Open research questions in Suicide and Self-Harm Studies

What the literature leaves open

• Although thyroid and sex hormones have been implicated in emotional and behavioral dysregulation, whether their associations with NSSI differ between major depressive disorder (MDD) and bipolar disorder (BD) remains unclear.

  Characteristics of non-suicidal self-injury and its associations with thyroid and sex hormones in adolescents with major depressive disorder and bipolar disorder · 2026 · DOI

• Although previous research has established associations between depressive symptoms, DER, and NSSI, the within- person temporal dynamics underlying these associations and their potential moderation by sex remain unclear.

  Emotion Dysregulation as a Longitudinal Mediator between Depressive Symptoms and Non-Suicidal Self-Injury in Adolescents: Insights from a Random Intercept Cross-Lagged Panel Model · 2026 · DOI

• There were mixed findings with regards to suicide-specific outcomes: multi-informant reports of FD were not associated with concurrent levels of adolescent-reported suicidal ideation, whereas caregiver-adolescent FD discrepancy was associ- ated with adolescent self-rated future suicide risk, a con- struct predictive of adolescents’ ability to keep themselves safe during suicide crises (Czyz et al.

  An Investigation of Family Functioning Among Caregiver-Adolescent Dyads Seeking Emergency Department Care for Adolescent Suicide Risk · 2026 · DOI

• To address the increasing prevalence of youth suicidal out- comes and the disproportionate burden of suicide on eth- noracially minoritized individuals, it is critical to investigate both the individual and systemic factors that increase risk for engagement in SITBs. In particular, identifying the unique and potentially compounded effect(s) of key risk and protec- tive factors – spanning JLS involvement, gender and racial- ethnic identity, ACEs, discrimination, and familism – with accounting for a number of potential confounding factors, is an important innovation. We await additional rigorous tests of these associations across more diverse designs, participant characteristics, etc. that are expected to accelerate innova- tions in intervention and prevention development. These innovations are necessary to reduce the significant clinical and public health burden associated with suicidality in youth. Authors Contributions All authors conceived research question and data analytic plan. SS analyzed data and wrote the manuscript. All au- thors edited the manuscript. All authors read and approved the manu- script. Funding This research received no specific grant from any funding agency, commercial or not-for-profit sectors. Data Availability Data used in the preparation of this article were obtained from the Adolescent Brain Cognitive DevelopmentSM (ABCD) Study (https://abcdstudy.org), held in the NIMH Data Archive (NDA). The ABCD Study® is supported by the National Institutes of Health and additional federal partners under award numbers U01DA041048, U01DA050989, U01DA051016, U01DA041022, U01DA051018, U01DA051037, U01DA050987, U01DA041174, U01DA041106, U01DA041117, U01DA041028, U01DA041134, U01DA050988, U01DA051039, U01DA041156, U01DA041025, U01DA041120, U01DA051038, U01DA041148, U01DA041093, U01DA041089, U24DA041123, U24DA041147. A full list of supporters is available at h t t p s : / / a b c d s t u d y . o r g / f e d e r a l - p a r t n e r s . h t m l. ABCD consortium i n v e s t i g a t o r s designed and implemented the study and/or provided data but did not necessarily participate in the analysis or writing of this report. This manuscript reflects the views of the authors and may not reflect the opinions or views of the NIH or ABCD consortium investigators. The ABCD data repository grows and changes over time. The ABCD data used in this report came from the 2024 Data Release 5.1 (DOI: h t t p s : / / d o i . o r g / 1 0 . 1 5 1 5 4 / z 5 6 3 - z d 2 4).

  Effects of Childhood Police Contact on Adolescent Suicidality: A Propensity Score Matched Analysis · 2026 · DOI

• The recommendations identified in this review must be cautioned for implementation given the low quality of results and lack of evidence- informed actions. The ability to synthe- sise evidence is hampered by poor reporting on outcomes of interest, lack of agreement in operational definitions of self-harm across the literature and limited quality of peer- reviewed publications. Professionals working in schools such as schools psychologists may face chal- lengs in such critical work in schools, without guidelines that highlight the important of tailoring responses to culture and contexts of young people and specific practice strate- gies.

  Systematic Review of Best Practice Guidance for Schools to Respond to Self-Harm · 2026 · DOI

• Although previous research has consistently documented elevated risk-taking in individuals with STB and identified mood disturbances as central features of suicidality, the precise cognitive and affective computational mechanisms underlying this increased risky behavior remain poorly understood.

  Mood computational mechanisms underlying increased risk behavior in adolescent suicidal patients · 2026 · DOI

• Accordingly, it remains unclear whether the observed biomarker alterations pre- cede, follow, or simply co-vary with self-harm pheno- types, and longitudinal studies are needed to clarify these relationships. Second, when grouping participants ac- cording to medication use, we did not control for the spe- cific psychotropic drug(s) used.

  Serum Wnt Pathway Regulators in Adolescents with Suicidal Behavior Disorder and Nonsuicidal Self-injury Disorder: A Case-control Study · 2026 · DOI

• Several limitations of this study should be acknowl- edged. First, the ecological design precludes inferences at the individual level, known as the ecological fallacy. While we identified associations at the population level, these relationships may not hold for individuals. Second, despite data cleaning and validation, the underreporting of suicide, particularly due to social and religious stigma, remains a potential source of bias, which is a common challenge in suicide research in the region. Third, the analysis did not include other potentially confounding variables, such as access to mental health services, sub- stance use patterns, or media reporting on suicide, which could influence incidence rates. Finally, the use of an- nual SDI data, while informative, may not capture more granular temporal changes within each year.

  The Relationship Between the Misery Index, Socio-demographic Index, and Suicide: A 10-year Analysis · 2026 · DOI

• Although the study followed a rigorous methodology, given the differential regional attention to mental health in Colombia, the regional differences in its approach and conception, and the participants in the population study, the comparison and generalization of our findings is lim- ited. Furthermore, other psychosocial aspects associated with recovery, other academic aspects related to psychi- atric training, and the role of mental health professionals other than physicians could have been better explored. Future research could address, from the perspective of health service administrators and decision-makers, those factors that link health professionals to coercive practices, especially the lack of continuous management and alterna- tive care. An additional limitation of this study is the potential for recall bias, as participants were asked to retrospectively describe suicide crisis events and the interventions that fol- lowed. In some cases, these experiences may have occurred several months before the interviews, which could have affected the precision, completeness, or interpretation of the accounts. This is particularly relevant given the emotionally intense nature of suicidal crises, as participants’ recollec- tions may have been shaped by the passage of time and by their subsequent experiences with care.

  “They Don’t Know About Suffering”: Reasons from Physicians and Users for the Use of Coercion After a Suicide Attempt in Latin America · 2026 · DOI

• There are limitations to the present study that warrant con- sideration. Importantly, most of our focus group participants identified as white and were predominantly women. We should consider more diverse perspectives in the develop- ment of suicide prevention interventions for youth exposed to child maltreatment. We recommend that future work uses culturally sensitive community-based approaches to intervention development and implementation and include diverse perspectives and community voices who are typi- cally invisible. Additionally, there was one participant who reported having lived experience of childhood maltreat- ment. We recommend future qualitative studies and inter- vention development efforts include youth and adult voices from those with lived experiences in the child protective system and/or histories of exposure to child maltreatment.

  Developing a Suicide Prevention Intervention for Youth with Maltreatment Histories: Challenges and Opportunities · 2026 · DOI

• The final domain that emerged from our coding of focus groups and interviews was Future Directions (Table 3). In this domain, participants spoke about ideas or next steps for ways to prevent suicidal thoughts and behaviors for youth exposed to maltreatment. Within this domain, there were three core ideas that were labeled as ‘typical’. First, partici- pants suggested various community settings (as opposed to clinical settings) may be ideal for preventing suicide in this subpopulation. A variety of settings were proposed, includ- ing community centers, sports leagues, and religious institu- tions. These settings may be optimal to intervene with youth who are maltreated, who often are transient due to their involvement in the foster care system. Relatedly, partici- pants commonly discussed schools as a setting for suicide prevention interventions. Schools can provide resources and support for youth who are having suicidal thoughts or who are struggling otherwise. Additionally, schools are an ideal setting to intervene on a large-scale (i.e., universal or selec- tive prevention). School-based suicide prevention interven- tions such as Sources of Strength (Wyman et al., 2010) may help to reduce STBs among at-risk youth with histories of child maltreatment, although this has yet to be tested. Par- ticipants also spoke about gatekeeper training, a suicide prevention strategy that imparts psychoeducation about sui- cide risk factors and referral resources to individuals likely to interact with populations at risk for suicide (Isaac et al., 2009): “And then also with those suicide preventions having the teachers and principals and whoever staff mem- bers attend to just give a refresher for them as well… If the teachers were revamped on it I think they would definitely be able to maybe not deal with it but be like hey school counselor I noticed this we gotta get some- thing going.” (Site 1) The third core idea rated as typical in the theme of future directions for suicide prevention was that suicide prevention strategies should be upstream, meaning we need to intervene to reduce risk factors and promote protective factors before STBs emerge. Participants suggested the need to help youth with maltreatment histories learn coping mechanisms, for instance, and to provide them with supportive adult figures they can talk to when in need. There were six core ideas about future directions which were labeled as variant. Several of these were specific ideas for types of suicide prevention interventions. For instance, Journal of Child & Adolescent Trauma1 3 several participants in both focus groups and interviews recommended peer-based prevention (i.e., suicide preven- tion programs facilitated by peers or that involve a focus on building peer relationships). Several focus group par- ticipants were youth peer specialists, and they consequently recommended peer specialists could provide suicide pre- vention. For instance: “We just started with a youth peer advocate and it’s also a youth peer support and we are also lived expe- rience. So a lot of people that are youth peer advo- cates also might have that same trauma or mental health issue and we can be able to help the youth. Be able to talk things out and try at least to help that youth.” (Site 1) Additionally, some participants recommended that youth peer advocates (or other similar positions, such as youth peer specialists) be entrenched in schools to support youth who have trauma exposure and/or who otherwise need support: “What if we had schools see if we can get all schools to be able to have youth peer advocates that have life experiences? That the youth can just come straight to the youth peer advocate.” (Site 1) Focus group and interview participants also gave recom- mendations for where to conduct suicide prevention pro- grams. Several participants recommended prevention be offered in reparative settings, including youth punishment system settings. Additionally, participants discussed the possibility of suicide prevention within the child protec- tive system. Specifically, offering gatekeeper training to CPS professionals and other adults who interact with youth within the system, such as foster care families, might help detect youth exposed to maltreatment with an elevated risk for suicide. Relatedly, the need for family-based prevention was discussed in one focus group and two interviews (Table 3).

  Developing a Suicide Prevention Intervention for Youth with Maltreatment Histories: Challenges and Opportunities · 2026 · DOI

• Several limitations should be acknowledged. First, the study employed a cross-sectional exploratory design and relied on a self-report, closed-ended questionnaire with binary-scored Journal of Child & Adolescent Trauma1 3 responses rather than objectively verified events. As such, the findings primarily reflect self-reported prevalence of ACEs and SI, and the binary scoring restricted the ability to capture the complexity and severity of these experiences. Second, while RF and MLR analyses identified bullying and SA as significant predictors of SI, the cross-sectional and self-report design of the study limits the ability to infer true causal rela- tionships between these variables (Baier et al., 2019). Third, the study was unable to externally verify or observe the reported experiences. Since all data were self- reported, responses may be subject to various forms of bias, such as social desirability bias, particularly for sensitive issues like sexual abuse (Fisher, 1993), response bias (both acquiescent and non-acquiescent bias), recall bias, and the inherent subjectivity associated with closed-ended ques- tions (Demetriou et al., 2015). Fourth, the small sample size also constrains the generalisability of the findings to the wider adolescent population. Given these limitations, the findings of this study should be interpreted with caution. Therefore, future research should consider larger and more representative samples, incorporating qualitative methods such as observations and interviews, to ascertain the present study`s findings. Finally, items related to war and collective violence were excluded in this study, assuming their low relevance in the Bhutanese context. Consequently, the measure`s intended scope may be somewhat limited. While similar approaches have been adopted in other contexts where such experiences are considered less relevant (Chen et al., 2022), we recom- mend that future research involving this population include collective/war violence items to ensure that any such expe- riences are adequately captured.

  Prevalence of Adverse Childhood Experiences and Suicidal Ideation Among Bhutanese Adolescents · 2026 · DOI

• This study was novel in its approach, as stakeholders are often only involved in research after it has been funded and the study commences. This is serves as a good example of collaboration at the study design stage. There is also a dearth of research where children and young people with experience of suicidality are involved beyond the role of research respondent, and we have evidenced that despite concerns about risk, this can not only be achieved, but experienced positively by those involved. A strength of this paper is the inclusion of co-author IM’s reflections on their involvement of the project. However, we also wish to acknowledge that it would have been preferrable to extend this offer to other CYP, but, as is often the case in academic research, paper writing takes place following completion of the funded study; therefore, we were unable to provide the follow-on support and resources needed for this. The careful planning and engagement approach taken throughout this project required dedicated researcher time. Future co-produced research should incorporate sufficient time as well as continued access to finances to compensate people fairly for their time to enable this. Although we had initially intended to recruit parents to the co-production group, we were unsuccessful prior to the first group workshop. At this workshop we asked those attending whether this was something we should urgently address; however, the young people strongly expressed that although parents’ views are important and they should be consulted, they should not be in the same space as young people as their voices can often be more dominant and inhibit young people from freely expressing their views. This is something we built into the design of the protocol for the future study, but the absence of parent views in this study remained. Another limitation was that we did not seek permission to use direct quotes from the evaluation forms and informal feedback we received in publications such as this. For future research activity requesting this by prior consent would be recommended.

  Co-production of a Research Protocol With Children and Young People With Experience of Suicidality: The Mechanics, Results and Reflections · 2026 · DOI

• Findings support CFT’s potential as a targeted intervention addressing core mechanisms underlying NSSI in this vulnerable population, warranting further investigation with larger samples and longer follow-ups.

  Compassion-Focused Therapy for non-suicidal self-injury, shame, and self-criticism in adolescent girls: A pilot study · 2026 · DOI

• Although chaplaincy is a key part of the Department of Veterans Affairs' (VA) healthcare services, few studies have investigated how classified suicide risk impacts this service utilization.

  Evaluating chaplaincy utilization in a suicide-risk-stratified Veterans Affairs patient sample · 2026 · DOI

• Despite growing recognition of the role of family dynamics in youth NSSI, the specific mechanisms through which parental communication behaviors contribute to early-onset NSSI remain poorly characterized, particularly within the Chinese cultural context.

  Attentional negativity and emotional symptoms as serial mediators linking parental verbosity to non-suicidal self-injury in Chinese pre-adolescents · 2026 · DOI

• Future studies should examine the performance of the FSII in clinical or high-risk samples, where a wider distribution of suicidal ideation scores may allow a more detailed evaluation of CFA and IRT parameter stability. Consequently, the diagnostic or screening performance of the FSII remains unknown, and sensitivity, specificity, and optimal cut-off points could not be estimated.

  Psychometric properties of the frequency of suicidal ideation inventory (FSII) in pregnant women: evidence from SEM, measurement invariance, and IRT models · 2026 · DOI

• Conclusion This report contributes to the literature by documenting a pro- longed fugue state directly following a suicide attempt, with compre- hensive multidisciplinary evaluation and longitudinal observation. The This case describes a rare presentation of dissociative amnesia with fugue emerging immediately after a suicide attempt, TABLE 2 Learning points from case report.

  Dissociative amnesia with fugue following a suicide attempt: a rare clinical intersection of identity loss and suicidal ambivalence: a case report · 2026 · DOI

• Findings should be considered alongside the study’s limitations. First, due to unexpected personnel changes, the CSQ (i.e., measure of client satisfaction), which was administered as a paper-based self-report survey following the PLOS One | https://doi.org/10.1371/journal.pone.0350008 June 10, 2026 10 / 13 participant's last group attendance, was only administered to just over half of the participants in the STEP condition. This means that self-reported satisfaction with the intervention is not as generalizable as we would have preferred. However, there were no clinical, demographic, or engagement related differences between those who did and did not complete the CSQ. Those who did complete the CSQ rated the intervention highly. Future researchers may seek to fully digitize administration of client satisfaction surveys to ensure completion. Relatedly, attendance in group sessions was not as high as we had planned and follow-up data was provided by just under 60% of the STEP condition. These retention rates are similar to what is found in other intervention studies with younger populations (see [40]), and likely reflect the barriers that commonly affect sustained engagement in treatment. These findings underscore the importance of incorporating flexible delivery models when implementing group-based interventions with youth. Third, the sample was small and not adequately powered to observe between-group differences; as such, we cannot fully speak to the efficacy of the treatment; however, preliminary findings were promising. Somewhat related to this point, preliminary efficacy of the treatment was assessed over a 4-month follow-up, a longer follow-up period would help substantiate whether treatment gains are robust and long-lasting. It is important to note that pilot studies are intended to only pro- vide information on feasibility, acceptability, and initial effects on outcomes, and the preliminary data from this study is promising in terms of STEP’s feasibility, acceptability, and potential efficacy in modifying the targets of the interven- tion. Finally, because the majority of the sample identified as female, the generalizability of findings to males is limited. This gender composition is consistent with other clinical trials, which also tend to overrepresent women [41]. Notably, one study suggests that men may have a slight preference for group-based interventions compared to women [41], highlighting the importance of intentionally recruiting more male participants in future research to better evaluate the broader applicability of this intervention.

  A pilot randomized clinical trial of the Skills to Enhance Positivity (STEP) group intervention for young adults with depression: Examining feasibility and acceptability · 2026 · DOI

• Overall, the findings from the current study demonstrate that schizophrenia-related suicide mortality in the United States has increased over the past 25 years, with recent increases driven primarily by male ARTICLE IN PRESS ARTICLE IN PRESS ACCEPTED MANUSCRIPT decedents. These findings underscore the need to strengthen suicide prevention for individuals with schizophrenia-spectrum and related psychotic disorders, particularly through sustained risk assessment, improved continuity of psychiatric care after hospitalization, support for medication adherence, integrated treatment for comorbid substance use, and outreach strategies that address male underutilization of mental health services. Expanding access to long-acting injectable antipsychotics may also reduce relapse and associated suicide risk. Given the elevated mortality observed among men, gender-responsive approaches, such as outreach embedded in community settings, peer support models, and interventions that address stigma and barriers to help-seeking, are particularly warranted. Although these findings are generalizable to U.S. death certificate-coded schizophrenia-related suicide mortality among individuals aged 15 to 74 years, they should not be interpreted as capturing all suicides among people living with schizophrenia. Future studies should compare mortality trends across psychiatric diagnostic groups, including schizophrenia-spectrum disorders, mood disorders, and substance use disorders, to determine whether the observed trends are specific to schizophrenia-related suicide mortality or reflect broader patterns among people with severe mental illness. Analyses that disaggregate F20-F29 diagnoses may also help determine whether temporal trends differ across chronic schizophrenia, delusional disorders, and other psychotic conditions. Longitudinal studies linking mortality data with ARTICLE IN PRESS ARTICLE IN PRESS ACCEPTED MANUSCRIPT clinical, medication, and service utilization records could help clarify the role of treatment adherence, comorbid substance use, and psychiatric care engagement in suicide risk. Additionally, qualitative and mixed-methods research is needed to understand how gendered experiences, such as stigma, social isolation, and help-seeking behavior, shape suicide trajectories among people with schizophrenia. Reducing schizophreniarelated suicide mortality will require rigorous evaluation of emerging interventions and sustained investment in accessible, coordinated, and equitable mental health care. TABLES AND FIGURES Table 1.

  Schizophrenia-related suicide mortality in the United States by sex, 1999–2023 · 2026 · DOI

• Several limitations should be considered when interpreting these findings. This analysis relied on death certificate data, which may underestimate the true burden of schizophrenia-related suicide due to potential misclassification of mental health diagnoses or manner of death. Although U.S. vital statistics data provide near-complete death registration, this coverage should not be interpreted as evidence of complete or perfectly accurate ascertainment of psychiatric diagnoses listed as contributing causes. Diagnostic accuracy may vary depending on available medical records, clinical documentation, certifier knowledge of psychiatric history, and local death investigation practices. Psychiatric conditions may be less consistently recorded on death certificates than acute medical causes or injuries, particularly when they are not viewed as directly contributing to the fatal event. Under-ascertainment may also reflect administrative burden, incomplete clinical documentation, limited access to psychiatric history at the time of death certification, and stigma surrounding severe mental illness. ARTICLE IN PRESS ARTICLE IN PRESS ACCEPTED MANUSCRIPT Additionally, the use of ICD-10 codes does not allow for differentiation among schizophrenia subtypes or comorbid psychiatric conditions, which could influence risk. The F20-F29 category also includes a heterogeneous group of schizophrenia-spectrum and related psychotic disorders that may differ in chronicity, etiology, clinical course, and suicide prevention needs. For example, some psychotic states may be more transient or substance- related, whereas others reflect chronic schizophrenia-spectrum illness. Because annual counts were small, especially among female decedents, subgroup analyses by individual F20-F29 diagnoses were not conducted. Moreover, suicide deaths in which schizophrenia, schizotypal disorder, or other delusional disorder was not listed as a contributing factor on the death certificate were not included. Therefore, the 3,507 deaths identified in this analysis represent a subset of suicide deaths among people with schizophrenia-spectrum disorders, rather than the full burden of suicide mortality in this population. Given that schizophrenia is highly stigmatized, the true public health burden of schizophrenia-related suicide mortality is likely to be underestimated. Finally, because schizophrenia-related suicide deaths are relatively rare events, annual counts, particularly among female decedents, were small, limiting precision in trend estimates.

  Schizophrenia-related suicide mortality in the United States by sex, 1999–2023 · 2026 · DOI

• Nonetheless, the study has several limitations. First, the relatively small sample size may limit the statistical power and generalizability of the findings. It is imperative that we exercise greater caution when interpreting our research find- ings, and we intend to conduct future studies with larger sam- www.psychiatryinvestigation.org 631 Y Yin et al. ple sizes. Second, the study was conducted at a single site, which significantly limits the generalizability of the results to diverse patient populations and different clinical settings. Fu- ture research should address this by conducting multi-center studies across various geographic locations and healthcare systems to validate the effectiveness of the parental IPT-G in- tervention. Third, participant blinding was not implemented. Although evaluators were blinded to the treatment condi- tions and participants were instructed not to disclose their group assignments, the absence of participant blinding re- mains a potential limitation. Fourth, the follow-up period was limited to 1 month post-intervention. Given the chronic and often relapsing nature of NSSI, this brief duration may be in- sufficient to fully confirm the long-term sustainability of the intervention effects. Future research should prioritize longi- tudinal designs with extended follow-up assessments (e.g., 6–12 months) to rigorously evaluate the durability of the be- havioral improvements and the lasting impact on family functioning. Finally, the reliance on participants’ self-reports introduces substantial risks of performance bias and detec- tion bias.

  Interpersonal Psychological Group Therapy for Parents Improves Self-Injurious Behavior and Family Intimacy in Non-Suicidal Self-Injurious Adolescents: A Randomized Controlled Study · 2026 · DOI

• This meta-analysis has several strengths, including its spe- cific focus on emotion regulation-focused interventions, which are increasingly recognized as central to treating NSSI. By evaluating both behavioral outcomes (NSSI frequency) and mechanistic outcomes (DERS scores), the review offers a comprehensive assessment of treatment effectiveness. The inclusion of multiple randomized controlled trials and recent studies on digital delivery formats, such as ERITA, increases the clinical relevance of the findings. The lack of evidence for publication bias and the consistent effect sizes across diverse populations further support the robustness of the conclusions. Additionally, the use of subgroup analyses, such as distinguishing between PPWC and SGPP designs, demonstrates methodological rigor in addressing potential sources of variability. However, some limitations should be noted. First, the DERS meta-analysis included a small number of studies, which may have reduced the statistical power to detect subtle moderator effects or publication bias. Second, the inclusion of non-RCT designs limits the strength of causal inferences, and the exclusion of gray literature may have led to the omission of relevant findings. Most participants were female and often had comorbid psychopathology, such as borderline personality disorder, but these factors were not systematically examined as moderators, which may limit generalizability to more diverse populations. Although sev- eral studies examined digital delivery formats, the number was too small for subgroup analyses. As more evidence becomes available, future research should examine potential differences in treatment outcomes across settings (e.g., inpa- tient versus outpatient, or online versus face-to-face deliv- ery). It is also important to clarify whether improvements in emotion regulation mediate treatment effects on NSSI, which would help explain mechanisms of change. Further research should identify which components of DBT (e.g., individual therapy, group skills training, or their combina- tion) contribute to efficacy, clarifying process-level effects. Finally, more systematic analyses of treatment duration and intensity are needed to determine the optimal balance 1 3Cognitive Therapy and Research between brevity and sufficiency for achieving clinically meaningful reductions in NSSI. Author Contributions Baek designed the research. Baek, Lee, and Park analyzed the data. Baek, Lee, and Park wrote the main manu- script text. Kim supervised the whole process of research. All authors reviewed the manuscript. Funding Open Access funding enabled and organized by Seoul Na- tional University. This research received no funding. Data Availability No datasets were generated or analysed during the current study.

  The Effectiveness of Emotion Regulation–Focused Interventions on Non-Suicidal Self-injury: A Meta-Analysis · 2026 · DOI

• While the present study has several notable strengths, key limitations should be acknowledged. One limitation of the current study is the reliance on latent growth mediation (LGM) models (Cheong et al., 2003; Di Maria & Didelez, 2024), which use linear trajectories of mediators and outcomes over time but do not account for dynamic mediation processes that can be modeled in data sets with many measurement waves. This issue is particularly relevant for two reasons. First, prior dynamic mediation research on CP interventions suggests that most of the effects—at least for non-STB outcomes—occur within the first two years postintervention (see Saavedra et al., 2025 which had 8 measurement waves). In the present integrated CP dataset, many of the studies had a limited number of measurement waves which precluded the use of these approaches that can more closely study the relation between intermediate endpoints and STBs during the time interval in the process where change would be expected to occur. LGM mediation can be applied to any study with at least three time points, giving it the advantage that it can be applied to each of the 11 studies in the IDA, permitting estimation of average mediational effects for mediators and STBs for all participants. However, the conclusions are based on the trajectories of the variables which might not be optimal. Alternative dynamic approaches study whether elevations in externalizing and internalizing precede suicidal thoughts, behaviors, and attempts values, clearly establishing temporal precedence. However, temporal precedence between mediators and STBs in this current study depends on the conceptual links between elevations in externalizing and internalizing that have been shown to precede suicidal thoughts, behaviors and attempts (Brent et al., 1999; Joseph et al., 2024; Kahn et al., 2024; Rhodes et al., 2014; Schaefer et al., 2018). Related are concerns regarding sequential ignorability for (a) effects of CP on the mediators, (b) effects of CP on STB outcomes, and (c) links between. We addressed interventionrelated confounding, given this study likely created confounding by combining intervention conditions across RCTs, via propensity score weighting; however, PSW cannot balance unobserved confounding in ways that randomization does. Sequential ignorability linking internalizing/externalizing to STBs outcomes is much more difficult, given most studies do not randomize participants to different levels of mediators (but see West & Aiken, 1997 for exceptions). While we examined whether the internalizing/externalizing-to-STBs effects differed by intervention conditions, consistent with examining potential outcomes for mediation (MacKinnon et al., 2020), other confounders were not examined here.

  Indirect Effects of the Coping Power Intervention on Latent Suicidal Thoughts and Behaviors: an Integrative Data Analysis · 2026 · DOI

• Several avenues for future research emerge from these find- ings. First, a critical next step is to examine mechanisms of action (MoAs) versus intermediate endpoints. Although the present study focused on indirect effects through intermedi- ate psychiatric endpoints, further investigation is needed to understand how CP interventions influence STBs through intervention-specific mechanisms, such as improvements in self-regulation, coping skills, or social connectedness. Sec- ond, given the observed biological sex-specific pathways where boys benefited more from CP through reductions in externalizing problems (e.g., aggression, conduct prob- lems) and girls showed some evidence of effects through internalizing pathways (i.e., anxiety), future studies of STB crossover effects studies should explicitly test differential intervention mechanisms by biological sex. This work could inform biological sex-tailored/enhanced adaptations of CP.

  Indirect Effects of the Coping Power Intervention on Latent Suicidal Thoughts and Behaviors: an Integrative Data Analysis · 2026 · DOI

Most-cited papers in Suicide and Self-Harm Studies

• Suicide as an outcome for mental disorders · The British Journal of Psychiatry · 1997 · 2,036 citations
• Psychological autopsy studies of suicide: a systematic review · Psychological Medicine · 2003 · 1,640 citations
• Toward a Clinical Model of Suicidal Behavior in Psychiatric Patients · American Journal of Psychiatry · 1999 · 1,338 citations
• Trends in Suicide Ideation, Plans, Gestures, and Attempts in the United States, 1990-1992 to 2001-2003 · JAMA · 2005 · 808 citations
• Characteristics and functions of non-suicidal self-injury in a community sample of adolescents · Psychological Medicine · 2007 · 687 citations
• Depressed Adolescents Grown Up · JAMA · 1999 · 660 citations
• Role of media reports in completed and prevented suicide: Werther v. Papageno effects · The British Journal of Psychiatry · 2010 · 580 citations
• Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital · The British Journal of Psychiatry · 2003 · 576 citations
• Non-suicidal self-injury in United States adults: prevalence, sociodemographics, topography and functions · Psychological Medicine · 2011 · 555 citations
• Deliberate Self-Harm in a Nonclinical Population: Prevalence and Psychological Correlates · American Journal of Psychiatry · 2003 · 548 citations

Most recent work

• Latent Profiles of Suicide Risk in University Students: a Multidimensional Model Integrating sleep, mood, interpersonal, and Behavioral Factors · Psychiatric Quarterly · 2026
• Ofsted experiences: performing inspection and suicidal ideations · Journal of Education Policy · 2026
• Clinical updates: Assessment and management of suicidal ideation in adults · BMJ · 2026
• Deep learning characterizes depression and suicidal ideation in young adults from eye movements · npj Digital Medicine · 2026
• Needs for suicide literacy and training among Vietnamese teachers: Findings from a cross-sectional study · Asian Journal of Psychiatry · 2026
• The Effectiveness of Psychotherapies in Suicide Ideation and Behavior—An Expert Review · Psychiatric Annals · 2026
• Mapping the Landscape of Acute-phase Interventions After Self-harm: A Scoping Review of Underrepresented Strategies · Psychiatric Annals · 2026
• Indirect Effects of the Coping Power Intervention on Latent Suicidal Thoughts and Behaviors: an Integrative Data Analysis · Prevention Science · 2026
• Development and validation of the SuPr-10 questionnaire for suicidality assessment in primary care patients with depressive symptoms · Scientific Reports · 2026
• An Update on Somatic Treatments for Suicide Risk · American Journal of Psychiatry · 2026

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