Shira Barzilay

Adolescents are among the most frequent smartphone users worldwide. Yet, few studies have examined how smartphone use appears among minority adolescents, including sexual and gender minority (SGM) youth and children of immigrant parents, who often experience unique stressors and heightened mental‐health risk. Passive smartphone monitoring provides a promising, low‐burden method for continuously and objectively assessing real‐world behavior, offering new opportunities to identify dynamic markers of mental health challenges, including suicide risk, in daily life. The present study evaluated the feasibility of a replicable framework for passive smartphone monitoring among adolescents at high risk for suicidal thoughts and behaviors (STB) and explored longitudinal differences in smartphone‐derived behavioral features across minority subgroups. Ninety‐nine adolescents aged 11–18 with recent STB completed baseline assessments and installed the iFeel app, which collected passive smartphone data for 6 months, including total and social‐media screen time and phone‐inactivity‐based proxy sleep indicators inferred from nighttime phone inactivity. Participants contributed 1500 participant‐weeks of data, with an average of 11.9 weeks of valid monitoring, supporting the feasibility and acceptability of this approach. Daily smartphone use time, social‐media activity time, and sleep duration were comparable to normative adolescent data. No significant longitudinal differences emerged between SGM and non‐SGM adolescents. However, immigrant‐origin adolescents displayed shorter but more stable sleep patterns compared to non‐immigrant origins, who exhibited longer baseline sleep with steeper declines over time. Findings highlight passive sensing as a feasible, inclusive, and scalable method for examining real‐world behavioral processes associated with STB and mental health outcomes among diverse adolescents. This framework offers a scalable approach that future studies can apply to deepen real‐time understanding of mental‐health challenges and behavioral patterns among diverse adolescents.

Suicide is a leading cause of death among adolescents, highlighting the importance of early intervention in school settings. Universal mental health awareness programs, aimed at improving mental health literacy and help-seeking behaviors, are a key preventive approach. This study examined whether changes in thwarted belongingness and perceived burdensomeness—two constructs from the Interpersonal Theory of Suicide (IPTS)—mediate the effects of school-based mental health interventions on suicidal ideation (SI). A total of 436 adolescents from central Israel (154 boys, 279 girls; M = 14.6, SD = 1.1) were randomly assigned to either a mental health awareness intervention ( N = 256) or a minimal-intervention control group with attendance monitoring ( N = 180). Belongingness, burdensomeness, and SI were assessed at baseline, 1-month, and 1-year post-intervention. Regression analyses showed that lower belongingness (β = –0.25, p < .001) and higher burdensomeness (β = 0.21, p < .01) predicted higher SI at 1-month, while only belongingness remained significant at 1-year (β = –0.19, p < .01). The mental health awareness intervention increased school-specific belongingness (β = 0.22, p < .001), whereas attendance monitoring intervention increased general belongingness (β = 0.18, p < .01). Mediation analysis indicated that the effects of the intervention type on SI were not significantly mediated by general and school belongingness. These findings suggest that promoting broader social connectedness beyond school environments may support reductions in adolescent suicide risk over time.

Introduction: Nondisclosure of suicidal ideation (SI) presents a challenge to assessing suicide risk, as assessments often rely on self‐reported SI. Cross‐national comparisons of rates of, and reasons for, SI nondisclosure remain understudied. The present study examined whether rates of SI nondisclosure from clinicians differed, and if there were differences in rates of reasons for SI nondisclosure, across 12 countries. Method: A subset of adult participants ( n = 6770) who reported a lifetime history of SI from 12 countries responded to the question: “Have you ever denied or concealed thinking about suicide from a doctor or clinician?” Those who selected “Yes” provided reason(s) for SI nondisclosure. Responses were coded according to inductively and deductively derived reasons for SI nondisclosure. Results: Rates of nondisclosure among participants who reported lifetime SI ranged from 7.2% (Taiwan) to 48.2% (United States). Among those participants, rates of reasons for SI nondisclosure ranged from 2.0% (participant was unsure/did not know why they concealed SI) to 35.6% (negative internal experiences). Conclusions: Findings provide insight into the frequency of and reasons for SI nondisclosure from clinicians at a country‐specific level. Results could serve as a rationale for clinicians to incorporate indirect suicide risk factors into risk assessments.

Child suicide rates and emergency department visits due to suicidal thoughts and behaviors (STB) are rising at an alarming rate globally. In the United States, suicide deaths among children aged 5–12 increased by 195% from 1990 to 2020, highlighting an urgent need for greater understanding of the underlying risk factors. Although poor parent–child relationships and child emotional dysregulation have been identified as correlates of STB, the precise mechanisms linking these factors remain insufficiently explored. This study aimed to examine the associations between insecure attachment styles (anxious and avoidant), emotional dysregulation and STB in children. Grounded in attachment theory, it was hypothesized that emotional dysregulation would mediate the relationship between insecure attachment and STB. A sample of 111 children aged 7–12, admitted to a pediatric emergency department (ED) for STB, completed self-report measures assessing attachment styles (ECR-RC), emotional dysregulation (DERS), and STB (C-SSRS). Cross-sectional mediation regression analyses revealed that emotional dysregulation significantly mediated the relationship between anxious attachment and suicidal behaviors. However, no mediation effect was found between avoidant attachment and suicidal thoughts. These findings suggest that children with anxious attachment styles are particularly vulnerable to experiencing emotional dysregulation associated with suicidal behaviors. The absence of a similar mediation effect for avoidant attachment and suicidal thoughts may point to distinct psychological pathways underlying different forms of STB. These results highlight the potential importance of targeting the parent–child relationship to enhance children's emotional regulation abilities, which may, in turn, reduce the risk of suicidal behaviors.

The global prevalence of suicidal behaviors in children is rising, with attention-deficit hyperactivity disorder (ADHD) proposed as a contributing factor. This study examines the association between ADHD facets (hyperactivity and inattention) and suicidal behavior and attempts in children. Additionally, it seeks to compare self-reported ADHD symptoms and suicide-related incidents with parental reports. A cohort of 71 children referred from emergency departments due to suicidal thoughts and behaviors completed self- and parental report questionnaires. The results revealed that elevated hyperactivity scores, surpassing the ADHD diagnosis threshold, were significantly associated with increased rates of suicidal behavior. Hyperactivity demonstrated a stronger association with lifetime suicide attempts compared to inattention. Moreover, children’s self-reported ADHD symptoms exhibited a stronger correlation with suicide attempts than parental reports. This study highlights the critical role of hyperactivity in understanding suicidal behaviors among children with ADHD. It underscores the importance of considering hyperactivity-related symptoms in assessment and treatment approaches for suicidal behavior in this population.

Background: Ambivalence in attitudes towards life and death are associated with suicide ideation (SI) among adolescents. However, previous research was mainly cross‐sectional and did not examine through which psychopathological mechanisms (such as depression) attitudes towards life and death are associated with SI.Objective: The current longitudinal study examined the mediating role of depression at follow‐up in the association between attitudes towards life and death at baseline and SI at follow‐up among at‐risk adolescents referred to an outpatient psychiatric clinic.Methods: 129 adolescents aged 10–18 years (75.2% females) with a history of suicidal thoughts and behaviors were assessed at clinic intake and 1 month follow‐up (80% retention rate at follow‐up). All participants completed a questionnaire assessing attitudes towards life and death and SI severity at clinic intake, and depression and SI severity at 1 month follow‐up.Results: While controlling for SI severity at intake, attraction towards life at baseline, rather than attraction and repulsion towards death at baseline, led to higher SI severity at follow‐up, while depression at follow‐up fully mediated this association.Conclusions: Attitudes towards life, as well as depression play critical roles in the development of SI among adolescents. Interventions targeting reasons for living and promoting meaning of life may be beneficial in preventing depression and SI.

Introduction: The suicide crisis syndrome (SCS) has demonstrated efficacy in predicting suicide attempts, showing potential utility in detecting at‐risk individuals who may not be willing to disclose suicidal ideation (SI). The present international study examined differences in intentions to utilize mental health and suicide prevention resources among community‐based adults with varying suicide risk (i.e., presence/absence of SCS and/or SI).Methods: A sample of 16,934 community‐based adults from 13 countries completed measures about the SCS and SI. Mental health and suicide prevention resources were provided to all participants, who indicated their intentions to use these resources.Results: Individuals with SCS (55.7%) were just as likely as those with SI alone (54.0%), and more likely than those with no suicide‐related symptoms (45.7%), to report willingness to utilize mental health resources. Those with SI (both with and without SCS) were more likely to seek suicide prevention resources (52.6% and 50.5%, respectively) than those without SI (41.7% and 41.8%); however, when examining endorsements for personal use, those with SCS (21.6%) were more likely to use resources than individuals not at risk (15.1%).Conclusions: These findings provide insight into individuals' willingness to use resources across configurations of explicitly disclosed (SI) and indirect (SCS) suicide risk.