Measures of Suicidal Thoughts and Behaviors in Children and Adolescents: A Systematic Review and Recommendations for Use in Clinical and Research Settings.

Empirically supported measures of suicidal thoughts and behaviors (STBs) are needed to serve as reference outcomes for suicide risk screening tools and to monitor severity and treatment progress in children and adolescents with STBs. The present paper systematically reviewed existing measures of STBs in youth and studies evaluating their psychometric properties and clinical utility. Measures were then evaluated on reliability, validity, and clinical utility. Sixteen articles (20 independent samples) were found with psychometric data with youth samples for eight measures. Interview-based measures were found to have the strongest psychometric support and clinical utility. Significant limitations exist for all self-report measures due to inherent characteristics of these measures that cannot be remedied through additional psychometric study. There is an urgent need for the development and validation of new self-report measures of STBs, particularly for preadolescent children, sexual and gender minority youth, and racial/ethnic minority youth.

How he saw: Jerome Kagan's contexts of discovery.

Jerome Kagan was a psychologist and pioneer of developmental psychology, but he was intrigued by the natural sciences and read widely across history, biography, poetry, philosophy, cross-cultural anthropology, and the humanities. Drawing on unpublished archival and other primary source material, this essay describes two of Kagan's seminal studies in child development to demonstrate how their "contexts" facilitated scientific discovery and Kagan's own development as a researcher. A subset of Kagan's archival papers-including grant materials, correspondence, personal notes, and clipped articles-are also discussed to showcase the personal and scholastic material that Kagan read, wrote, and annotated, and which further advanced his scientific thinking. Collectively, these materials reveal the multiple contexts, both applied and private, in which Kagan "saw," thereby guiding his interdisciplinary approach to the scientific study of child development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An examination of episodic future thinking in the emergency department among youth experiencing suicidal thoughts and behaviors.

Youth experiencing suicidal thoughts and/or behaviors (STBs) frequently present to emergency departments for acute psychiatric care. These settings offer a transitory yet pivotal opportunity to assess, intervene on, and plan continued care for STBs. This study examined a clinically relevant, understudied aspect of psychological functioning among youth experiencing STBs in the emergency department: episodic future thinking, or the ability to imagine discrete autobiographical future events. A sample of 167 youths (10-17 years) presenting to a pediatric psychiatric emergency department for STBs completed a performance-based measure of episodic future thinking assessing richness in detail and subjective characteristics of imagined future events. STB recurrence was assessed 6 months later. Immediately following a suicide-related crisis, youth demonstrated mixed abilities to imagine their future: they generated some concrete future event details but did not subjectively perceive these events as being very detailed or likely to occur. Older adolescents (i.e., 15-17) generated more episodic details than pre-/younger adolescents (i.e., 10-14), particularly those pertaining to actions or sensory perceptions. There was no evidence linking less detailed episodic future thinking and greater likelihood of STBs following the emergency department visit; instead, hopelessness was a more robust risk factor. Findings underscore the importance and clinical utility of better understanding the psychological state of youth during or immediately following a suicide-related crisis. In particular, assessing youths' future thinking abilities in the emergency department may directly inform approaches to acute care delivery.

Why Suicide? Suicide Propinquity and Adolescent Risk for Suicidal Thoughts and Behaviors.

Suicide represents an international public health concern, and for adolescents aged 14 to 18 in the United States, is the third leading cause of death (Centers for Disease Control and Prevention. 2021 Youth Risk Behavior Survey Data. Available at: www.cdc.gov/yrbs . Accessed on August 30, 2023.). In response to this alarming rate, as well as the relative lack of meaningful progress in the prediction and prevention of suicidal thoughts and behaviors (STB) over the past decades (see Franklin et al., 2017), recent reviews of the suicide literature have advocated for the adoption of novel frameworks and theoretical reexamination of the processes that confer risk for suicide. Currently, the majority of suicide theories emphasize distal factors associated with suicide risk, but these factors also generalize to other types of psychopathology and do not answer the fundamental question of "why suicide?" vs. other maladaptive outcomes. In an effort to address this gap and build off existing theoretical and empirical science from various disciplines, the current theoretical paper will explore the concept of suicide propinquity, the degree of closeness and identification with STB, as a potential moderator of the link between psychological distress and suicide. Specifically, this paper: (1) provides context within the existing theories of suicide, highlighting gaps that might otherwise be explained by propinquity; (2) discusses historical and scientific evidence of suicide phenomena that support the existence of propinquity; (3) explores potential processes of how propinquity may confer risk for STB in adolescence; and (4) suggests future directions for research to examine adolescent suicide from a propinquity perspective.

Social problem-solving and suicidal behavior in adolescent girls: A prospective examination of proximal and distal social stress-related risk factors.

Adverse social experiences are often linked to suicidal behavior in adolescence, perhaps particularly for girls. Social problem-solving abilities may indicate more or less adaptive responses to adverse social experiences that contribute to adolescent girls' risk for suicidal behavior. While social problem-solving is implicated in cognitive and behavioral theories of suicidal behavior, prior work is largely cross-sectional and examines bivariate associations between social problem-solving, assessed in neutral conditions, and suicidal behavior. Using a novel performance-based task, this study assessed social problem-solving in adolescent girls (N = 185, Mage = 14.66, SD = 1.41) before and after an experimentally simulated social stressor and examined associations between social problem-solving and past-year suicidal behavior. Prospective analyses tested whether greater changes in specific social problem-solving domains following the social stressor predicted greater likelihood of suicidal behavior over a 9-month follow-up in contexts of elevated, real-life interpersonal stress. Results revealed that adolescent girls who showed greater changes (i.e., reflecting declines) in problem-solving effectiveness following acute social stress were more likely to exhibit suicidal behavior over the following 9 months, but only if they also experienced elevated interpersonal stress in real life. State-dependent changes in social problem-solving may indicate a cognitive vulnerability following social stress that, in combination with cumulative interpersonal stress in real life, distinguishes adolescent girls at heightened risk for future suicidal behavior. Findings demonstrate the importance of examining suicide risk factors under conditions that may more closely mirror the interpersonal contexts in which adolescents' risk for suicidal behavior may be elevated. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An RDoC-based approach to adolescent self-injurious thoughts and behaviors: The interactive role of social affiliation and cardiac arousal.

Recent theoretical models have posited that increases in self-injurious thoughts and behaviors (SITBs) during adolescence may be linked to failures in biological stress regulation in contexts of social stress. However, there is a lack of data examining this hypothesis during the transition to adolescence, a sensitive period of development characterized by changes across socioaffective and psychophysiological domains. Building on principles from developmental psychopathology and the RDoC framework, the present study used a longitudinal design in a sample of 147 adolescents to test whether interactions among experiences of social (i.e., parent and peer) conflict and cardiac arousal (i.e., resting heart rate) predicted adolescents' engagement in SITBs (i.e., nonsuicidal self-injury, NSSI; and suicidal ideation; SI) across 1-year follow-up. Prospective analyses revealed that adolescents experiencing a combination of greater peer, but not family, conflict and higher cardiac arousal at baseline showed significant longitudinal increases in NSSI. In contrast, social conflict did not interact with cardiac arousal to predict future SI. Findings indicate that greater peer-related interpersonal stress in adolescents may increase risk for future NSSI among youth with physiological vulnerabilities (i.e., higher resting heart rate) that may be markers of maladaptive stress responses. Future research should examine these processes at finer timescales to elucidate whether these factors are proximal predictors of within-day SITBs.

Using Behavioral Measures to Assess Suicide Risk in the Psychiatric Emergency Department for Youth.

Suicide screening is critical in pediatric emergency departments (EDs). Behavioral measures of suicide risk may complement self-report measures. The current study examines suicide-specific behavioral measures and tests their potential short-term within-person effects among respondents, ability to discriminate future suicide attempt from suicidal ideation, and translation into interpretable categorical composite scores. The sample included 167 youth (10-17 years), presenting for suicide-related reasons to a pediatric psychiatric ED. During their ED visit, participants completed the Death/Life Implicit Association Test (IAT) and the Suicide Stroop Task. Recurrent suicidal thoughts and attempts were assessed within 6 months of the ED visit via medical records and email surveys. Youth displayed a decrease in the levels of distress and self-injurious desires (negative mood, desire to hurt themselves, and desire to die) after completing the behavioral tasks. The Death/Life IAT prospectively differentiated with 68% accuracy between youth who attempted suicide after their ED visit and those who had suicidal ideation but no attempt, p = 0.04, OR = 5.65, although this effect became marginally significant after controlling for self-report and demographic covariates. Neither the Suicide Stroop Task, nor the categorical composite scores predicted suicide attempts, ps = 0.08-0.87, ORs = 0.96-3.95. Behavioral measures of suicide risk administered in the ED do not appear to increase distress or self-injurious desires. They may be able to distinguish those who go on to attempt suicide (vs. consider suicide) within six months after discharge.

Neural Reactivity to Social Punishment Predicts Future Engagement in Nonsuicidal Self-injury Among Peer-Rejected Adolescents.

BACKGROUND: Rates of nonsuicidal self-injury (NSSI) increase dramatically in adolescence. Affective reactivity and adverse social experiences have been linked to NSSI, but less is known about whether these factors may separately or interactively predict NSSI, especially longitudinally. This study combined functional magnetic resonance imaging and a sociometric measure to test whether a combination of neural (e.g., amygdala) reactivity to social punishment and peer-nominated peer acceptance/rejection predicts NSSI longitudinally in adolescence. Amygdala reactivity was examined as a potential neural marker of affective reactivity to social punishment, which may heighten NSSI risk in contexts of social adversity. METHODS: One hundred twenty-five adolescents (63 female) completed a social incentive delay task during neuroimaging and school-based peer nominations to measure peer acceptance/rejection. NSSI engagement was assessed at baseline and 1-year follow-up. RESULTS: Greater amygdala reactivity to social punishment predicted greater NSSI engagement 1 year later among adolescents with high peer rejection. This effect for the amygdala was specific to social punishment (vs. reward) and held when controlling for biological sex and pubertal development. Exploratory analyses found that ventral striatum reactivity to social reward and punishment similarly interacted with peer rejection to predict NSSI but that amygdala connectivity with salience network regions did not. CONCLUSIONS: Amygdala reactivity to social punishment, in combination with high peer rejection, may increase NSSI risk in adolescence, possibly via heightened affective reactivity to adverse social experiences. Objective measures of neurobiological and social risk factors may improve prediction of NSSI, while therapeutic approaches that target affective reactivity and increase prosocial skills may protect against NSSI in adolescence.

Single- vs. Multi-Item Assessment of Suicidal Ideation Among Adolescents.

Several barriers exist to routine assessment of suicidal ideation (SI) in adolescents across settings, including insufficient time, tools, and training. Such barriers often result in the use of brief or even single-item assessments of SI, which may result in misclassification. The present study sought to compare single- and multi-item assessment of SI in adolescents, and to examine factors associated with different response profiles. Adolescents (n =206) were recruited from the community and completed a lab visit including a single and multi-item assessment for SI. Results suggest that two thirds of adolescents with passive SI go undetected when relying solely on a single-item screener, yet they present a similar clinical profile to those with passive SI who endorse the screener question. The present study provides support for the notion that multi-item assessment paints a more accurate, nuanced picture of SI among adolescents and may be an important component of routine screening.

Self-Injurious Thoughts and Behaviors Interview-Revised (SITBI-R): Reliability, Validity, and Inter-Informant Agreement in an Adolescent Sample.

OBJECTIVE: The present study sought to evaluate the psychometric properties and inter-informant agreement of the Self-Injurious Thoughts and Behaviors Interview-Revised (SITBI-R) in adolescents and their parents. METHOD: Suicidal and nonsuicidal adolescents from the community (N = 206), ages 12-19 years, were administered the SITBI-R during a lab visit. Approximately half of the adolescents' parents opted to complete a parent assessment, including the SITBI-R, on behalf of their child. Inter-rater reliability, convergent validity, and inter-informant agreement were assessed. RESULTS: The SITBI-R exhibited overall excellent inter-rater reliability and good convergent validity in adolescents. Parent-adolescent agreement ranged from fair to poor across most outcomes, with parents tending not to report past self-injurious thoughts and behaviors endorsed by their children. CONCLUSIONS: The present study suggests that the SITBI-R can be extended for use with adolescents. Future research should evaluate moderators and implications of parent-adolescent disagreement, particularly with regard to suicide risk.

Advances in Research on Adolescent Suicide and a High Priority Agenda for Future Research.

Suicide is the second leading cause of death for adolescents in the United States, yet remarkably little is known regarding risk factors for suicidal thoughts and behaviors (STBs), relatively few federal grants and scientific publications focus on STBs, and few evidence-based approaches to prevent or treat STBs are available. This "decade in review" article discusses five domains of recent empirical findings that span biological, environmental, and contextual systems and can guide future research in this high priority area: (1) the role of the central nervous system; (2) physiological risk factors, including the peripheral nervous system; (3) proximal acute stress responses; (4) novel behavioral and psychological risk factors; and (5) broader societal factors impacting diverse populations and several additional nascent areas worthy of further investigation.

Corrigendum: Defeat, Entrapment, and Positive Future Thinking: Examining Key Theoretical Predictors of Suicidal Ideation Among Adolescents.

[This corrects the article DOI: 10.3389/fpsyg.2021.590388.].

Conceptualizing death: How do suicidal adolescents view the end of their lives?

OBJECTIVE: Adolescence marks an important time to detect suicide risk, as suicidal ideation often emerges during this developmental period. Death-themed cognitions represent a promising domain of risk factors for suicidal ideation, but they have been understudied among adolescents. To address this knowledge gap, the present study examines the association between adolescents' attitudes and beliefs about death, hereafter referred to as death conceptualizations, and suicidal ideation. METHODS: Seventy-four adolescents (12-19 years) completed a self-report measure assessing three types of death conceptualizations: Death Avoidance (i.e., suppression of death-related thoughts), Neutral Acceptance (i.e., belief that death is a natural part of life), and Escape Acceptance (i.e., belief that death is a viable escape from pain). Suicidal ideation was assessed at baseline, as well as 3 and 6 months later. RESULTS: At baseline, suicidal adolescents endorsed higher Escape Acceptance and lower Death Avoidance. Suicidal and nonsuicidal adolescents did not differ in their degree of Neutral Acceptance. Death conceptualizations, especially Escape Acceptance, also predicted future suicidal ideation. CONCLUSIONS: Initial findings suggest that suicidal adolescents are more likely to believe that death is a viable escape from pain and that this death-related cognition is a risk factor for suicidal ideation.

Defeat, Entrapment, and Positive Future Thinking: Examining Key Theoretical Predictors of Suicidal Ideation Among Adolescents.

Adult-based suicide theories have determined much of what we know about suicidal ideation. Here, we investigate the extent to which elements of the Integrated Motivational-Volitional (IMV) model generalize to adolescence, a period when rates of suicidal ideation increase dramatically. In a sample of community-based adolescents (n = 74), we tested whether defeat and entrapment related to suicidal ideation, and whether poor positive future thinking abilities exacerbated this association. Consistent with the IMV model, we found that defeat/entrapment was associated specifically with history of suicidal ideation, and not with history of suicide attempt. Defeat/entrapment was related to baseline suicidal ideation severity above and beyond depressive symptoms. While defeat/entrapment predicted future suicidal ideation controlling for history of ideation, it did not do so controlling for depressive symptoms. Counter to the IMV model, we initially found that the association between defeat/entrapment and suicidal ideation was strongest among adolescents with greater positive future thinking abilities. This was driven by the tendency to imagine more positive future events, particularly those that are less realistic and achievable. These findings call for a more nuanced understanding of defeat/entrapment and positive future thinking among adolescents, particularly in how they interact to predict recurrent suicidal ideation.

Does function predict persistence? Nonsuicidal self-injury among adolescents during and after hospitalization.

Nonsuicidal self-injury (NSSI) is a prevalent, concerning behavior among adolescents. Importantly, NSSI can serve a variety of functions. Some adolescents engage in NSSI to fulfill automatic or self-oriented functions (e.g., cutting to avoid internal negative states), whereas others engage in NSSI to serve social functions (e.g., cutting to communicate with others). This study tests whether self-reported reasons for engaging in NSSI, hereafter referred to as NSSI functions, predict NSSI thoughts and behaviors during and after hospitalization among adolescent psychiatric inpatients. Endorsement of both automatic and social NSSI functions, as well as positive and negative reinforcement subtypes, was assessed at hospital admission. Results showed that endorsement of overall automatic function predicted which adolescents engaged in NSSI behavior during hospitalization. Moreover, automatic and social functions showed distinct predictive patterns, such that automatic functions corresponded to greater likelihood of NSSI-related thoughts and behaviors whereas social functions mainly corresponded to reduced likelihood of NSSI-related outcomes. Of note, NSSI functions were less predictive of NSSI-related outcomes after hospital discharge. These findings suggest that identifying adolescent inpatients' reasons for NSSI engagement may meaningfully distinguish those at higher risk (and those at lower risk) of NSSI persistence during their hospital stay.