for the YST Study Team IMPORTANCE The prevalence of suicide among adolescents is rising, yet little is known about effective interventions. To date, no intervention for suicidal adolescents has been shown to reduce mortality.

Background: Our understanding of suicidal ideation (SI) and its risk precursors is largely informed by studies spanning over wide time intervals (weeks, months, years). Little is known about SI as it occurs in daily lives of individuals at risk for suicide, the extent to which suicidal thoughts are dynamic over short periods of time, and the degree to which theoretically informed risk factors predict near-term SI. Methods: Thirty-four adolescents hospitalized due to last-month suicide attempt and/or last-week SI (76% female; ages 13-17) responded to daily surveys sent to their cell phones for four consecutive weeks after discharge (n = 652 observations). Results: There was notable variability in day-to-day SI, with half of ideation ratings changing at least one within-person standard deviation from one day to the next. Results of mixed effects models revealed concurrent (same-day), but not shortterm prospective (next-day), associations between SI (frequency, duration, urge) and well-established predictors (connectedness, burdensomeness, hopelessness). However, synergistic effects of low connectedness with either high burdensomeness or high hopelessness were reliably associated with more severe same-and next-day suicidal ideation. Conclusions: This study adds to emerging literature indicating that suicidal thoughts fluctuate considerably among individuals at risk for suicide, further extending it by focusing on adolescents in the critical posthospitalization period. Fostering high-risk adolescents' sense of connectedness to others may be an especially promising intervention target. Frequent assessment of SI and its predictors, independently and in combination, could help identify promising predictors of short-term risk and meaningful intervention targets in high-risk teens.Little is known about the dynamic nature of suicidal ideation and its near-term association with risk factors; this study of adolescent utilized daily electronic diaries for a month after psychiatric hospitalization. Suicidal ideation, and its risk factors (hopelessness, connectedness, burdensomeness), fluctuated considerably day-to-day in the postdischarge period. These risk factors were concurrently, but not short-term prospectively, associated with suicidal ideation. Low connectedness combined with either high hopelessness or high burdensomeness was reliability associated with more severe same-and next-day ideation.

The current study examined characteristics of bullying involvement and social connectedness in relation to suicide ideation and attempts in a sample of youth who report bully victimization, bully perpetration, and/or low social connectedness. The sample was comprised of 321 youth (67% female), ages 12e15 years (M ¼ 13.6), recruited from an emergency department in the Midwest region of the United States. Results indicated that lower levels of social connectedness and higher levels of bully victimization and perpetration were significantly associated with suicide ideation and attempts. Level of social connectedness did not moderate the relationship between bullying involvement and suicide risk. The associations between the severity of subtypes of bully victimization and perpetration (verbal, relational, physical), electronic bullying involvement, and suicide risk were examined. Results highlight a continuum in severity of bullying involvement and social connectedness associated with suicide risk. Implications of these results are discussed.

The challenge of identifying suicide risk in adolescents, and particularly among high-risk subgroups such as adolescent inpatients, calls for further study of models of suicidal behavior that could meaningfully aid in the prediction of risk. This study examined how well the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS)—with its constructs of thwarted belongingness (TB), perceived burdensomeness (PB), and an acquired capability (AC) for lethal self-injury—predicts suicide attempts among adolescents (N = 376) 3 and 12 months after hospitalization. The three-way interaction between PB, TB, and AC, defined as a history of multiple suicide attempts, was not significant. However, there were significant 2-way interaction effects, which varied by sex: girls with low AC and increasing TB, and boys with high AC and increasing PB, were more likely to attempt suicide at 3 months. Only high AC predicted 12-month attempts. Results suggest gender-specific associations between theory components and attempts. The time-limited effects of these associations point to TB and PB being dynamic and modifiable in high-risk populations, whereas the effects of AC are more lasting. The study also fills an important gap in existing research by examining IPTS prospectively.

This longitudinal study examined the relationship between connectedness subtypes (family, school, community) and youth depression and suicidal ideation across a 6-month period within a sample of bully victimized youth. Participants were 142 youth (74.6% female, 47.18% African American, 36.62% Caucasian), 12-15 years of age (M = 13.6, SD = 1.12), recruited from an emergency department, who screened positive for elevated levels of bullying victimization and were reevaluated at a 6-month follow-up assessment. Data on bullying victimization, depression, suicidal ideation, and connectedness (family, school, community) were collected at baseline and 6-month follow-up assessments. Separate Bayesian mixed models were used to examine the effects of connectedness (family, school, community) on depression and suicidal ideation while accounting for dependent observations across time points. Prospectively, family and school connectedness were negatively associated with depression and suicidal ideation. Across time points, community connectedness was negatively associated with suicidal ideation. Results highlight the importance of acknowledging and understanding subtypes of interpersonal connectedness among victimized youth as the three subtypes examined (family, school, community) were associated with depression and suicidal ideation. Findings support the importance of bolstering distinct subtypes of connectedness in efforts to improve functioning and attenuate suicide risk among victimized youth.