Richard T LiuHarvard Medical School | HMS · Department of Psychiatry
Richard T Liu
Ph.D.
About
140
Publications
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Introduction
Additional affiliations
July 2020 - present
July 2019 - June 2020
March 2014 - June 2019
Publications
Publications (140)
Stress generation posits that (a) individuals at-risk for psychopathology may inadvertently experience higher rates of prospective dependent stress (i.e., stressors that are in part influenced by their thoughts and behaviors) but not independent stress (i.e., stressors occurring outside their influence), and (b) this elevated dependent stress, in s...
Background
Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensiv...
Empirically supported measures of suicidal thoughts and behaviors (STBs) are needed to serve as reference outcomes for suicide risk screening tools and to monitor severity and treatment progress in children and adolescents with STBs. The present paper systematically reviewed existing measures of STBs in youth and studies evaluating their psychometr...
Objective: Although life stress has been linked to adolescent suicidal ideation, most past research has been cross-sectional, and potential processes characterizing this relation remain unclear. One possibility may be a lack of emotional clarity. Informed by stress generation, the current study examined prospective relations between episodic life s...
Background
Family caregivers of persons living with dementia often experience increased depression and suicidal ideation (SI). However, the feasibility and impact of therapies on caregiver SI has remained largely unexplored. Mentalizing imagery therapy (MIT) helps reduce psychological symptoms through mindfulness and guided imagery. This pilot stud...
Although posttraumatic stress disorder (PTSD) has been well characterized in adults, its epidemiology in children is unclear. The current study provides the first population-based examination of the prevalence of PTSD, sociodemographic and psychiatric correlates, clinical sequelae, and associations with psychiatric treatment in preadolescents 9-10...
Importance
The use of tobacco products, including e-cigarettes and vaping, has rapidly increased among children. However, despite consistent associations found between smoking cigarettes and suicidal behaviors among adolescents and adults, there are limited data on associations between emerging tobacco products and suicidal behaviors, especially am...
Background
Two decades ago, the Surgeon General issued a report highlighting concerning disparities in mental healthcare among racial and ethnic minority populations. The present study characterised national trends in mental health treatment utilisation by race and ethnicity across a 13-year period.
Methods
Nationally representative data were draw...
OBJECTIVES
There is a dearth of literature on the prevalence and predictors of nonsuicidal self-injury (NSSI) history and onset among preadolescent youth. This gap in the literature is significant given evidence suggesting that NSSI is a robust predictor of negative mental health outcomes, and that early onset NSSI may be associated with a more sev...
This handbook is currently in development, with individual articles publishing online in advance of print publication. At this time, we cannot add information about unpublished articles in this handbook; however, the table of contents will continue to grow as additional articles pass through the review process and are added to the site. Please note...
Although persistent health disparities affecting marginalized communities have long been recognized, marginalized populations (i.e., oppressed groups with stigmatized social identities) have remained significantly understudied in clinical science and allied disciplines. To reduce mental health disparities, it is critical to examine the experiences...
Cognitive impairment related to major depressive disorder (MDD) is highly prevalent, debilitating and is lacking in effective treatments; dysregulated inflammatory physiology is a putative mechanism and may represent a therapeutic target. In depressed individuals exhibiting a pro-inflammatory phenotype who were enrolled in a 12-week randomized plac...
Introduction:
Transgender and gender non-conforming (TGNC) youth experience higher rates of depression and anxiety. Risk for these outcomes in racial and ethnic minority populations remains unclear. This study aimed to examine disparities in depression and anxiety at the intersection of race and ethnicity and TGNC status in a population-based samp...
Background:
Cognitive inflexibility has recently been investigated as potential vulnerability factor for suicidal ideation (SI), but the context in which it may convey risk is unclear. Life stress has also been reliably associated with SI among adolescents, and following a stress-diathesis model, may be a factor that moderates the relationship bet...
Background:
The vast majority of research on, and clinical assessment of, cognitions related to suicide and non-suicidal self-injury (NSSI) has focused on verbal thoughts. And yet, mental imagery is more realistic and emotionally arousing than verbal thoughts.
Methods:
We conducted a systematic review and meta-analysis documenting the prevalence...
Within the Dimensional Model of Adversity and Psychopathology, extant research shows that exposure to threat-including emotional, physical, and sexual abuse-is linked to psychopathology among adolescents; problems with emotion regulation may, at least in part, explain this association. Both theoretical and empirical work also suggests that emotion...
In the past decade, two themes have emerged across suicide research. First, according to meta-analyses, the ability to predict and prevent suicidal thoughts and behaviours is weaker than would be expected for the size of the field. Second, review and commentary papers propose that technological and statistical methods (such as smartphones, wearable...
Background
Although the clinical importance of non-suicidal self-injury (NSSI) has received increasing recognition, relatively little is known about its epidemiology. The objective of this study was to estimate the lifetime prevalence of NSSI in adults and its association with sociodemographic characteristics, psychiatric disorders, and lifetime tr...
Importance:
Suicide rates have been increasing among youth in the US. While the heritability of suicide risk is well established, there is limited understanding of how genetic risk is associated with suicidal thoughts and behaviors in young children.
Objective:
To examine whether genetic susceptibility to suicide attempts (SAs) is associated wit...
Importance:
Considerably less is known about self-injurious thoughts and behaviors (SITBs) in preadolescence than older age groups, owing partly to the common view that young children are incapable of suicidal thoughts. Yet, preadolescent suicide has increased in recent years and is now the fifth leading cause of death in this age group, leading t...
Study Objectives
The objectives of this study were to examine the relationships between sleep regularity and nonsuicidal self-injury (NSSI), including lifetime NSSI history and daily NSSI urges.
Methods
Undergraduate students (N=119; 18-26 years), approximately half of whom endorsed a lifetime history of repetitive NSSI, completed a 10-day actigra...
Background
Although the prevalence rates of preadolescent eating disorders (EDs) are on the rise, considerably less is known about the correlates and treatment of EDs in this age group. Clarifying the epidemiology of EDs in preadolescent children is a necessary first step to understand the nature and scope of this problem in this age group.
Method...
S
Background
Suicide is among the leading cause of death in children and adolescents. There are well-known risk factors of suicide, including childhood abuse, family conflicts, social adversity, and psychopathology. While suicide risk is also known to be heritable, few studies have investigated genetic risk in younger individuals.
Methods
Using p...
Objective
Interpersonal negative life events (NLEs) have been linked to risk for suicidal thoughts and behaviors. However, little is known about how this risk is conferred over the short term and the mechanisms linking interpersonal NLEs to suicide risk, particularly in adolescents. This study used an intensive longitudinal design to examine thwart...
The present study evaluated sociodemographic and diagnostic predictors of suicidal ideation and attempts in a nationally representative sample of preadolescent youth enrolled in the Adolescent Brain Cognitive Development Study. Rates and predictors of psychiatric treatment utilization among suicidal youth also were examined. Eleven thousand eight h...
Objective
Although theoretical conceptualizations of suicide hold that passive and active suicidal ideation are etiologically distinct, existing research observing this distinction is modest, with most prior studies focusing exclusively on active ideation. Understanding processes associated with passive ideation is clinically important insofar as p...
Objective:
To evaluate whether a history of depression or self-injurious thoughts and behaviors predict elevated BMI and elevated waist-to-height ratio in pre-adolescents.
Methods:
Baseline data were evaluated from a large, nationally representative cohort study of 9- and 10-year-old children (unweighted n = 11,875), the Adolescent Brain and Cog...
The ability to regulate emotions in response to stress is central to healthy development. Whereas early research in emotion regulation predominantly employed static, self-report measurement, the past decade has seen a shift in focus toward understanding the dynamic nature of regulation processes. This is reflected in recent refinements in the defin...
Objective:
Depressive disorders are common among adults with alcohol use disorder and with suicidality; however, demographic differences in comorbid alcohol use disorder, binge drinking, and suicidality are understudied. The objective of this study was to determine the extent to which comorbid suicidality and alcohol use disorders and comorbid sui...
Background
The COVID-19 pandemic has spurred the implementation of several public safety measures to contain virus spread, most notably socially distancing policies. Prior research has linked similar public safety measures (i.e., quarantine) with suicide risk, in addition to supporting the role of social connection in suicidal thoughts and behavior...
A correction to this paper has been published: https://doi.org/10.1007/s10802-021-00827-8
Despite considerable public and scholarly debate about the role of social media in self-injurious thoughts and behaviors (SITBs), no comprehensive, quantitative synthesis of this literature has previously been undertaken. The current systematic review and meta-analysis examines associations between social media use and SITBs, including suicidal ide...
The current study investigated whether impaired emotional response inhibition to self-harm stimuli is a risk factor for real-time nonsuicidal self-injury (NSSI) urges. Participants were 60 university students with a history of repetitive NSSI. At baseline, participants completed an emotional stop-signal task assessing response inhibition to self-ha...
Although most lesbian, gay, bisexual, transgender, and questioning youths are quite resilient and emerge from adolescence as healthy adults, the effects of stigma and heterosexism can contribute to health disparities. Part 2 of this first-of-its-kind 3-part series can help pediatric primary care providers become stronger allies for TGD patients and...
Suicide is the second leading cause of death in adolescents and suicide rates in this population have increased in recent years. A critical step in preventing suicide is improving the accuracy of suicide risk assessment. Measurement of suicidal cognitions typically emphasizes assessment of verbal thoughts about suicide. Recent research suggests, ho...
The current chapter provides a review of the current theoretical and empirical literature on the development of cognitive vulnerability to depression in youth. First, cognitive formulations of risk for depression are introduced, with a particular focus on the developmental antecedents of cognitive vulnerability. The potential role of childhood emot...
Despite considerable public and scholarly debate about the role of social media in self-injurious thoughts and behaviors (SITBs), no comprehensive, quantitative synthesis of this literature has previously been undertaken. The current systematic review and meta-analysis examines associations between social media use and SITBs, including suicidal ide...
Background:
The relationship between life stress and depression and anxiety is well characterized in adolescents and adults. Further, research has shown that adolescents and adults with a history of childhood maltreatment are more likely to develop depression and anxiety after being exposed to stress than those without this history. However, the p...
Background
The family environment is an important context for the development and maintenance of depressive symptoms within families. In this study, we evaluated whether parent and adolescent self-reports of emotion regulation constructs are linked with their own (actor effects) and each other's (partner effects) depressive symptoms.
Methods
Parti...
Self-injurious thoughts and behaviors (SITBs) remain a common clinical problem in youth. This article reviews the state of knowledge regarding psychosocial treatments for SITBs in youth. Broadly speaking, psychosocial treatments that incorporate parents/family and that emphasize skills development (including emotion regulation and interpersonal ski...
Introduction
Given increasing concern in suicide in preadolescent children, this study aimed to characterize and identify potential indicators of risk for suicidal ideation (SI) and suicide attempts (SAs) in this population.
Methods
Data were drawn from two population‐based samples of preadolescents: the 2007 and 2010 Minnesota Student Survey and...
The current review provides a quantitative synthesis of the empirical literature on sleep disturbance as a risk factor for suicidal thoughts and behaviors (STBs). A systematic search of PsycINFO, MEDLINE, and the references of prior reviews resulted in 41 eligible studies included in this meta-analysis. Sleep disturbance, including insomnia, prospe...
Objective
Rates of self-injurious thoughts and behaviors have increased in adolescents over the past two decades. Sexual and gender minority (SGM) youth report elevated rates of self-injurious thoughts and behaviors compared to heterosexual and cisgender youth. Studies of factors influencing suicide risk in SGM youth remain limited, however, and ha...
We assessed the gut microbiota of 90 American young adults, comparing 43 participants with major depressive disorder (MDD) and 47 healthy controls, and found that the MDD subjects had significantly different gut microbiota compared to the healthy controls at multiple taxonomic levels. At the phylum level, participants with MDD had lower levels of F...
Objectives:
In this study, we determined trends in prevalence of suicidal thoughts and behaviors among lesbian, gay, bisexual, and heterosexual youth from 1995 to 2017 using population-based surveillance data.
Methods:
Data were drawn from the Massachusetts Youth Risk Behavior Survey from 1995 to 2017 (unweighted N = 41 636). The annual percent...
Background
Compared to active ideation, passive ideation remains relatively understudied and its clinical importance poorly defined. The weight that should be accorded passive ideation in clinical risk assessment is therefore unclear.
Methods
We conducted a systematic review and meta-analysis of the prevalence of passive ideation, its psychiatric...
Self-injurious thoughts and behaviors in childhood have received increasing recognition as an important clinical concern. Self-injurious thoughts and behaviors in childhood have been reported to be associated with concurrent psychiatric impairment, particularly externalizing disorders,¹ and to be predictors associated with negative outcomes, includ...
The current review presents a meta-analysis of the existing empirical literature on the prevalence of non-suicidal self-injury (NSSI) among lesbian, gay, bisexual, and transgender (LGBT) individuals, as well as on correlates of NSSI within sexual and gender minority populations. Eligible publications (n=51) were identified through a systematic sear...
Depression in adolescence is highly prevalent and associated with negative long-term outcomes.¹ Despite decades of research on treatment for adolescent depression, sexual minority youths remain a particularly at-risk group.² Temporal trends inform progress in addressing the need to eliminate health disparities among sexual minority populations.³ To...
Recent advances in real-time monitoring technology make this an exciting time to study risk for suicidal thoughts and behaviors among youth. Although there is good reason to be excited about these methods, there is also reason for caution in adopting them without first understanding their limitations. In this article, we present several broad futur...
Despite research indicating that stressful life events are associated with subsequent suicidal ideation (SI) and behavior, there is a lack of clarity regarding whether specific types of life events are differentially related to SI and attempts. The current prospective study examines whether social rejection related life events are proximally relate...
Background
Suicide is the second leading cause of death among adolescents. The purpose of this study was to test a family‐focused outpatient cognitive behavioral treatment (F‐CBT) protocol for depressed adolescents following psychiatric hospitalization for a suicide attempt or suicidal ideation, and who had a co‐occurring risk factor (suicidal beha...
Purpose: The aim of the article was to assess temporal changes in adolescent treatment utilization
for disordered eating.
Methods: Data were drawn from adolescents (unweighted N = 236,752), aged 12-17 years, in the
National Survey on Drug Use and Health for 2004-2017. Joinpoint regression assessed temporal trends in
overall treatment utilization fo...
Nonsuicidal self-injury (NSSI) has received increasing attention in recent years as a clinically important phenomenon; it has been included in the DSM-5 as a syndrome warranting further investigation. Sexual minority youth are particularly at risk for NSSI.¹ An important step toward addressing this issue is to characterize the prevalence of NSSI am...
Background:
Over the past several years there has been considerable interest in the relation between emotion dysregulation and non-suicidal self-injury (NSSI), particularly given that rates of NSSI have been increasing and NSSI is a critical risk factor for suicidal behavior. To date, however, no synthesis of empirical findings exists.
Methods:...
Both childhood maltreatment and impulsivity have been implicated in a broad array of negative public health outcomes and have been much studied in relation to each other. Characterizing this relationship, and the processes underlying it, are important for informing intervention efforts targeting this association and its psychopathological sequelae....
Not only is suicidal behavior strongly predicted by its past occurrence, but the risk for recurrence appears to increase with each subsequent attempt. The current paper discusses a potential explanation for this phenomenon, that suicide attempts may leave a residual psychological scar that heightens risk for future attempts. This possibility is eva...
Stress generation has potential to account for recurrent suicidal behavior. The current study represents a first step toward evaluating this possibility in a sample of adolescent psychiatric inpatients (n = 99; 79.80% female) followed over six months. At index admission, participants completed baseline measures of depressive symptom severity, suici...
Child maltreatment and sleep disturbances are particularly prevalent among individuals with a history of depression. However, the precise relation between child maltreatment and sleep within this population is unclear. The present study evaluated childhood maltreatment and trauma as a predictor of sleep duration and insomnia symptoms among young ad...
Whether cognitive vulnerability to depression exists along a continuum of severity or as a qualitatively discrete phenomenological entity has direct bearing on theoretical formulations of risk for depression and clinical risk assessment. This question is of particular relevance to adolescence, given that cognitive vulnerability appears to coalesce...
Suicide rates have increased over the past several decades. Prior research has evaluated risk factors for suicidal behavior, but much of this work does not adequately differentiate between risk factors for suicidal ideation (SI) and suicide attempts, nor does it differentiate between first-onset SI and recurrent ideation. This study seeks to identi...
This study aimed to: (1) examine rates of readmission among young children with oppositional defiant disorder (ODD) following discharge from a psychiatric partial hospital treatment program, and (2) examine child factors (i.e., age, sex, co-occurring diagnoses, suicidality) and family factors (i.e., parental depression, stress) as prospective predi...
Objectives:
This study evaluated the feasibility and initial efficacy of an empirically informed psychosocial intervention on an adolescent psychiatric inpatient unit.
Methods:
Data were obtained for 463 adolescents 12-16 years of age on a psychiatric inpatient unit. Information collected included demographics, psychiatric diagnoses, length of i...
Background:
Non-suicidal self-injury is being increasingly recognised as a prominent public health concern. Identification of early and modifiable risk factors is necessary to advance the screening and intervention efforts, particularly early detection of at-risk individuals. We aimed to examine childhood maltreatment, including its specific subty...
Background: We addressed two unanswered questions from prior research, demonstrating a prospective association
between frequent religious service attendance and decreased risk for suicide. First, we assessed whether
religious service attendance conferred protection from suicide even after accounting for strength of religious
affiliation. Second, we...
Behavioral Approach System (BAS) sensitivity has been implicated in the development of a variety of different psychiatric disorders. Prominent among these in the empirical literature are bipolar spectrum disorders (BSDs). Given that adolescence represents a critical developmental stage of risk for the onset of BSDs, it is important to clarify the l...
At the intersection between neuroscience, microbiology, and psychiatry, the enteric microbiome has potential to become a novel paradigm for studying the psychobiological underpinnings of mental illness. Several studies provide support for the view that the enteric microbiome influences behavior through the microbiota-gut-brain axis. Moreover, recen...
We conducted a meta-analysis of neurobehavioral and neurocognitive indices of impulsivity in relation to suicidal thoughts and behaviors, as well as non-suicidal self-injury (NSSI). In our systematic review, 34 studies were identified and submitted to a random-effects meta-analysis. A small pooled effect size was observed for the association betwee...
Non-suicidal self-injury (NSSI) has received increasing recognition as a clinically significant phenomenon. Although in most individuals who engage in NSSI, this behavior is short-lived, for a significant proportion of these individuals, NSSI follows a chronic course. There is a need for research advancing our understanding of the mechanisms of ris...
Suicidal ideation (SI) is a common presenting problem for psychiatric hospitalizations in adolescents and often persists following discharge. This study examines whether distinct trajectories of SI could be delineated following hospitalization and the risk factors most strongly related to these trajectories. Adolescents (N?=?104; 76 females; 28 mal...
Considerable support exists establishing a relationship between childhood adversities and adult depression. Consistent evidence has emerged linking early life adversities with a more chronic course for depression, as well as to poorer treatment outcomes. What remain decidedly less clear, however, are the moderators and mediating mechanisms underlyi...