Regina Miranda

Background: Adolescent emergency department visits for suicide ideation or attempts are increasing, particularly among youth of color. Many adolescents do not disclose their suicidal thoughts to anyone prior to presentation, and it is unclear why. The present study examined adolescents' reasons for not disclosing their suicide ideation or attempts prior to presenting for clinical care. Methods: Adolescents, ages 12–19 years, who presented to emergency departments in New York City with recent suicide ideation or a suicide attempt were interviewed about the circumstances surrounding their recent ideation or attempt. Those who reported not disclosing their suicide ideation to others ( N = 70; 79% Hispanic/Latine; 77% female) – 23 of whom presented with suicide ideation, 47 with a suicide attempt – were asked about their reasons for not disclosing their ideation in a semi‐structured interview. Results: Through thematic analysis, we found eight reasons that adolescents gave for not disclosing their suicide ideation. Four reasons were related to others' reactions, including perceived unavailability of support, negative impacts of their disclosure on others, anticipating others' negative judgments, and fear of punitive consequences (e.g., institutionalized responses). Four reasons were related to internal factors, including their wish to die, desire for privacy and nondisclosure, anticipating their own emotional distress, and believing their suicide ideation did not warrant disclosure. Conclusions: These findings highlight the importance of addressing both interpersonal and intrapersonal barriers to suicide‐related disclosure among adolescents. Enhancing provider communication strategies and developing culturally responsive screening tools and interventions may help identify at‐risk adolescents who might otherwise remain undetected.

Introduction: Limited research has examined the circumstances surrounding childhood suicidal thoughts and behaviors. The interpersonal psychological theory of suicide proposes that suicidal desire arises from perceived burdensomeness and thwarted belongingness, and that suicide attempts result from an acquired capability for suicide. No published study, of which we are aware, has tested whether this theory applies to children’s suicidal thoughts or behaviors. The present study examined whether components of the interpersonal psychological theory of suicide would be present in the narratives of children who presented for clinical care with suicide ideation or attempts. Methods: Thirty-nine children, ages 7–12 years, recruited from two public hospitals and one outpatient clinic, completed semi-structured interviews assessing the circumstances surrounding their recent suicide ideation or attempts. Interviews were analyzed thematically using a hybrid inductive-deductive approach. Results: Findings indicated that thwarted belongingness stemmed from loneliness, perceived rejection, and a lack of reciprocal care. Themes reflecting perceived burdensomeness included internalized criticism, low self-esteem, and perceived liability. Children described experiences, such as physical punishment, that may contribute to acquired capability for suicide. Discussion: These findings support the relevance of the interpersonal psychological theory of suicide in childhood and underscore the critical role caregivers play in protecting children from suicide-related risk.

Assessing suicide risk among children is complex, in part due to their developmental differences in identifying, recalling, and verbally describing internal states, alongside cultural differences in how distress is experienced. This study aimed to identify expressions of distress around suicide ideation or attempts through body mapping, a qualitative technique that facilitates both visual and verbal expressions. Twenty-three children, ages 8-12 years (26% Black, 22% White, and 30% other races; 57% Hispanic/Latine), were recruited from an inpatient unit and interviewed within 14 days of their admission for a suicide attempt (n = 7) or suicide ideation (n = 16). Children completed the Childhood Suicide Ideation Interview, which included semi-structured questions about their suicide ideation and/or attempt and a body mapping activity, where children illustrated and described their thoughts, feelings, body sensations, and social connections surrounding their suicidal crisis on a printed body silhouette. Analyses conducted with Anthropac yielded 94 expressions of distress. The congruence in overall experiences across children was low (24%), yet specific somatic experiences like "shaking" (70%), "pain" (43%), and "dizziness" (39%) were prevalent. Other frequent experiences included "sad" (48%), "passive suicide ideation" (43%), and "thoughts about family" (39%). Body mapping was a valuable tool for uncovering unique expressions of distress among ethnoracially diverse children. Somatic expressions, often overlooked in risk assessments, were prominent. Ours and similar studies have the potential to inform the design of culturally and developmentally responsive risk assessment tools and safety planning protocols.

Objective Prior studies have found associations between sleep disturbances and suicide ideation among adolescents. However, there is limited prospective research examining cognitive mechanisms that explain this relationship. This present longitudinal study aimed to examine the mediating role of rumination in the relationship between sleep quality and suicide ideation over time. We hypothesized that low sleep quality would be associated with increased suicide ideation severity over time and that rumination would mediate the relationship. Methods Adolescents (N = 117), ages 12–19, who presented to hospitals or outpatient clinics with suicide ideation or attempt completed self-report measures of sleep quality and suicide ideation severity at baseline, rumination at 3-month follow-up, and depressive symptoms and suicide ideation at 12-month follow-up. Results There was no statistically significant direct relation between sleep quality and suicide ideation. However, rumination and depressive symptoms serially mediated the relationship between sleep quality and suicide ideation, suggesting an indirect relationship. Interestingly, rumination did not predict later sleep quality. Conclusions Improving sleep quality may reduce rumination, which, in turn, may reduce depressive symptoms and lower SI severity. Improving sleep quality may ameliorate the impact of cognitive mechanisms—like rumination—that may indirectly exacerbate suicide ideation severity through depressive symptoms.

Suicide ideation and attempts account for over half of emergency department visits among adolescents in the United States. Social connectedness has been identified as a protective factor, yet little is known about its role in the moments during a suicidal crisis. We examined adolescents' retrospective anticipation of others' emotional reactions to their prospective death by suicide as an indicator of perceived social (dis)connectedness during a suicidal crisis. Qualitative responses from a clinical sample of 104 adolescents (79 female), ages 12-19, with recent suicide ideation or attempt were analyzed using reflexive thematic analysis. Three superordinate themes were developed: (1) living for others: social bonds as protective anchors, (2) social disconnection and emotional disengagement, and (3) navigating dynamic social connections: protective or risk amplifying. These findings suggest that suicide-related interventions should address adolescents' perceptions of social (dis)connectedness and target both interpersonal and intrapersonal factors during moments of crisis to improve clinical outcomes.

Suicide is a leading cause of death among adolescents in the United States. Timely suicide-related disclosure may be a gateway to life-saving interventions and support, yet little is known about how adolescents interpret the specific responses they receive after disclosing suicide ideation (SI) or suicide attempts (SAs). Existing research has relied heavily on self-report surveys and has not captured the concrete verbal, emotional, and behavioral reactions adolescents perceive as supportive or unsupportive. This study addresses this gap by qualitatively exploring adolescents' recalled experiences of disclosure responses from both informal and formal supports. Semi-structured interviews were conducted with 82 adolescents (ages 12-19 years) who presented for clinical care related to SI or SA within the prior two weeks. Interviews drew from the Adolescent Suicide Ideation Interview and probed disclosure decisions and perceived reactions. Data were analyzed using thematic analysis to identify patterns in supportive and unsupportive responses. Analysis revealed a range of supportive (i.e., Providing Guidance and Supportive Action, Shared Emotional Experiences, Encouragement and Affirmation, Engagement and Communication, and Physical Presence and Comfort) and unsupportive (i.e., Forcible or Coercive Action, Minimizing or Dismissing Concerns, Blame and Guilt-Inducing Responses, and Anger and Hostile Reactions) disclosure responses. Supportive responses fostered safety and willingness to seek help, while unsupportive responses contributed to emotional distress and the desire to conceal in the future. Findings highlight the importance of caregiver and peer responses following suicide-related disclosure and suggest opportunities for interventions in crisis settings to enhance the disclosure experience.

A major limitation in understanding which forms of adolescent suicide ideation might predict the risk of a future suicide attempt is that current assessments of adolescents presenting to emergency departments do not consider suicide ideation subtype in assessing risk. The current study examined whether adolescent suicide ideation subtypes, assessed via interview, would differentially predict an increased risk of a future suicide attempt over time. Adolescents (N = 131) (78% female; 84% Hispanic/Latine), ages 12-19, who presented with suicide ideation (n = 85) or a suicide attempt (n = 46) were recruited primarily from an emergency department and outpatient clinics in New York City for a longitudinal study. Adolescents were interviewed and classified into three suicide ideation subtypes (brief, intermittent, and persistent suicide ideation) and followed up to 3 times over 12 months. A higher proportion of adolescents with persistent suicide ideation made a suicide attempt at follow-up (47%), compared to those with brief ideation (21%), p < .05. A survival analysis suggested that persistent suicide ideation was associated with a significantly greater risk of making a future suicide attempt sooner (HR = 3.64; 95% CI = 1.61-8.24), compared to brief suicide ideation, with a similar trend for intermittent suicide ideation (HR = 2.30; 95% CI = 1.00-5.28). Adolescents who present for clinical care with persistent or intermittent suicide ideation may warrant more immediate clinical attention to prevent risk of a future suicide attempt.

How people respond when adolescents disclose their suicidal thoughts or behaviors may significantly shape their help-seeking and mental health outcomes. Drawing on the Intimacy Process Model and Interpersonal Theory of Suicide, the present study examined interpersonal needs as mediators of the relationship between adolescents’ supportive and unsupportive experiences with suicide-related disclosure and future suicide ideation (SI) and attempts (SAs). Ethnoracially diverse adolescents (n = 119; 78% female), aged 12–19 years (M = 15.2, SD = 1.9), were recruited from hospitals and clinics following SI or SA and interviewed about how others responded to their disclosure of SI/SA. Interpersonal needs (perceived burdensomeness, thwarted belongingness) were measured at one-month follow-up, SI severity was measured at baseline and 3-month follow-up, and SA since baseline was assessed at 1-, 3-, and 12-month follow-up. Thirty-nine percent of adolescents (n = 47) did not disclose their SI/SA, 43% (n = 51) had a supportive disclosure experience, and 18% (n = 21) had an unsupportive disclosure experience. Perceived supportiveness vs. unsupportiveness of responses was not associated with interpersonal needs nor with SI. Only thwarted belongingness predicted SI at 3 months, adjusting for baseline SI, among adolescents who disclosed their SI or SA. However, a perceived supportive (vs. unsupportive) response to disclosure significantly predicted lower odds of making a SA by 12 months. Treatments should address thwarted belongingness to reduce SI severity among adolescents presenting for clinical care following SI or SA. Increasing supportive experiences with suicide-related disclosure may reduce adolescents’ risk of SAs.

Background: Parental relationships should be considered in models of suicide risk among adolescents. Studies have shown that negative parent–child interactions contribute significantly to adolescent suicide ideation (SI) and attempts, while positive parental relationship dynamics can protect against suicidal thoughts and behaviors. Given the known association between emotion reactivity and SI in youth, we hypothesized that parent–child conflict resolution would moderate this pathway by weakening this link. This is the first longitudinal study of adolescent SI, of which we are aware, to examine the interaction between the parental relationship and emotion reactivity in a clinical sample of ethnoracially and socioeconomically diverse teenagers. Methods: Participants were adolescents ( N = 106; 86 female; 84 Hispanic/Latine), ages 12–19, with recent SI or an attempt recruited from hospitals and clinics in the Northeastern United States between 2017 and 2023. Adolescents reported on parent–child interaction quality, emotion reactivity, and severity of their SI at baseline and on their SI severity 3 months later. Moderation was examined via linear regression analysis. Results: Emotion reactivity predicted greater 3‐month SI, b = 0.18, SE = 0.07, p < .01, but parent–child conflict resolution did not moderate this relation. Conclusion: These findings reinforce the importance of addressing emotion reactivity in clinical assessment and intervention to reduce SI severity. Addressing parent–child conflict resolution may not be sufficient to impact the association between emotion reactivity and SI severity among adolescents who present to hospitals following SI or an attempt without consideration of other culturally related factors that impact the parent–adolescent relationship among ethnoracially diverse adolescents.