Search Results (198)

Background and objectives: Suicide attempts and self-harm are critical issues in adolescence, often leading to serious and irreversible consequences. These behaviours frequently co-occur and share common biopsychosocial risk factors. Identifying these factors enables a more comprehensive assessment of suicide and self-harm risk, helping specialists recognize high-risk individuals and implement effective preventive measures. This study aimed to examine the association between suicide attempts, self-harm and psychosocial factors among hospitalized adolescents. Materials and methods: A retrospective data analysis was performed using the database of the University Department of Children and Adolescents of the Republican Vilnius Psychiatric Hospital. The study covered patients’ records from December 2022 to February 2025. Information on gender, age, suicide attempts, self-harm, adverse events (bullying, psychological abuse, physical violence within the family, and sexual abuse) and unhealthy habits (smoking, harmful alcohol consumption, and psychoactive substance use), was selected and analyzed in this study. A Chi-square test was used to assess the difference between groups. Results were considered statistically significant when p < 0.05. Results: The study included 599 hospitalized adolescents (26.9% boys; mean age 15.1 ± 1.4 years), of whom 70.8% reported at least one episode of self-harm and 37.8% at least one suicide attempt. Rates of self-harm and suicide attempts were significantly higher in girls than in boys (self-harm: 81.3% vs. 42.2%, $\varphi =0.381$, $p<0.001$; suicide attempts: 45.5% vs. 16.5%, $\varphi =0.304$, $p<0.001$), and adolescents with self-harm had a significantly higher prevalence of suicide attempts than those without self-harm (46.7% vs. 15.8%, $\varphi =0.308$, $p<0.001$). Adverse childhood experiences and unhealthy behaviours were significantly more frequent in adolescents with self-harm and suicide attempts, although effect sizes were small to moderate ($\varphi$ range 0.086–0.230, all $p<0.05$). In multivariable models, female gender ($\beta =0.355$, $p<0.001$) and smoking ($\beta =0.330$, $p<0.001$) were the strongest predictors of self-harm, whereas alcohol use ($\beta =0.337$, $p<0.001$) and self-harm ($\beta =0.232$, $p<0.001$). Conclusions: Exposure to adverse childhood experiences and engagement in unhealthy habits were associated with higher rates of both self-harm and suicide attempts. A comprehensive assessment and early detection of self-harm behaviours and adverse psychosocial circumstances are crucial elements of effective suicide prevention strategies and prompt intervention among high-risk adolescents. Full article

Background: Adolescence is a developmental phase characterised by profound biological, emotional and social changes and these changes make adolescents particularly vulnerable to the emergence of psychiatric disorders. In this context, gender differences in mental health disorders are of increasing clinical interest. Method: We conducted a scoping review of the literature regarding gender differences in psychiatric disorders during adolescence. Three databases, PubMed, Web of Science and EBSCO, were used to identify articles published in English from 2015 until 2025. Twenty-one studies fulfilled the inclusion criteria. Results: Ten studies deal with mood disorders, with a focus on gender differences in depression and anxiety during adolescence. Two articles analyse eating disorders, highlighting that girls show higher levels of food restriction and body dissatisfaction. Two studies focus on externalising and neurobehavioural disorders, showing a higher prevalence in boys than in girls. Four articles examine self-harm and suicidal behaviour, where girls report higher rates of suicidal ideation and self-harm. Finally, two studies address personality disorders in adolescence, noting a higher incidence of borderline traits and impulsive behaviour among girls. Conclusions: Research has revealed gender differences in the onset, frequency and factors associated with psychiatric disorders in adolescence. Understanding these differences is essential for developing prevention strategies, early diagnosis and specific interventions. Full article

Early detection of suicidal risk in adolescents requires valid tools adapted to the clinical and educational context. However, there are currently no observational scales developed specifically for use by significant people in the adolescent’s environment. Therefore, the aim of the present study was to design, validate and apply to a pilot sample an observational scale to identify behavioural and emotional signs of suicidal risk in adolescents, from the perspective of adolescents, parents and teachers. Validation study of an Observational Adolescent Suicide Risk Scale (EORSA) based on a theoretical review and expert consensus. Content validity was evaluated through expert judgement by professionals with recognised experience in mental health, psychometrics, and suicide prevention. The scale was subsequently applied to a sample of adolescents, parents and teachers, analysing the mean scores per item in each group. The final scale included 19 items with a high level of agreement among experts (content validity index > 0.80). When applied to the pilot sample, significant differences were observed in the items considered most frequent by each group. The EORSA is a valid and potentially useful tool for identifying signs of suicidal risk in adolescents from an observational perspective. Its design and application allow for a contextualised and multidimensional assessment, favouring preventive interventions adapted to each setting. Full article

Suicide in children and young adults is a leading cause of premature mortality, and there is a need to develop a more profound understanding of the factors that contribute to these deaths. This study is part of the nationwide Retrospective Investigation of Health Care Utilization in Individuals who died by Suicide in Sweden 2015, conducted at Lund University, Sweden. The aim was to examine symptoms and diagnoses in children and young adults who died by suicide, as documented in their medical records at their last visits for primary care, somatic specialist care, or psychiatric care 24 months prior to suicide, and to apply contemporary psychological research in youth suicidality to the findings to formulate clinical implications. The proportions of symptoms and diagnoses in children (0–17 years), young adults (18–24 years), males, and females are described. The main symptoms noted in the cohort were depressive symptoms (28%), anxiety symptoms (26%), and pain (25%). The diagnoses predominately covered mental and behavioural disorders, and the most frequent of the mental and behavioural diagnoses were neurotic, stress-related, and somatoform disorders (32%) and mood (affective) disorders (29%). The diagnoses and symptoms were not sufficient to uncover suicidality in children and young adults. The clinical implications for alternative assessments and preventive interventions are discussed. Full article

Background: Self-harm is a growing public health concern and the strongest predictor of suicide in young people (YP). The “Supporting Adolescents with Self-Harm” (SASH) intervention was developed with YP with lived experience and expert clinicians. It involves rapid follow-up after ED attendance and up to six intervention sessions. The intervention has three components: Therapeutic Assessment (TA) of self-harm; an enhanced safety plan (SP); and Solution-Focused Brief Therapy (SFBT). Depending on the YP’s preference, carers can join sessions. Carers can also receive two individual sessions. The clinical and cost-effectiveness of SASH is being evaluated in a randomised controlled trial across nine emergency departments in three NHS Trusts in London, England. A total of 154 YP were recruited between May 2023 and March 2025 and randomised on a 1:1 ratio to SASH alongside Treatment As Usual (TAU) or TAU. A logic model describes the SASH inputs, activities, mechanisms, outcomes and longer-term impacts. The aim of this paper is to (1) illustrate how TA, SP, and SFBT were implemented in practice by presenting intervention materials and session recordings for four YP cases and one carer case and (2) explore how the case study materials/recordings reflect the intervention mechanisms in the SASH logic model. Methods: Each case focused on a different component of the intervention. Intervention materials (TA self-harm diagram and completed SP) and recorded SFBT sessions with four YP and one carer were analysed using a descriptive case study approach. The TA diagram and SP were extracted from medical records. Audio/video recordings of intervention sessions were identified. Recordings of intervention sessions and qualitative interviews were transcribed. Quotes from qualitative interviews with the same participants were included where relevant. Results: Across the four YP cases, some core themes emerged. The role of friendships for young people, particularly at school, was important in both negative and positive ways. Experiencing difficulties with friends at school led to feelings of sadness and stress, which could become overwhelming, leading to thoughts of self-harm (“I just need to hurt myself”), triggering self-harm behaviour. YP described mood changes and signs that they were becoming stressed, which improved their self-awareness and understanding of the link between their feelings and self-harm behaviour. They reflected on what kept them feeling calm and overcoming their fear of burdening others by sharing how they were feeling, as this helped them not to self-harm. They also described difficult feelings stemming from a need to please everyone or needing validation from others. Overcoming these feelings led to less social anxiety and more confidence. This made it easier to go to school and to be more social with friends/student peers, which in turn improved their mood. Conclusions: These case studies demonstrate how YP improved their self-awareness and understanding of the link between feelings and self-harm behaviour and identified personal strategies for managing difficult feelings and situations. The carer case study demonstrates how sessions with carers can facilitate carers better supporting their YP’s mental health. Supporting YP and carers in this way has the potential to reduce the risk of future self-harm. Full article

Ecological momentary assessment (EMA) captures real-time data on thoughts, emotions, and behaviours within individuals’ natural environments. Although EMA has been increasingly used to examine self-harm, existing reviews have not focused specifically on adolescents. This systematic review examines EMA research on adolescent self-harm, focusing on methodological considerations and key risk and protective factors for self-harm. Five databases, plus pre-print, unpublished and grey literature sources, were searched up to 30 January 2024. Studies were included if published in English, used EMA methodology, included adolescents aged 10–24 years and measured suicidal ideation, suicidal behaviours, or self-harm. The review included 79 studies, published from 2009 to the present. Self-harm was associated with numerous risk factors, including negative affect, stress, interpersonal influences and sleep. EMA was generally well-accepted by adolescent participants, with high compliance rates. The findings highlight the value of EMA in capturing real-time fluctuations in self-harm and associated risk factors among adolescents. EMA demonstrates strong potential for improving understanding and prediction of self-harm; yet challenges remain, including variability in study designs and a lack of clear reporting of the methodologies. Future research should focus on standardising methodologies, increasing participant diversity, and exploring the clinical utility of EMA in early intervention and prevention strategies. Full article

(1) Background: Understanding suicide risk across cultures requires examining both universal and culturally specific factors that inform assessment and intervention. This study explores the influence of interpersonal variables—such as interpersonal competence, perceived social support, and constructs from the Interpersonal Theory of Suicide (ITS)—on suicidal behaviour in two culturally distinct samples: young adults from Spain and Japan. (2) Methods: A total of [437] participants (Spanish sample: n = 260; Japanese sample: n = 177) completed validated measures assessing suicide risk, depression, perceived burdensomeness, thwarted belongingness, acquired capability for suicide, interpersonal competence, and perceived social support. Moderated mediation and SEM comparative analyses were conducted to identify predictors of suicide risk in each cultural context. (3) Results: Social support was a consistent protective factor against depression and suicidal ideation, and interpersonal competence showed more contextual protective effects, significant only in the Japanese sample. Perceived burdensomeness stood out as a robust predictor of depression and suicidal ideation in both samples, and suicidal ideation was strongly associated with suicidal behaviour, while acquired capability for suicide and interpersonal competence did not show a direct association with it. (4) Conclusions: The findings highlight the protective role of interpersonal competence and perceived social support in the progression to suicidal behavior, suggesting cultural similarities and differences in how these factors operate. Full article

Self-harm among young women has been rising internationally and in Australia, yet many are not in contact with formal services. Peer support may play an important role in managing self-harm; however, it remains under-investigated. This qualitative study explored how young Australian women perceive peer support for managing self-harm. Using purposive sampling, twenty-seven women (M = 20.9, SD = 2.1) with lived or living experiences of self-harm participated in semi-structured interviews. Data were analysed using reflexive thematic analysis. Five themes highlighted perceived benefits and risks of peer support: 1. Affirmation—peer support offers understanding and validation that reduce shame and stigma; 2. Connection to community—shared experience reduces isolation and supports learning; 3. Empowerment—peer support promotes hope, autonomy, and help-seeking; 4. Capacity matters—limited psychological knowledge and emotional resources can constrain or burden peers; 5. Perception can be distorted—in un-moderated online contexts, normalisation, glamorisation, and competitive dynamics of self-harm may increase risk. These findings offer insight into how young women understand the different aspects of peer support for self-harm and may inform the development of structured and moderated peer support options. Future research should focus on the design and evaluation of safe and effective peer support initiatives. Full article

Rates of self-harm in Australian young people have increased significantly in recent years, especially in young women. Self-harm has been associated with several risk factors, including a history of abuse, bullying, mood and personality disorders, social isolation and suicidal ideation. However, little is known about why rates have increased in the past decade, and the voices of young Australian women have been conspicuously absent from the research. This study explored perceived subjective reasons for the increase in self-harm rates by interviewing 24 young Australian women with lived experience of self-harming behaviours. A reflexive thematic analysis identified three interwoven themes: ‘The world is hard, and it’s getting harder’, ‘New media exacerbates old challenges’, and ‘The online world brings unique challenges’. Participants also highlighted the complexity of social media as both a negative influence and a supportive factor. These themes extend previous research by highlighting the nuanced and multi-faceted psychosocial factors that influence self-harming behaviours and may help inform effective, evidence-based strategies that help minimise harm. Full article

Background/Objectives: A need for suicide prevention and postvention strategies in Higher Education was identified in the United Kingdom and has more recently been addressed with policies that provide national guidance for organisations. However, a paucity of qualitative research related to the lived and living experiences of attempted suicide in young adults remains. The experts in attempted suicide are those who have experienced it and the objective of our study was to learn from these lived experiences, with a particular focus on 16–25-year-olds in Further and Higher Education. Methods: The research presented in this article was part of a nationwide study in the UK which included 21 semi-structured interviews with young adults who met these criteria on the impact of attempting suicide on a personal, interpersonal, and institutional level, and support service experiences and engagement. It aimed to answer two key questions: 1. What can we learn from the lived experiences of young adults who have attempted suicide? and 2. How can these findings be applied to better meet the needs of young adults experiencing suicidal thoughts/behaviour in Further and Higher Education? Results: Reflexive Thematic Analysis was used to analyse the data, and four main themes were identified: firstly, the impact on ‘self’, including emotional and psychological impact; secondly, ‘others’, revealing the impact of and on relational factors, stigma, and judgement; thirdly, ‘systemic’, which highlighted support service experiences and barriers to accessing and engaging with possible support, and, fourthly, ‘what helps or could help’ on a relational, educational, and institutional level. Conclusions: The findings from this study generate new insights into this under-explored and stigmatised area and point to key barriers to support and gaps in service provision. Attempting suicide is one of the highest risk factors for a death by suicide and this study highlights the need for additional policy and support guidance for attempted suicide in Further and Higher Education. Full article

Background/Objectives: This study examined the specific vulnerabilities and experiences of persons with disabilities (PwDs) regarding sexual violence (SV) in Belgium. Methods: Data were drawn from the nationally representative UN-MENAMAIS survey (n = 4944), which included adults aged 16–99 years. SV was assessed using behaviourally specific questions based on validated international instruments. Logistic regression analyses examined associations between SV, disability status, sociodemographic, and mental health indicators. Results: PwDs reported a significantly higher lifetime prevalence of hands-on SV (37.8%) compared with those without disabilities (29.4%; p < 0.001, V = 0.065). PwDs also reported lower quality of life (p < 0.001, V = 0.273), and higher rates of depression (p < 0.001, V = 0.214), anxiety (p < 0.001, V = 0.145), PTSD (p < 0.001, V = 0.101), sedative use (p < 0.001, V = 0.237), and suicide attempts (p < 0.001, V = 0.124), though they reported less hazardous alcohol use (p < 0.001, V = 0.103) and cannabis use (p < 0.001, V = 0.080). Regression analyses showed that individuals assigned female at birth (p < 0.001) and those identifying as LGB+ (p < 0.001) were at a higher risk of both hands-off and hands-on SV. Among mental health correlates, depression, anxiety, PTSD, substance use, self-harm, and suicide attempts were significantly (all p < 0.001) associated with increased odds of SV. Conclusions: The findings highlight the need for targeted, inclusive prevention and support strategies addressing structural inequalities, ableism, and barriers to care to effectively prevent SV and revictimization among PwDs. Full article

Background: Artificial intelligence (AI) has been proposed as a transformative tool in suicide prevention, yet most evidence remains observational. To provide a rigorous benchmark, we systematically reviewed randomized controlled trials (RCTs) evaluating AI-based interventions targeting suicidal thoughts, behaviours, or help-seeking. Methods: Following PRISMA 2020 guidelines, MEDLINE, Web of Science, and Scopus were searched to 31 May 2025. Eligible studies were RCTs in humans that incorporated AI or machine learning for risk prediction, automated intervention, or treatment allocation. Methodological quality was assessed with the PEDro scale and certainty of evidence with GRADE. Results: From 1101 screened records, six RCTs (n = 793) met all criteria. Three studies tested machine learning risk prediction, two evaluated fully automated interventions (a transformer-based recommender and a digital nudge), and one examined AI-assisted treatment allocation. Risk-prediction models stratified short-term suicidal outcomes with accuracies of up to 0.67 and AUC values around 0.70. Digital interventions reduced counsellor response latency or increased crisis-service uptake by 23%. Algorithm-guided allocation reduced the occurrence of suicidal events when randomisation aligned with model recommendations. Methodological quality was moderate to high (median PEDro = 8/10), but GRADE certainty was low due to small samples and imprecision. Conclusions: AI can enhance discrete processes in suicide prevention, including risk stratification, help-seeking, and personalized treatment. However, the current evidence is limited, and larger multisite RCTs with longer follow-up, CONSORT-AI compliance, and equity-focused design are urgently required. Full article

Self-harm is often stigmatised by healthcare professionals. Little is known about how certain characteristics of the behaviour, like the degree of suicidal intent, affect clinicians’ judgements and responses. This study explored how intent of self-harm (suicidal or non-suicidal) affects trainee practitioners’ views and attitudes towards behaviour and clinical decision-making. A qualitative study using semi-structured online interviews was conducted. Interviews were audio-recorded, transcribed verbatim and analysed using a reflexive thematic analysis. Fifteen trainee healthcare practitioners (psychological wellbeing practitioners, clinical/counselling psychologists, nurses, and medics) were interviewed. Three themes were identified: (1) interpreting intent in self-harm: clinical utility and challenges, (2) the perceived responsibility of self-harm, (3) trainees’ struggle for equal care in a hierarchical system. Participants observed staff expressing pejorative views towards both forms of self-harm but did not share them. Across most clinical decisions, intent informed trainees’ judgements and beliefs. Clients presenting with suicidal-related self-harm received more urgent care but fewer therapeutic interventions. Trainees felt ambivalent about distinguishing intent. Nevertheless, this distinction was evident across treatment, risk and care decisions. A consistent approach towards suicidal and non-suicidal self-harm is important. Trainees should be supported in addressing difficult emotions arising from this work, helping to shift the blame culture and promoting a more empathic approach. Full article

Suicidal ideation and behaviours are common among adolescents. Parents play a fundamental protective role in the prevention of adolescent suicide, but many describe feeling ill-equipped in their caretaking role. This is despite prior research indicating that it is important for these parents to feel empowered to emotionally support their adolescent if they are experiencing suicidality. An online parenting program could offer parents flexible access to evidence-based parenting strategies. However, there are limited digital resources for these parents and, further, very little is known about how an intervention could be designed to support the empowerment of these parents. Therefore, the aim of the current study is to explore how an existing evidence-based, digital parenting intervention, Partners in Parenting (PiP+), could be adapted through co-design to empower parents. Four parents who have lived experience of caring for a suicidal adolescent, four young people who experienced suicidality during adolescence, and four experts in youth mental health/suicide prevention participated in four sets of co-design workshops to innovate adaptations to PiP+ to empower parents of suicidal adolescents. Affinity mapping was used to analyse and interpret findings. Three key themes highlight how a digital intervention could be innovated and adapted to empower parents caring for a suicidal adolescent. Specifically, for parents to feel empowered to parent a suicidal adolescent, a digital intervention should support them to (1) “deal with the now”; (2) “acknowledge needs and understand their role”, and (3) “hold hope for the future”. Further, ten sub-themes were developed illustrating different concepts related to these themes. Findings highlight how technological features could support parents to feel more empowered when caring for a suicidal adolescent. In conclusion, the proposed technological features illustrate how digital interventions can be adapted to empower parents in their role of emotionally supporting and managing the suicide risk of their adolescent. Full article