schools varying in resource availability and populations in one southeastern state of the United States about supports and services provided to returning students; and (2) conducted in-depth interviews with a subset of these professionals (n = 19) regarding their perceptions of the hospital to school transition for youth recovering from suicide-related crises. Findings from survey responses indicated that, compared to schools located in urban and suburban areas, schools in rural areas were less likely to have school reintegration protocols for returning students. More generally, however, available interventions and modifications were relatively consistent across rural and urban/suburban schools, schools serving high and low poverty communities, and schools with predominantly white and predominantly ethnic and racial minoritized student bodies. Key themes across interviews signify the importance of communication between stakeholders, the type of information used to develop re-entry plans, available school-based services for returning youth, and the need to mitigate stigma associated with mental health crises. Findings inform recommendations that can be provided by hospitals to schools to support adolescent recovery as they return to school following psychiatric hospitalization.

Returning to School Following Hospitalization for Suicide-Related Behaviors: Recognizing Student Voices for Improving Practice.

Adolescent hospitalizations for suicide-related behaviors have increased in recent years, with the highest rates occurring during the academic school year. Schools are a primary environment that adolescents return to following hospitalization, making them an important context for understanding recovery following a suicidal crisis. Although previous research highlights provider perceptions for improving this transition, limited research has focused on adolescent views. This qualitative study presents findings from interviews with 19 adolescents previously hospitalized for a suicide-related crisis. Results highlight the need to strengthen social supports for returning youth. Specifically, findings suggest the importance of emotional supports (e.g., positive school relationships and a safer psychosocial school climate), instrumental supports (e.g., collaborations and communication around re-entry), informational supports (clearer procedures for academics and re-entry processes), and appraisal supports that acknowledge the complexity of adolescent functioning upon return. Findings reinforce the importance of the school psychologist's role in partnering with returning youth and their families and providing consultation to other school professionals about supporting their recovery.

School Risk and Protective Factors of Suicide: A Cultural Model of Suicide Risk and Protective Factors in Schools.

There are known cultural variations in correlates of and symptoms related to suicide-related thoughts and behaviors; however, the majority of research that informs suicide prevention in school systems has focused on research based on Euro-American/White students. By exploring school-related risk and protective factors in ethnic-racial minoritized students, we expand existing multicultural models of suicide prevention for school settings. Specifically, this systematic literature review identified 33 studies conducted with American Indian and Alaskan Native, Hispanic and Latinx, Black and African American, and Asian American and Pacific Islander students. Findings underscore the importance of building relationships with the school community and fostering a sense of safety for students, the need to approach school-based suicide prevention and intervention with cultural considerations, and the importance of connecting students and families with providers in culturally sensitive and informed ways. Taken together, schools need to build school-family-community partnerships that promote culturally sensitive approaches to suicide prevention.

Single nucleotide polymorphism heritability and differential patterns of genetic overlap between inattention and four neurocognitive factors in youth.

Theoretical models of attention-deficit/hyperactivity disorder implicate neurocognitive dysfunction, yet neurocognitive functioning covers a range of abilities that may not all be linked with inattention. This study (a) investigated the single nucleotide polymorphism (SNP) heritability (h2SNP) of inattention and aspects of neurocognitive efficiency (memory, social cognition, executive function, and complex cognition) based on additive genome-wide effects; (b) examined if there were shared genetic effects among inattention and each aspect of neurocognitive efficiency; and (c) conducted an exploratory genome-wide association study to identify genetic regions associated with inattention. The sample included 3,563 participants of the Philadelphia Neurodevelopmental Cohort, a general population sample aged 8-21 years who completed the Penn Neurocognitive Battery. Data on inattention was obtained with the Kiddie Schedule of Affective Disorders (adapted). Genomic relatedness matrix restricted maximum likelihood was implemented in genome-wide complex trait analysis. Analyses revealed significant h2SNP for inattention (20%, SE = 0.08), social cognition (13%, SE = 0.08), memory (17%, SE = 0.08), executive function (25%, SE = 0.08), and complex cognition (24%, SE = 0.08). There was a positive genetic correlation (0.67, SE = 0.37) and a negative residual covariance (-0.23, SE = 0.06) between inattention and social cognition. No SNPs reached genome-wide significance for inattention. Results suggest specificity in genetic overlap among inattention and different aspects of neurocognitive efficiency.

Characterizing children hospitalized for suicide-related thoughts and behaviors.

BACKGROUND: Despite alarming increases in suicide deaths among preadolescent children, knowledge of the precipitants of suicide risk and the characteristics of children who seek treatment for suicidality is limited. This study's purpose is to describe children (ages 6-12) hospitalized for suicide-related concerns and compare demographic and diagnostic differences between children and adolescent (ages 13-18) patients. METHODS: This retrospective study analyzed medical records of 502 children and adolescents ages 6-18 admitted for suicide-related risk to one psychiatric inpatient hospital in southeastern United States between 2015 and 2018. RESULTS: Patients were predominantly White (63.5%), female (64.5%), and non-Hispanic/Latino (85.1%). We conducted descriptive analyses and a series of logistic regressions comparing children and adolescents with data extracted from discharge summaries, (i.e. primary reasons for admission, environmental stressors, and diagnostic categories). Common environmental stressors included school (63.2%) and family (60.7%), and the most common diagnosis included depressive disorders. Compared to adolescents, children were more likely to be Black (OR = 1.99), male (OR = 1.94), and receive neurodevelopmental disorder (aOR = 3.0) or trauma and stress-related disorder (aOR = 2.6) diagnoses, but less likely to be diagnosed with a depressive disorder (aOR = 0.4). Across both age-groups, Black patients were more likely to be diagnosed with neurodevelopmental disorders and less likely to receive internalizing disorder diagnoses. CONCLUSIONS: Characteristics of children hospitalized for suicide-related risk are relatively similar to characteristics of children dying by suicide. Compared to adolescents, hospitalized children are more likely to be Black, male, and have a neurodevelopmental disorder diagnosis. Proactively identifying and providing strengths-based supports for Black boys and families appear critical for suicide prevention in children.

Meta-Analysis of Associations Between Hypothalamic-Pituitary-Adrenal Axis Genes and Risk of Posttraumatic Stress Disorder.

The hypothalamic-pituitary-adrenal (HPA) axis has been of interest in attempts to identify genetic vulnerability for posttraumatic stress disorder (PTSD). Although numerous HPA-axis genes have been implicated in candidate gene studies, the findings are mixed and interpretation is limited by study design and methodological inconsistencies. To address these inconsistencies in the PTSD candidate gene literature, we conducted meta-analyses of HPA-related genes from both a traditional single nucleotide polymorphism (SNP)-level analysis and a gene-level analysis, using novel methods aggregating markers in the same gene. Database searches (PubMed and PsycINFO) identified 24 unique articles examining six HPA-axis genes in PTSD; analyses were conducted on four genes (ADCYAP1R1, CRHR1, FKBP5, NR3C1) that met study eligibility criteria (original research, human subjects, main effect association study of selected genes, PTSD as an outcome, trauma-exposed control group) and had sufficient data and number of studies for use in meta-analysis, within 20 unique articles. Findings from SNP-level analyses indicated that two variants (rs9296158 in FKBP5 and rs258747 in NR3C1) were nominally associated with PTSD, ps = .001 and .001, respectively, following multiple testing correction. At the gene level, significant relations between PTSD and both NR3C1 and FKBP5 were detected and robust to sensitivity analyses. Although study limitations exist (e.g., varied outcomes, inability to test moderators), taken together, these results provide support for FKBP5 and NR3C1 in risk for PTSD. Overall, this work highlights the utility of meta-analyses in resolving discrepancies in the literature and the value of adopting gene-level approaches to investigate the etiology of PTSD.

Interpersonal Autonomic Physiology: A Systematic Review of the Literature.

Interpersonal autonomic physiology is defined as the relationship between people's physiological dynamics, as indexed by continuous measures of the autonomic nervous system. Findings from this field of study indicate that physiological activity between two or more people can become associated or interdependent, often referred to as physiological synchrony. Physiological synchrony has been found in both new and established relationships across a range of contexts, and it correlates with a number of psychosocial constructs. Given these findings, interpersonal physiological interactions are theorized to be ubiquitous social processes that co-occur with observable behavior. However, this scientific literature is fragmented, making it difficult to evaluate consistency across reports. In an effort to facilitate more standardized scholarly approaches, this systematic review provides a description of existing work in the area and highlights theoretical, methodological, and statistical issues to be addressed in future interpersonal autonomic physiology research.

Association of Posttraumatic Stress Disorder With rs2267735 in the ADCYAP1R1 Gene: A Meta-Analysis.

Recent studies point to the potential role of the (pituitary) adenylate cyclase activating polypeptide receptor 1 (ADCYAP1R1) gene, which has been implicated in stress response, in posttraumatic stress disorder (PTSD). Multiple genetic association studies have examined potential PTSD risk related to this gene, with mixed results. We conducted a meta-analysis of rs2267735 in ADCYAP1R1 in PTSD. A literature search was conducted using PubMed and PsycINFO, resulting in nine studies that met criteria for inclusion in analysis. Biostat's Comprehensive Meta-Analysis was used to conduct the main meta-analysis on the combined sex sample, as well as two subanalyses examining effects separately in female and male participants. Results indicated that the C allele of rs2267735 conferred significant risk for PTSD in the combined sex data, OR = 1.210, 95% CI [1.007, 1.454], p = .042, and in the subsample of women and girls, OR = 1.328, 95% CI [1.026, 1.719], p = .031; but not in the subsample of men and boys, OR = 0.964, 95% CI [0.733, 1.269], p = .796. These results provide evidence for an association between ADCYAP1R1 and PTSD and indicate that there may indeed be sex differences. Implications of these findings, including the role of rs2267735 as one modulator of the stress system, are discussed.

Practice experiences for school reintegration: Endorsement for virtual reality with adolescents hospitalized for suicide-related crises.

This study applied qualitative methods and a user design approach to develop and iteratively refine a model for a virtual reality intervention designed to supplement standard inpatient treatment for adolescents hospitalized for suicide-related crises: the practice experiences for school reintegration (PrESR). The PrESR model allows patients to practice therapeutic skills within an immersive school environment to increase skill knowledge and skill use and to improve school reintegration. Adolescents previously hospitalized for suicide-related thoughts and behaviors (n = 13), hospital professionals with experience providing supports to hospitalized adolescents (n = 7), and school professionals with experience supporting adolescents with suicide-related risks (n = 12) completed focus group and/or one-on-one interviews to inform the development of the PrESR model. Transcribed interviews were analyzed using content analysis, and structured feedback was analyzed by calculating frequencies. Participating adolescents were between the ages of 13 and 18, identifying their race as White (61%), Asian (7.7%), American Indian and Black (7.7%), or Black (7.7%; note that 15.4% preferred not to answer) and their ethnicity as Hispanic (23%) or non-Hispanic (77%). Adolescents identified their gender as girl or woman (46%), boy or man (38%), or "some other way" (15%). A majority of adolescent and professional participants endorsed the PrESR as holding the potential to promote skill learning. Feedback addressed improvements to scenarios and skills; safety concerns, constraints to consider, and barriers to implementation; and information to include in the treatment manual. Findings also informed the types of difficulties adolescents face in schools and the potential feasibility of a virtual reality intervention to enhance standard inpatient care of adolescents hospitalized for suicide-related crises. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Collaborating to support school reintegration following suicide-related crises: Voices from the field.

Adolescent psychiatric hospitalization for suicide-related crises continues to rise. Although previous reviews have identified frameworks for supporting youth as they return to school settings, there is a need to identify and address barriers to collaboration across hospitals and schools. This qualitative study explored school and hospital professional perspectives to inform a pathway toward partnership for improving practices for school reintegration. As part of a larger project that has been developing guidelines for adolescent school reintegration following psychiatric hospitalization for suicide-related crises, the present study explored professional perceptions of (a) school interactions during hospital stays and (b) recommendations for adolescents, families, school professionals, and hospital professionals. We conducted in-depth interviews with 19 school professionals and seven hospital professionals and analyzed transcribed interviews using Applied Thematic Analysis. Communication and collaboration emerged as cross-cutting themes across research questions, with additional themes considered across a continuum of care. Findings inform the ways in which professionals can collaborate to support adolescent recovery, spanning universal approaches implemented in advance of a crisis to approaches enacted during and following psychiatric care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Caregiver Experiences of Adolescent School Reentry After Adolescent Hospitalization Due to Suicidal Thoughts and Behaviors: Recommendations to Improve Reentry Practices.

BACKGROUND: Suicide rates among adolescents increased over the past few decades. Following psychiatric hospitalization, many adolescents return to school, a context that can influence recovery. Families can play an integral role in supporting adolescents through the hospitalization and school reentry process; however, little research has focused on family experiences during adolescent school reentry. Grounded in ecological systems theory, the aim of the present study was to explore the experiences of caregivers whose children were hospitalized for suicidal thoughts and behaviors (STBs) and provide recommendations for the school reentry process. METHODS: In-depth interviews were conducted with caregivers (n = 19) whose adolescents returned to school following hospitalization for suicide-related crises. Researchers analyzed the transcribed interviews using applied thematic analysis. RESULTS: Themes emerged regarding academic difficulties during hospitalization; breakdowns in communication between schools, families, and hospitals; logistical challenges during the school reentry planning process; and challenges navigating peer relationships and academics following school reentry. IMPLICATIONS AND CONCLUSIONS: Few reentry recommendations account for the specific challenges faced by families. Recommendations informed by caregiver experiences are needed to ensure that families can effectively support the recoveries of their children. This study presents caregiver-informed recommendations to facilitate an improved reentry process for caregivers and adolescents.

Ecological Momentary Assessment of Cannabis Use and Affect Among Adolescents Following Psychiatric Discharge.

OBJECTIVE: Affect regulation is central to multiple theoretical models that explain cannabis use (CU) behavior. However, much of the research has been conducted with adults, leaving unanswered questions about the nature of associations among adolescents, especially those with affective disorders. Using clinical interviews and ecological momentary assessment (EMA), we assessed rates of adolescent CU and momentary associations with affect following psychiatric discharge among youth hospitalized for suicidal thoughts and behaviors. METHOD: Participants were 13- to 18-year-olds (N = 62; 64.5% female) recruited from an inpatient psychiatric hospital who reported having ever used cannabis. Participants completed clinical interviews during hospitalization. EMA was conducted for 21 days upon discharge. RESULTS: Concurrent use of other drugs was associated with greater odds of CU (odds ratio = 27.63). Momentary CU was associated with higher levels of positive affect and lower levels of anger/irritability, but not with negative affect. The effect of momentary CU on positive affect was greater among youth with a diagnosis of posttraumatic stress disorder (PTSD) or generalized anxiety disorder (GAD). CONCLUSIONS: Findings suggest that adolescents may use cannabis to enhance positive emotion, especially those with PTSD/GAD. Results highlight the importance of tailored interventions that focus on providing alternative and adaptive methods to enhance positive affect.

School-based Mental Health Supports During COVID-19: School Professional Perspectives.

Objective: The present study explored the ways school professionals adapted school-based mental health supports and services for remote delivery during the COVID-19 pandemic. Method: We surveyed 81 school professionals (e.g., counselors, psychologists, social workers) and conducted in-depth interviews with a subsample of professionals (n=14) to explore their perceptions and experiences of supporting youth with mental health concerns and suicide-related risk during the fall and winter of the 2020-2021 school year. Results: Commonly endorsed school-based mental health interventions (e.g., counseling services, checking in), ways of communicating (phone, email), and individuals delivering supports and services to students with suicide-related risk (e.g., counselors, teachers) were identified based on school professional survey responses. Qualitative findings point to facilitators (e.g., specific platforms for connecting with students and families) and barriers (e.g., limited communication) to successful service delivery during COVID-19. Conclusion: Findings highlight the creative ways school support professionals adapted to provide school-based mental health supports. Implications for remote school-based mental health services during and following the pandemic are discussed.

Adolescent perceptions of school before and after psychiatric hospitalization: Predicting suicidal ideation.

During the immediate period following psychiatric hospitalization, adolescents are at increased risk for suicide attempts and rehospitalization. Because most adolescents return to school during this time, school-related experiences are important considerations during the transition from inpatient hospitalization. This study sought to understand how adolescent perceptions of school may change following hospitalization, and how these changes may predict recovery from a suicide-related crisis. Participants included 155 adolescents (Mage = 15.2 years; 68.6% female, 65.4% White; 14.7% Hispanic/Latinx; grades 7-12) hospitalized for a suicide-related crisis assessed 3 weeks and 6 months following discharge. Results from Latent Change Score models indicated a worsening of perceptions of teacher relationships (mean change (Δ) = 1.52), connectedness to learning (Δ = 1.55), parent involvement (Δ = 1.82), and academic satisfaction (Δ = 1.34), as well as higher frequency of perceived bullying victimization (Δ = 0.71) following hospitalization. Poorer perceptions of teacher relationships and higher frequency of perceived bullying victimization during hospitalization (ß = 0.31 and 0.34), as well as worsening changes of teacher relationships and increased frequency of perceived bullying victimization following hospitalization (ß = 0.48 and 0.41) were associated with higher levels of suicidal ideation severity 3 weeks following discharge. Poorer and worsening perceptions of teacher relationships were associated with higher levels of suicidal ideation intensity at 3 weeks (ß = 0.37 and 0.54). Poorer perceptions of connectedness to learning during hospitalization emerged as a significant predictor of higher levels of suicidal ideation intensity 6 months following hospitalization (ß = 0.20). Results reinforce the importance of fostering positive adult relationships and preventing bullying both prior to and immediately following psychiatric hospitalization. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adolescent, parent, and provider perspectives on school-related influences of mental health in adolescents with suicide-related thoughts and behaviors.

Previous research supports a link between school-related factors, such as bullying and school connectedness, and suicidal thoughts and behaviors. To deepen understanding of how school experiences may function as both protective and risk factors for youth struggling with suicidal thoughts and behaviors, this qualitative study explored multiple perspectives. Specifically, in-depth interviews were conducted with adolescents previously hospitalized for a suicidal crisis (n = 19), their parents (n = 19), and the professionals they may interact with in schools and hospitals (i.e., school professionals [n = 19] and hospital providers [n = 7]). Data were analyzed using applied thematic analysis revealing three main themes related to perceptions of how school experiences can positively or negatively impact mental health, including (a) school activities, (b) school social experiences, and (c) school interventions. An emergent theme related to the complexity of suicide-related risk identified the ways in which school experiences may intersect with other environmental, biological, and psychological factors. Findings underscore the need for school-based approaches to address the unique academic, social, and emotional needs of students with suicide-related risk that complement the supports and services provided in their home and community.

Comprehensive attention training system (CATS): A computerized executive-functioning training for school-aged children with autism spectrum disorder.

Objective: Theory suggests that impaired executive functioning (EF) might explain several symptoms of autism spectrum disorder (ASD) in children. However, only a few studies have examined the efficacy of EF training for the children using randomized control trial designs, and only two of them found significant benefits of the training. Method: We designed Comprehensive Attention Training System (CATS), and tested this new EF intervention for children with ASD in a small-sampled randomized controlled trial. Twenty-five children with ASD aged six to twelve were randomly assigned to either the CATS or the control training and were assessed pre- and post-training. Results: Relative to the control group, the CATS group improved on EF as measured by the trail-making test, avoiding perseverative errors, and forming conceptual responses in the Wisconsin Card Sorting Task. There were also indications that CATS contributed to long-term communication skills as measured by the Vineland adaptive behavior scales. Conclusions: We report preliminary evidence that the CATS intervention may improve the EF of school-aged children with ASD compared to a control intervention. We discuss the results in terms of their generalizability to other developmental disorders.

The roles of school in supporting LGBTQ+ youth: A systematic review and ecological framework for understanding risk for suicide-related thoughts and behaviors.

The extant literature on suicide-related thoughts and behaviors (STB) has highlighted increased patterns of risk among specific minoritized populations, including lesbian, gay, bisexual, transgender, questioning, intersex, two spirit, and queer (LGBTQ+) youth. Compared to their heterosexual and cisgender peers, LGBTQ+ youth are at increased risk for having STB. Identity-specific stressors such as homonegativity and anti-queerness are among the unique factors posited to contribute to this risk and inhibit factors that protect against suicide. The school setting has been a focal point for suicide prevention and intervention and may also play a key role in linking students to care; however, schools also hold the potential to provide supports and experiences that may buffer against risk factors for STB in LGBTQ+ students. This systematic literature review presents findings from 44 studies examining school-related correlates of STB in LGBTQ+ students, informing an ecological approach to suicide prevention for school settings. Findings underscore the importance of school context for preventing STB in LGBTQ+ youth. Approaches that prioritize safety and acceptance of LGBTQ+ youth should span multiple layers of a student's ecology, including district and state level policies and school programs and interventions, such as Gender and Sexuality Alliances and universal bullying prevention programs. Beyond their role as a primary access point for behavioral health services, schools offer a unique opportunity to support suicide prevention by combating minority stressors through promoting positive social relationships and a safe community for LGBTQ+ students.

Prescription opioid misuse among university students: A systematic review.

Misuse of prescription opioids has substantially increased in the past decade among the general population, including among university students. Relative to the literature concerning opioid misuse among the general population, little information is available regarding the college student population. Objective: The purpose of the present study was to conduct a systematic review of the literature concerning the prevalence of prescription opioid misuse among the university student population. Results: The lifetime estimate for prescription opioid misuse among general populations of students ranged from 4% to 19.7%, with higher estimates for special student populations. Students most at risk for misuse of prescription opioids are those who report higher rates of psychological distress, depression, and suicidal thoughts and behaviors, and white, male students who use alcohol and illicit drugs. Conclusions: Findings from this study underscore the need for opioid prevention and intervention programs on university campuses.