Alberto Forte

Background: Adolescence represents a developmental period marked by heightened vulnerability to suicidal thoughts and behaviors (STBs), which remain a leading cause of death among youth, particularly psychiatric inpatients and after discharge. Contemporary ideation-to-action models conceptualize suicidal crises as dynamic processes driven by proximal psychological factors rather than static risk markers. While recent work has begun to examine these processes as they unfold in daily life, their integration into the clinical course of suicidal distress remains limited. From this perspective, relating short-term microlevel processes of STBs to their broader temporal changes across the transition of adolescents from acute inpatient hospitalization to early ambulatory aftercare constitutes an important area for further investigation. Objective: This protocol describes a multimodal, intensive longitudinal study examining the temporal unfolding of suicidal distress across complementary timescales. The integrative framework aims to identify prototypical trajectories of STBs from inpatient admission through the early postdischarge period. It further seeks to characterize heterogeneity in within-person processes central to ideation-to-action theories and STB-related affect regulation. Finally, the study aims to interrelate these microlevel dynamics of suicidal distress with its longitudinal trajectories at the macrolevel. Within this framework, the study examines how modifiable bioregulatory factors, including sleep and physical activity, as well as clinical process factors such as therapeutic alliance, are dynamically implicated across timescales. Methods: The study plans to recruit 100 adolescents hospitalized at a single site in French-speaking Switzerland. Within 72 hours of admission, participants start a first assessment period of up to 14 days, comprising 4 daily Ecological Momentary Assessment (EMA) surveys and continuous actigraphy recordings. A second assessment period follows participants for the 10 days after discharge and includes 2 daily EMA surveys. In addition, 4 in-person assessment sessions contextualize the intensive longitudinal time series with baseline clinical characteristics, diagnostic status, therapeutic processes, and episodic stressors. Planned analyses will use multilevel and latent class modeling approaches to identify longitudinal patterns of STBs, characterize between-person differences in within-person dynamics, and examine how these patterns relate to contextual factors. Results: Recruitment began on October 31, 2025, and is expected to continue until June 2028. The protocol was developed through the active integration of former patients’ perspectives and clinicians’ lived experience. Feedback from the first 5 participants supported the current implementation of the protocol. Conclusions: By focusing on the link between intraindividual short-term processes and clinical trajectories of STBs, this study will advance our understanding of how STBs and related psychological and behavioral processes interact over time during a critical period of distress. These insights aim to inform targeted, person-centered approaches to acute psychiatric care, offering better support for vulnerable adolescents transitioning from inpatient to outpatient care. International Registered Report Identifier (IRRID): DERR1-10.2196/93016

BackgroundAdolescence represents a developmental period marked by heightened vulnerability to suicidal thoughts and behaviors (STBs), which remain a leading cause of death among youth, particularly psychiatric inpatients and after discharge. Contemporary ideation-to-action models conceptualize suicidal crises as dynamic processes driven by proximal psychological factors rather than static risk markers. While recent work has begun to examine these processes as they unfold in daily life, their integration into the clinical course of suicidal distress remains limited. In this perspective, relating short-term micro-level processes of STBs to their broader temporal changes across the transition of adolescents from acute inpatient hospitalization to early ambulatory aftercare constitutes an important area for further investigation.ObjectivesThis protocol describes a multimodal, intensive longitudinal study examining the temporal unfolding of suicidal distress across complementary timescales. The integrative framework aims to identify prototypical trajectories of STBs from inpatient admission through early post-discharge. It further seeks to characterize heterogeneity in within-person processes central to ideation-to-action theories and STB-related affect regulation. Finally, the study aims to interrelate these micro-level dynamics of suicidal distress with its longitudinal trajectories on the macro-level. Within this framework, the study examines how modifiable bioregulatory factors, including sleep and physical activity, as well as clinical process factors such as therapeutic alliance, are dynamically implicated across timescales.MethodsThe study plans to recruit 100 adolescents hospitalized from a single site in French-speaking Switzerland. Within 72h upon admission, participants start a first ambulatory assessment period of up to 14 days, comprising with 4 daily Ecological Momentary Assessment (EMA) surveys and continuous actigraphy recordings. A second assessment period follows participants from discharge over the following 10 days and includes 2 daily EMA surveys. In addition, 4 in-person assessment sessions contextualize the intensive longitudinal time-series with baseline clinical characteristics, diagnostic status, therapeutic processes, and episodic stressors. Planned analyses will use multilevel and latent class modeling approaches to identify longitudinal patterns of STBs, characterize between-person differences in within-person dynamics, and examine how these patterns relate to contextual factors. ResultsRecruitment began in October 2025 and is expected to continue until spring 2028. The protocol was developed by actively the perspectives of former patients and the lived experience of clinicians. Feedback from the first five participants supported maintaining the initial implementation of the protocol.ConclusionsBy focusing on the link between intraindividual short-term ...

BACKGROUND Adolescence represents a developmental period marked by heightened vulnerability to suicidal thoughts and behaviors (STBs), which remain a leading cause of death among youth, particularly psychiatric inpatients and after discharge. Contemporary ideation-to-action models conceptualize suicidal crises as dynamic processes driven by proximal psychological factors rather than static risk markers. While recent work has begun to examine these processes as they unfold in daily life, their integration into the clinical course of suicidal distress remains limited. From this perspective, relating short-term microlevel processes of STBs to their broader temporal changes across the transition of adolescents from acute inpatient hospitalization to early ambulatory aftercare constitutes an important area for further investigation. OBJECTIVE This protocol describes a multimodal, intensive longitudinal study examining the temporal unfolding of suicidal distress across complementary timescales. The integrative framework aims to identify prototypical trajectories of STBs from inpatient admission through the early postdischarge period. It further seeks to characterize heterogeneity in within-person processes central to ideation-to-action theories and STB-related affect regulation. Finally, the study aims to interrelate these microlevel dynamics of suicidal distress with its longitudinal trajectories at the macrolevel. Within this framework, the study examines how modifiable bioregulatory factors, including sleep and physical activity, as well as clinical process factors such as therapeutic alliance, are dynamically implicated across timescales. METHODS The study plans to recruit 100 adolescents hospitalized at a single site in French-speaking Switzerland. Within 72 hours of admission, participants start a first assessment period of up to 14 days, comprising 4 daily Ecological Momentary Assessment (EMA) surveys and continuous actigraphy recordings. A second assessment period follows participants for the 10 days after discharge and includes 2 daily EMA surveys. In addition, 4 in-person assessment sessions contextualize the intensive longitudinal time series with baseline clinical characteristics, diagnostic status, therapeutic processes, and episodic stressors. Planned analyses will use multilevel and latent class modeling approaches to identify longitudinal patterns of STBs, characterize between-person differences in within-person dynamics, and examine how these patterns relate to contextual factors. RESULTS Recruitment began on October 31, 2025, and is expected to continue until June 2028. The protocol was developed through the active integration of former patients’ perspectives and clinicians’ lived experience. Feedback from the first 5 participants supported the current implementation of the protocol. CONCLUSIONS By focusing on the link between intraindividual short-term processes and clinical trajectories of STBs, this study will advance our understanding of how STBs and related psychological and behavioral processes interact over time during a critical period of distress. These insights aim to inform targeted, person-centered approaches to acute psychiatric care, offering better support for vulnerable adolescents transitioning from inpatient to outpatient care. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT DERR1-10.2196/93016

Background: Clozapine is the only treatment with regulatory-recognition of lowering suicidal risk, at least in schizophrenia patients. It remains uncertain whether such effects extend to other drugs for psychosis. Methods: We searched for reports on rates of suicidal behavior during treatment with clozapine and other modern drugs for psychosis (aripiprazole, olanzapine, risperidone, quetiapine, and ziprasidone) versus comparison or control treatments and analyzed the contrasts by random-effect meta-analysis to obtain pooled odds ratios (ORs) with 95% confidence intervals (CIs). Results: We identified 35 paired comparisons of modern drugs for psychosis versus comparison or control treatments in 18 reports. There was moderate overall superiority of all agents tested over alternatives (OR = 0.522, p = 0.004). With clozapine, this effect was large (OR = 0.229, p < 0.0001) and consistent (7/7 trials), but significant antisuicidal effects were not found with other drugs for psychosis in 28 other trials (OR = 0.941, p = 0.497). Apparent efficacy of specific agents ranked: risperidone ⩾ olanzapine ⩾ aripiprazole ⩾ ziprasidone ⩾ mixed drugs for psychosis ⩾ quetiapine, but none of these differences was significant. Conclusions: An ability of clozapine to reduce risk of suicides and attempts in schizophrenia patients appears to be a unique effect not shared with other modern medicines indicated for schizophrenia or bipolar disorder.

This study investigates, using an online self-report questionnaire, adolescents’ emotional reactions during the lockdown in a sample of 2105 secondary school students (aged 14–19) in Italy, Romania, and Croatia. We used a self-reported online questionnaire (answers on a 5-point scale or binary), composed of 73 questions investigating the opinions, feelings, and emotions of teenagers, along with sociodemographic information and measures of the exposure to lockdown. The survey was conducted online through a web platform in Italy (between 27 April and 15 June 2020), Romania, and Croatia (3 June and 2 July 2020). Students aged >14 years, living in a small flat, and not spending time outside were more likely to report anger, sadness, boredom/emptiness, and anxiety. Boys were significantly less likely than girls to report all measured emotional reactions. Those who lost someone from COVID-19 were more than twice as likely to experience anger compared to those who did not. Our findings may help identifying adolescents more likely to report negative emotional reactions during the COVID-19 pandemic and inform public health strategies for improving mental health among adolescents during/after the COVID-19 crisis.

Background: Irritable children are at increased risk of suicidal ideation and suicide attempt, but the underlying environmental mechanisms accounting for these associations are largely unknown. We aimed to investigate the mediating role of peer victimization and harsh parenting in the association between childhood irritability and adolescent suicidal ideation and attempt. Method: N = 1,483 participants from the Québec Longitudinal Study of Child Development followed up from 5 months until 20 years of age (2018) with annual or biannual assessments. Irritability was operationalized using assessments of teacher‐reported temper tantrums and reactive aggression. Suicidal ideation and suicide attempt at ages 13, 15, 17, and 20 years were self‐reported. Peer victimization (self‐reported at age 13) and harsh parenting (mothers reported at age 13) were considered as potential mediators. Results: We identified four trajectories of teacher‐reported irritability symptoms from 6 to 12 years: low (74.8%), rising (12.9%), declining (7.3%), and persistent (4.9%). In adjusted models, children in the persistent and rising trajectories had, respectively, 2.81‐fold (CI, 1.27–6.22) and 2.14‐fold (CI, 1.20–3.81) increased odds of suicide attempt in adolescence, but not suicidal ideation. We found that a significant proportion of the association between irritability trajectories and suicide attempt was mediated by peer victimization (33% and 35% for rising and persistent, respectively), but there was no mediation via harsh parenting. Conclusions: Our findings suggest that peer victimization may be a key mechanism explaining the increased suicide attempt risk of children presenting with persistently high or increasing irritability. Interventions to reduce peer victimization may be helpful to reduce suicide risk among irritable children.

Background and objectives: Suicide in adolescents represents a major public health concern. To date, a growing number of suicide preventive strategies based on the use of new technologies are emerging. We aimed to provide an overview of the present literature on the use of new technologies in adolescent suicide prevention. Materials and methods: An electronic search was run using the following keywords: Technology OR Technologies OR APP OR Application OR mobile application) AND (Adolescent OR youth OR puberty) AND (Suicid* OR Self-harm OR self-destruction). Inclusion criteria were: English language, published in a peer-reviewed journal, suicide prevention with the use of new technologies among adolescents. Results: Our search strategy yielded a total of 12 studies on the use of telemedicine, 7 on mobile applications, and 3 on language detection. We also found heterogeneity regarding the study design: 3 are randomized controlled trials (RCT), 13 are open-label single group trials, 2 are randomized studies, and 1 is a cross-sectional study. Telemedicine was the most adopted tool, especially web-based approaches. Mobile applications mostly focused on screening of depressive symptoms and suicidal ideation, and for clinical monitoring through the use of text messages. Although telepsychiatry and mobile applications can provide a fast and safe tool, supporting and preceding a face-to-face clinical assessment, only a few studies demonstrated efficacy in preventing suicide among adolescents through the use of these interventions. Some studies suggested algorithms able to recognize people at risk of suicide from the exploration of the language on social media posts. Conclusions: New technologies were found to be well accepted and tolerated supports for suicide prevention in adolescents. However, to date, few data support the use of such interventions in clinical practice and preventive strategies. Further studies are needed to test their efficacy in suicide prevention among adolescents and young adults.

Learning objectives: After participating in this activity, learners should be better able to:• Evaluate risk of suicide and suicide attempts following psychiatric hospitalization• Assess the relationship between suicide attempts and completed suicidesBackground: Suicidal risks among psychiatric patients appear to be especially high soon after hospitalization. Given the importance of such outcomes, and the lack of recent reviews of post-discharge suicide attempt risks, we evaluated reported findings on the risk of suicide and attempts following psychiatric hospitalization.Methods: With systematic, computerized searching, we identified 48 studies (1964–2017) involving 1,700,785 subjects. Follow-up was limited to ≥12 months after discharge from psychiatric hospitalization to avoid inflation of annualized rates due to shorter exposure times.Results: The overall observed pooled, annualized rate of completed suicide was 241 (confidence interval, 238–243) per 100,000 person-exposure years in 41 studies, and for attempts, 722 (698–746) in 13 studies. In six studies (64,848 subjects) reporting on both suicides and attempts, the ratio of annualized rates for attempts/completed suicides was 8.79 (6.63–12.0). Among all 48 studies, cumulative distribution of suicidal events included 26.4% (25.9–26.9) within the initial month, 40.8% (40.2–41.4) within 3 months, and 73.2% (72.7–73.7) within 12 months of discharge.Conclusions: Among patients recently discharged from psychiatric hospitalization, rates of suicide deaths and attempts were far higher than in the general population or even in unselected clinical samples of comparable patients, with a strong inverse association with time post-discharge. Improved monitoring and care of patients discharged from psychiatric hospitalization are needed, ideally with detailed planning and implementation of aftercare prior to discharge.