Long-term impact of the Fostering Healthy Futures for Preteens program on suicide-related thoughts and behaviors for youth in out-of-home care: A randomized controlled trial.

Youth in out-of-home care are at high risk for suicide-related thoughts and behaviors (STB), yet there are no known efficacious interventions that reduce STB for this population. Fostering Healthy Futures for Preteens (FHF-P) is a 9-month community-based mentoring and skills training preventive intervention for children in out-of-home care. A randomized controlled trial enrolled 156 participants aged 9-11 years who were placed in out-of-home care over the prior year. Participants were 48.9% female, 54.1% Hispanic, 30.1% Black, and 27.1% American Indian. Follow-up interviews, conducted 7-12 years postintervention (85.2% retention rate), asked young adult participants, aged 18-22, to self-report lifetime STB as indexed by non-suicidal self-injury, suicidal thoughts, plans, and/or attempts. There was a nonsignificant reduction in the odds of STB for the intervention group at follow-up (OR = 0.74; CI, 0.32, 1.69). However, FHF-P significantly moderated the effect of baseline STB; control youth who reported baseline STB had 10 times the odds of young adult STB (OR = 10.44, CI, 2.28, 47.78), but there was no increase in the odds of adult-reported STB for intervention youth. Findings suggest that FHF-P buffers the impact of pre-existing STB on young adult STB for care-experienced youth. Further research is needed to identify mechanisms that may reduce STB in this population.

Sources and Types of Social Supports and Their Association with Mental Health Symptoms and Life Satisfaction among Young Adults with a History of Out-of-Home Care.

Young adults with a history of out-of-home care report poorer mental health and life satisfaction compared to non-care-experienced peers. Social support is a known protective factor for mental health. There is limited evidence, however, on the relationship between sources (e.g., family members) and types (e.g., information) of social support and mental health symptoms and life satisfaction in this population. Reporting cross-sectional survey data from 215 young adults aged 18-22 years with a history of out-of-home care, the current study conducted descriptive, bivariate, and linear regression analysis to examine the different sources and types of support young adults receive and their relation to mental health symptoms and life satisfaction. Participants had high levels of support from family members, friends, and other adults. Most participants had informational support, but less than half had consistent material support. Regression analyses demonstrated that having enough informational and material support were associated with fewer mental health symptoms. Having family support and material support were associated with greater life satisfaction. Further longitudinal research is needed to understand the trajectory between social supports and mental health functioning and life satisfaction.

Examining the Post-High School Effects of a Primary Prevention Program on Exposure to Bullying and Sexual Violence among Emerging Adults.

Emerging adulthood (EA) is a time of self-exploration as new opportunities for independence and autonomy arise. Yet, for some youth, this may also contribute to instability, uncertainty, and anxiety. Consequently, evidence suggests that rates of exposure to various forms of violence increase in EA. This study examined changes in experiences of bullying and sexual violence (SV) victimization among a sample of post-high school emerging adults who were exposed to a primary prevention program, Sources of Strength (Sources). We also examined whether Sources skills (e.g., healthy coping and help-seeking) buffer against these experiences. Participants were 102 emerging adults (73.5% identifying as female, 36.3% as Latinx, and 22.6% as LGBQ), who completed surveys at three time points: 1 month prior to graduation and at 6- and 12-months post-graduation. Results suggest that as youth transition into emerging adulthood, experiences of bullying victimization were relatively low and slightly decreased whereas experiences of SV were also relatively low, but stable over time. Notably, bullying victimization was lower when female-identifying participants, relative to males, had higher levels of healthy coping. In addition, SV victimization for participants identifying as non-white was higher at lower levels of coping than those identifying as white; however, at higher levels of coping, non-white participants reported lower rates of SV victimization, while rates were relatively stable for white participants at high and low levels of coping. These findings provide some support for the Sources program model where engaging in healthy coping may protect young women from bullying exposure and buffer against SV victimization for racial and ethnic minoritized young adults. Implications for violence prevention are discussed.

Few Do and To Few: Disclosure of Suicidal Thoughts in Friendship Networks of Young Adults Experiencing Homelessness.

Disclosure of one's suicidal thoughts is a pivotal but under-investigated mechanism for preventing suicide among young adults experiencing homelessness (YAEH). In a sample of 527 YAEH, we adopted a multi-level perspective to assess patterns and correlates of disclosure in their friendship networks. Less than one-third of YAEH disclosed their suicidal thoughts-half of them doing so during a suicidal crisis-and only disclosed to 21% of their friends. Multilevel modeling showed that YAEH who reported a history of unmet mental health needs were more likely to have disclosed to a friend, and friends who were sources of social support were most highly sought out for disclosures. Our findings highlight the need for cultivating safe environments that promote disclosures among YAEH.

Does the source matter? Social support and suicide attempts among homeless youth.

The impact of social support on suicide is understudied among youth experiencing homelessness (YEH). This is problematic because assumptions about the protectiveness of relationships may not generalize to conflictive YEH environments. This study, which included 1047 YEH, used path modeling with a logistic regression estimator to examine associations between social support from family, home-based friends, and street-based friends and past-year suicide attempt. Social support from home-based friends but not family or street-based friends decreased suicide attempt risk. Moreover, social support from home-based friends moderated the association between depression and attempt risk. Targeted programming strengthening home-based-friend relationships represents a valuable endeavor.

Burden, Belonging, and Homelessness: Disclosure and Social Network Differences among LGBTQ Youth Recruited from a Suicide Crisis Service Provider.

Among LGBTQ youth, suicidality and homelessness occur at heightened rates. Using the Interpersonal Theory of Suicide (ITS), this study seeks to explore the associations of having a parent, family member, friend, or romantic partner in one's social network and not being "out" to specific network members (lack of disclosure) with ITS constructs (perceived burdensomeness and thwarted belonging), considering homelessness history. Data include 462 youth aged 12-24 who contacted an LGBTQ youth-focused suicide crisis provider from 2015 to 2017. Disclosure status and network composition differed by homelessness experience. Homeless youth were more likely to disclose to their parents and less likely to disclose to other family members. Youth who had not disclosed to their parents reported higher perceived burdensomeness and thwarted belonging whereas having more family members and peers in one's network was associated with lower scores on ITS constructs. Implications for prevention approaches with youth who may be at increased risk for suicide are discussed.

Gatekeeping beliefs, intent, and behavior among homeless youth.

No research has explored the potential of homeless youth to serve as gatekeepers for suicide prevention purposes. This study described and examined associations between gatekeeping beliefs (i.e. preparedness and efficacy), intent-to-intervene, and gatekeeping behaviors (approach/referral behavior). In a sample of 139 homeless youth (aged 14-24), regression analysis was used to characterize associations between gatekeeper beliefs, intent, and behaviors. On average, participants engaged in gatekeeper behaviors with 1-2 people over the past 3 months. Gatekeeping beliefs and intent were positively associated with behaviors. Gatekeeper training that targets these attributes is a promising prevention strategy for homeless youth, but may require population-specific adaptation.

A longitudinal examination of the interpersonal theory of suicide for predicting suicidal ideation among LGBTQ+ youth who utilize crisis services: The moderating effect of gender.

INTRODUCTION: Despite high rates of suicide among LGBTQ+ youth, the interpersonal theory of suicide (IPTS) has rarely been examined in this population. The current study utilized a longitudinal design to examine whether perceived burdensomeness and thwarted belongingness independently and simultaneously predicted higher levels of suicidal ideation over time in a sample of LGBTQ+ youth who utilized crisis services. We also investigated whether gender identity moderated these associations. METHODS: A total of 592 youth (12-24 years old) who had contacted a national crisis hotline for LGBTQ+ youth completed two assessments 1-month apart. RESULTS: Perceived burdensomeness and thwarted belongingness independently predicted greater suicidal ideation 1 month later; however, only perceived burdensomeness remained prospectively associated with suicidal ideation when both factors were tested in the same model. Gender identity moderated the associations between IPTS factors and suicidal ideation, such that both perceived burdensomeness and thwarted belongingness were associated with greater suicidal ideation 1 month later for sexual minority cisgender young women and transgender/genderqueer individuals, but not for sexual minority cisgender young men. CONCLUSION: The IPTS helps explain increases in suicidal ideation over time among LGBTQ+ youth and therefore can be used to inform suicide prevention and intervention approaches for this population.

Understanding the Correlates of Firearm Violence Involvement Among Young Adults Experiencing Homelessness: A 7-City Study.

INTRODUCTION: Young adults experiencing homelessness are vulnerable to firearm violence. This study aims to explore the correlates of firearm violence involvement among this vulnerable population, which may inform firearm violence reduction intervention development. METHODS: Between 2016 and 2017, young adults experiencing homelessness aged 18-26 years (N=1,426) were recruited in 7 U.S. cities. Respondents completed a self-administered computer-assisted anonymous survey regarding their homeless experiences and violence involvement. Separate multivariate logistic regression models were conducted in 2020 to explore the correlates of direct firearm violence victimization, witness of firearm violence, and firearm violence perpetration. RESULTS: A high proportion of young adults experiencing homelessness were involved in firearm violence (witnessing firearm violence: 40%; direct firearm violence victimization: 28%; perpetration: 18%). Stressful experiences, such as childhood trauma and street victimization, were associated with greater odds of firearm violence involvement. Black (OR=2.4, p<0.001) and Latinx (OR=2.0, p<0.05) young adults had greater odds of experiencing direct firearm violence victimization than White young adults. Black (OR=2.0, p<0.01) and Latinx (OR=2.4, p<0.001) young adults were also at greater risk of witnessing firearm violence. Young adults with mental illness had greater odds of being directly victimized by firearm violence (OR=1.7, p<0.01). CONCLUSIONS: Given the inter-related nature of firearm violence involvement and given that risk factors for violence are often embedded in social and structural contexts, multipronged community-based approaches to prevent firearm violence among young adults experiencing homelessness are necessary. Targeted efforts may be indicated to attenuate the risk and promote resilience among subgroups of young adults experiencing homelessness who are disproportionately affected by firearm violence.

Firearm Access and Suicidal Crises Among Young Adults Experiencing Homelessness in the United States.

Background: Young adults experiencing homelessness (YAEH) report high rates of suicidal crises. Having access to firearms during suicidal crises elevates risk of death by suicide. Yet, no known information exists about firearm access among YAEH. Aims: We aimed to examine the proportion of participants who had firearm access, as well as the association between past-year suicidal crises and firearm access among participants. Method: We recruited 1,426 YAEH (18-26 years old) from homelessness service settings in seven US cities. Logistic regression analyses were used to examine the association between past-year suicidal crises and firearm access. Results: One third of the sample reported having easy firearm access. YAEH who experienced suicidal ideation and suicide attempts were more likely to report firearm access. Limitations: Results from this cross-sectional study cannot be causally interpreted nor generalized to all YAEH. Conclusion: A substantial segment of YAEH had easy firearm access and it was more common for YAEH with suicidal crises to have firearm access. Reducing firearm access should be part of suicide prevention planning for YAEH in the US but requires comprehensive and innovative solutions.

Sexual Minority Stress, Mental Health Symptoms, and Suicidality among LGBTQ Youth Accessing Crisis Services.

Sexual and gender minority youth are at elevated risk for suicide. Studies have separately established the relation between minority stress and mental health symptoms, as well as minority stress and suicidality. However, no known research has simultaneously examined different mental health mechanisms whereby minority stress may be associated with different suicidal experiences (e.g., suicidal ideation, suicide attempts). The present study used data from a national sample of 572 sexual and gender minority youth aged 12 to 24 (mean age = 17.59; SD = 3.13) recruited from an LGBTQ youth-focused suicide crisis prevention provider. Nearly one-third of the sample (30.2%) identified as transgender, genderqueer, or questioning. Nearly one quarter of the sample (24.3%) identified as gay, 17.1% as pansexual, 16.8% as bisexual, and 15.2% as lesbian. Structural equation modeling was used for mediation analyses to explain suicidal ideation and suicide attempts. Serial mediation models were determined to be the best fit for both suicide-related outcomes. Minority stress was associated with depressive and PTSD symptoms, which were linked with suicidal ideation and attempt through hopelessness. The findings supported the hypotheses that minority stress would be associated with suicidality not just directly, but also indirectly through multiple mental health symptom pathways.

Firearm Violence Exposure and Suicidal Ideation Among Young Adults Experiencing Homelessness.

PURPOSE: This study aimed to explore the association between direct exposure, indirect exposure, and perpetration of gun violence and suicidal ideation among young adults experiencing homelessness (YAEH). METHODS: YAEH (n = 1,426) in seven cities across the U.S. were surveyed. Logistic regression analyses were conducted to examine the association between lifetime gun violence exposure and suicidal ideation in the past 12 months. RESULTS: Forty-five percent (n = 641) of YAEH had experienced direct or indirect gun violence, whereas 17% (n = 247) had engaged in gun violence perpetration. Gun violence perpetration is associated with elevated suicidal ideation risk (odds ratio = 1.46; 95% confidence interval = 1.02-2.01) among YAEH. CONCLUSIONS: A high percentage of YAEH were exposed to firearm violence. Cross-sector, multiagency collaborations are warranted to reduce firearm violence exposure among this vulnerable population. Homeless service providers should screen for gun violence exposure and suicide risk and target prevention efforts on YAEH with a history of gun violence perpetration.

Integrating Minority Stress Theory and the Interpersonal Theory of Suicide among Sexual Minority Youth Who Engage Crisis Services.

OBJECTIVE: The present study sought to integrate minority stress theory (MST) and the interpersonal theory of suicide (ITS) to better understand high rates of suicide among sexual minority youth (SMY). To date, the ITS and MST have largely advanced independently from one another even though the research base for each theory contains gaps that the other theory may help fill. METHOD: Using data from a national sample of 564 SMY (aged 12-24) recruited from an LGBTQ youth-focused suicide crisis prevention provider, we examined structural equation models to understand how perceived burdensomeness and thwarted belongingness mediate the relationship between minority stress and suicidal ideation and attempt. RESULTS: Sexual minority stress was significantly associated with both perceived burdensomeness and thwarted belongingness in models predicting suicidal ideation and attempt. Moreover, minority stress had a direct effect on suicide attempt and an indirect effect on both suicidal ideation and suicide attempt through burdensomeness. CONCLUSIONS: Given that minority stress is associated with greater thwarted belongingness, perceived burdensomeness, and suicide attempts, there should be greater demand for continuing education centered on sexual minority populations and population-specific services. Identifying burdensomeness as a minority stress-suicide mechanism highlights the potential gains of piloting recently developed burdensomeness interventions among SMY.

Individual and Social Network Correlates of Sexual Health Communication Among Youth Experiencing Homelessness.

Despite the potential for sexual health communication to be leveraged for HIV prevention among youth experiencing homelessness (YEH), there has yet to be a rigorous examination of individual and network or relational characteristics associated with sexual health communication in this group of young people. Cross-sectional survey and social network data from 1014 YEH aged 14-25 recruited in Los Angeles, California, were utilized to assess individual and network or relational characteristics associated with communication regarding condom use and HIV testing among YEH. Results suggest that social networks are key to understanding sexual health communication; YEH's engagement in sexual health communication was significantly related to the composition of their networks. To increase testing and decrease new HIV cases, a prudent strategy would be to train existing social network members (e.g., staff members, home-based peers, or partners) as agents of change in naturally occurring social networks of YEH.

Are the "Right" People Selected for First Disclosures About Suicidal Thoughts? Exploring What We Know About Advance Care Planning in the Context of Safety Planning.

Nominating primary confidants (i.e., safety plan nominees) is central to safety planning for suicide but there is a dearth of research about such confidants-a serious oversight given their high-leverage position to affect pathways into clinical care. Informed by advance care planning (ACP) work, this study examined differences between social network members who were and were not identified as primary confidants on attributes that could impact their effectiveness in a helping role. Using social network methodology, information was collected from 41 individuals with affective disorders about the 332 people and relationships in their networks. Logistic regression analysis revealed that being perceived as capable of managing stress and prioritizing the participant's best interests over one's own increased the odds of being a primary confidant. Clinicians working with suicidal individuals may benefit from integrating ACP principles-which recognize the thoughtful selection of nominees based on specific attributes-into their safety planning procedures.

What's in a word? Clarifying terminology on suicide-related communication.

Efforts to clarify suicide terminology fail to address nuances in suicide-related communication, often relying on poorly-defined terms or implying communication exists primarily as manipulation. In the present paper, we review examples from existing literature and explore how personal suicide-related communication differs from prevention and exposure communication. We also separate definitions for five common types of personal-suicide-related communication: (a) suicide-related disclosure, (b) suicide-related notification, (c) unintended suicide-related communication, (d) coerced suicide-related communication, and (e) conditional suicide-related communication. Finally, we provide specific ways in which standardized definitions can enhance both research and clinical efforts in the future.

Recipients of Suicide-Related Disclosure: The Link between Disclosure and Posttraumatic Growth for Suicide Attempt Survivors.

It is important to explore factors that could help or hinder one's wellbeing following a suicide attempt, which could yield not only negative consequences but also posttraumatic growth (PTG; positive changes following a traumatic event). The present study used a multivariate analysis of covariance (MANCOVA) to test the relationship between disclosure, PTG, and posttraumatic depreciation among suicide attempt survivors when controlling for time since attempt and to test whether these effects remained after controlling for quality of support from family and friends. Suicide attempt survivors (n = 159) completed an online survey about their experiences. Increases in disclosure to family and friends but not to healthcare providers predicted changes in PTG. The effects of family disclosure remained even after controlling for quality of support. Disclosure to healthcare providers demonstrated some statistical effects on PTG, yet in the opposite direction and only after controlling for quality of support. The control variables-time since attempt and quality of support-were the only variables that predicted a change in posttraumatic depreciation. These findings suggest there is value in disclosing one's personal story to family regardless of whether one receives supportive responses and that social support can impact one's PTG.

Is There a Need for LGBT-Specific Suicide Crisis Services?

Background: Lesbian, gay, bisexual, and transgender (LGBT) youth are more than twice as likely to attempt suicide than their peers. Although LGBT-specific crisis services have been developed, little is known about the need for these services beyond that of general lifeline services. Aims: The present study sought to (a) describe the primary reasons for calling a specialized provider as opposed to another and (b) examine sociodemographic differences in the primary reason by race, ethnicity, gender, age, and sexual orientation. Method: Data from 657 youth who sought crisis services from an LGBT-specific national service provider in the United States were assessed. Logistic regression models assessed demographic differences. Thematic analysis of open-ended responses regarding reasons for choosing this LGBT-specific crisis service provider followed a consensus model. Results: Most respondents indicated they either would not have contacted another helpline (26%) or were not sure (48%). Nearly half (42%) indicated they called specifically because of LGBT-affirming counselors, a reason more commonly reported by gender minority (transgender and gender nonbinary) and queer or pansexual youth than cisgender, gay, or lesbian youth. Conclusion: LGBT-specific crisis services appear to play an important role in suicide prevention. Further research is needed to understand the use of culturally tailored suicide prevention approaches.

Exploring suicide-related disclosure motivation and the impact on mechanisms linked to suicide.

Suicide-related disclosure enables improved risk management but disclosure motivations are understudied. This study identified reasons for and against disclosing suicidal thoughts and examined their link to future disclosure and interpersonal needs among 44 people receiving psychiatric care. The most endorsed reasons for disclosure (approach-motivations) included help-seeking, shared background, and catharsis. The most endorsed reasons against disclosure (avoidance-motivations) included fear of rejection, shame, and hospitalization. Higher mean approach motivation was associated with more disclosure intent and less burdensomeness. No associations with avoidance motivation were observed. Programming that seeks to orient people toward approach motivation holds promise for attenuating suicide risk.

Suicidal Ideation and Behavior Among Youth Victims of Sex Trafficking in Kentuckiana.

Background: Youth experiencing homelessness are at risk for sex trafficking and mental health concerns. Aims: More information is needed to elucidate the prevalence and characteristics of suicidal ideation and behavior among youth experiencing sex trafficking. Method: The present study examined suicidal ideation and behavior in a convenience sample of 128 youths experiencing homelessness aged 12-25 years in metropolitan Louisville, Kentucky, and southern Indiana. Participants were asked seven questions regarding suicidal ideation and attempts as part of an enhanced version of the 60-item Youth Experiences Survey (YES). Results: Approximately 53% of the sample reported experiencing suicidal ideation at some point in their lifetime and the odds of a youth experiencing homelessness who had experienced sex trafficking reporting suicidal ideation was 3.87 times higher than the odds of a youth experiencing homelessness who had not experienced sex trafficking. Additionally, of those who reported experiencing suicidal ideation, the majority (84.4%) reported they had attempted suicide in their lifetime. Limitations: This study relied on a convenience sample of youth receiving services in the Kentuckiana region and brief, self-report measures yielding categorical data. Conclusion: Programs servicing youth experiencing homelessness should require additional training and resources regarding the identification, screening, and assessment of youth who are at risk of or who have experienced sex trafficking in order to more quickly connect youth with much-needed, trauma-informed services.