Disclosures of self-injurious thoughts and behaviors to parents in the context of adolescent therapy: A qualitative investigation.

Self-injurious thoughts and behaviors (SITBs), including suicidal thoughts, suicide attempts, and nonsuicidal self-injury, are highly prevalent among adolescents. Identifying adolescents at risk for SITBs relies on their disclosure, and these disclosures commonly occur in therapy context. Moreover, therapists often breach confidentiality to inform adolescents' parent or guardian when they disclose SITBs. Research has explored rates of and barriers to disclosure among adolescents, yet no studies have examined adolescents' experiences of disclosure in the therapy context. Further, no studies have examined adolescents' experiences when their parents are then informed. In this study, we examined qualitative responses from 1495 adolescents who had experienced a SITB disclosure in the therapy context. Qualitative questions included asking adolescents to describe how the SITB disclosure occurred, how their parents were informed, and their parents' reactions. Using open and axial coding, several themes emerged. Adolescents described therapist breaches of confidentiality as collaborative, noncollaborative, or unclear. Adolescents described their parents' affective responses, communication about SITBs, validating and invalidating responses, treatment-oriented responses, and ways that parents restricted their access to people, places, and activities. Findings have implications for the development of clinical guidelines when adolescents disclose SITBs in therapy and highlight areas for future research in adolescent SITB disclosure.

Multilevel Interventions That Protect and Promote Youth Autonomy Could Reduce Depression at Scale.

Depression is a major public health problem among adolescents and preadolescents in the United States. Clinical scientists have spent considerable resources designing and testing depression interventions. Some programs can prevent and reduce depression to a modest degree,1 while others show null or potentially adverse impacts on youth mental health.2 However, due to low access to treatment for depression (more than 50% of adolescents with depression symptoms never access treatment at all3) and the heterogeneity of depressive symptoms, no interventions have led to meaningful declines in the overall burdens of depression for adolescents.4 In high school students, rates of self-reported persistent feelings of sadness or hopelessness and suicidal thoughts and behaviors increased between 2011 and 2021 in the United States.5 Status quo approaches are unlikely to sustainably improve adolescent depression. We propose that a critical and often overlooked contributor to this shortfall is youth autonomy-a key, developmentally aligned need for adolescents-to reduce rates of depression at the population level. During adolescence, individuals begin to separate from their parents, guardians, and caregivers (hereafter caregivers) and make decisions independently. This process is critical for healthy identity formation, self-efficacy, and mental health, including prevention and reduction of depression.6 Youth autonomy is among myriad multilevel factors (eg, social connectedness, food and housing insecurity, adversity exposure) relevant to depression trajectories. However, in contrast to many social and structural contributors to depression, perceived autonomy of youths is relatively modifiable through individual-level intervention, making it a promising intervention target. The psychosocial importance of youth autonomy stands in sharp contrast to modern policies and structures that undermine youth independence and control-including within many existing depression interventions.

Accounting for diversity in the treatment of suicide and self-injury: A systematic review of the past 50 years of randomized controlled trials.

PURPOSE: Patients receiving treatment for self-injurious thoughts and behaviors (SITBs) have diverse backgrounds, yet it remains unclear exactly who is represented in the current SITB treatment literature. METHODS: We conducted a systematic review of the past 50 years of randomized controlled trials (RCTs) testing SITB treatments to evaluate sampling practices and reporting of sample characteristics, as well as inclusion of global populations across the included 525 papers. We also assessed changes over the past five decades in these three domains. RESULTS: SITB RCTs frequently reported age and sex (98.6%-95.1%), less frequently reported race (83.4%-38.6%), socioeconomic status (48.1%-46.1%) and ethnicity (41.9%-8.1%), and rarely reported LGBTQ+ status (3.7%-1.6%). U.S.-based RCTs featured predominantly White, non-Hispanic, and non-LGBTQ+ samples. Most RCTs were conducted in high-income North American or European countries. Sample reporting practices, sample representativeness, and inclusion of global populations modestly and inconsistently improved over time. CONCLUSIONS: There has not been substantial improvement in reporting practices, sample representativeness, or inclusion of global populations in SITB RCTs over the past 50 years. Acknowledging who is being studied and representing diverse populations in SITB treatment research is key to connecting research advances with those who may need it most.

Adolescents' beliefs about what symptoms constitute depression: Are more expansive definitions helpful or harmful?

Purpose: What symptoms do people think constitute "depression"? In a mental health literacy framework, knowing more of depression's nine core symptoms (per formal psychiatric diagnostic criteria) is thought to help people identify and seek help for depression. However, the common-sense model of self-regulation suggests that more expansive beliefs about what symptoms constitute an illness may be maladaptive, whereby viewing more symptoms as characterizing a disorder predicts greater functional impairment. Methods: We collected data from N = 281 U.S. adolescents experiencing elevated depression symptoms, recruited via social media. Symptom beliefs were assessed descriptively and with a latent profile analysis to test associations with other variables. Results: Adolescents' beliefs about what symptoms constitute depression varied widely, and only 49% endorsed all DSM-5 depression symptoms as characterizing the disorder. Adolescents who identified more symptoms as belonging to depression had more severe depression symptoms (p = .004), reported more hopelessness (p = .021), and were more pessimistic about the permanence of depression (p = .007); they were also more likely to rate medication as potentially helpful (p = .001). Conclusion: These findings simultaneously support and challenge elements of both the common-sense model and the mental health literacy framework. Future research on mental health literacy may examine why adolescents with more psychiatrically-accurate understandings of depression experience worse clinical outcomes. Likewise, future research on the common sense model should explore whether more expansive depression symptom beliefs may be adaptive as well as maladaptive.