Vanessa Robin Weersing

Suicide is a major public health concern at the global level and is responsible for an estimated 800,000 deaths annually worldwide (World Health Organization, 2025). In the United States, suicide r...

Background: Patient navigation (PN), paired with the safety planning intervention (SPI), may allay mechanisms that theoretically underlie suicide among sexual and gender minorities (SGM). This paper describes (a) the iterative development of a theory‐informed PN + SPI intervention (QueerCare) to prevent suicide among at‐risk SGM youth and young adults and (b) a case series examining the feasibility and acceptability of study procedures, measures, and QueerCare.Methods: Seven initial QueerCare modules and a glossary of terms were drafted. Seven participants completed the case series. Feasibility and acceptability over 3 months were examined by triangulating multi‐method data.Results: The study procedures and measures in the at‐risk population were feasible and sensitive, provided that remote safety monitoring and parental consent waivers were in place. QueerCare was feasible, helpful, and appropriate based on satisfaction ratings and four emerging themes: matched identity care, internalized barriers, support, and flexibility valued. Two additional modules and guardian materials were created. Suicidal crisis management protocols were continuously refined.Conclusion: QueerCare was developed as a highly flexible modular intervention to meet the needs of SGM youth and young adults and prevent repeat suicide attempts in this population. Findings indicate study procedures, measures, and QueerCare were feasible and acceptable based on triangulated data.Trial Registration: This study was registered under ClinicalTrials.gov identifier NCT04757649

The current study estimated effects of intervention dose (attendance) of a cognitive behavioral prevention (CBP) program on depression-free days (DFDs) in adolescent offspring of parents with a history of depression. As part of secondary analyses of a multisite randomized controlled trial, we analyzed the complete intention-to-treat sample of 316 at-risk adolescents ages 13 to 17 years. Youth were randomly assigned to the CBP program plus usual care (n = 159) or to usual care alone (n = 157). The CBP program involved 8 weekly acute sessions and 6 monthly continuation sessions. Results showed that higher CBP program dose predicted more DFDs, with a key threshold of approximately 75% of a full dose in analyses employing instrumental variable methodology to control multiple channels of bias. Specifically, attending at more than 75% of acute phase sessions led to 45.3 more DFDs over the 9-month period after randomization, which accounted for over 12% of the total follow-up days. Instrument sets were informed by study variables and external data, including weather and travel burden. In contrast, conventional analysis methods failed to find a significant dose-outcome relation. Application of the instrumental variable approach, which better controls the influence of confounding, demonstrated that higher CBP program dose resulted in more DFDs. This article is part of a Special Collection on Mental Health.

By adolescence, two-thirds of youth report exposure to at least one traumatic event, yet the impact of trauma history is not routinely considered when evaluating the effect of psychotherapeutic interventions. Trauma may be a particularly important moderator of the effects of transdiagnostic therapies for emotional disorders, as trauma exposure is associated with risk for the development of comorbid depression and anxiety. The current study examined the history of trauma exposure and the presence of clinically significant depression as moderators of treatment outcomes in the Brief Behavioral Therapy (BBT) trial, the largest study of transdiagnostic psychotherapy for youth. Youths (age 8–16 years) were randomized to BBT (n = 89) based in pediatric primary care or assisted referral to outpatient community care (ARC; n = 86). Clinical response, functioning, anxiety symptoms, and depression symptoms were assessed at post-treatment (Week 16) and at follow-up (Week 32). A significant three-way interaction emerged between the treatment group, comorbid depression, and trauma exposure. BBT was broadly effective for 3/4 of the sample, but, for anxious-depressed youth with trauma exposure, BBT never significantly separated from ARC. Differences in outcome were not accounted for by other participant characteristics or by therapist-rated measures of alliance, youth engagement, or homework completion. Implications for models of learning and for intervention theory and development are discussed.

Background: Pediatric anxiety and depression are prevalent, impairing, and highly comorbid. Available evidence‐based treatments have an average response rate of 60%. One path to increasing response may be to identify likely non‐responders midway through treatment to adjust course prior to completing an episode of care. The aims of this study, thus, were to identify predictors of post‐intervention response assessing (a) mid‐treatment symptom severity, (b) session‐by‐session treatment process factors, and (c) a model optimizing the combination of these. Method: Data were drawn from the treatment arm ( N = 95, ages 8–16) of a randomized transdiagnostic intervention trial ( M _sessions = 11.2). Mid‐point measures of youth‐ and parent‐reported anxiety and depression were collected, and therapists rated homework completion, youth and parent engagement, and youth therapeutic alliance at each session. Logistic regression was used to predict response on the Clinical Global Impression Improvement Scale (CGI‐I ≤2) rated by independent evaluators masked to treatment condition. Results: Mid‐point symptom measures were significant predictors of treatment response, as were therapist‐ratings of youth and parent engagement, therapeutic alliance, and homework completion. Therapist ratings were significant when tested as mean ratings summing across the first eight sessions of treatment (all p s < .004) and at individual session points (all p s Nagelkerke R ² = .59, χ ² (4, 80) = 46.54, p < .001). Conclusion: This study provides initial evidence that response to transdiagnostic intervention for pediatric anxiety and depression may be reliably predicted by mid‐point. These data may serve as foundational evidence to develop adaptive treatment strategies to personalize intervention, correct treatment course, and optimize outcomes for youth with anxiety and depression.

Anxiety and depression are the most prevalent and least treated pediatric mental health problems. Racial/ethnic minority youths face greater risks for developing anxiety and depression and experience higher burden as they are less likely to receive adequate mental health services for these conditions or to have their needs met. Further, standard evidence‐based interventions for youth anxiety and depression may show diminished effects with racial/ethnic minority youths and with families of lower socioeconomic status. While community‐level interventions to combat structural racism and reduce population‐level risk are sorely needed, many youths will continue to require acute treatment services for anxiety and depression and interventionists must understand how to bring equity to the forefront of care. In this review, we adopt a health system framework to examine racial/ethnic disparities in system‐, intervention‐, provider‐, and patient‐level factors for psychosocial treatment of pediatric anxiety and depression. Current evidence on disparities in access and in efficacy of psychosocial intervention for anxious and depressed youths is summarized, and we use our work in primary care as a case example of adapting an intervention to mitigate disparities and increase equity. We conclude with recommendations for disparity action targets at each level of the health system framework and provide example strategies for intervening on these mechanisms to improve the outcomes of racial/ethnic minority youths.

Objective: Trauma exposure is widely prevalent, with more than 60% of adolescents having experienced at least 1 traumatic event and a third of those at high risk to develop posttraumatic stress disorder (PTSD). Data are scarce and out of date on the services children and adolescents with PTSD receive, impeding efforts to improve care and outcomes. This study examines health service use for a large and diverse sample of children and adolescents with and without a diagnosis of PTSD. Method: Using a matched case-control study, we gathered information from 4 large health care systems participating in the Mental Health Research Network. Data from each site's electronic medical records on diagnoses, health care encounters, and demographics were analyzed. Nine hundred fifty-five 4- to 18-year-olds with a diagnosis of PTSD were identified and matched on a 1:5 ratio to 4770 controls. We compared cases with controls on frequency of service use in outpatient primary care, medical specialty care, acute care, and mental health care. We also assessed psychotropic medication use. Results: Children and adolescents diagnosed with PTSD used nearly all physical and mental health service categories at a higher rate than controls. However, one-third of children and adolescents did not receive even 1 outpatient mental health visit (36.86%) during the year-long sampling window. Conclusion: Our findings suggest that children and adolescents diagnosed with PTSD may have unmet mental health needs. They are high utilizers of health services overall, but lower utilizers of the sectors that may be most helpful in resolving their symptoms.