Joan Asarnow

• Doctor of Psychology
• Professor of Psychiatry & Biobehavioral Sciences at University of California, Los Angeles

Background Suicide attempts are common in youth and have potentially lethal outcomes. Effective treatments targeting suicide attempts are scarce. Objective To assess the feasibility and preliminary efficacy of a family-based cognitive behavioural treatment relative to an active control for youth with suicidal behaviour. Methods 30 youths (93% fem...

Background Self‐harm in adolescents is an international concern. Evidence highlights that therapeutic intervention (TI), such as cognitive behaviour therapy informed treatments, after self‐harm leads to reduced self‐harm repetition. However, there is no prior literature about the effects of TI on future mortality in adolescents. We examined the eff...

Suicide is a leading cause of death among adolescents ages 15–17 and young adults ages 18–24 (collectively referred to as “youth”). There are important subpopulations about whom little is known concerning possible risks for firearm injury, including youth. In this policy brief, we use data from the 2021 and 2022 California Health Interview Surveys...

Background Suicide is the second leading cause of death in 12- to 17-year-old adolescents in the USA. Research on biological mechanisms contributing to self-harm risk that could be targeted in treatment could help to prevent suicide and self-harm episodes. Aims We aimed to evaluate whether markers of inflammation, interleukin-6 (IL-6) and C-reacti...

Background Frequently presenting with symptoms of mood or anxiety disorders, substance abuse or borderline personality disorder, suicidal and self-harming adolescents often are prescribed psychotropic medication. Though such treatment may be warranted, recurrent suicidal and self-harming behaviour is often linked to emotion dysregulation where phar...

Background: Suicide is a leading cause of death globally in youths, and suicidal behavior and self-harm are major clinical concerns. This article updates the previous practitioner review (2012) with the aims of integrating new research evidence, including that reported in this Special Issue. Methods: The article reviews scientific evidence relat...

Background Adopting a common elements approach, this practitioner review aims to highlight specific treatment elements that are common to interventions with demonstrated benefits in randomized controlled trials (RCTs) for reducing suicide attempts and self‐harm in youth. Identification of common treatment elements among effective interventions offe...

Racial/ethnic minoritized (REM) youth represent a high-risk group for suicide, yet there are striking disparities in their use of mental health services (MHS) even after risk is identified in schools. Prior research suggests that school-based risk assessments and hospitalization encounters can be negatively experienced by REM youth and families, th...

One Mind, in partnership with Meadows Mental Health Policy Institute, convened several virtual meetings of mental health researchers, clinicians, and other stakeholders in 2020 to identify first steps toward creating an initiative for early screening and linkage to care for youths (individuals in early adolescence through early adulthood, ages 10-2...

Background: Suicide is the second‑leading cause of death among adolescents and young adults in the United States, with rates rising over much of the last decade. The design, testing, and implementation of interventions to prevent suicide in this population is a public health priority. This manuscript outlines the design and methods for a research...

Objective: This study evaluated the effects of Safe Alternatives for Teens and Youths-Acute (SAFETY-A), a brief strengths-based, cognitive-behavioral family intervention, on racial-ethnic minority youths receiving emergency department (ED) treatment for suicidal episodes. Methods: Participants were 105 racial-ethnic minority youths enrolled in a...

Objective To examine trajectories of treatment response in suicidal youth who participated in a randomized controlled trial (RCT) comparing dialectical behavior therapy (DBT) and individual and group supportive therapy (IGST). Method Using latent class analysis across both treatment conditions, we conducted secondary analyses of data from a multis...

Although the last several years have been marked by significant advances in intervention efforts for youth suicide prevention, suicide remains the second leading cause of death among this age group in the United States. We discuss promising results from intervention research with the goal of informing policies for enhancing suicide prevention care...

Objective: Reducing access to lethal methods is an effective suicide prevention strategy that is often neglected in routine care. Digital interventions have shown promise for addressing such gaps in care; and decision aids have proven useful for supporting complicated health-related decisions, like those involving lethal means restriction. This art...

This editorial discusses lessons learned from the COVID‐19 public health emergency as they relate to the prevention of suicide, the second leading cause of death in adolescents and young adults globally. Recognizing that COVID‐19 impact and response varied across nations, we offer a US perspective, addressing two questions: (a) what have we learned...

The Safe Alternatives for Teens and Youth (SAFETY) treatment was developed to decrease the risk of repeat suicidal and self-harm behavior in youth presenting with elevated suicide risk. This paper uses case illustrations to demonstrate the SAFETY treatment, building upon the companion paper describing our “incubator” treatment development model and...

Suicide, suicidal behaviors, and self-harm are major public health problems among youth and can often co-occur with traumatic stress experiences and related symptoms. Given this interrelation, it is important that suicide prevention and intervention practices take a trauma-informed approach to reflect the complex, intertwined relation of traumatic...

Suicide is the second leading cause of death of school-aged youth, and youth with histories of trauma are at increased risk of suicidal thoughts and actions. Given the impact of trauma on youth development, there has been an increased emphasis on trauma-informed practices in schools. However, while school-based providers encounter, assess, and inte...

Lesbian, Gay, Bisexual, Transgender, and Queer or Questioning (LGBTQ) youth are at elevated risk for suicide. Despite this, there is limited information on how to optimize care for suicidal LGBTQ youth. Qualitative interviews were conducted with LGBTQ youth with a history of mental health treatment to identify treatment recommendations and barriers...

Youth suicide clusters are a tragedy that no community should have to face. This paper details how a large community came together to better understand and prevent the future loss of young lives in their County using interdisciplinary quality improvement (QI) teams and a multi-component, continuous QI project. This includes the formation of a Youth...

Given the increasing number of children presenting to the emergency department (ED) in psychiatric crisis, our tertiary children’s hospital ED adopted SAFETY-Acute/Family Intervention for Suicide Prevention (SAFETY-A), an evidence-based practice for suicide prevention. Because of the relationship between trauma and suicide among youth, this study p...

Objective: Research shows elevated rates of trauma exposure and traumatic stress among youth with suicidal thoughts and behaviors, underscoring the need for a trauma-informed approach to suicide prevention and intervention. The purpose of this study was to identify, from the perspective of caregivers, clinical practices that are sensitive to the n...

Patient-centered care requires providing care that is responsive to patient preferences, needs, and values, yet data on parent and youth treatment preferences remains sparse. The present study (1) identifies variations in parent and youth preferences for depression treatment, and (2) explores relationships between parent and youth demographics and...

The most effective treatments for child and adolescent psychopathology are often family-based, emphasising the active involvement of family members beyond the referred individual. This book details the clinical skills, knowledge, and attitudes that form the core competencies for the delivery of evidence-based family interventions for a range of men...

Youths who make suicide attempts or engage in repetitive self-harm are at risk for future suicide attempts and death by suicide or self-harm. This treatment development report focuses on the Safe Alternatives for Teens and Youth (SAFETY) treatment. SAFETY is a 12-week outpatient child and family-centered cognitive-behavioral treatment, informed by...

Objective This study evaluated mechanisms, mediation, and secondary/exploratory outcomes in our randomized controlled trial evaluating Dialectical Behavior Therapy (DBT) compared to Individual and Group Supportive Therapy (IGST), expanding on previously reported results indicating a DBT advantage at post-treatment on planned suicide/self-harm outco...

Suicide and self-harm are major public health problems. Individuals who die by or attempt suicide and those who self-harm have elevated rates of traumatic stress exposure, underscoring the importance of a trauma-informed approach to suicide prevention. Rooted in the evidence on care for traumatic stress and suicide prevention, and our collective ex...

This paper describes our approach to youth suicide prevention care. We emphasize two related interventions: (a) our emergency/acute care intervention for youths presenting with suicidal and/or self-harm episodes, SAFETY-Acute (A) also called the Family Intervention for Suicide Prevention (FISP); and (b) the SAFE Alternatives for Teens and Youth (SA...

Objective Mobile technology has facilitated rapid growth in the use of intensive longitudinal methods (ILM), such as ecological momentary assessments (EMA), that help identify proximal indicators of risk in real-time and real-world settings. To realize the potential of ILM for advancing knowledge regarding suicidal and self-injurious thoughts and b...

Background: This study aimed to clarify the predictive significance of youth perceptions of parental criticism assessed using a brief measure designed to enhance clinical utility. We hypothesized that high perceived parental criticism would be associated with more severe depression over 18-months of follow-up. Methods: The study involved seconda...

Background Depression in childhood frequently involves significant impairment, comorbidity, stress, and mental health problems within the family. Family-Focused Treatment for Childhood Depression (FFT-CD) is a 15-session developmentally-informed, evidence-based intervention targeting family interactions to enhance resiliency within the family syste...

Objective To elucidate processes contributing to continuing self‐harm in youth at very high risk for suicide, focusing on sleep disturbance, a putative warning sign of imminent suicide risk. Method 101 youth (ages 12–18) selected for high risk of suicide/suicide attempts based on suicidal episodes plus repeated self‐harm (suicide attempts and/or n...

Stepped care is a health service delivery model aimed at enhancing the cost-effectiveness of and access to care for a range of health domains (Bower & Gilbody, 2005). The defining feature of stepped care is that patients are initially assigned to receive the lowest level of care still expected to yield therapeutic benefits, with an emphasis on repe...

Objective Childhood‐onset depression is associated with increased risk of recurrent depression and high morbidity extending into adolescence and adulthood. This multisite randomized controlled trial evaluated two active psychosocial treatments for childhood depression: family‐focused treatment for childhood depression (FFT‐CD) and individual suppor...

Background Suicide is a leading cause of death globally in youths, and suicidal behavior and self‐harm are major clinical concerns. This article updates the previous practitioner review (2012) with the aims of integrating new research evidence, including that reported in this Special Issue. Methods The article reviews scientific evidence related t...

Globally, suicide is the second leading cause of death among youth ages 15–29‐years, and self‐harm is one of the strongest known predictors of death by suicide. This editorial introduces the Special Issue on suicide and self‐harm, emphasizing the research and policy implications of the included articles. By illustrating advances in our science, the...

Background In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self‐harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial...

Background: Suicide attempts (SA) and other types of self-harm (SH) are strong predictors of death by suicide in adolescents, emphasizing the need to investigate therapeutic interventions in reduction of these and other symptoms. We conducted an updated systematic review of randomized controlled trials (RCTs) from our previous study reporting thera...

Objective: To estimate additional payments associated with co-existing mental health or substance use disorders (MH/SUDs) among commercially insured children and youth with chronic medical conditions (CMCs) and to determine whether children's MH/SUDs have similar associations with parental health care payments. Methods: Cross-sectional analysis...

Objective: Primary care (PC) is a major service delivery setting that can provide preventive behavioral health care to youths. To explore the hypothesis that reducing health risk behaviors (HRBs) would lower depressive symptoms, and that health risk and depression can be efficiently targeted together in PC, this study (1) evaluates an intervention...

Importance Suicide is a leading cause of death among 10- to 24-year-old individuals in the United States; evidence on effective treatment for adolescents who engage in suicidal and self-harm behaviors is limited. Objective To evaluate the efficacy of dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) fo...

The JCPP works at the cutting edge of clinical science to publish ground‐breaking research across the full range of topics in the field of child psychology and psychiatry. As JCPP editors, who are also active researcher's in our own right, we are conscious of the threat posed to our field by what has come to be known as the reproducibility crisis ‐...

Suicide leads to more deaths in youths aged 15 to 24 years than any single major medical illness. This article reviews scientific knowledge on youth suicide and suicidal behavior, with the goal of highlighting treatment, prevention, and care strategies with the potential for reducing life threatening suicidal and self-harm tendencies. https://www...

Emergency departments (EDs) can offer life-saving suicide prevention care. This article focuses on the ED and emergency services as service delivery sites for suicide prevention. Characteristics of EDs, models of emergency care, ED screening and brief intervention models, and practice guidelines and parameters are reviewed. A care process model for...

Anxiety disorders are among the most prevalent pediatric behavioral health conditions, affecting roughly 32% of youths prior to adulthood, and associated with impaired functioning that can continue into adulthood and increase in severity.¹,2 In this issue of JAMA Pediatrics, Wang et al³ report an updated meta-analysis evaluating the comparative eff...

Objective Despite the morbidity and negative outcomes associated with early-onset depression, few studies have examined the efficacy of psychosocial treatment for depressive disorders during childhood. Integrating family in treatment could have particularly salutary effects during this developmental period. This trial compared immediate posttreatme...

Objective: Suicide is a leading cause of death. New data indicate alarming increases in suicide death rates, yet no treatments with replicated efficacy or effectiveness exist for youths with self-harm presentations, a high-risk group for both fatal and nonfatal suicide attempts. We addressed this gap by evaluating Safe Alternatives for Teens and Y...

Objectives?: Depression, a chronic and disabling condition, frequently has its first onset during adolescence, underscoring the value of early effective treatment and prevention. Integrated medical-behavioral health care provides one strategy for improving treatment access for adolescents and young adults (AYA). This study examined predictors of a...

This article examines the concept of the Patient-Centered Medical Home (PCMH) as it applies to children and adolescents, emphasizing care for behavioral health conditions, the role of psychology and psychological science, and next steps for developing evidence-informed models for the Pediatric PCMH. The PCMH concept for pediatric populations offers...

This prospective study of suicidal emergency department (ED) patients (ages 10-18) examined the timing, cumulative probability, and predictors of suicide attempts through 18 months of follow-up. The cumulative probability of attempts was as follows: .15 at 6 months, .22 at 1 year, and .24 by 18 months. One attempt was fatal, yielding a death rate o...

FROM: Godoy Garraza L, Walrath C, Goldston DB, et al . Effect of the Garrett Lee Smith Memorial Suicide Prevention Program on suicide attempts among youths. JAMA Psychiatry 2015;72:1143–9. This study advances work on suicide prevention and intervention implementation/dissemination research. Rigorous suicide prevention research is critically needed...

Suicide is the second leading cause of death among youth ages 10?24. An estimated 1.5 million US adolescents receive their primary health care in the emergency department (ED); this is particularly true for low-income and minority youths who often lack a regular source of care. ED visits can provide a window of opportunity to screen and identify yo...

Youth suicide attempters presenting to the emergency department (ED) are frequently admitted to psychiatric inpatient hospitals, yet little is known about how clinicians decide which youths to admit versus discharge to outpatient care. We examine predictors of inpatient hospitalization and describe service use outcomes associated with hospitalizati...

Although the evidence base for treatment of depressive disorders in adolescents has strengthened in recent years, less is known about the treatment of depression in middle to late childhood. A family-based treatment may be optimal in addressing the interpersonal problems and symptoms frequently evident among depressed children during this developme...

Across development depression is associated with impairments in interpersonal and family functioning. In turn, these impairments may predict a more negative depression course and outcome. This study examined family functioning and parental Expressed Emotion (EE) among depressed youth during middle childhood and early adolescence and their relations...

Recent health care legislation and shifting health care financing strategies are transforming health and behavioral health (a broad term referring to mental health, substance use, and health behavior) care in the United States. Advances in knowledge regarding effective treatment and services coupled with incentives for innovation in health and beha...

Recent health care legislation and shifting health care financing strategies are transforming health and behavioral health care in the United States and incentivizing integrated medical-behavioral health care as a strategy for improving access to high-quality care for behavioral health conditions, enhancing patient outcomes, and containing costs. T...

ABSTRACT FROM: Richardson LP, Ludman E, McCauley E, et al. Collaborative care for adolescents with depression in primary care: a randomised clinical trial. JAMA 2014;312:809-16. What is already known on this topic As most adolescents have access to primary care, collaborative care models that bring evidence-based treatments into primary care have s...

Suicidal behavior and self-harm are common in adolescents and are associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm and links between self-harm and suicide and risk of suicide attempt, progress in reducing suicide death rates has been...

Accurate evaluation of suicidal adolescents in the emergency department (ED) is critical for safety and linkage to follow-up care. We examined self-reports of 181 adolescents who presented to an ED with suicidal ideation (SI) or a suicide attempt (SA). Parents also completed self-reports. Results showed fair agreement between parents and youth on t...

The purpose of this article is to describe feasibility, safety, and outcome results from a treatment development trial of the SAFETY Program, a brief intervention designed for integration with emergency services for suicide-attempting youths. Suicide-attempting youths, ages 11 to 18, were enrolled in a 12-week trial of the SAFETY Program, a cogniti...

Research on effective treatments for adolescent suicide attempters is urgently needed. However, there has been a lack of research in this area. This is likely a result of the multiple challenges faced by investigators working with individuals at high risk of suicide. Based on our experiences conducting a large, randomized clinical trial with adoles...

Purpose Depression and health risk behaviors in adolescents are leading causes of preventable morbidity and mortality. Primary care visits provide prime opportunities to screen and provide preventive services addressing risk behaviors/conditions. This study evaluated the co-occurrence of depression and health risk behaviors (focusing on smoking, dr...

This article reviews the literature on interventions and services for depression and suicide prevention among adolescents, with the goals of placing this science within the context of currently changing health care environments and highlighting innovative models for improving health and mental health. We examine the challenges and opportunities off...

There is growing appreciation of the role of family interventions in preventing youth suicide and treating youth struggling with suicidal thoughts and behaviors. Increasingly, clinical investigators include parent (e.g., caregivers) in treatments in order to target family processes associated with risk and protection from suicide. On a continuum, t...

In 2008-2009, we conducted a 6-week, open-label trial of transdermal nicotine replacement therapy and practical counseling for 34 adolescents seeking smoking cessation in Los Angeles. Dependent outcomes were study retention, use of the patch, and 7-day quit status at the end-of-study and at follow-up visits. Predictors of outcomes included cigarett...

To assess the relative efficacy of antidepressant medication, alone and in combination with cognitive behavioral therapy (CBT), on comorbid symptoms of anxiety, attention, and disruptive behavior disorders in participants in the Treatment of Resistant Depression in Adolescents (TORDIA) trial. Adolescents with selective serotonin reuptake inhibitor...

To examine the bidirectional relationship between parent-child discord and treatment outcome for adolescent treatment-resistant depression. Depressed youth who had not responded to an adequate course of a selective serotonin reuptake inhibitor (SSRI) were randomized to either a switch to another SSRI or venlafaxine, with or without the addition of...

Suicide is the third leading cause of death in adolescents, and often, youths with suicidal behavior or ideation present to the emergency department (ED) for care. Many suicidal youths do not receive mental health care after discharge from the ED, and interventions are needed to enhance linkage to outpatient intervention. This article describes the...

Large-scale treatment studies suggest that effective depression treatment and reduced depression are associated with improved substance use outcomes. Yet information is limited regarding the longitudinal association between depressive symptoms and problematic substance use and its predictors, particularly in real-world practice settings. Using late...

The Harkavy-Asnis Suicide Scale (HASS), one of the few self-report scales assessing suicidal behavior was evaluated and ideation, was evaluated and predictors of suicide attempts (SAs) were identified with the goal of developing a model that clinicians can use for monitoring SA risk. Participants were 131 pediatric emergency department (ED) patient...

Background Maternal Expressed Emotion (EE) is a poor prognostic indicator for multiple forms of child and adolescent psychopathology; however, there has been relatively little examination of its role in pediatric obsessive compulsive disorder (OCD). This study examined rates of high maternal EE in pediatric OCD, their cross-sectional parent and chi...

  Repeated self-harm in adolescents is common and associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm there have been few systematic reviews of the topic.   The main aim of this article is to review randomised controlled trials (RCTs) re...

To identify symptom dimensions of depression that predict recovery among selective serotonin reuptake inhibitor (SSRI) treatment-resistant adolescents undergoing second-step treatment. The Treatment of Resistant Depression in Adolescents (TORDIA) trial included 334 SSRI treatment-resistant youth randomized to a medication switch, or a medication sw...