{ "summary": { "audit_version": "stratified-blind-audit-v1.0", "model": "qwen3.6:27b", "method": "Reproducible stratified random sample; blind one-record rescreen; thinking-mode adjudication of every disagreement", "random_seed": 20260802, "sample_per_group": 20, "total_sampled": 100, "group_statistics": { "Irrelevant": { "sampled": 20, "full_label_agreements": 18, "full_label_agreement_rate": 0.9 }, "Relevant Non-empirical": { "sampled": 20, "full_label_agreements": 19, "full_label_agreement_rate": 0.95 }, "Quantitative": { "sampled": 20, "full_label_agreements": 19, "full_label_agreement_rate": 0.95 }, "Qualitative": { "sampled": 20, "full_label_agreements": 16, "full_label_agreement_rate": 0.8 }, "Review": { "sampled": 20, "full_label_agreements": 20, "full_label_agreement_rate": 1.0 } }, "full_label_agreements": 92, "full_label_agreement_rate": 0.92, "disagreements_adjudicated": 8, "sampled_records_corrected_after_adjudication": 6, "completed_at": "2026-08-02T19:39:00.981392+00:00" }, "audited_records": [ { "record_key": "SWRD:110534", "input_index": 67, "sample_group": "Irrelevant", "title": "Teenage Drugs Subculture: Implications for Preventive Strategies in Social Work Practice", "abstract": "Rapid social change due to emigration & the development of new towns has weakened parental bonds & the social support networks of families & clans. These changes may lead to an immense increase in teenage drug abuse & suicide. The drug dependence of teenagers is not simply a result of curiosity, but a reflection of stress management in the form of escape from reality. This paper gives an account of the stages of adolescent drug dependence, & the levels of intervention where social work practitioners can play a more active role in drug prevention. Strategies related to primary, secondary, & tertiary prevention are discussed. 1 Table, 81 References. Adapted from the source document.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Suicide is mentioned only as a potential consequence of social change and drug abuse in the background context, but it is not a central focus, outcome, or subject of analysis in this paper on drug prevention strategies.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Since the record is deemed irrelevant because suicide is merely background context and not analyzed, the evidence class and empirical method are marked as Not applicable.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:22021", "input_index": 120, "sample_group": "Irrelevant", "title": "Ethical issues in the social worker's role in physician-assisted suicide - Response to Miller and Hedlund", "abstract": null, "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "The title indicates a commentary or response regarding ethical issues in physician-assisted suicide, which falls under euthanasia rather than the specified focus on suicide, suicidality, or suicide prevention.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Since the record is deemed irrelevant to the suicide-focused evidence corpus, the evidence class and empirical method are marked as not applicable.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:26829", "input_index": 281, "sample_group": "Irrelevant", "title": "Responding to the Individual Trauma of Domestic Violence: Challenges for Mental Health Professionals", "abstract": "A clear link exists between domestic violence and mental health problems for women. Depression, trauma symptoms, and suicide attempts are issues that seriously undermine the emotional well-being of women who have been subjected to violence and abuse from their partner or ex-partner. This paper draws on a research project that highlighted the mental health issues for women using domestic violence services and raised a number of pertinent problems for policy and practice in this area. Bringing services for survivors into the mainstream of service provision within the health and mental health arena may bring problems if a model of individualized service provision is not enhanced by the involvement of professionals and their organizations in the social movement to support survivors and skills that enhance social support. Ideas put forward by Judith Herman (1992) are used to explore this argument.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Suicide attempts are mentioned only as background context illustrating mental health problems associated with domestic violence, not as a central focus, outcome, or analyzed component of the study.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Since the record is deemed irrelevant because suicide is merely background context rather than a substantive focus, the evidence class and empirical method are marked as not applicable.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2009-U-0067", "input_index": 293, "sample_group": "Irrelevant", "title": "Impact of Maternal Childhood Abuse and Neglect on the Outcomes of a Perinatal Depression Trial", "abstract": "Background and Purpose. Traumatic experiences of abuse and neglect during childhood have been linked with a greater risk in adulthood of insecure attachment (Mickelson et al.,1997), depression (Widom et al.,2007), PTSD (Breslau,1999), and quality of life (Rikhye et al.,2008). Depression during pregnancy has been demonstrated to be one of the strongest predictors of postpartum depression (O'Hara & Swain,1996) and may emerge, in part, or be exacerbated by maternal trauma exposure in childhood. One of the aims of this randomized pilot study was to investigate whether the effects of using a brief, evidence-based psychotherapy to treat antenatal depression --brief Interpersonal Psychotherapy (IPT-B; 8 acute sessions, plus monthly maintenance IPT sessions up to 6 months postpartum) would be moderated by childhood trauma exposure in depressed, pregnant women on low incomes who attended an Ob/Gyn clinic in a large urban hospital. IPT-B was enhanced to be culturally relevant to women disadvantaged by race and/or poverty in order to engage and retain them in treatment. Methods. Using a randomized, controlled trial design, 53 pregnant African American and White women on low-incomes, entered the study and were randomly assigned to 8 weekly sessions of IPT-B(n=25) delivered on site in the Ob/Gyn clinic or to a referral to treatment-as-usual (TAU) at a behavioral health center on site in the clinic(n=28). Primary inclusion criteria included 18 years or older, a score of >13 on the Edinburgh Postnatal Depression Scale, 12-28 weeks gestation, fluent in English, and access to a household phone. Exclusion criteria included acute suicidal behavior, psychosis, organic problem, bipolar disorder, substance abuse/dependence within the past six months, or current intimate partner violence. Participants were assessed before and after treatment on depressive symptoms, depression diagnoses, anxiety symptoms, and social functioning. They were also assessed before treatment on childhood traumatic experiences and anxiety disorder diagnoses. Data analyses included descriptive statistics and repeated measures MANOVA, using the intent-to-treat approach. Results. 45% and 51% of the sample, respectively, reported high levels of childhood trauma and at least one current anxiety disorder. At the post-treatment and 6-month postpartum assessments, intent-to-treat analyses showed that women in the IPT-B group displayed significant reductions in depressive and anxiety symptoms, in depression diagnoses, and improved social functioning, compared to those in the TAU group, regardless of trauma or anxiety disorder status. However, those with more trauma exposure showed more impairment on post-treatment and 6-month postpartum outcomes compared to those with less trauma exposure. Conclusions and Implications. Findings suggest that an evidence-based psychotherapy, modified to be culturally relevant, ameliorates antenatal depression and improves social functioning, even in depressed women exposed to childhood trauma or suffering from a comorbid anxiety disorder. Results also show that women with more trauma exposure, though improved, were still at more risk for depressive relapse than were women with less exposure. In planning to disseminate this treatment to depressed, pregnant women in a large public health setting, we think it judicious to provide maintenance sessions up to 12 months postpartum to sustain recovery, especially in women exposed to childhood trauma.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Suicide is mentioned only as an exclusion criterion (acute suicidal behavior) and is not a central focus, outcome, or analyzed component of the study.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is irrelevant because suicide is merely background context for exclusion criteria rather than a substantive focus of the research.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:128122", "input_index": 500, "sample_group": "Irrelevant", "title": "Problem gambling: A suitable case for social work?", "abstract": "Problem gambling attracts little attention from health and social care agencies in the UK. Prevalence surveys suggest that 0.6% of the population are problem gamblers and it is suggested that for each of these individuals, 10–17 other people, including children and other family members, are affected. Problem gambling is linked to many individual and social problems including: depression, suicide, significant debt, bankruptcy, family conflict, domestic violence, neglect and maltreatment of children and offending. This makes the issue central to social work territory. Yet, the training of social workers in the UK has consistently neglected issues of addictive behaviour. Whilst some attention has been paid in recent years to substance abuse issues, there has remained a silence in relation to gambling problems. Social workers provide more help for problems relating to addictions than other helping professions. There is good evidence that treatment, and early intervention for gambling problems, including psycho-social and public health approaches, can be very effective. This paper argues that problem gambling should be moved onto the radar of the social work profession, via inclusion on qualifying and post-qualifying training programmes and via research and dissemination of good practice via institutions such as the Social Care Institute for Excellence (SCIE). (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Suicide is mentioned only as one of several negative consequences linked to problem gambling in the background context, not as a central focus, outcome, or analyzed component.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is a commentary/argumentative piece advocating for policy and training changes regarding problem gambling in social work, without presenting empirical data analysis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2014-U-0541", "input_index": 523, "sample_group": "Irrelevant", "title": "Psychometric Properties of the Beck Depression Inventory � II Among Adult Psychiatric Inpatients", "abstract": "Purpose: Major depressive disorder (MDD) is a common mental disorder (U.S. lifetime prevalence rate = 16.5%) associated with severe clinical consequences (e.g., functional impairment and suicide). For providers seeking to screen clients for MDD, the well-established Beck Depression Inventory (BDI-I) has been widely utilized due to its demonstrated psychometrics across multiple clinical subpopulations. Yet, the psychometric properties and clinical utility of the revised BDI-II among adult psychiatric inpatients, a group at elevated risk for MDD, is largely unknown; a gap in the literature this paper sought to address. Methods: Psychiatric inpatient participants ( N = 1,904) recruited from a non-profit psychiatric hospital in Texas completed the BDI-II and the Behavior and Symptom Identification Scale (BASIS-24) upon admission. BDI-II reliability was examined via Cronbach’s alpha and construct validity via inter-item correlations and BDI-II total score correlations with BASIS-24 subscales. Factor analyses (exploratory and confirmatory) evaluated BDI-II factor structure. Diagnostic utility was explored using receiver operating characteristic (ROC) analyses of a 575 participant subsample assessed for MDD using the Structured Clinical Interview for DSM Disorders (SCID). Results:  The BDI-II sample mean was 24.93 (SD=13.20), indicating that on average, participants experienced moderate depression at admission. Analyses of psychometric properties yielded Cronbach’s alpha of .93, and significant ( p <0.01) BDI-II correlations with the BASIS-24 Depression ( r =.79) and Overall subscales ( r =.81). BDI-II factorial structure was explored by splitting the sample into two random halves. Maximum likelihood estimation extraction with direct oblimin rotation conducted on one random half decomposed the items into three factors with eigenvalues greater than one (8.57, 1.51, 1.20) although scree plot and principal components parallel analyses supported a two factor model (i.e., Cognitive and Affective/Anhedonia) that accounted for 48.03% of variance. The pattern and structure matrices indicated all items loaded onto one of the two factors (>.35); inter-factor correlation was -.68. Generalized least squares with bootstrapping confirmatory factor analysis (CFA) was conducted on the second random half due to non-normality of data; factors were correlated, correlated errors were not permitted. Chi-square tests were significant ( p <0.001) due to the large sample size (Hoelter’s critical N =285). The RMSEA=.06, SRMR=.06, GFI=.93, and Adjusted GFI=.91 indicated good model fit. As the RMSEA of the null model was lower than .158 (RMSEA=.07), incremental indices of fit such as TLI and CFI were not valid. ROC analyses on the SCID subsample (72% prevalence rate of major depression) revealed low AUC (95% CI) = .65 (.61 - .71) for the BDI-II and produced cutoff scores with poor balance between sensitivity/specificity. Implications: This large-scale psychometric investigation of the BDI-II with psychiatric inpatients revealed good internal consistency and convergent validity but suboptimal MDD diagnostic performance. Factor analyses decomposed the BDI-II into two factors (Cognitive and Affective/Anhedonia), mirroring the Cognitive and Somatic/Affective factors previously reported for psychiatric outpatients by the instrument authors. Study findings support BDI-II utility as an inpatient screening measure of depressive symptomology but call into question its diagnostic capabilities. Social workers within inpatient settings are recommended to use the BDI-II to assess depression severity but to consider alternative screening methods for MDD.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Suicide is mentioned only as background context regarding the consequences of major depressive disorder, not as a central focus, outcome, or analyzed component of the study.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is classified as irrelevant because the primary aim is to evaluate the psychometric properties of the Beck Depression Inventory-II for assessing depression severity and diagnosing MDD, with no substantive analysis of suicide or suicidality.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:42716", "input_index": 539, "sample_group": "Irrelevant", "title": "Exploring e-Mental Health Preferences of Generation Y", "abstract": "E-Mental Health services could substantially increase the capacity of the mental health care system. This article explores youth consumer preferences for online interventions targeting depression and anxiety. Twenty-three participants who had experienced suicidal ideation and either depression or anxiety and completed one qualitative interview were included. Interviews were topically guided to cover themes of e-Mental Health service preferences around online help-seeking behavior, appearance, content, privacy, and support. We found that youth positively received the idea of, and appreciated the need for, e-Mental Health services. Noted preferences for services were those that are simple to use, interactive, and include support through an online community.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study population is explicitly defined as individuals who have experienced suicidal ideation, making suicidality a central inclusion criterion and substantive focus of the research.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract describes data collection through qualitative interviews with a specific sample size (n=23) and reports thematic findings regarding preferences.", "confidence": "High" }, "full_label_agreement": false, "adjudicated_screening": { "is_relevant": false, "relevance_rationale": "Suicidal ideation is mentioned only as a background clinical characteristic of the recruited sample (participants with depression/anxiety). It is not a central substantive focus, primary outcome, exposure, or distinctly analyzed component. The study's aim and reported findings focus exclusively on e-mental health preferences for depression and anxiety, making SI merely contextual/background per the rubric.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Per the decision rules, when is_relevant=false, both evidence_class and empirical_method must be set to 'Not applicable'.", "confidence": "High" }, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2015-P-0047", "input_index": 578, "sample_group": "Irrelevant", "title": "Cross-Cultural Equivalence of the CES-D with Native American/Alaskan Native and White Youth over the Transition to Adulthood", "abstract": "Background and Purpose: Previous research has shown a lack of cultural equivalence for some items in the Center for Epidemiologic Studies Depression (CES-D) scale, a scale applied in each wave of the National Longitudinal Study of Adolescent Health (Add Health) to assess the emotional state of study respondents. However, measures employed longitudinally with adolescents and young adults need to reliably and validly measure and capture changes in latent constructs over the transition to adulthood for the appropriate developmental age and ethnicity of respondents. This is particularly important for Native American/Alaskan Native youth with documented high rates of completed suicide and depression risk. Consequently, my objective was to examine the cross-cultural measurement equivalence and stability over time of the factor structure of the ten CES-D questions used in Waves I and IV of Add Health for Native American/Alaskan Native respondents. White respondents were included for comparison. Methods: Secondary public use Add Health data previously collected through self-administered questionnaires and interviews between 1994 and 2008 was analyzed. The sample included all Native American/Alaskan Native ( n = 187; n = 135) and White ( n = 3,496; n = 2,870) young adults who responded to the ten CES-D questions at Wave I and Wave IV, respectively. Due to the small sample size, respondents who self-identified as both Native American/Alaskan Native and White were included in the Native American/Alaskan Native sample. Item-rest correlations, factor patterns and loadings, measurement errors, and variance and covariance matrices for the ten CES-D questions included in Waves I and IV, as well as a final model reduced to nine questions, were assessed with descriptive statistics, internal consistency analysis, and exploratory and confirmatory factor analysis. Results: At Wave IV, respondents were aged 24 to 33 with a mean age of 28. Females comprised the majority of the sample with 61% in the Native American/Alaskan Native sample and 52% in the White sample. Results showed that the ten-item, three-factor reduced CES-D scale lacks cultural measurement equivalence between Native American/Alaskan Native and White youth and young adults, as expected. Additionally, the ten items have less than adequate factor structure stability regardless of ethnicity over both waves examined. The nine-item, two-factor scale had similar issues. Conclusions and Implications: The CES-D shows instability of factor structures and inadequate cross-cultural measurement equivalence over time for Native American/Alaskan Native and White respondents in Add Health, even using a reduced scale. Consequently, findings reported using this measure might be invalid. Limitations include the small sample of Native American/Alaskan Native respondents. Future longitudinal studies attempting to examine latent mental health constructs over the transition to adulthood should ensure that chosen scales are constructed and validated for use with respondents from all age groups and ethnicities in the sample. These findings highlight the importance of ensuring cross-cultural validity of scales administered in longitudinal research and in evidence-based practice. Cross-cultural validity is a vital condition required by social work researchers who strive for cultural competency and ultimately cultural proficiency with both the populations they serve and those with whom they conduct research.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "The study focuses on the psychometric properties (cross-cultural equivalence and factor structure stability) of the CES-D depression scale, not on suicide or suicidality as a substantive outcome or exposure.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Although the abstract mentions high suicide rates in Native American/Alaskan Native youth as background context for why valid depression measures are important, the actual analysis is strictly limited to psychometric validation of a depression scale using factor analysis; suicide is not analyzed or reported as an outcome.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2015-O-0645", "input_index": 591, "sample_group": "Irrelevant", "title": "Initial Development and Validation of the Bullyharm: The Bullying, Harassment, and Aggression Receipt Measure", "abstract": "Background and Purpose : Bullying is a significant social problem that can negatively affect the physical, social, emotional, and educational well-being of youth.  Research demonstrates that victims of bullying are more likely to report depression, anxiety, low self-esteem, psychosomatic problems, loneliness, suicidal ideation and behavior, tobacco and alcohol use, oppositional behavior, lower academic achievement, missing school, and dropping out of school. Instruments that accurately and reliably measure bullying are essential for the development and evaluation of interventions.  However, critical reviews of bullying instruments indicate problems with existing measures, including failure to include all types or dimensions of bullying behaviors, inadequate psychometric properties or a lack of information about psychometric properties, and item characteristics that threaten score validity, such as confusing wording or lack of appropriate recall time frames. This paper describes the development and preliminary validation of the BullyHARM (Bullying, Harassment, and Aggression Receipt Measure), which was designed to assess students’ experiences of being bullied by peers in school settings. Methods : The development of the BullyHARM involved a number of steps and methods designed to promote validity of scores obtained from the instrument.  Scale development steps included a review of the bullying literature and existing measures, development of an item pool, expert review of items, cognitive interviewing with members of the target population ( N = 5), readability testing, and data collection from a large sample.  A sample of 275 middle school students was used to examine descriptive statistics, psychometric properties, and the factor structure of the BullyHARM. Results : The BullyHARM consisted of 22 items and 6 subscales.  Internal consistency reliability for the overall scale is good (α = .93) and for each subscale: physical bullying (α = .85), verbal bullying (α = .85), relational or social bullying (α = .82), cyber-bullying (α = .91), property bullying (α = .83), and sexual bullying (α = .85).  Mplus was used to perform a confirmatory factor analysis (CFA) to evaluate first-order and second-order factor models of the BullyHARM.  Results showed that the first-order factor model met all of the pre-stated model fit criteria (CFI ≥ 0.97, TLI ≥ 0.97, RMSEA ≤ 0.05, and WRMR ≤ 0.90) whereas the second-order factor model only met two of the criteria.  In addition, results of the DIFFTEST procedure comparing the models showed that the second-order factor model significantly worsened model fit, χ 2 (9) = 32.66, p < 0.05.  The findings indicate that the first-order model should be retained. Conclusions and Implications : The steps used to develop the BullyHARM were designed to ensure that the scale measured all relevant dimensions of bullying victimization, and that scores were valid for members of the target population.  Analyses of scores from 275 students indicate that the BullyHARM has good properties regarding content validation and responded-related validation, and is a promising instrument for measuring students’ experiences of being bullied at school.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "The study focuses on the development and validation of a bullying measurement tool, where suicide is only mentioned as background context rather than a central outcome or focus.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Although the abstract describes empirical psychometric validation methods, the record is deemed irrelevant because suicide is not a substantive focus of the analysis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2015-O-0730", "input_index": 609, "sample_group": "Irrelevant", "title": "Social Cognition and Interaction Training (SCIT) for Deaf People with Schizophrenia: Preliminary Findings", "abstract": "Background and Purpose: Social Cognition and Interaction Training (SCIT) is a manual-based group intervention designed to improve social cognition in schizophrenia. Previous research has revealed that SCIT improves emotion perception and theory of mind, two domains of social cognition consistently related to functional outcomes. Ongoing work by this researcher and others aims to evaluate SCIT’s effectiveness in reducing such deficits so that people with schizophrenia can enjoy higher levels of social integration and independence. The purpose of this pilot study was to examine the feasibility, acceptability, and effectiveness of SCIT with deaf participants in the context of a collaborative research-clinical approach. The evaluation met the administrative goals of participating clinics and worked within the constraints of real-world clinical practice. It was hypothesized that an adapted version of SCIT would be well-tolerated due to its emphasis on social interaction, role play, and (sign language) communication. Methods: Participants were recruited from a psychiatric center in New York. A total of six deaf persons completed the 12-week training: Three with schizophrenia and three with other psychotic disorders. The intervention was facilitated by two fluent signers (one deaf, one hearing), each of whom had worked with the population for many years. An uncontrolled, pre-post design was employed. Outcomes were evaluated in terms of symptom ratings and client satisfaction ratings; social-cognitive and cognitive outcome measures assessed emotion perception, theory of mind, visual-spatial and word memory. Pre- and post-treatment values were probed using dependent sample t-tests for each outcome variable (one-tailed, p<.10) and both with-in group and intra-individual effect sizes were estimated using Cohen's d. Results: Client satisfaction ratings revealed a high level of acceptability and tolerance for the intervention. Statistical analyses indicated a significant reduction, from pre- to post testing, in affective symptoms (depression, suicidality, and anxiety) as well as thought disorder symptoms (unusual thought content, grandiosity, and suspiciousness) (change in mean [ΔM])=.42, p<.10, d=-1.09; ΔM=.17, p<.10, d=-1.09, respectively). Word memory ability improved significantly for all participants (ΔM=10.67, p<.10, d=.82; ΔM=3.00,P<.10, d=1.75), while a trend level reduction was apparent in levels of visual-spatial memory (ΔM=4.5, p<.12, d=.67). Among the participants with schizophrenia (n=3), large effect sizes and significant (positive) intra-individual differences in pre- and post-test scores were found for emotion perception (ΔM=5.34, P<.05 d=4.62) and theory of mind (the Hinting Task) (ΔM=3.34, p<.05, d=1.44) . Conclusions and Implications: Deaf participants who received an adaptation of SCIT showed a significant reduction in affect and thought disorder symptoms. Social-cognitive abilities were improved only in patients with schizophrenia, supporting the idea that SCIT is particularly effective with this population. To our knowledge, this is the first study on social cognition training for deaf people and it provided preliminary evidence that SCIT can be used effectively. SCIT tasks represent highly valued activities in the deaf community and are integral to Deaf Culture. Practice implications relate directly to expanding opportunities for deaf individuals to participate in interventions, like SCIT, that broaden social interactions and create opportunities to engage with high level signers in meaningful treatment experiences.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Although the abstract mentions a reduction in 'suicidality' as part of a composite measure for affective symptoms, suicide is not a central substantive focus, primary outcome, or distinctly analyzed component; it is merely one item within a broad list of general psychiatric symptoms assessed in a study focused on social cognition training.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is classified as not relevant because the primary aim and outcomes concern social cognition and general symptom reduction in schizophrenia, with suicidality appearing only as a minor, unsegregated component of a broader affective symptom cluster rather than a distinct focus of analysis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2016-P-0470", "input_index": 684, "sample_group": "Irrelevant", "title": "Perceptions Regarding Access to Social and Mental Health Services in a Rural Community in Southern New Mexico", "abstract": "Introduction : Rural communities in the US encounter lack of opportunities such as large distances from health and learning services, public transportation, food deserts, scarcity of social and mental health services that are culturally and linguistically appropriate (Aguilar-Gaxiola, Loera, Mendez, et. al, 2012).  Additionally these communities embrace 85% of this country’s poverty. Rural areas include a high percentage of English-language learners and minority children in middle and high schools. Suicide among adolescents is approximately double in rural communities that in urban settings (Fontanella, Hiance-Steelesmith, Phillips, et. al, 2015). Furthermore, substance use/abuse and overdoses are higher in rural communities increasing the vulnerability of its residents. Nevertheless, this paper examines the involvement of local community leaders, parents and caregivers addressing barriers by emphasizing strengths and bringing together resources to invest in their youth future. Methods : Participants were recruited through a leader and promotora from a rural colonia in Southern NM. Participants included 15 adult and 15 adolescent, men and women. They participated in a 6-month community garden project in their local community. Participants engaged in-group discussions following a semi-structure questionnaire including questions related to their experiences living in a rural community and access to services. There were a total of 6 group discussions of 60 to 90 minutes each, 3 with adolescents and 3 with adults. The group voice recordings were transcribed and followed grounded theory techniques for the analysis. Results : Adult participants were first-generation of Latino immigrants from Mexico. Adolescents were second generation Latinos. Adults were 45 to 92 years old and adolescents 12 to 18. Participants reported high incidents of mental health issues including substance use/abuse and overdoses in the community, middle and high schools. Adolescents reported about the lack of empathy and interest from the teachers. The adults spoke about their concerns regarding new availability of drugs such as alcohol in powder and how adolescents are not a priority in their community. Another main issue discussed by the two groups is the misconception of mental health. Both groups communicated about the stigma of being “loco” and the resistance to seek services. At the same time they discussed different venues to engage people without shaming. The two groups mentioned education as the main tool to increase awareness about mental health and for adolescents to learn the consequences of substance use. Also adolescents talked about the lack of activities after school and the need of a place or program to engage in healthy activities. Participants in the community garden were able to voice their concerns and learn about community needs and resources within their community. Discussion and Implications : Communities create their own identity by combining their capital/assets including their human, social and cultural capital. Rural communities gather their strengths to empower the youth and adults by connecting them with their local resources. Social workers need to advocate increasing social and mental health services for rural communities emphasizing substance use. Also social workers can be a link/brokers between policy writers in the social services to address the particular needs in rural communities.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Although suicide is mentioned in the introduction as background context regarding higher rates in rural areas, it is not a central focus, outcome, or analyzed component of the study, which primarily examines perceptions of access to social and mental health services.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is classified as irrelevant because suicide serves only as contextual background rather than a substantive focus or analyzed outcome; therefore, evidence class and method are not applicable.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2017-U-0523", "input_index": 803, "sample_group": "Irrelevant", "title": "The Impact of Language in Discourses on Physician Assisted Dying: Untangling Threads of Discord in the Case of Brittany Maynard", "abstract": "Background: Physician assisted dying for the terminally ill is permitted in only a handful of places in the United States. However, locales continue to actively consider the issue through legislation or legal action. The year 2015 saw physician-assisted death legalized by a Supreme Court decision in Canada, and by legislative action in the State of California. Prior to this legislation, in 2014, 29 year-old California native and Oregon transplant Brittany Maynard became an outspoken activist in the Death-with-Dignity movement at the national level. During the course of her advocacy for terminal patients’ rights to hasten their deaths, she identified use of the word “suicide” as “inflammatory”. Polemic internet communication surrounding Maynard’s case constitutes a salient case study in the most recent chapter of this ethical and moral debate. As hastened death is increasingly discussed and legalized, social work and other disciplines providing services to persons and families facing the end of life should actively consider ways to think and talk about physician assisted dying. Method: This study uses discourse analysis to examine publically available internet texts focusing on individuals contesting the ‘best terminology’ to use in debates focusing on Maynard’s story and advocacy. Internet articles were selected for inclusion if they contained contestations about correct terminology in both the article itself and in comment threads related to the article. These articles and qualifying comments, totaling­­­­ 173 pages of text, were coded for major themes, then recoded and labeled based on fitness with three major themes emerging from expressed meaning behind contestations of correct terminology. Findings: I argue that reasoning offered in declarations of ‘correct’ or ‘best’ terminology within these texts gives a candid view of what is important to individuals taking part in the debate. Three major themes emerging from the data include defending agency, relation, and moral acts; seeking an objective truth; and concerns about sociocultural morality. For those defending agency, relation, and moral acts, it was important to feel like their death choice, or the choice of their loved ones, was a moral choice that they indeed had the right to make. Individuals appealing to some objective truth often argued that there was only one correct and objective name for physician assisted dying. Finally, concerns of sociocultural morality often hypothesized that what physician assisted dying is called could have serious effects on a national morality. Conclusion: Linguistic and medical anthropology offer useful theory for helping social work consider cultural beliefs about terminal illness and meaning in language disagreements surrounding physician assisted dying. Using these theories and emergent themes, discussion focuses on how social workers might approach language and dialogue surrounding death choices in thoughtful, respectful, and productive ways to both enhance resource access and build sound therapeutic alliances in end-of-life care. Finally, this analysis helps to inform future social work research about communication and values at the end of life as physician assisted dying becomes more widely accepted and available. Whether in a national debate, social work research, or at our clients’ bedside, language matters in death choice discourses.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "The study focuses on physician-assisted dying and euthanasia, which are explicitly excluded from the relevance criteria unless they substantively analyze suicide or suicidality, which this record does not.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Since the record is deemed irrelevant because it concerns physician-assisted dying rather than suicide, the evidence class and empirical method are marked as Not applicable.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:36880", "input_index": 823, "sample_group": "Irrelevant", "title": "Behavioral economics of death and dying decisions: Both rational and irrational approaches", "abstract": "A decision to accept death and forego life-extending medical procedures can be both rational and irrational. This article reviews perspectives on death from the viewpoint of behavioral economics, which relies on psychology as the basis of decision-making in this regard. According to behavioral economics, both the benefits of living and the costs of death should be emphasized so that a person who is thinking about suicide reconsiders that option and, hopefully, changes his or her mind and tries to safeguard life and avoid life-threatening risks. One way to make dying decisions more rational is to write out a living will or advance directives to help doctors understand a patients' intentions with regard to decisions about dying should they become unable to articulate that intention at some later, critical, life-or-death situation. Living wills and advance directives can therefore reduce the chances of mercy killing or euthanasia, especially in the context of a developing country, especially when life-extending technologies are limited.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "The abstract focuses on end-of-life decision-making, advance directives, and euthanasia from a behavioral economics perspective, with suicide mentioned only as a passing example of irrational decision-making rather than a central focus or analyzed outcome.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Since the record is deemed irrelevant to the suicide-focused corpus, evidence class and empirical method are marked as not applicable.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:35000", "input_index": 836, "sample_group": "Irrelevant", "title": "Psychometric Properties of the CES-D Among Black Adolescents in Public Housing", "abstract": "Objective: The Center for Epidemiologic Studies Depression Scale (CES-D) has not been fully validated as a depression screening scale among Black adolescents. This study examines the psychometric properties of the CES-D as applied to Black adolescents, seeking to understand the unique way in which Black adolescents express their depression symptoms. Method: We hypothesized that the expression and factor structure of depressive symptoms measured by CES-D would be different when applied to Black adolescents. Black adolescents (N = 782) ages 11-21 were recruited from 9 urban public housing developments in 4 large U.S. cities. Confirmatory factor analysis and exploratory structural equation modeling (ESEM) were used to compare the fit of competing models. Convergent validity of the CES-D was examined via associations with gender, age, and suicidal ideation in the ESEM model. Results: Instead of the original 4-factor structure of the CES-D, a 2-factor ESEM model demonstrated satisfactory fit to our data (CFI = 0.95, TLI = 0.93, RMSEA = 0.04). Compared with females, Black males were less likely to endorse positive affect items of the CES-D (r = -0.13, p < 0.01). Conclusions: Conceptualizations of depression among Black adolescents may differ from any other populations previously studied. Clinicians should assess the unique expression of depression among Black youth when developing treatment plans.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "The study focuses on the psychometric validation of a depression screening tool (CES-D), and while suicidal ideation is mentioned as a variable for convergent validity, it is not a central substantive focus, primary outcome, or distinctly analyzed component of the research.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Suicide is merely a background covariate used to establish convergent validity for a depression scale, not the primary subject of analysis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2018-P-0286", "input_index": 927, "sample_group": "Irrelevant", "title": "What Makes a Community Supportive? Sgm Youth's Perceptions of Community Strengths", "abstract": "Background : Sexual and gender minority (SGM) youth in small towns may be at risk of stigma and victimization leading to poor well-being (Burton et al., 2013; D’Augelli et al., 2007; Gray, 2007; Rosario et al., 2006). Research on rural communities and SGM populations has primarily taken a deficit approach, describing the negative experiences of SGM people in small towns, with a few exceptions (see Gray, 2007; Oswald & Culton, 2003). However, research also suggests that community-level support can mitigate negative outcomes SGM youth experience (Saltzburg & Locke, 2010), yet we know little about what factors SGM youth believe make a community supportive. Community climate is one conceptualization of community-level support or hostility experienced by SGM people (Oswald et al., 2010). While hostile climates are associated with greater suicide attempts among SGM youth, supportive climates, particularly religious support, is associated with fewer symptoms of alcohol abuse and fewer sexual partners (Olson et al., 2006). Drawing on a social work strengths perspective, this study aimed to understand the specific factors that SGM youth perceive as making communities supportive to SGM people. Methods : In-depth interviews were conducted with SGM youth (ages 14-18, M=16) across rural and small towns in one Midwestern state. Participants (N=34) were recruited using purposive sampling via fliers, referral, and social media advertisements. Youth were majority White (64%), cisgender female (53%), and bisexual or pansexual (64%). 21% of participants identified as transgender or questioning. Interview questions assessed youth’s perception of community climate toward SGM people, the factors that made their communities supportive or hostile, and their ideas about what would make their community more supportive toward SGM people. Multiple analysts engaged in an iterative coding process involving open, axial, and selective coding to develop and refine coding categories and ensure consistency with the data (Strauss & Corbin, 1990). Results : Findings revealed four major categories that youth linked to communities being supportive of SGM people: supportive people, resources and education, visibility, and policies. Supportive people included being open to talking about SGM people and issues and community members standing up for SGM rights and equity. Resources and education included the presence of SGM supportive organizations and groups such as SGM community centers and SGM-specific training for school counselors and other professionals. Visibility encompassed youth seeing signs of SGM support in their community such as rainbow flags or ally stickers. Additionally, youth expressed that a supportive community has out SGM people who are visible to youth. Finally, youth indicated that a supportive community would have pro-SGM policies such as SGM-inclusive non-discrimination policies and gender neutral restrooms, reflecting just and equitable treatment of SGM people. Conclusions and Implications : These findings reveal important potential strengths of rural communities and how they can be harnessed to promote the well-being and equity of SGM youth. Future research should test the associations between these factors and SGM youth well-being. Practice and policy implications directly map onto the findings and indicate ways in which social workers can intervene at the community level to promote well-being.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Although the background mentions suicide attempts as a known negative outcome of hostile climates, the study's primary aim and results focus on identifying factors that make communities supportive (e.g., visibility, policies) rather than analyzing suicide or suicidality as an outcome.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is classified as not relevant because suicide is only cited in the background literature to justify the importance of community support, but it is not a variable measured, analyzed, or reported in this qualitative study on community perceptions.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2020-U-0149", "input_index": 1128, "sample_group": "Irrelevant", "title": "Excluded from \"Inclusive\" Communities: LGBTQ Youths' Perception of \"Their\" Community", "abstract": "(Qualitative Data) Oral Papers Excluded from “Inclusive” Communities: LGBTQ Youths’ Perception of “Their” Community Background and purpose: Many young LGBTQ people are encouraged to seek support in the LGBTQ community, by both researchers and social service providers. The ultimate goal of finding a supportive community is to foster within youth a sense of belonging. The experience of belonging is associated with decreased risks of suicide, drug abuse, and depression. Implicit in this framework is the assumption all LGBTQ young people will be accepted within the community. However, the LGBTQ community is may be often less inclusive than assumed, in part because of the blending of issues around sexuality and gender. This paper is part of a larger phenomenological study that asked participants about their experiences of bullying and how they were able to cope with their experiences. In this paper, we explore the participants’ narratives regarding the exclusionary and inclusionary aspects of the LGBTQ community. Methods: LGBTQ young adults aged 18-29 were recruited through LGBTQ service agencies, LGBTQ publication advertising and through social media in a Midwestern state for individual interviews regarding their experiences of bullying. Additional participants were found through snowball sampling. Twenty-four young adults of multiple gender and sexual identities participated in semi-structured in-depth interviews that were audio-recorded. Interviews were transcribed and analyzed for themes. For the purpose of this study, we explored the participant narratives related to negotiating their identities within the LGBTQ community, which frequently emerged in answers to the questions: “How did you deal with being bullied?” and “Where did you go for support?” Findings: Although a majority of the youth reported their connections to the LGBTQ community as helpful in terms of coping with the bullying they experienced, several described experiences such as “not being gay enough,” or “feeling like I don’t belong.” Some youth reported disappointment in finding the LGBTQ community to be exclusionary when they expected it to be inclusive. Additionally, youths’ identity development and sense of belonging appear to be moderated by many factors, such as race, socio-economic status, and gender presentation. Further, these exclusionary and inclusionary aspects are not often discussed within the LGBTQ community. Conclusions and implications: Although some youth feel a sense of belonging to the LGBTQ community, some youth do not feel a sense of belonging. In terms of resilience, for youth feeling excluded from a community that they hoped would be inclusive may be detrimental to their well-being, as they will need to work harder to find the supports they need to thrive. Results from this study indicate that clinicians working with LGBTQ young people need to have an understanding of the communities in which they make referrals and adequately prepare youth for the need to find communities that “fit.”", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The abstract explicitly links the experience of belonging within the LGBTQ community to decreased risks of suicide, making suicide risk a central substantive focus and outcome context for the study.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The study utilizes semi-structured in-depth interviews with 24 participants and analyzes transcripts for themes, which constitutes a qualitative empirical design.", "confidence": "High" }, "full_label_agreement": false, "adjudicated_screening": { "is_relevant": false, "relevance_rationale": "Suicide is mentioned only once in the background section as part of a general list of risks (alongside drug abuse and depression) associated with a lack of belonging. It is not a research question, outcome, exposure, intervention, or distinctly analyzed component. The study's actual focus is on LGBTQ youths' perceptions of community inclusion/exclusion, coping with bullying, and identity negotiation. Per the rubric, suicide as mere background context does not meet the threshold for relevance.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Because the record is deemed irrelevant per the rubric, evidence class and empirical method are set to 'Not applicable' as required by the decision rules.", "confidence": "High" }, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2022-U-0645", "input_index": 1353, "sample_group": "Irrelevant", "title": "Adherence Trends from Objective Dispensing Data: Evaluation Results from a Telemedicine Intervention", "abstract": "Introduction : Individuals with Serious Mental Illnesses (SMI) have a substantially lower life expectancy due to cardiovascular disease, hypertension, diabetes, and suicide. Pharmacological treatments exist but have limited effectiveness because of low adherence to medications. Good adherence is 80% or more of medication taken as prescribed, but the average patient with SMI takes 50-70% of prescribed somatic and psychiatric medications. Currently intrusive interventions like residential treatment and direct observation of medication consumption are used to improve adherence. Telehealth offers an opportunity to support adherence while increasing consumer independence. Medherent is a telehealth adherence platform being used to dispense medication and monitor consumer adherence in community settings. Methods : Medherent devices record if an individual dispenses their medication within a two-hour window set by the consumer and their prescriber. Medherent sends data to the pharmacy server that includes dose and dispense time. We downloaded server data for all consumers using the device between 1/1/2019 and 6/20/2021. We constructed indicators for weekends and number of months using the Medherent device. Individuals were coded as missing a dose if they did not dispense a dose within the two-hour window. Using a random intercept model nested in consumers and robust standard errors to adjust for heteroskedasticity, the dispensing data was analyzed to understand medication dispensing averages and individual variability. A random coefficient model was estimated including the weekend indicator and time on the device. Results : The data did not include any demographic information about consumers but all individuals using the device were clients of community mental health agencies and most consumers lived in residential treatment facilities. 121 individuals had at least two weeks of device use. There were 82,860 scheduled doses and 73,125 (88%) dispensed doses. Using a random intercept model, we found that 14% of the variance was between individuals. Individual adherence ranged from 36% to 99% with 79% of participants having adherence above the recommended 80%. We included indicators for weekend to understand the effect of lower agency support staff on weekends and length of time on the device to measure the effect of device novelty on adherence. There was no evidence that time of the device influenced adherence. On average individuals had a 1.7% lower adherence on the weekend but there was statistically significant ( p < 0.001) variability between participants with the top 95% having a 1.7% higher weekend adherence. Conclusion : The evidence from this study suggest that Medherent has potential to help individuals with serious mental illness adhere to complicated medication regimens in independent living settings. In this sample 79% of individuals had high rates of adherence and the 21% with lower adherence can be identified for targeted interventions to address those adherence issues. On weekends, when support staffing levels are lower, adherence decreased on average less than 2% suggesting that individuals will be able to maintain adequate adherence in more independent settings. This evidence suggests that telehealth approaches can help mental health systems support recovery and consumer independence while maintain high levels of medication adherence.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Suicide is mentioned only as background context regarding life expectancy in serious mental illness, not as a studied outcome or focus.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The study analyzes objective dispensing data to evaluate medication adherence trends, but since suicide is not a central focus, the record is deemed irrelevant.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2022-U-0674", "input_index": 1390, "sample_group": "Irrelevant", "title": "Learning to Thrive in a Binary World: Promotive and Corrosive Factors of Wellbeing Among Nonbinary Individuals", "abstract": "Background and Purpose: The research on trans and nonbinary individuals has been overwhelmingly about deficits and adverse outcomes (e.g., suicidality, depression, anxiety, low employment, murder, gender dysphoria), which centers on survival and coping rather than endorsing long-term goals of resilience and wellbeing. Despite a growing literature on the experiences of binary transgender individuals, little has been explored regarding experiences unique to nonbinary individuals and even less about their wellbeing in relation to their gender. In the face of limited information, more research is warranted to understand the gendered experiences of nonbinary individuals and their relationship to wellbeing to inform social work practice. Methods: A qualitative participatory action study using PhotoVoice was conducted virtually to address the identified gaps in the literature on nonbinary individuals concerning gendered experiences and wellbeing. One aim of the study was to identify promotive and corrosive factors to wellbeing as conceptualized by nonbinary individuals. Prevailing theories of wellbeing informed the study along with the minority stress model and an ecological approach to resilience to account for environmental factors of oppression and individual and community resilience. A sample of nonbinary adults ( N =17) in the midwest was recruited using convenience and snowball sampling. Participants completed group discussions on a dedicated Canvas page and one-on-one zoom interviews. Data were analyzed using thematic analysis by the author and a second coder for trustworthiness. Results: The findings contribute to a thorough description of how nonbinary individuals perceive their wellbeing concerning their gender and as part of a marginalized population. The analysis identified seven themes of promotive and corrosive factors of wellbeing: (1) Coping Skills to Manage Minority Stressors, (2) Interpersonal Support, (3) Environmental Support, (4) Nurturance Through Care Practices, (5) Positive, Accurate, and Nuanced Representation, (6) Advocacy, and (7) Agency in Wellbeing. The direct environment was found to be the primary source of external corrosive factors and contributed to reduced mental health (e.g., anxiety, depression) and insecurities (e.g., internalized transphobia). Of the seven themes presented, only two themes related to the internal processing of coping and resilience (coping skills to manage minority stressors and agency in wellbeing). The other five themes concern building a supportive network and mitigating toxicity and creating systemic change to raise awareness and reduce microaggressions. This proportion further corroborates the importance of the environment in their wellbeing. Conclusions and Implications: This study contributes a new approach to PhotoVoice methodology, wellbeing literature, and trans literature. The ways in which participants researchers dealt with and adapted to marginalization are meaningful contributions to understanding wellbeing among members of a marginalized population. Further, their ability to advocate for changes in the environment to improve their lives and the lives of other nonbinary individuals indicates a high level of resilience and perseverance that was possible through community care. The findings provide a concrete understanding of the gendered experiences of nonbinary individuals and their relationship to wellbeing, which can be used to inform ways for social workers to serve the community appropriately and effectively. Recommendations for practice application and advocacy will be discussed.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Although suicidality is mentioned in the background as an example of adverse outcomes often studied in this population, it is not a central focus, outcome, or analyzed component of this study, which primarily investigates general wellbeing and resilience factors.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is classified as irrelevant because suicide is only cited as background context rather than a substantive focus or analyzed outcome.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:77630", "input_index": 1564, "sample_group": "Irrelevant", "title": "Needs and experiences of cancer care in patients’ perspectives among the lesbian, gay, bisexual, transgender and queer community: a systematic review", "abstract": "Individuals within the Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) community who are diagnosed with cancer experience inequitable treatment in healthcare systems worldwide, resulting in dissatisfaction, communication challenges with healthcare providers, and a deep sense of disappointment. Stigma, discrimination, and perceived homophobia further heighten the risk of psychological and attitudinal disorders, including depression and suicidal tendencies, among LGBTQ cancer patients. To comprehensively assess the discrimination faced by LGBTQ cancer patients and gain deeper insights into their needs and experiences, we conducted a systematic review following PRISMA guidelines. We searched for relevant articles using specific keywords in reputable databases such as PubMed, Google Scholar, and PsycINFO. We rigorously evaluated article quality using the CASP (Critical Appraisal Skills Programme) checklist. From a total of 75 eligible studies, we carefully selected 14 studies, specifically examining LGBTQ cancer patients who were currently undergoing or had previously undergone cancer treatment. The studies revealed various factors, including unmet needs related to anxiety and depression, instances of discrimination, disparities in care, and inadequate support systems. A majority of patients expressed dissatisfaction with their cancer care and continued to encounter discrimination and disparities throughout their treatment journeys. Consequently, this led to heightened levels of anxiety, stress, depression, and negative perceptions of healthcare providers. Based on these findings, we recommend providing specialized training to social workers and healthcare providers. This training will equip them with the necessary skills and knowledge to deliver culturally sensitive care tailored to the unique needs of LGBTQ cancer patients. By addressing discrimination, reducing disparities, and fostering an inclusive environment, healthcare professionals can strive to ensure that LGBTQ cancer patients receive the care they deserve.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Suicide is mentioned only as a background risk factor associated with stigma in the introduction, but it is not a central focus, outcome, or analyzed component of the systematic review.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is a systematic review, which would be empirical if relevant, but since suicide is not a substantive focus, it is classified as irrelevant.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2025-P-0771", "input_index": 1841, "sample_group": "Irrelevant", "title": "Social Networks and Military Sexual Harassment: Implications for Depression Among U.S. Army Personnel", "abstract": "Background and Purpose: Military sexual harassment victimization is associated with poor mental and physical health and the erosion of morale and cohesion within military units. Social support can mitigate the psychological and emotional distress that survivors may endure, enabling them to cope more effectively. However, there is a significant gap in current knowledge regarding how social networks may moderate the relationship between military sexual harassment and depression. Methods: Data was collected using a cross-sectional design. A convenience sample of 242 active-duty U.S. Army personnel were recruited from one domestically stationed battalion in 2019. Participants completed a self-report questionnaire and a social network interview, which asked participants to list as many as ten people they had contact with in the past 30 days and then answer questions about their relationships with and characteristics of network members. Linear regressions were used to examine the relationship between depression, military sexual harassment, and social networks, controlling for demographic variables (such as gender, race, and age), as well as mental health variables, including PTSD and suicidality. It was hypothesized that social support size would positively moderate the relationship between military sexual harassment and depression. Results : 74% of women and 40% of men reported experiencing military sexual harassment. The adjusted R-square of 0.496 indicates that approximately 49.6% of the variance in depression among the sampled individuals is accounted for by the model. There was a significant network interaction effect, such that the effect of military sexual harassment did significantly vary by social network size t(220) = 2.31, p < .05) while controlling for demographic variables, PTSD, and suicidality. As the harassment level increases, the negative association of social support with depression is attenuated. Conclusions and Implications: The findings underscore the alarming prevalence of military sexual harassment and its detrimental impact on mental health. The study revealed a crucial moderating role of social support network size and harassment. When people experience higher levels of harassment, their support networks appear to be less able to protect them from depressive symptoms. These results emphasize the importance of fostering robust social support systems within military units as a means of buffering against the adverse effects of sexual harassment. Efforts to strengthen interpersonal connections and promote a culture of solidarity and empathy may help mitigate the psychological toll of harassment and enhance overall well-being among service members.", "primary_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Suicidality is mentioned only as a control variable in the statistical model, not as a primary outcome or central focus of the study.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is classified as irrelevant because suicide/suicidality is merely a covariate rather than a substantive focus, so no evidence class or method is assigned.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:34152", "input_index": 24, "sample_group": "Relevant Non-empirical", "title": "OF AGEISM, SUICIDE, AND LIMITING LIFE", "abstract": "Increased longevity, life-extending medical technology, and growing health-care costs have given rise to much discussion of the meaning of life in old age and to suggestions that limits be set on the length of life: by suicide or by limiting medical treatment. It is argued that, while recommendations that treatment be limited or suicide be viewed as rational solely because of a person's age are based on ageism and a misunderstanding of the life course, voluntary suicide in cases of hopeless illness is defensible and need not lead down a slippery slope in which lives of ''useless'' people are devalued. Implications for social work practice are discussed.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The article centrally analyzes the ethical arguments surrounding suicide in the context of aging and ageism, specifically discussing when voluntary suicide is defensible versus when it constitutes ageist devaluation.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The abstract describes a theoretical argument and discussion of implications for practice without presenting any primary data, systematic search methods, or empirical analysis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:53622", "input_index": 35, "sample_group": "Relevant Non-empirical", "title": "PREADOLESCENT SUICIDE - HOW TO ASK AND HOW TO RESPOND", "abstract": "Studies of preadolescents strongly suggest that the prevalence of depression and suicidal activity among them has been seriously underestimated. The authors review current thinking about preadolescent suicide; discuss its implications for clinicians, supervisors, and agency administrators; and recommend a research agenda to guide and support effective practice with preadolescents at risk for suicide.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The record focuses centrally on preadolescent suicide, discussing prevalence, clinical implications, and assessment strategies.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The abstract explicitly states that the authors 'review current thinking' and discuss implications, indicating a narrative literature review rather than an empirical study with analyzed data.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:24197", "input_index": 64, "sample_group": "Relevant Non-empirical", "title": "Global trends in suicide prevention: Towards the development of national strategies for suicide prevention - Ramsay,RF, Tanney,BL", "abstract": null, "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The title explicitly focuses on global trends in suicide prevention and the development of national strategies, making suicide prevention a central substantive focus.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "As a title-only record with no abstract, there is no defensible indication of an empirical design (such as data analysis or systematic search methods), so the conservative fallback to Non-empirical is applied.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:22936", "input_index": 97, "sample_group": "Relevant Non-empirical", "title": "Night falls fast: Understanding suicide.", "abstract": null, "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The title explicitly focuses on understanding suicide, indicating that suicide is the central substantive topic of the record.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "As a title-only record with no abstract or methodological details provided, there is no defensible evidence of an empirical design, so the conservative fallback to Non-empirical is applied.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:31461", "input_index": 102, "sample_group": "Relevant Non-empirical", "title": "Understanding suicide attempts by adolescent Hispanic females", "abstract": "This article presents integrative model to aid clinicians in understanding suicide attempts by adolescent Hispanic females. On the basis of knowledge accumulated through clinical and research experience, the model describes a convergence of sociocultural, familial, developmental, and psychological factors that include considerations of family and parental functioning; adolescent female development; and the relationships of fathers, mothers, and daughters.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The article focuses centrally on understanding suicide attempts by a specific population (adolescent Hispanic females), making suicidality the primary subject matter.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The abstract describes the presentation of an integrative conceptual model based on accumulated clinical and research experience, rather than reporting new data analysis or a systematic review process.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:30902", "input_index": 108, "sample_group": "Relevant Non-empirical", "title": "Night falls fast: Understanding suicide.", "abstract": null, "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The title explicitly focuses on understanding suicide, indicating that suicide is the central substantive topic of the record.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "As a title-only record with no abstract or methodological details provided, there is no defensible evidence of an empirical design, so the conservative fallback to Non-empirical is applied.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:88703", "input_index": 236, "sample_group": "Relevant Non-empirical", "title": "Evidence-Based Suicide Prevention Screening in Schools", "abstract": "Screening for suicidality, as called for by the President's New Freedom Commission on Mental Health, is a major public health concern. As a place where adolescents spend a considerable amount of their waking hours, school is an important venue for screening adolescents for suicidal behaviors and providing preventive education and risk management. Social workers, as the largest occupational group of mental health professionals in the United States, have a significant role to play in the national strategy to prevent youth suicide, especially at the school level. This article reviews the literature on suicide prevention screening, warning signs, and risk factors to gain a better understanding of evidence-based screening strategies and discuss the implications for school social workers, counselors, and psychologists. It focuses on the identification of research-based information and explication of potential means for guiding preventive screening and clinical practice with suicidal adolescents.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The article centrally focuses on evidence-based suicide prevention screening strategies, warning signs, and risk factors for adolescents in school settings.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The abstract explicitly states that the article 'reviews the literature' to discuss implications for practice, indicating a narrative or traditional review rather than a systematic empirical study with analyzed data.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:18956", "input_index": 245, "sample_group": "Relevant Non-empirical", "title": "The role of affect regulation in a case of attempted maternal-filicide suicide: Commentary on an act of despair", "abstract": "A case of attempted maternal-filial suicide is discussed from the perspective of trauma, emotional regulation and defense mechanisms. Case details which include childhood sexual abuse, observed parental violence and emotional neglect allow for an illustration of the impact of childhood family experiences on adult intimacy and coping patterns. Domestic violence and the perception of protection are also explored. Emotional regulation in the experience of despair is approached from an object relations perspective. Based on this, implications for prevention and treatment are presented.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The record focuses centrally on a specific case of attempted maternal-filicide suicide, analyzing the psychological factors and implications for prevention.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The article is explicitly labeled as a commentary on a single case vignette used to illustrate theoretical concepts (trauma, emotional regulation) rather than presenting systematic empirical data analysis or a formal case study with rigorous methodology.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:27051", "input_index": 268, "sample_group": "Relevant Non-empirical", "title": "An Evidence-Based Approach to Managing Suicidal Behavior in Patients with BPD", "abstract": "This review will suggest an evidence-based approach to managing suicidal patients with borderline personality disorder (BPD). Many principles currently used in practice have little basis in empirical data. And some approaches used to manage chronic suicidality, particularly the emphasis on \"safety,\" may actually be counter-productive. (C) 2008 by The Haworth Press. All rights reserved.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The record focuses centrally on managing suicidal behavior in patients with borderline personality disorder, making suicide a primary substantive focus.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The abstract describes the article as a review that suggests an approach and critiques current practices without describing a systematic search strategy, data synthesis, or original empirical analysis, classifying it as a narrative or conceptual review.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:49031", "input_index": 345, "sample_group": "Relevant Non-empirical", "title": "Identity and Trauma in Adolescents Within the Context of Political Violence: A Psychosocial and Communitarian View", "abstract": "The author explores the concept of identity as a frame of analysis in adolescents responding to various actual experiences of trauma. The author looks into numerous themes including the impact of broken identities, different ways of understanding the \"victim identity\", the identities of trauma, the role of transitions, as well as identity dilemmas. By examining the experience of young Mapuche in South America, the experience of war and political violence in Mexico and el Salvador, the identity of displaced young people in Colombia, and a multilevel analysis of child suicides among the Embera ethnic group in Choco, Colombia, a psychosocial and communitarian analysis of the impact of violence and war on youth is offered.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The abstract explicitly mentions a 'multilevel analysis of child suicides' among the Embera ethnic group as a central component of the study's examination of trauma and identity.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The text describes the author 'exploring concepts' and 'offering an analysis' based on examining experiences, which characterizes a conceptual or theoretical review rather than a report of primary data collection or systematic empirical synthesis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:45636", "input_index": 452, "sample_group": "Relevant Non-empirical", "title": "Understanding Suicide: A Sociological Autopsy", "abstract": null, "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The title explicitly focuses on understanding suicide through a sociological lens, indicating suicide is the central substantive topic.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "As a title-only record with no abstract to indicate data analysis or systematic methods, the conservative fallback for design is Non-empirical.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:38206", "input_index": 721, "sample_group": "Relevant Non-empirical", "title": "A review of the effectiveness of military suicide prevention programs in reducing rates of military suicides", "abstract": "The suicide rate within the U.S. armed forces remains a pressing issue for the country. This comprehensive literature review found only five published studies on military suicide prevention programs and their outcomes. Substantial research design and methodological issues are noted, and only one study produces statistically significant results. Findings reveal a serious lack of empirical evidence demonstrating effective suicide prevention programs within the U.S. armed forces.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The record focuses centrally on evaluating the effectiveness of military suicide prevention programs and analyzing outcomes related to suicide rates.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "Although it reviews literature, the abstract describes a 'comprehensive literature review' without explicitly stating systematic search methods or meta-analytic techniques, classifying it as a narrative/traditional review rather than a systematic empirical synthesis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:38630", "input_index": 743, "sample_group": "Relevant Non-empirical", "title": "The Wish to Die: Assisted Suicide and Mental Illness", "abstract": null, "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The title explicitly addresses assisted suicide in the context of mental illness, which falls under the scope of suicide-specific policy, practice, and risk factors.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "As a title-only record with no abstract to indicate data analysis or systematic methods, the conservative fallback is Non-empirical.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:101944", "input_index": 937, "sample_group": "Relevant Non-empirical", "title": "Editorial: The Right for the Elderly to Commit Suicide", "abstract": null, "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The title explicitly addresses suicide among the elderly as a central substantive focus regarding rights and policy.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The record is identified as an editorial, which is a commentary or opinion piece rather than an empirical study involving data analysis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:96305", "input_index": 955, "sample_group": "Relevant Non-empirical", "title": "Toxic Masculinity and Mental Health in Young Women: An Analysis of 13 Reasons Why", "abstract": "The recent release of the Netflix series 13 Reasons Why, which focuses on the suicide of an adolescent girl, has been accompanied by a large amount of social commentary. However, most of this commentary focuses on the suicide itself and does not consider how the series constructs the root causes of suicide. In this brief article, we argue that from a feminist social work perspective, the series highlights a key root cause of mental health problems—sexual violence—and that the discussion of this violence has been woefully absent in the commentary on the series. To support this argument, we highlight relevant examples from the show and discuss three key themes: (1) the overwhelming presence of toxic masculinity, (2) slut-shaming as a form of devaluing the female body and female sexual expression, and (3) the failure of adult systems to adequately respond to youth. We then provide suggestions for adults who work with youth around how to better engage in critical discourse about series content.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The article centrally analyzes the construction of root causes of suicide and mental health problems within the context of the Netflix series '13 Reasons Why', making suicide a primary substantive focus.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The abstract describes a theoretical argument and thematic discussion based on examples from a media text, without any systematic data collection, statistical analysis, or reproducible search process, classifying it as a conceptual/narrative commentary.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:114651", "input_index": 1083, "sample_group": "Relevant Non-empirical", "title": "Social Work Practice and Gun Safety in the United States", "abstract": "Public policy debate about guns continues in the United States, with many professional organizations taking strong stands in policy statements. Moreover, many clinical organizations have provided recommendations for practitioners to use with clients to encourage gun safety in the home, particularly for vulnerable populations such as families with young children and those at risk of suicide. Social workers are in an excellent position to encourage gun safety with some of the most at-risk populations; however, clinical guidelines and research on preventing gun violence has lagged in social work compared to other disciplines. In this article we examine the importance of gun safety for social work clients (with special attention to families with children, families experiencing violence, and individuals at risk of suicide), consider the recommendations made by other professional organizations, and provide some initial thoughts about how social workers might engage with the families they ser", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The article explicitly focuses on gun safety interventions for individuals at risk of suicide as a central substantive component of social work practice.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The abstract describes an examination of importance, consideration of recommendations from other organizations, and provision of initial thoughts, which characterizes a narrative review or conceptual overview rather than an empirical study with analyzed data.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:102509", "input_index": 1420, "sample_group": "Relevant Non-empirical", "title": "A Social Worker’s Experience with Client Suicide", "abstract": "Mental health social workers often work with clients experiencing suicidal ideation. It is not uncommon for social workers to experience the suicide of a client during their practice. Social workers may experience guilt, shame, anxiety, and depression following a client suicide. Agencies play a prominent role in influencing how social workers will cope with a client suicide. This paper reflects on my experience when my client died by suicide and the response of my agency. Procedures that agencies can utilize to promote support of mental health workers after a client suicide are also discussed. Agencies can ensure a supportive environment by having a clearly developed plan in place before a client suicide occurs. Agency policies and procedures should outline what steps to take and how to provide support to staff during a client suicide crisis. Literature recommendations for agency supportive postvention policy development will be discussed. Social work leaders can decrease adverse reactions that could lead to burnout of social workers who have experienced a client suicide by implementing recommended procedures. Agency policies that focus on supporting the social worker after client suicide influence how staff cope and promote a positive workplace culture.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The record focuses on the experience of social workers following a client's suicide and discusses agency postvention policies and support procedures, which are central to suicide bereavement and prevention contexts.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The abstract describes a personal reflection on a specific experience and discusses literature recommendations and policy implications without presenting data from a systematic search, statistical analysis, or qualitative study design.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:87867", "input_index": 1436, "sample_group": "Relevant Non-empirical", "title": "High-Achieving Asian American Adolescents and Suicide: The Need for Culturally Sensitive Suicide Intervention Approaches in Schools, A Case Study", "abstract": "Within the field of suicidology, high-achieving Asian American adolescents are an under-researched at-risk population. The present paper reviews the existing literature on this topic, addressing the increase in suicidal ideation and suicide attempts within this at-risk group, and explores ecologically valid social work interventions. School social workers are first responders to these at-risk youth and must be well-versed in the risk-factors, including parental resistance to treatment, within the specific populations they serve. To illustrate the relevant issues, a case example is presented of an adolescent Bangladeshi male who attempted suicide while attending school. Finally, this paper recommends suicide prevention measures, including a culturally appropriate suicide assessment and family therapy.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The record focuses centrally on suicide risk factors, suicidal ideation, and suicide attempts among high-achieving Asian American adolescents, along with specific prevention interventions.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The abstract explicitly states that the paper 'reviews the existing literature' and presents a single illustrative case example rather than analyzing primary data or conducting a systematic search, classifying it as a narrative review/conceptual article.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:82226", "input_index": 1719, "sample_group": "Relevant Non-empirical", "title": "Demoralization as a specifier for adjustment disorders", "abstract": "Adjustment disorder (AD) is the most common psychiatric diagnosis yet carries the most loosely defined diagnostic criteria. The phenomenology of demoralization (hopelessness, pointlessness, discouragement, and entrapment) enriches criteria for AD substantially. Moreover, demoralization mediates the suicidality that can follow from maladaptive coping. The focus of treatment seeks to restore morale, hope, and meaning as clear therapeutic targets. Use of demoralization as a \"specifier\"for AD introduces a subtype that will enhance understanding of and communication about a patient, while providing optimal treatment targets.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Suicide is mentioned only as background context regarding the phenomenology of demoralization in adjustment disorders, not as a central focus, outcome, or analyzed component.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is a conceptual/theoretical argument proposing a diagnostic specifier without presenting empirical data or analysis.", "confidence": "High" }, "full_label_agreement": false, "adjudicated_screening": { "is_relevant": false, "relevance_rationale": "Suicidality is mentioned only in a single sentence as a clinical consequence mediated by demoralization. It functions as background context to support the theoretical proposal of using demoralization as a diagnostic specifier for adjustment disorder, rather than serving as a central focus, primary outcome, exposure, or distinctly analyzed component.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is a conceptual/theoretical argument proposing a diagnostic refinement without presenting or analyzing empirical data. Per protocol, because the record does not meet the relevance threshold for suicide-focused research, evidence class and empirical method are set to Not applicable.", "confidence": "High" }, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:757", "input_index": 1740, "sample_group": "Relevant Non-empirical", "title": "Native HeArts: Digital Storytelling Through Indigenous Art", "abstract": "Health disparities for Native/Indigenous youth are perpetuated by systemic bias and racism. Both the scientific literature and media play a role in maintaining disparities by telling stories through narrative or numbers that invalidate Indigenous knowledge and ways of systematic investigation, intervention, and communication regarding health and well-being. Youth were mentored by Indigenous artists to develop culturally relevant digital stories that speak to community wellness efforts, strengths, and resilience in regard to substance abuse and suicide prevention (from youth perspectives) to target root causes of health disparities by shifting narrative power to decolonial Indigenous philosophies. Together, we developed an intervention that targets the underlying root causes of health disparities by transforming the very structures upon which health interventions hinge. The realm of communication is one of these structures that is ripe with possibilities for new conceptions that uplift strength-based narratives through digital media. We created an intervention that emphasizes possibilities through positive images of Indigenous people, effectively addressing community issues by building community-based narrative power.", "primary_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The abstract explicitly identifies suicide prevention as a central focus of the digital storytelling intervention developed for Indigenous youth.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The text describes the development and conceptual framework of an intervention but does not report on data collection, analysis, or empirical results from a study.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:80235", "input_index": 237, "sample_group": "Quantitative", "title": "Family interaction patterns and dysfunction analysis in suicide attempters", "abstract": "The literature on suicide reveals that this phenomenon has been frequently investigated in several specific groups such as the elderly, adolescents, substance abusere, the terminally ill, and other clinical populations. While literature on suicidology has been forthcoming in the international media, sufficient exploration has not occurred in the Indian context. The present study was conducted with a group of 50 suicide attempters admitted to a private psychiatric facility in India following a failed suicide attempt. Instruments to assess their family interaction pattern as well as the extent of dysfunction experienced in several domains were administered, besides studying their suicidal intent and the stressful life events faced. Poor family interaction pattern, particularly with regard to cohesion and leadership were observed. Dysfunction was high across all domains. The analysis was also based on gender and comparison of marital status. It was observed that while female respondents reported better family interaction, their dysfunction levels were higher than that for men. Unmarried respondents reported better family interaction, while the married respondents experienced greater dysfunction. The implications for therapeutic intervention have also been discussed.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly focuses on a population of suicide attempters and analyzes their suicidal intent, family interaction patterns, and dysfunction levels as central outcomes.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes an observational study involving the administration of assessment instruments to a specific sample size (N=50) and reports statistical comparisons based on gender and marital status.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2008-O-7788", "input_index": 262, "sample_group": "Quantitative", "title": "Profile and Use of Social Work Services", "abstract": "Background and Purpose: Depression among Arthritic individuals is associated with lower quality of life, increased risk of suicide, lower medical compliance and greater reliance on the health care system. Despite these problems, social workers and other health professionals do not consistently screen for depression among their clients with arthritis. The purpose of our study was to determine the extent of social work contact with depressed individuals with Arthritis or Rheumatism as well as to compare and contrast depressed and non-depressed individuals with Arthritis or Rheumatism in a large, national Canadian sample. Our hypothesis was that depression is correlated with a range of demographic (e.g. gender, age), physical health (e.g. ADL limitations, pain) and psychosocial characteristics (e.g. social support, self-esteem).Methods: The nationally representative Canadian Community Health Survey 2000-2001 (CCHS) had a response rate of 84.7%, which resulted in a final sample of 130, 880 respondents. Our sample was comprised of 24,511 Canadians who reported they had been diagnosed with arthritis or rheumatism by a health professional. Respondents were diagnosed as depressed by using a subset of items from the Composite International Diagnostic Interview (CIDI). Chi-square tests, independent t-tests and logistic regression analyses were conducted with depression as the outcome.Results: One in 10 Canadians with Arthritis or rheumatism has clinically relevant levels of depression. Depression rates were significantly higher among females, the unmarried, younger, and poorer individuals (p<.01). Individuals in pain, with limitations in ADLs or IADLs, with less social support and with alcohol dependency were vulnerable to depression (p<.01). Less than half of the depressed individuals had consulted a mental health professional and one-third were receiving anti-depressants. One in five depressed arthritic or rheumatic individuals had been suicidal in the past year. With respect to social work contact, two in every five individuals consulting a social worker were depressed. In fact, twenty-three percent of all depressed individuals with arthritis or rheumatism had seen a social worker in the past year and one-third of these depressed clients had seriously considered suicide in the past year. Only ten percent of those with depression had discussed mental health issues with a social worker.Conclusions and Implications: The majority of depressed individuals with arthritis or rheumatism were not receiving adequate treatment for depression. Even depressed individuals seeing social workers were unlikely to discuss their mental health needs. Our findings suggest that all social work clients with arthritis or rheumatism should be screened for depression and suicidal ideation. Furthermore, this study's findings can help all health professionals to improve targeting and outreach efforts for identifying and treating the most vulnerable individuals with arthritis or rheumatism.See more of[MH] Depression and Medical ConditionsSee more ofOral and PosterSee more ofResearch That Matters (January 17 - 20, 2008)", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly analyzes suicide risk factors and suicidal ideation prevalence among depressed individuals with arthritis, reporting specific statistics on past-year suicidality and its correlation with social work contact.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes a quantitative analysis of national survey data using statistical methods such as chi-square tests, t-tests, and logistic regression to examine depression and suicide-related outcomes.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SWRD:52811", "input_index": 353, "sample_group": "Quantitative", "title": "The Effect of Parental Remarriage Following Parental Divorce on Offspring Suicide Attempt", "abstract": "Parental divorce during childhood is associated with an increased risk of suicide attempts for male but not female offspring. This study examines whether parental remarriage has a differential effect on suicide risk for male and female adult offspring. Using the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the sample consists of respondents who experienced parental divorce (N = 6,436). Multivariable regressions were estimated. Females who lived with a stepparent were significantly more likely to report a lifetime suicide attempt compared with females who had not. Clinicians should note that female depressed patients who have a history of childhood parental divorce and remarriage may be at more risk for suicide attempt than previously recognized.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly investigates the association between parental remarriage following divorce and offspring suicide attempts, making suicide attempt a central outcome.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes the use of survey data (NESARC) and multivariable regression analysis to estimate associations, which constitutes quantitative empirical research.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2012-U-0426", "input_index": 416, "sample_group": "Quantitative", "title": "Predictors of Response to Suicide Prevention Trainings: Towards Maximizing Training Impact", "abstract": "Purpose and Background: Suicide is the third leading cause of death among youth aged 10-24 years old in the United States. Gatekeeper trainings are designed to educate adults who have frequent contact with young people to recognize the warning signs for suicidal behaviors and to make appropriate referrals. The effectiveness of gatekeeper training on prevention attitudes and knowledge has been well demonstrated, but little is known about what trainee characteristics are associated with greater training effect. The current study used data from an evaluation of the gatekeeper trainings QPR and RESPONSE, and the suicide intervention skill training, ASIST. This study tested the association of trainee characteristics with change from pre-training to follow-up in suicide prevention attitudes, knowledge and behavior. Methods: A 3 group quasi-experimental design was used, with 3 measurement points (pre � and post-training, and a 6 month follow-up). This study evaluates the 2 hour gatekeeper training component of RESPONSE (a comprehensive high school suicide prevention program), the 2 hour gatekeeper training QPR, and the 2 day suicide intervention skill training ASIST. Of the 180 participants, 77(43%) were male and 101 (57%) were female. Eighty-five percent identified as white; about one-third of the sample were teachers and one-third were clinicians. The average age of the trainees was 42.8 years old (SD=12.0). Seventy six (42%) of the trainees participated in the RESPONSE training, 59 (33%) in QPR, and 44 (24%) in ASIST. Measures were adapted from a previous clinical trial and showed excellent reliability. Regression residualized change scores were computed of pretraining to 6 month follow-up change in prevention attitudes, knowledge and behavior. The association of trainee characteristics and change scores was tested with bivariate correlation and partial correlation, controlling for training condition. Results: The relationships that emerged in both bivariate and partial correlation analyses included: medium to small-medium effects that showed weaker training effects for teachers on 4 of 7 outcomes; and female trainees showed stronger training effects on three outcomes. Significant correlates, not controlling for training type, included small to moderate, positive correlations for clinicians on half of the prevention behavior variables and one attitude variable, and hours of previous suicide prevention training had small to moderate, positive correlations on the majority of prevention behavior variables, and small, positive correlations on attitude and efficacy. While the sample was largely White, no differences were found by race. Conclusions and Implications: Teachers experienced dampening effects on change in suicide prevention behaviors and attitudes, indicating that trainings might be better tailored to teachers. Previous suicide prevention training appears to prime trainees for greater change in suicide prevention outcomes, supporting continued prevention trainings. Gatekeeper trainings have been shown to be an effective component of suicide prevention trainings. The results of this study some areas of modification of prevention trainings to maximize the impact on participants. Despite the public health importance of suicide, it has received little attention in social work training. Further steps for research and implications for social work training and practice are discussed.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study centrally focuses on evaluating the effectiveness of suicide prevention gatekeeper trainings by analyzing changes in suicide-specific attitudes, knowledge, and behaviors among trainees.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes a quasi-experimental design with pre- and post-training measurements, using statistical methods such as regression and correlation to analyze numerical data on suicide prevention outcomes.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SWRD:46096", "input_index": 428, "sample_group": "Quantitative", "title": "Age at Entry into Prostitution: Relationship to Drug Use, Race, Suicide, Education Level, Childhood Abuse, and Family Experiences", "abstract": "This study seeks to explore factors related to age at entry into prostitution. Participants were 389 women arrested for prostitution who had attended a diversion program. Women who entered prostitution as minors were found to be more likely to be African-American; report having a family member with a substance use problem; have a history of attempted suicide; and not have completed middle or high school. The age at first drug use was found to significantly impact the reported age at entry. Key areas for intervention should include improving school connectedness and preventing adolescent substance abuse, specifically for African-Americans.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly analyzes a history of attempted suicide as a distinct outcome associated with age at entry into prostitution.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes an analysis of data from 389 participants using statistical associations (e.g., 'more likely', 'significantly impact'), indicating a quantitative empirical design.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2016-U-0304", "input_index": 668, "sample_group": "Quantitative", "title": "Former Foster Youth Typology of Risk: A Latent Class Analysis of Risk Factors Prior to Homelessness", "abstract": "Background : Homeless youth suffer from a wide range of risk factors that impact the length and quality of their lives. As many as 40% of all homeless youth report a history of foster care and emerging research suggests some experiences while in foster care may impact behavioral health outcomes. Given the rates of foster youth who become homeless, and risk behaviors associated with both a foster care experience and homelessness, this paper will seek to understand how a variety of adverse childhood experiences (ACEs) can be used to generate a typology of homeless former foster youth and subsequently how this typology based upon ACE’s is related to substance use and sexual risk taking during homelessness. Such a typology may be useful in identifying early intervention strategies for subset of homeless former foster youth and foster youth at risk of becoming homeless. Methods : The YouthNet data set was used for this analysis, utilizing a convenience sample of 1046 homeless youth (age 13-25) from three drop in centers in Hollywood, Venice, and Santa Monica CA, collected as part of a longitudinal study of social networks at those locations. A latent class analysis (LCA) was conducted in SAS to determine a profile of risks among these homeless former foster youth, using ACE variables to construct these classes Results: The latent class analysis revealed a four-class solution. Results of the LCA indicated that risk factors common to these youth belonged to a model with four risk classes including those with high homelessness risk and low trauma experience (class1), low homelessness risk and low trauma experience (class 2), low homelessness risk and high trauma experiences (class 3), and high homelessness risk and high trauma experience (class 4). Results indicated that the presence of homelessness risk more highly predicts engagement in drug and sex risk behaviors compared to you with both homelessness risk and trauma experience. In the logistic regression models, class 1 predicted the largest number of drug use, sex risk, and depressive/suicidal risk variables; those youth who had largely experienced homelessness risk variables were more like to engage in lifetime drug use with a variety of drugs, engage in sex risks, to have experienced suicidal ideation in the past 12 months and have above average CESD scores. Discussion: This study indicates that homeless former foster youth generally fit into four distinct risk classes where their homelessness risk and trauma are concerned. While prior literature has looked at risk typologies for foster youth, this study specifically examined class membership of homeless former foster youth by their risks prior to homelessness. These findings may influence the way interventions examine risk among homeless former foster youth; youth who have experienced trauma may also have other skills or experiences that have helped reduce their incidence in drug and sex risks, and lower their levels of depressive/suicidal symptoms. Finally, these results suggest that the risk incurred by so many homeless youth, is similarly influential in the lives of homeless former foster youth, impacting behavioral health outcomes.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "Suicidal ideation and depressive/suicidal risk are explicitly analyzed as distinct outcome variables in the logistic regression models predicting class membership.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The study utilizes a latent class analysis and logistic regression on a dataset of 1046 youth, which constitutes a quantitative statistical analysis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SWRD:35523", "input_index": 835, "sample_group": "Quantitative", "title": "Physical and Mental Health Disparities for Young Women with Arrest Histories", "abstract": "Young women ages 18 to 25 make up approximately 30 percent of women arrested in the United States. Although health disparities have been found for incarcerated adults, health concerns for this subpopulation of women have not been as closely examined. Aiming to fill this gap in the literature, this study examined national data for young women ages 18 to 25 who participated in the National Survey of Drug Use and Health. Physical and mental health concerns were compared for young women with and without arrest histories. Young women with arrest histories had significantly higher odds ratios of multiple physical health concerns and all forms of mental health concerns, including recent suicide attempts. This study indicates that history of arrest is significantly associated with health disparities for young women and thus expands and builds gender-specific knowledge for the field of criminal justice epidemiology. Given the intersecting needs of physical health, mental health, and criminal justice involvement, the fields of public health and social work may contribute to gender-responsive interventions that incorporate health promotion specifically for this population of women.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly reports recent suicide attempts as a distinct mental health outcome analyzed in the comparison of young women with and without arrest histories.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes an analysis of national survey data using statistical methods (odds ratios) to compare health outcomes between groups.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2018-G-0003", "input_index": 901, "sample_group": "Quantitative", "title": "Police Victimization in the U.S.: Measurement, Estimates of Prevalence, and Mental Health Significance", "abstract": "Background: The widespread adaptation of smartphone technology and consequent availability of real-time footage of police-public interactions has greatly increased public awareness of police violence. This awareness has contributed to interest in policy change around police accountability. However, such efforts have been impeded by (1) significantly limited data regarding police violence in the United States and (2) a lack of validated measures of police violence. Further, there has been little data on, or attention to, health and mental health consequences of violent interactions other than death or severe physical injury. This oral presentation will provide an overview of efforts to address these gaps in the Survey of Police-Public Encounters, a general population survey conducted in Baltimore, New York City, Philadelphia, and Washington D.C. Methods: Adult residents (N=1615) of four Eastern U.S. cities were sampled through Qualtrics Panels, an internet-based survey administration service. Quota sampling was used to create a sample that was within +/-10% of census distributions for each city in terms of race, gender, and age. Respondents were assessed with two novel measures of police violence: the Police Practices Inventory, which assesses past history of exposure, and the Expectations of Police Practices Scale, which assesses anticipated exposures over the subsequent year. Mental health constructs included psychological distress (K-6 scale), depression (PHQ-9), psychosis (WHO-CIDI screen), and suicidal ideation and attempts (WHO-CIDI screen). Both novel measures of police violence were assessed for psychometric properties. The Police Practices Inventory was used to calculate estimated prevalence of police violence among the entire sample and within specific demographic sub-groups. Finally, regression analyses were used to examine associations between police violence exposures and mental health outcomes. Results: Prevalence of specific sub-types of police victimization ranged from 2.8% for sexual violence up to 18.6% for psychological violence (e.g., threatening, discriminatory slurs). All types of victimization were more common among Black and Latino respondents, male and transgender respondents, and younger adults. Test-retest reliability data and internal consistency data showed the novel measures of police violence to be reliable and valid. All forms of police violence were associated with psychological distress, depression, and psychosis-like symptoms, whereas only assaultive forms of victimization (i.e., physical violence and sexual violence) were associated with suicide attempts. Experiences of positive policing were more common among white respondents and generally did not bestow a protective effect for mental health. Discussion: Recent media and community reports of widespread and inequitably distributed police violence appear to be supported by study data. While these cross-sectional data should be replicated using a prospective design in order to better understand causality, recommendations to improve police-community interactions are likely to be beneficial regardless of the direction of these relationships. Potential pathways to addressing this issue include improved training and screening of police officers, greater police accountability, community policing approaches that enhance relationships between the police and members of the community, and development of community-based restorative justice alternatives to policing.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly analyzes suicide attempts as a distinct mental health outcome associated with police victimization using validated screening tools.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes a primary data collection effort involving a large-scale survey (N=1615) and statistical analyses including prevalence estimation and regression modeling.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2018-O-0018", "input_index": 909, "sample_group": "Quantitative", "title": "Subtypes of Substance Users and Suicide Behaviors: An Adolescent Risk Profile", "abstract": "Background & Purpose : Suicide and substance use are pervasive problems for adolescents in the U.S. Among U.S. youth, suicide is the second leading cause of death for those age 15-19. Drugs and alcohol also pose a significant public health concern as 8% of all U.S. youth are diagnosed with a substance use disorder, and 78.2% have consumed alcohol by late adolescence. Substance use, in general, is a known risk factor related to suicide among adolescents. Past postmortem analyses, for example, have found that up to 70% of adolescents who completed suicide were drug and alcohol users and that adolescent completers were more likely to have been under the influence of alcohol. The adolescent substance use literature has proposed varying typologies of users, with the four most reported being experimentation, regular use, abuse, and dependence/addiction. We apply a similar typology to examine the risk and profile of adolescents, including their demographic characteristics, who engage in suicidal behaviors. Methods: Data were obtained from the 2015 National Youth Risk Behavior Survey (YRBS). The analytic sample includes 15,624 adolescents who reported a range of substance use behaviors. Marijuana, cigarette, and alcohol use were measured by both lifetime and current use (ever use, age at initiation, current frequency of use, and current intensity of use). We utilize the term “polysubstance use” to describe reported usage of all three substances (marijuana, cigarettes, and alcohol) by adolescents. Latent class analysis was used to identify homogeneous subgroups of adolescent substance use patterns. After determining the appropriate number of classes, a final model was run in which the associations between substance use class membership and suicidal behaviors were assessed while controlling for age, gender, and race/ethnicity effects on each through multinomial logistic regression. All analyses were conducted using Mplus 7.4 and incorporated sample weights, stratum, and cluster variables to account for the complex sample design of the YRBS. Results: A four-class model provided the best fit to the data, which was conceptualized as experimental polysubstance users, frequent polysubstance users, moderate polysubstance users, and nonusers. Using the nonusers’ class as the reference group, all the other three groups had a higher likelihood of engagement in suicidal behaviors, with adolescents in the frequent polysubstance users group, which included older males, exhibited the highest odds of suicidal ideation (OR=2.28), suicide plan (OR=2.25), and suicide attempt (OR=3.152). The moderate polysubstance users group contained more Black and Hispanic/Latino youth than the nonusers group. Conclusion & Implications: Adolescents who are frequent polysubstance users are at heightened risk for suicidal behaviors compared to nonusers, moderate users, and adolescents who use substances somewhat experimentally. Moderate and experimental polysubstance users are at even greater risk for suicidal thoughts, plans, and attempts when compared to nonusers. The findings provide important information regarding the profile of adolescents with high risk for engagement in suicidal behaviors. Practitioners and health professionals should consider screening for “polysubstance use” (and its frequency) in adolescents given the association with suicide risk.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly analyzes the association between substance use subtypes and specific suicidal behaviors (ideation, planning, and attempts) as primary outcomes.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The research utilizes secondary data from the National Youth Risk Behavior Survey and employs statistical methods including latent class analysis and multinomial logistic regression to assess risk factors.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SWRD:64101", "input_index": 1331, "sample_group": "Quantitative", "title": "Health disparities in access to health care for HIV infection, substance abuse, and mental health among Latino men who have sex with men in a U.S.-Mexico Border City", "abstract": "A cross-sectional study among 150 community-dwelling Latino men who have sex with men (MSM) in a U.S.-Mexico border city was conducted to describe health disparities in access to care for HIV infection, substance use/abuse, and mental health. Data were collected in 2013 and 2014. Median age of participants was 26 years, and the majority of participants identified as a sexual minority and born in the United States. Half did not have health insurance and reported suicidal ideation. One-eighth reported living with HIV. Most common substances reported were alcohol, tobacco, and marijuana. Clinicians who provide care for Latino MSM should be aware of intersecting comorbidities.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Suicidal ideation is mentioned only as a descriptive statistic in the background/context of broader health disparities (HIV, substance abuse, mental health) and is not a central focus, primary outcome, or distinctly analyzed component of the study.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is deemed irrelevant because suicide is not a substantive focus; therefore, evidence class and method are not applicable.", "confidence": "High" }, "full_label_agreement": false, "adjudicated_screening": { "is_relevant": false, "relevance_rationale": "Suicidal ideation is mentioned only once as a descriptive baseline characteristic alongside health insurance status. It is not a central focus, primary outcome, exposure, or distinctly analyzed component of the study, which primarily examines access to care for HIV, substance use, and general mental health.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Because the record does not meet the relevance threshold for suicide/suicidality, evidence class and empirical method are set to Not applicable per protocol.", "confidence": "High" }, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:62393", "input_index": 1452, "sample_group": "Quantitative", "title": "The impact of COVID-19 on first responders' resilience and attachment", "abstract": "COVID-19 continues to have a deleterious impact on vulnerable populations in our society, and unfortunately, first responders are often overlooked in this conversation. To address that gap, we retrospectively compared routinely collected baseline assessment data from 69 treatment-seeking first responders who presented for treatment before COVID-19 to data collected from 75 similar first responders at the same agency during the pandemic. Data assessments gauged first responders' attachment avoidance, attachment anxiety, resilience, depression, generalized anxiety, PTSD, and suicidality. Findings indicate that the strength of correlations between resilience, depression, generalized anxiety, and PTSD increased for these responders during the COVID-19 pandemic. They further highlight the role that attachment anxiety plays for first responder ability to cope during the pandemic. Practitioners can use these findings to create a conversation early in the treatment process and guide a collaborative treatment plan.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly measures and reports on suicidality as one of the key outcomes assessed in first responders during the pandemic.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes a retrospective comparison of routinely collected assessment data using statistical correlations, which constitutes quantitative empirical analysis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2023-P-0173", "input_index": 1462, "sample_group": "Quantitative", "title": "(see Poster Gallery) Bathroom Access and Suicide Risk Among Transgender, Nonbinary, and Gender-Questioning Youth", "abstract": "Background: Transgender youth are at elevated risk for suicide compared with their cisgender peers- including those who are lesbian, gay, or bisexual- due to minority stress. Recent anti-transgender legislation targets transgender youth by restricting their access to gender-affirming healthcare, school sports, and bathroom facilities that align with their gender identity. This study examines bathroom access among transgender, nonbinary, and gender-questioning (TNBGQ) youth ages 13 to 24, as well as the relationship between avoiding public restrooms and suicide risk. Methods: Data were collected from an online survey conducted between September 2021 and December 2021 of 33,993 LGBTQ youth recruited via targeted ads on social media. 19,970 respondents reported their gender identity to be TNBGQ and were included in this analysis. Adjusted logistic regression models were conducted to determine the association between avoiding public bathrooms in the last year and recent anxiety, recent depression, seriously considering suicide in the last year, and attempting suicide in the last year, while controlling for age, Census Region, socioeconomic status, race/ethnicity, gender identity, and sexual identity. Findings: TNBGQ youth reported various negative experiences while trying to access bathroom facilities. 43% of respondents reported that they had been prevented or discouraged from using a bathroom that corresponds with their gender identity. This occurred in a number of settings: 36% of youth experienced it at school, 22% at a place of business, 17% at a bar or restaurant, 13% at a doctor’s office or hospital, 10% at their workplace, and 10% in a government building. TNBGQ youth also reported negative consequences due to avoiding using bathrooms in public. 65% of respondents reported not using the restroom when they needed to in public. 36% reported that they had avoided eating and drinking to try to prevent needing to use the restroom. 9% reported that they had gotten an urinary-tract infection due to not using the bathroom when they needed to. 1% reported kidney infection, and 1% reported other kidney-related problems. The majority of TNBGQ respondents (69%) reported that they had avoided using public restrooms in the last year because they were afraid of having problems. 48% of respondents reported that they sometimes avoided bathrooms and 21% reported that they always avoided them. Avoiding bathrooms due to fear in the last year was associated worse mental health and greater suicide risk. TGNBGQ youth who reported that they sometimes or always avoided bathrooms in the last year had greater odds of recent anxiety (aOR=1.72, p <.001), recent depression (aOR=1.66, p <.001), seriously considering suicide (aOR=1.61, p <.001), or attempting suicide in the last year (aOR=1.87, p <.001). Conclusions: These findings highlight the need to protect TNBGQ youths’ access to bathrooms that align with their gender identities in all public spaces. Recent attempts to restrict TNBGQ youths’ access to bathrooms and other single-gender facilities pose a threat to TNBGQ youths’ physical and mental health. Schools, workplaces, and public establishments should develop policies protecting bathroom access and establishing gender-neutral bathrooms.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly analyzes the association between bathroom avoidance and suicide risk outcomes, including seriously considering suicide and attempting suicide, among transgender, nonbinary, and gender-questioning youth.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes an online survey of a large sample size with statistical analysis using adjusted logistic regression models to determine associations between exposures and outcomes.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2023-P-0344", "input_index": 1464, "sample_group": "Quantitative", "title": "(see Poster Gallery) Characteristics of and Circumstances Associated with Female Suicide Related to Intimate Partner Problems", "abstract": "Background and Purpose: Suicide research has found that intimate partner problems (IPP), including divorce, conflict, and violence are robust precipitating factors for suicidal thoughts and behaviors. Although suicide triggered by IPP is prevalent in both men and women, IPP-related female suicide may have unique risk factors and circumstances. However, little is known about the distinct circumstances surrounding suicidality among women struggling with IPP. Evidence concerning IPP suicides can inform the development of gender-specific suicide prevention guidelines for social work practice. Accordingly, we aimed to explore the psychosocial circumstances and suicide incident characteristics surrounding female IPP-related suicide using a singular national data set. Methods: Data were taken from the National Violent Death Reporting System-Restricted Access Database (NVDRS-RAD, 2003-2019). Of the total suicide cases (n=267,804), only the 58,545 (21.9%) female suicide cases were selected for analysis. Prior to analysis, the data were thoroughly checked and cleaned for missingness and errors. The primary analyses were descriptive univariate and bivariate chi-square tests to determine preliminary and exploratory evidence related to the characteristics and circumstances surrounding IPP-related suicide cases relative to non-IPP-related suicide cases. All p values were two-sided, and p values <.05 were considered indicative of significance. Results: Findings showed that of the 58,545 female suicides, 13,496 cases were related to IPP, indicating that about 23% of female suicide victims struggled with IPP. Overall, compared to non- IPP related suicide, IPP-related suicide was identified at a higher rate in groups that were (a) younger, (b) non-white, (c) of higher education levels, (d) U.S.-born, and (e) pregnant or postpartum ( p <.001). IPP-related suicide victims were also more likely than non-IPP-related suicide victims to have experienced previous (a) trauma, (b) mental health problems, (c) alcohol/substance abuse problems, (d) financial challenges, and (e) relational problems with family and others ( p <.001). Additionally, compared to non-IPP-related suicides, IPP-related suicides largely occurred at night between 6pm and 6am and at a home or private residence ( p <.001). While poisoning was the most common method of female suicide, IPP-related suicide victims tended to use firearms as the most common method. Conclusions and Implications: Study findings identified that women with IPP struggled not only with IPP itself, but also with previous traumas and psychosocial challenges. Given that IPP, trauma, and mental health problems may be bidirectional and co-occurring, our presentation will focus on providing recommendations for a comprehensive, trauma-informed approach for preventing suicide among women who are facing multiple psychosocial risk factors. We will also discuss that how women’s social and racial vulnerability might be related to suicidal risk. Additionally, the study findings provide novel evidence regarding suicide incidence characteristics such as methods, locations, and time. Although these are preliminary findings, they provide meaningful information in understanding where, when, and how IPP-related female suicides tend to take place. The presentation will provide recommendations for how social work practitioners and scholars can make an important contribution in preventing suicide among women who face IPP. Overall, this work fills an important need in the “Mental Health” SSWR clusters.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly analyzes characteristics and circumstances associated with female suicide deaths related to intimate partner problems using national data.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes a quantitative analysis of secondary data from the National Violent Death Reporting System, utilizing descriptive statistics and chi-square tests.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2023-U-0155", "input_index": 1513, "sample_group": "Quantitative", "title": "Racialized Gender Stress, Mental Health, and Suicide Risk Among Black Women: A Longitudinal Test of the Vance-Wade Intersectional Suicide Risk Model", "abstract": "Background: Black females, ages 15-24, experienced a 125% increase in suicide from 1999 to 2017. The recent shift in Black women’s suicide risk calls for a new paradigm, focused on predictors of increased risk and not the low prevalence of Black women’s mental health and suicide-related behaviors. The Vance Wade Intersectional Suicide Risk Model (VWISRM) was introduced to contextualize this unexpected spike. According to the VWISRM, for Black women, psychosocial risk factors, gendered racism, and the Strong Black Woman script (SBW) leads to racialized gender stress (RGS) which results in mental health outcomes which are established predictors of suicide- related behaviors . Here we use the National Longitudinal Study of Adolescent Health to test for empirical evidence supporting the VWISRM. Methods: Our sample consisted of 418 Black female respondents who fully participated in data collection during Waves 1, 3, and 4. Wave 1 provided demographic information. Wave 3 provided measures of psychosocial risk factors, SBW traits, and RGS and was collected when respondents were 18 to 26 years old. Wave 4 provided measures of gendered racism and our mental health outcomes of interest, which were collected when the respondents were 25 to 33 years old. We ran bivariate analyses with mental health outcomes as dependent variables (e.g., depression, anxiety, PTSD, and suicidality). We then added psychosocial factors (e.g., education, employment, health insurance, and religiosity) as controls in a series of regression models. Results: Those who experienced RGS were more likely to have a PTSD diagnosis and have attempted suicide significantly more. Scoring lower on the SBW traits was significantly associated with having an anxiety diagnosis, a PTSD diagnosis, and contemplating suicide. Those who experienced RGS were more likely to have a depression diagnosis, have an anxiety diagnosis, and contemplate suicide, in comparison to those who had not. Having both lower scores on the SBW traits and experiencing gendered racism is associated with a PTSD diagnosis. Specifically, it explained 30% of the variation in PTSD diagnoses among Black women. Similarly, having both lower scores on the SBW traits and RGS is associated with an anxiety diagnosis. Lastly, having both lower scores on the SBW traits and having to grow up faster is associated with contemplating suicide. Importantly, there were no moderating effects among these VWISRM factors on PTSD, anxiety, or suicidality. Conclusions and Implications: The findings from this study highlight important research and clinical implications for Black women’s mental health. The VWISRM analysis contributed to the development of a modified version of the model, the Gendered Racism Intersectional Trauma model (GRIT) to better understand the breadth of mental health outcomes for Black women. Specifically, GRIT considers three unique factors of Black womanhood (SBW traits, RGS, and gendered racism) and their relationship to negative psychological outcomes and therefore should be addressed and targeted in assessments and interventions. Notably, our findings make a new contribution to the scientific inquiry of PTSD in Black women.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly analyzes suicide risk factors, including suicidal ideation and suicide attempts, as primary outcomes within a longitudinal test of an intersectional suicide risk model.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes the use of secondary data from the National Longitudinal Study of Adolescent Health, employing bivariate analyses and regression models to test hypotheses about suicide-related behaviors.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2024-P-0247", "input_index": 1608, "sample_group": "Quantitative", "title": "Bullying Victimization and Suicidal Thoughts Among African American Adolescents in Southside of Chicago: Emotional Distress and Neighborhood Conditions", "abstract": "Background Numerous cases of victims of bullying taking their own lives have been reported in the media. The media publicity around the suicide of adolescents who are victims of bullying led to the assumption that bullying victimization leads to suicide. A growing body of research findings provides evidence that bullying victimization plays a significant role in children’s and adolescents’ suicidal thoughts and behaviors. Despite the significant relationship between bullying victimization and suicidality, victims at risk of suicidality frequently experience emotional distress, which would trigger suicidal thoughts and behaviors. A strong association between bullying victimization and emotional distress (e.g., depression and anxiety) has been reported in the research literature. Moreover, emotional distress, particularly depression and hopelessness, is among the strongest predictors of suicidal thoughts. The rates of bullying victimization and suicidality have reportedly been high among African American adolescents. For African American youth in low-income and low-resourced urban neighborhoods, suicidality might be a serious concern, given that high levels of internalizing problems have been reported among urban youth. For these adolescents, the linkage between bullying victimization and suicidality may be influenced by the condition of their neighborhood. The study aims to examine neighborhood conditions as a moderated mediated model of the association between bullying victimization, emotional distress, and suicidal thoughts. Method The sample comprised 414 African American youth (ages 12-17) in Chicago’s Southside. From 2013 to 2014, participants were recruited from four low-income neighborhoods consisting of predominantly African American residents. The participants were recruited from three high schools, one church youth group, two community youth programs, and four public venues. The participants completed the questionnaires in these locations, which took up to 45 minutes to complete. Variables included suicidal thoughts, bullying victimization, emotional distress, neighborhood conditions, age, sex, and receiving government assistance. Analyses included descriptive statistics, bivariate correlations, and multivariate regression analyses. Result The study found that bullying victimization was not directly associated with suicidal thoughts. However, bullying victimization was positively associated with emotional distress, which was related to suicidal thoughts. Moreover, emotional distress as a mediator of the association between bullying victimization and suicidal thoughts was observed when neighborhood conditions were a moderator. Conclusions/Implications Schoolteachers, social workers, psychologists, community centers, and church staff need to collaborate to deliver programming to increase information about bullying, including the risk and protective factors associated with this type of violence. Next, practitioners, such as social workers and school psychologists should consider screening the youth at risk for bullying to identify victims of bullying. Assessing youths’ vulnerabilities and the degree to which they have experienced bullying perpetration and feel emotional distress is critical. Also, suppose therapists have information indicating that youth might reside in potentially low-income/high-crime residential areas, such as neighborhoods with houses that have broken windows or windows with bars. In that case, they can benefit from being aware of such living conditions and taking them into account when planning appropriate interventions. Furthermore, cost-effective programs that are culturally feasible, easy to implement, and sustainable are needed.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly investigates suicidal thoughts as a primary outcome in relation to bullying victimization, emotional distress, and neighborhood conditions among African American adolescents.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes a specific sample of 414 participants, data collection via questionnaires, and statistical analyses including descriptive statistics, correlations, and multivariate regression.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2024-U-0248", "input_index": 1631, "sample_group": "Quantitative", "title": "Firearms and Suicide Completion Among Persons Recently Released from Psychiatric Hospitalization", "abstract": "Background and Purpose: There is a high risk for suicide completion among persons recently released from psychiatric hospitalization. Firearm-related suicide and firearm violence is the leading cause of death among adults in the United States. In this study, we use the most comprehensive, restricted database available for firearm-related fatalities to examine associations with suicide completion among persons who were released from a psychiatric hospital less than 30 days prior to their death. Method: Data is from the National Violent Death Reporting System (NVDRS), which includes all violent deaths from 44 states and territories in the U.S., between the years 2003 and 2019. NVDRS data includes reports from death certificates, coroners, law enforcement, and toxicology reports. Our sample included persons that were released from a psychiatric hospital no more than 30 days prior to their death (N = 2,556). Suicide completion was a binary measure, constructed from information available in death certificates, responding officer reports, and coroner reports. Demographic measures included gender, age, race/ethnicity, education level, and marital status. Circumstances associated with death included firearm use, prior drug or alcohol use problems, prior diagnosis for a major depressive disorder, history of suicidal thoughts, and history of suicide attempts. A logistic regression model examined associations with suicide completions following release from a psychiatric hospital. Results: Results showed that odds of suicide completion, compared to other manners of death, were higher when a firearm was involved (OR = 1.82, p < .01). Among demographics, odds of suicide completions were higher among men (OR = 1.87, p < .01), persons older in age (OR = 1.01, p < .05), and those with higher levels of education (OR = 1.98, p < .05). Odds of suicide completions were higher among those with a prior diagnosis for a major depressive disorder (OR = 1.65, p < .01), history of suicidal thoughts (OR = 2.87, p < .01), and history of suicide attempts (OR = 2.04, p < .01). Odds of suicide completions were lower among persons with prior drug or alcohol use problems (OR = 0.34, p < .01). Marital status was not associated with suicide completion. Follow up analyses showed handguns (opposed to shotguns or rifles) were involved in 73% of all firearm-related suicide completions, and firearms used in suicide completions belonged to the decedent in only slightly more than half of all cases. Conclusion and Implications: Among persons recently released from a psychiatric hospital, suicide completion was more likely to include the use of a firearm than any other type of death. These results underscore the importance of addressing gun violence in the United States, especially among persons with psychiatric disabilities. Social work researchers and practitioners can address this issue through the analysis of, and advocacy for, policies that limit access to firearms. Recent policies on the subject include state/federal “red flag” policies which limit people in crisis from accessing firearms and implements universal standard assessment of access to firearms prior to psychiatric discharge.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly analyzes suicide completion rates and associated risk factors among individuals recently released from psychiatric hospitalization, making suicide a central substantive focus.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes the use of secondary administrative data (NVDRS) and statistical analysis (logistic regression) to examine associations with suicide completion, which constitutes a quantitative empirical study.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2024-P-0151", "input_index": 1670, "sample_group": "Quantitative", "title": "Suicide Involving Intimate Partner Problems Among Immigrants in the U.S", "abstract": "Background : Individuals facing intimate partner problems (IPP) such as divorce, conflict, and violence often experience mental health issues, including suicidal thoughts and behaviors. According to the 2019 National Violent Death Reporting System (NVDRS), 25% of suicides were linked to IPP in the US. Immigrants are particularly at risk of mental health problems and suicide due to the stress of acculturation, adding to the limited access to health care services. Although immigrants with IPP are increasingly vulnerable to suicidal thoughts, there have been few studies made to understand the comprehensive risk factors for suicide among this population. This study aims to identify distinct patterns of risk factors among immigrant suicide victims with IPP and determine if these patterns vary significantly based on sociodemographic characteristics, methods of suicide, and suicide disclosure patterns. Methods : Data comprised seventeen waves of the NVDRS from 2003–2019, which includes 3,177 immigrant suicide victims facing IPP. A latent class analysis was conducted to identify groups of immigrant suicide victims based on seven dichotomous items reflecting the types of problems they had before committing suicide: mental health problem; depressed mood; alcohol problem; substance use; other addiction; current mental health treatment, and; mental health history. The number of latent classes was determined based on several goodness-of-fit statistics and substantial distinctions among classes. Differences across classes were examined by demographic and event characteristics subsequently. Results : Three-class solution was identified: Low Risk (66.9%, n =2,126), with a low likelihood of having depressed mood; Mental Health (MH, 26.6%, n =844) with high probabilities of having mental health problem, and current and previous treatment experiences; Alcohol (6.5%, n =207) with a high probability of having alcohol problems and moderate probabilities of having substance and MH problems. More females were in the MH, while more males were in Alcohol. More Whites belonged to both MH and Alcohol, and more Hispanics were in Alcohol. More divorced ones were in MH, while never married were represented more in Low Risk. MH used firearms as a method of suicide more than Low Risk did. MH attempted suicide the most, followed by Alcohol. MH and Alcohol had history of suicidal thoughts and disclosed their suicidal thoughts more than Low Risk. Conclusions : This study is a first-of-its-kind attempt to understand the distinctive patterns of risk factors among immigrant suicide victims with IPP using a robust national data set. Results demonstrate that immigrant suicide victims with IPP show unique risk factors as associated with their demographic and suicidal event characteristics. These findings can inform the development of assessment tools and targeted services and programs for preventing immigrant suicide, especially among individuals struggling with IPP. For example, social work practitioners working in marriage counseling, domestic violence, and health care settings may identify warning signs and tailor their service provision to the needs of different subgroups. Given the descriptive/exploratory nature of this study, future research needs to examine the process and mechanisms of immigrants with IPP being exposed to the idea of suicide and considering seriously committing it as influenced by the multitude of risk factors.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly analyzes suicide victims among immigrants facing intimate partner problems, identifying distinct patterns of risk factors and demographic characteristics associated with suicide death.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The research utilizes secondary analysis of administrative data from the National Violent Death Reporting System (NVDRS) employing latent class analysis to identify statistical patterns among suicide victims.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SWRD:567", "input_index": 1883, "sample_group": "Quantitative", "title": "Engaging in Lethal Means Safety (ELMS): An Evaluation of a Suicide Prevention Means Safety Training Program for Mental Health First Responders", "abstract": "Firearm-related suicide is a preventable yet leading cause of death in the United States, and screening for access to firearms in clinical settings is rare. The lack of screening in clinical practice may be compounded by the fact that clinicians are not often trained to effectively screen for access to lethal means. This article evaluates the effectiveness of the novel Engaging in Lethal Means Safety (ELMS) suicide prevention program. ELMS is a theoretically driven, empirically supported lethal means safety training program that trains mental health first responders in engaging clients in discussions of lethal means safety with a particular focus on firearm access and storage. Pretest, posttest, and one-month follow-up assessments measured knowledge of lethal means, confidence, and comfort in screening for access to lethal means, and future intent to counsel on means safety measures. All constructs increased significantly at posttest. Confidence was sustained at posttest. Comfort and intent to counsel levels decreased at follow-up but not to pretraining levels. Booster sessions are recommended for future iterations of the program to further sustain overall effects. Further, additional research using a treatment control is encouraged.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study evaluates a suicide prevention training program focused on lethal means safety and measures outcomes related to clinicians' knowledge, confidence, and intent to counsel on suicide risk factors.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes a pretest-posttest-follow-up evaluation with statistical analysis of changes in measured constructs (knowledge, confidence, comfort, intent), indicating a quantitative empirical design.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2026-P-0044", "input_index": 1948, "sample_group": "Quantitative", "title": "Effects of School Violence Victimization on Suicide Risk : Moderated Mediation of Loneliness and Family Support", "abstract": "Abstract Background: School violence victimization is a serious issue that significantly affects adolescents' mental health, potentially increasing their risk of suicide. Prior research indicates that loneliness can mediate the relationship between school violence victimization and suicidal risk, while family support may act as a protective factor. However, the mechanisms underlying these relationships require further investigation. Objective: This study examines the moderated mediation effect of loneliness and family support on the relationship between school violence victimization and suicidal risk among adolescents. Participants and Setting: The study utilized survey data collected in October 2023 from 1,000 middle and high school students across various regions in South Korea. Methods: Data were analyzed using SPSS and PROCESS Macro Model 14 to test direct, indirect, and conditional indirect effects. Bootstrapping techniques were applied to ensure statistical reliability. Results: School violence victimization was positively associated with suicidal risk, with loneliness serving as a mediator. Additionally, family support moderated the indirect effect of school violence victimization on suicidal risk via loneliness, reducing the negative impact. Adolescents with higher family support exhibited a weaker indirect effect of loneliness on suicidal risk. Conclusions: This study highlights the critical role of loneliness in linking school violence victimization to suicidal risk and underscores the protective function of family support. Intervention programs should prioritize reducing loneliness among victims of school violence and enhancing family support to mitigate suicidal risk. Keywords : School violence victimization; Suicidal risk; Loneliness; Family support; Adolescents", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly investigates suicidal risk as a primary outcome and analyzes the mechanisms linking school violence victimization to suicide risk through loneliness and family support.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The abstract describes a survey-based study with numerical data analysis using statistical models (PROCESS Macro) to test mediation and moderation effects.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2026-U-0502", "input_index": 1959, "sample_group": "Quantitative", "title": "Findings from a Mixed Methods Study of Social Networks Among American Indian Adolescents", "abstract": "Background: Social relations and multigenerational networks remain a salient fixture of American Indian (AI) culture, survival, and thriving. Research in other populations has demonstrated how social networks impact youth risk and resilience, but data are lacking among AI adolescents. Settler colonialism’s historical and contemporary impacts lead some AI youth to early initiation of substance use, along with high risk for suicide and witnessing and experiencing violence. Aims of this study were to describe peer, kin and community social networks and associations with risk and protection for substance use, violence, and suicide among adolescents in a reservation community. This presentation will describe the development and implementation of this innovative mixed-methods study. Development of the social network survey and its mixed methods design will be described and findings from the study will be shared. Methods: Social network surveys were completed by 9th and 10th graders (N = 263) at three high schools on a Northern Plains reservation. Social network measures were adapted for reservation-based AI youth. Following an explanatory sequential mixed methods design, qualitative interviews were conducted with a subsample of participants (n = 16) to interpret findings from their individual and school networks. Participants for the qualitative interviews were randomly selected after stratifying by gender and risk levels for substance use, violence, and suicidality. Results: Cross-sectional findings support the hypotheses that the social networks of AI youth may not conform to prevailing social network theories. Dominant theories suggest network formation and maintenance tied to racial homophily, but in our study 93% of networks were Native and tie formation was not significantly related to race. Youth nominated more family members than what has been found among non-Native adolescents. Students demonstrated similar in-degree centrality, a measure of how many times an individual was nominated by someone in their school network. And school networks varied by size and density. We also observed associations between students’ social networks and substance use, suicide ideation, and exposure to violence. Implications: Variation in networks across schools suggests unique community contexts that may make a universal approach to prevention development and implementation less effective. Findings also suggest that ways of defining family relations varied across students. This has implications for future measurement of family networks with this population. And finally, similar in-degree within networks suggests that prevailing key opinion leader social network interventions may not work in this population. Adaptations to social network interventions offer a promising new approach to prevention with AI communities. This work aligns with the conference theme by aligning innovations in social network science and mixed methods with transformative changes in prevention efforts with Indigenous communities.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly analyzes associations between social networks and suicide ideation among American Indian adolescents, making suicidality a central outcome of interest.", "evidence_class": "Empirical", "empirical_method": "Quantitative", "classification_rationale": "The study employs an explanatory sequential mixed-methods design with a primary quantitative component involving survey data from 263 adolescents to analyze statistical associations, supplemented by qualitative interviews.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Quantitative" } }, { "record_key": "SSWR:2008-O-8705", "input_index": 253, "sample_group": "Qualitative", "title": "Assessing and Advancing the Validity of Adolescent Suicidality Questionnaires", "abstract": "Purpose: Completed suicides tripled among youth between 1952 and 1996. In 1999 the Surgeon General called for expanded research on youth suicide prevention and the specific need to advance the validity of youth suicidality assessment tools. A call for research that matters; the current study was a direct response to that call. Assessment questionnaire development is a quantitative endeavor; however, there is growing interest in the systematic application of mixed methods to questionnaire development and validity assessment. Such mixed methods in questionnaire development, or cognitive methods, are used to collect qualitative data directly from potential respondents about how they understand, think about, and choose responses to assessment questionnaires.Method: Two such mixed methods were used to collect data from adolescents (13-17) who had been psychiatrically hospitalized for suicidality (ideation to attempt). Cognitive pretesting (CP) interviews involve asking a respondent, while they read and respond to an assessment question, to explain what/how he/she: (a) interprets what a question is asking, (b) thinks about while forming a response, such as experiences, feelings, beliefs, etc., and (c) chooses an answer option. CPed was the Suicidal Ideation Questionnaire-Junior (SIQ-JR: Reynolds & Mazza, 1999), the most widely utilized such questionnaire. Construct probe interviews (CPI) apply open-ended questions to gather qualitative data about how adolescents experience the context and content of a targeted construct, suicidality.Results: To date, 34 adolescents have been interviewed, with the full sample to be collected by the end of June 2007. Preliminary analyses indicate that while many of the SIQ-JR items perform well, several items have validity problems. For example, the item I thought about writing a will, which is infrequently endorsed but seen as a high risk sign; while some adolescents knew what a will was, most did not interpret this question as intended. Nearly half thought wills were what old people write, some felt wills are for people with money and property, and they have neither, finally several just did not know what a will was. The question I thought about telling people I plan to kill myself, several serious suicide attempters interpreted this wording as attention seeking behavior, and not something they would endorse. For those respondents it does not assess suicide risk, even the opposite. For the SSWR poster, full analyses will be available for the cognitive pretesting, including describing a codebook to quantitatively code the validity of responses, and the inter-rater reliability of multiple coders of the data. Finally, the CPI data are revealing a wide range of circumstances, dynamics, and responses to stressors and struggles that lead adolescents to think about or attempt suicide, and make them want to live or help when they feel suicidal.Implications: The implications of this research matters. We need valid teen suicide assessment risk questionnaires that can both be used to screen a population in a school or applied in a clinical setting. Current findings will be used to develop such a questionnaire. Finally, the application and ongoing evolutions of such mixed methods in questionnaire development will be discussed.See more ofPoster Session II Adolescents, Child Welfare, Gender/Women's Issues, Other, Research Design/MeasurementSee more ofOral and PosterSee more ofResearch That Matters (January 17 - 20, 2008)", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study focuses on assessing the validity of adolescent suicidality questionnaires using data from hospitalized youth with suicidal ideation or attempts, making suicide assessment a central substantive focus.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The research employs cognitive pretesting interviews and construct probe interviews to collect qualitative data on how adolescents interpret suicide risk items, which constitutes a predominantly qualitative empirical design despite mentions of future quantitative coding.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SSWR:2013-X-0010", "input_index": 468, "sample_group": "Qualitative", "title": "How Are Mothers Impacted by Their Adolescent's Suicide Attempt? �Things Are Never the Same�", "abstract": "Background and Purpose: Suicidal behavior is a major mental health problem among adolescents.  In order to effectively intervene with youths who have made suicide attempts and their families, it is important to consider how their mothers are affected by their suicidal behaviors.  Mothers’ reactions to their adolescent’s suicidal behavior can vary considerably; their reactions may impact their interactions with adolescents, parenting practices, and follow-through with treatment recommendations.  Nonetheless, few studies examine how mothers are impacted by their adolescent’s suicide attempt.  Such research has direct implications for addressing the mental health needs of mothers and the ways in which mothers can be most effectively involved in the treatment of suicidal adolescents.  The purpose of this study was to address this gap in the literature by exploring mothers’ reactions and experiences after their adolescent attempted suicide. Methods: This study used data collected for a NIMH-funded research study designed to examine the reactions of 288 mothers of hospitalized adolescents that made recent suicide attempts and mothers of adolescents who were hospitalized for other reasons.  The mothers are assessed at 1, 3, 6, and 12 months following youths’ discharge from the hospital. The current analysis focused on qualitative data collected during the first assessment from 16 randomly selected mothers of adolescents who attempted suicide.  Semi-structured interviews were conducted by trained Master- or Doctoral-level staff.  Interviews lasted between 20 and 40 minutes and were digitally recorded and transcribed.  Nvivo 9 qualitative software was used for data management and as a tool for data analysis.  Using an iterative process, six individuals collaborated to develop a codebook.  Emergent themes were systematically identified via grounded theory methods.  Inter-rater reliability was achieved when coding reached 75% agreement. Results: Although mothers varied in their reaction to their adolescent’s suicide attempt (e.g., anger, confusion, disbelief), most mothers reported changing how they supervised and monitored their adolescent.  Mothers also reported changes in their relationships with their adolescent (e.g., more communication) and with others (e.g., seeking additional supports and fewer interactions with others because of concerns about stigma).  Mothers encountered barriers to treatment (e.g., access to care, cost) and challenges with communicating with mental health providers.  Mothers provided suggestions on how to improve the mental health system and indicated the need for additional supports (e.g., support groups, pamphlets) to help them cope.  The interviews revealed the mothers’ insight into how their adolescent’s coping and emotions impacted their emotional experience. Conclusions and Implications: Results from this study suggest that mothers would like to be more involved with their adolescent’s treatment providers and that mothers frequently question their parenting practices because they feel like they are “walking on egg shells.” This study provides practice implications for mothers of youths who have attempted suicide.  Specifically, mothers need more emotional support and may benefit from formal and/or informal support groups.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study centrally focuses on the experiences and reactions of mothers following their adolescent's suicide attempt, which falls under suicide bereavement/survivors and postvention contexts.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract describes a primary data analysis using semi-structured interviews and grounded theory methods to identify emergent themes from qualitative data.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SSWR:2014-U-0529", "input_index": 532, "sample_group": "Qualitative", "title": "�The Role of Religion and Spirituality in Building Resiliency Among Muslim Armed Forces Personnel�", "abstract": "Studies show that religion and spirituality protect military personnel from stress, trauma, and suicidality; support coping; and build resilience. Additionally, the Army has identified spirituality as a salient component of its strategic planning and training. As most relevant literature on resiliency focuses on mainstream populations’ definitions of healthy functioning, it remains unclear how such strategies apply to non-mainstream populations and religions such as Muslims and Islam. Objectives : This study will explore (1) How and to what extent do religion/spirituality help Muslim Armed Forces Personnel (MAFP) cope with service and war-related stress?; (2) What factors contribute to their spiritual fitness?; (3) What other strategies do MAFP use to cope with daily life and war?; (4) What are the risk and protective factors of religious/spiritual-based coping?; (5) How do religious/spiritual-based coping strategies impact MAFP’s resiliency?; and (6) How does family and community support impact MAFP’s resiliency and health resources? Hypotheses : (1) that MAFP using religious/spiritual coping strategies and receiving family and community support will more effectively deal with adversity and further increase their resiliency, and, conversely, (2) that the presence of faith-related stressors can cause observant MAFP to experience increased stress and decreased resiliency. Methods : This study utilized in-depth semi structured individual face-to-face interviews with 20 active and retired MAFP.  All interviews were audio-recorded and transcribed for analysis. Data Analysis : Grounded thematic analysis guided the processing of qualitative interview data.  Two authors and one research assistant have reviewed the transcriptions of each interview and used the qualitative data analysis software package NVivo9 to develop hierarchies of themes and sub-themes through constant comparison across interviews.  Theme summaries were integrated into theoretical memos to explore emerging perspectives on the data. Results : The level to which religion serves as either a protective or risk factor for a participant varied depending on race, ethnicity, gender, rank, skin color, branch of military service and immigration status.  While some participants faced more religious discrimination after 9/11, practicing religion and seeking familial and social support were important strategies used to reinforce their spiritual fitness and cope with war and life stressors.   Participants faced many barriers including a lack of access to faith-based services, inability to attend Jumuah prayer service on Fridays, and an absence of halal food on base.  All Participants recommended incorporating educational and cultural competency training about Islam and Muslims into the U.S. Armed Forces System as a way to help foster resiliency and spiritual fitness among both Muslims and other Armed Forces personnel. Implications : Individuals of minority cultural, religious, racial, and ethnic backgrounds are likely to have different needs than their majority counterparts. The study’s results can help mental health providers identify common coping strategies among MAFP, and provide the necessary services to help them become more resilient while facing stresses associated with trauma. Findings will also identify the role of family and community as a source of support to service members as they begin to understand the service members’ experiences. This could strengthen family life and connectedness, while maintaining the highest state of military readiness.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Although suicidality is mentioned in the background context as a general stressor protected against by religion, it is not a central focus, outcome, or analyzed component of this study, which primarily investigates resilience and coping mechanisms.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is classified as irrelevant because suicide is only cited as background context rather than a substantive focus or analyzed outcome.", "confidence": "High" }, "full_label_agreement": false, "adjudicated_screening": { "is_relevant": false, "relevance_rationale": "Suicidality is cited only once in the opening background sentence to contextualize the broader topic of resilience and coping. It is not a central substantive focus, primary outcome, exposure, or distinctly analyzed component in the study's objectives, methods, results, or implications.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Per the rubric, records where suicide/suicidality serves merely as background context are classified as irrelevant. Following the explicit decision rules, evidence_class and empirical_method must be set to 'Not applicable' when is_relevant=false.", "confidence": "High" }, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2016-X-0027", "input_index": 673, "sample_group": "Qualitative", "title": "How Are Mothers Impacted By Their Adolescent's Suicide Attempt?: �It about Trust�", "abstract": "Purpose: Suicidal behavior among adolescents is one of the primary precipitants of psychiatric emergencies and psychiatric hospitalization.  The suicidal behavior and need for emergency intervention may have multiple impacts on the primary caretakers, often mothers, of these youths.  Nonetheless, few studies have examined how mothers are impacted by their adolescent’s suicide attempt, and even fewer studies examine how their reactions change over time. The purpose of this study was to address this gap in the literature by exploring the similarities and differences between mothers’ reactions one month, three months, six, and twelve months after their adolescent attempted suicide. Methods: This study used data collected for a NIMH-funded research study designed to examine the reactions of 288 mothers of hospitalized adolescents that made recent suicide attempts and mothers of adolescents who were hospitalized for other reasons.  The mothers are assessed at 1, 3, 6, and 12 months following youths’ discharge from the hospital. The current analysis focused on qualitative data collected during all four time-points from 64 randomly selected mothers of adolescents who attempted suicide.  Semi-structured interviews were conducted by trained Master- or Doctoral-level staff.  Interviews lasted between 20 and 40 minutes and were digitally recorded and transcribed.  Nvivo 10 qualitative software was used for data management.  Using an iterative process, six scholars collaborated to develop a codebook. Coding was completed by trained research assistants.  Emergent themes were systematically identified as informed by grounded theory methods.  Inter-rater reliability was achieved when coding reached 67% agreement. Results: Although mothers varied in their reaction to their adolescent’s suicide attempt overtime, several themes emerged. First, across all assessments, mothers reported distress, but their descriptions differed overtime.  Mothers often reported (a) one month afterwards feelings of anger, confusion, and disbelief, (b) three months afterwards feeling numb (b), nervous, and worried, (c) six months afterwards feeling stressed and drained (e.g., “tired of it all.”), and (d) twelve months afterwards feeling relieved and improved confidences in coping with their adolescent’s illness.  Parents reported positive improvements in caregivers’ reactions when they started to trust their adolescent more. Conclusions and Implications: Results from this study suggest that mothers continue to be impacted by their adolescent’s suicide attempt a year afterwards; however, the nature of this impact varies.  Moreover, mothers’ reactions from one, three, six, and twelve months afterwards appear to shift from confusion to numbness/anxiety to stress to acceptance/understanding. This study provides practice implications for development of interventions that support of mothers of adolescents who have attempted suicide.  For example, mothers may benefit from psychoeducation about how their reaction may change overtime, which could validate their experience.  Further, clinicians should be aware of and assess for shifts in a mother’s reactions to their adolescent’s suicide attempt and consider these reactions in treatment planning and implementation.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study centrally focuses on the impact of an adolescent's suicide attempt on their mothers, analyzing maternal reactions over time as a primary outcome.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract describes the analysis of semi-structured interview data using grounded theory methods and thematic coding to identify emergent themes in maternal experiences.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SSWR:2016-X-0015", "input_index": 705, "sample_group": "Qualitative", "title": "The Other Side of Risk: Reframing Homelessness for Transgender and Gender Non-Conforming Young People", "abstract": "Background: The limited amount of literature concerned with the population of unstably housed transgender and gender non-conforming (TGNC) young people is primarily focused on psychiatric adjustment, and the sexual, physical and mental health related risk factors associated with these identities and experiences.   With the exception of a few notable publications (Grossman, D’Augelli, & Frank, 2011; Mallon, 2009; Stieglitz, 2010) there has been little in depth investigation into the population from an affirmative, non-pathological standpoint. This provides a narrow and limited view of their life contexts (Stieglitz, 2010). Burgess (2009) mentions the need to modify and expand the academic literature to balance negative references with diverse, unbiased representations of the transgender community. This inquiry explored homelessness among TGNC youth holistically, seeking to identify what concurrently exists alongside the inherent risks involved with their homeless experiences. Methods: A purposive sample of TGNC young people was recruited from New York City youth serving agencies for this qualitative study. Data were collected through semi-structured interviews, in which participants were asked to describe their experiences related to both their gender identity and homelessness. NVivo9 was utilized for data management and storage. The heuristic process of phenomenological inquiry guided analysis. The final sample included 27 TGNC youth ages 19 – 24 (mean 21.5). Participants identified their gender in the following ways: trans female (37%), trans male (11%), female (19%), male (7%), something else (7%) and 19% chose multiple labels to represent their gender identity. The participants identified as heterosexual (30%), gay (19%), lesbian (11%), queer (7%), bisexual (7%), and demisexual (4%), something else (7%), and 15% chose multiple labels to describe their sexual orientation. Findings: Homelessness presented many challenges for these young people as might be expected. However, all participants also described instances of affirmation and growth during their periods of homelessness.  These instances were related to the articulation of their gender identity and involved an expanding sense of self, connection to community, access to information, and concrete skill development.  Notably, one-third of the participants explicitly stated they would have committed suicide had they not left their homes. The findings challenge the dominant discourse related to homelessness and require that we rethink how we inquire about homeless transgender youth’s needs and best provide their services. Conclusion and Implications: The findings prohibit conceptualizations of homelessness among TGNC young people as solely a mechanism for risk and violence.  This one-dimensional understanding undermines the resourcefulness and growth of young people who actively search for a world in which they can be themselves. While the participants did share experiences that supported the dominant discourse related to homelessness, including experiences of violence, risk, and victimization, they also described situations that they experienced as beneficial and growth-producing. Their narratives were populated with much more than risk, and they talked about things other than risk with more frequency.  They also described instances of affirmation, connection, and growth and referenced the development of skills and feelings of self-sufficiency. Understanding these experiences enables the creation of programs and services that may better meet their needs.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Although one-third of participants mentioned they would have committed suicide had they not left home, this is a single illustrative finding within a broader qualitative study focused on holistic experiences of homelessness and affirmation, rather than a central substantive focus or primary outcome analysis of suicidality.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is classified as irrelevant because suicide is not the central focus, primary outcome, or distinctly analyzed component; it appears only as a passing mention in the findings to support the broader argument about reframing risk.", "confidence": "High" }, "full_label_agreement": false, "adjudicated_screening": { "is_relevant": false, "relevance_rationale": "Suicide is mentioned only once in the abstract as an illustrative finding ('one-third... stated they would have committed suicide had they not left their homes') to support the broader argument that leaving home was life-saving and affirming. It is not a central focus, primary outcome, exposure, or distinctly analyzed component; the study's substantive aim is to holistically examine affirmation, growth, and community connection among homeless TGNC youth.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Per the decision rules, records deemed irrelevant are assigned 'Not applicable' for both evidence class and empirical method.", "confidence": "High" }, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2017-X-0019", "input_index": 814, "sample_group": "Qualitative", "title": "What Is the Difference in Mothers' Experience When Adolescents Are Psychiatrically Hospitalized for a Suicide Attempt or Other Reasons? �Why You Are Whispering All of a Sudden?�", "abstract": "Purpose: The trend toward brief psychiatric hospitalizations may place increased demands on mothers after their adolescent is psychiatrically hospitalized. Short inpatient stays may increase mothers’ need to adjust and resolve seemingly insurmountable circumstances with little-to-no external support. Few studies have yet to examine mothers’ experiences after their adolescent is psychiatrically hospitalized, and even fewer studies examine whether their experiences differ because of the reason for the hospitalization (i.e., adolescents hospitalized for a suicide attempt versus adolescents hospitalized for other reasons).  Such research has direct implications for addressing the mental health needs of mothers and the ways in which mothers can be most effectively involved in the treatment of adolescents.  The purpose of this study was to address this gap in the literature by exploring the difference in mothers’ experience when adolescents are psychiatrically hospitalized for a suicide attempt or other reasons. Methods: This study used data collected for a NIMH-funded research study designed to examine the reactions of 288 mothers of hospitalized adolescents that made recent suicide attempts and mothers of adolescents who were hospitalized for other reasons.  The mothers are assessed at 1, 3, 6, and 12 months following youths’ discharge from the hospital. The current analysis focused on qualitative data collected during the first assessment from 32 randomly selected mothers of adolescents who were psychiatrically hospitalized (16 suicide, 16 other reasons).  Semi-structured interviews were conducted by trained Master- or Doctoral-level staff.  Interviews lasted between 20 and 40 minutes and were digitally recorded and transcribed.  Nvivo 11 qualitative software was used for data management and as a tool for data analysis.  Using an iterative process, six individuals collaborated to develop a codebook.  Emergent themes were systematically identified via grounded theory methods.  Inter-rater reliability was achieved when coding reached 67% agreement. Results: Although mothers varied in their experiences after their adolescent was psychiatrically hospitalized, several themes emerged.  In particular, regardless of the reason for the psychiatric hospitalization, mothers felt guilty, stressed, afraid, confused, and optimistic. Nonetheless, mothers of youth hospitalized for other reasons differed from mothers of youth hospitalized for a suicide attempt in three ways.  First, they felt angry. Second, they described seeking treatment prior to the hospitalization and being unable to receive it. Lastly, they felt stigmatized.  For example, one mother stated, “My daughter is in the hospital…no one sent prayers and cards or phone calls or food.  Nothing…it wasn’t fair, cause [daughter’s name] didn’t do this to herself.  And that is where the stigma comes from.” Conclusions and Implications: This study provides practice implications for development of interventions that support mothers of adolescents who have been psychiatrically hospitalized.  For example, mothers may benefit from psychoeducation about possible experiences they may encounter, which could validate their emotions.  Further, clinicians should be aware of differences in mothers’ experiences based on reasons for the adolescent’s hospitalization and consider these experiences in treatment planning and implementation.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly compares maternal experiences when adolescents are hospitalized specifically for a suicide attempt versus other reasons, making suicide a central exposure and focus of the analysis.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract describes the collection and thematic analysis of semi-structured interview data using grounded theory methods to identify emergent themes, which constitutes a qualitative empirical design.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SWRD:81184", "input_index": 839, "sample_group": "Qualitative", "title": "Resolution of Delusional Parasitosis within Complicated Grief Group Therapy: A Case Analysis", "abstract": "In this article, the authors present the case of a 71-year-old female suicide survivor in our Complicated Grief Group Therapy research study who presented with delusional parasitosis (DP) that resolved over the course of treatment. The authors describe Complicated Grief Group Therapy for survivors of suicide and the effect of therapy on her DP symptoms. The unique treatment elements of Complicated Grief Group Therapy addressed the trauma features of her grief, her relationship with her deceased son, her social isolation, health care adherence, and progression to a healthy grief process.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study focuses on a suicide survivor receiving Complicated Grief Group Therapy, making suicide bereavement and its treatment the central substantive focus.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The abstract describes a single illustrative clinical vignette or case analysis without detailing a systematic empirical design, statistical analysis, or reproducible methodology, fitting the definition of a non-empirical illustrative case study.", "confidence": "High" }, "full_label_agreement": false, "adjudicated_screening": { "is_relevant": true, "relevance_rationale": "The record explicitly focuses on a suicide bereavement survivor undergoing specialized grief therapy, making suicide loss and its treatment the central substantive focus, which meets the inclusion criteria for suicide bereavement research.", "evidence_class": "Non-empirical", "empirical_method": "Not applicable", "classification_rationale": "The abstract presents a single clinical case/vignette describing therapeutic progress without detailing a systematic research design, data collection protocol, or analytical methodology. Per the rubric, illustrative clinical vignettes and case analyses lacking empirical design details are classified as Non-empirical.", "confidence": "High" }, "final_screening": { "is_relevant": true, "evidence_class": "Non-empirical", "empirical_method": "Not applicable" } }, { "record_key": "SWRD:69776", "input_index": 948, "sample_group": "Qualitative", "title": "Shadows from the past: The mothering experience of women survivors of maternal suicide", "abstract": "Raising children, while challenging in the best of times, can be more complicated for a woman who lost her own mother during her childhood/adolescent years. This study examines the long-term impact of maternal suicide as evident in the mothering experiences of 12 Israeli women. Findings The participants' descriptions reveal a constant Sisyphean struggle to move away from their legacy only to be pulled backa fervent wish to be different from their mothers along with the simultaneous realization that they cannot escape their past. This continuing struggle is captured through four themes: (a) being a mother long before having children, (b) the past casting a pall over the present, (c) mothering as a means of fixing what is broken, and (d) the lack of a maternal model: an irrevocable absence. Applications The results of this study are discussed from an emotional socialization perspective which points to the relevance of two theoretical perspectives: the modeling and the compensation views of emotional socialization in the participants' mothering experiences. These views can help social workers both to understand and to attend to the distinctive difficulties of mothers who have survived the suicide of their own mothers.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study focuses on the mothering experiences of women bereaved by maternal suicide, which falls under the category of suicide bereavement/survivors.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract describes a study examining the experiences of 12 participants and reports findings derived from themes identified in their descriptions, indicating a qualitative empirical design.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SSWR:2019-P-0450", "input_index": 1044, "sample_group": "Qualitative", "title": "Veterans' Voices: A Qualitative Study on Veteran Theories of Suicide", "abstract": "Background and Purpose Veterans struggling with community reintegration after military life face significant challenges including job insecurity, relationship difficulties, anxiety, social isolation, depression, and suicide.  Although mental health researchers have long studied suicide, little is known about how veterans explain the phenomenon of suicide.  This paper addresses the gap in published perspectives on suicide by including the voices and lived experiences of veterans themselves. Methods A phenomenological qualitative design was used to examine the lived experience of veterans, with a special focus on personal narrative theories of suicide.  In-depth, semi-structured interviews were conducted with 155 Veterans.  The sample is predominantly male (78%), mixed in ethnicity (72% White; 17% African American; 6% Latinx; 1% Native American).  All branches of the military and eras of service were represented, with 59% having seen combat, and a mean 9.47 years of military tenure.  Verbatim transcripts were coded and analyzed using template analysis and Atlas TI software in partnership with Veteran research consultants. Results Data analysis yielded 110 individual codes, categorized and organized into themes.  Many participants described attempting suicide, losing friends to suicide, and seriously contemplating suicide.  A central theme, grounded in military culture and training, was the perception of suicide as a legitimate (and for some honorable) solution to complex personal struggles.  Several factors contributed to this belief, with participants describing feeling hopeless and misunderstood by civilians.  Participants discussed the importance of military concepts such as honor, duty, and the alleviation of burden to others as related to the decision to take one’s life.  Veterans also described the loss of mission and purpose, which can lead to alienation and social isolation, another identified key risk factor. Participants further theorized suicide as related to traumatic exposure, moral injury, and unmet mental health needs (particularly post-traumatic stress and depression).  Most described help-seeking stigma, attributed to military ideals of stoicism, pride and need to mask vulnerability.  Veterans also discussed engagement in extreme high-risk activities that mirror the adrenalin rush of combat.  This phenomenon is associated with increased risk of mortality and may mask a desire for suicide.  Many also discussed access to firearms as an additional risk factor.  Finally, veterans identified protective factors including family and community support, meaningful work, mission and purpose, and veteran peer relationships. Conclusion Findings suggest social workers need training in military culture to better understand and assess for unique suicide risk factors and behaviors.  Veteran perspectives and theories of suicide need consideration in policy-making, program design and intervention delivery.  Social workers intervening with veterans should emphasize prosocial activity, finding meaning/purpose, and strengthening peer relationships.  Through including veterans as a source of expertise and wisdom in policy and program implementation, social workers across multiple settings can help improve understanding of the veteran suicide phenomenon and work toward its reduction.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly investigates veterans' theories, risk factors, and protective factors regarding suicide, making suicidality the central substantive focus.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract describes a phenomenological qualitative design using in-depth semi-structured interviews with 155 veterans and thematic analysis of transcripts.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SWRD:64048", "input_index": 1319, "sample_group": "Qualitative", "title": "\"Togetherness:\" the role of intergenerational and cultural engagement in urban American Indian and Alaskan Native youth suicide prevention", "abstract": "In a collaborative study with an Urban Indian Health Organization (UIHO) and a University, we conducted six talking circles over three years with American Indian and Alaskan Native (AI/AN) elders, adults, and youth to examine perceptions of suicide and suicide prevention strategies within their community. Results of a thematic analysis indicated that normalization of suicide, stigma, and historical trauma were barriers to suicide prevention. Consistent themes of elders, adults, and youth over all three years reflected the need for intergenerational engagement and cultural connectedness as suicide prevention strategies. Implications for culturally-grounded social work practice with AI/ANs are presented.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly examines perceptions of suicide and suicide prevention strategies within an American Indian and Alaskan Native community, making suicide a central substantive focus.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract describes conducting talking circles (a qualitative data collection method) and performing thematic analysis on the resulting data, which constitutes primary qualitative empirical research.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SSWR:2022-P-0291", "input_index": 1360, "sample_group": "Qualitative", "title": "Client, Peer, and Provider Stakeholder Input on the Modification of a Cognitive Behavioral Suicide Prevention Treatment for Adults with Psychosis", "abstract": "Background and Purpose: Suicide is among the leading causes of death for adults with schizophrenia spectrum and other psychotic disorders (SSPDs) with suicide risk estimates being over eight times greater than among the general population. There is a paucity of evidence-based interventions to reduce suicide among adults with SSPDs and our study sought to modify and evaluate the acceptability and preliminary effectiveness of Cognitive Behavioral Suicide Prevention for psychosis (CBSPp) for a community mental health (CMH) setting. This paper presents on Aim 1 qualitative data of the NIMH-funded pilot effectiveness clinical trial (R34) to gain input from stakeholders to inform treatment modifications prior to testing in a randomized controlled trial (Aim 2). Methods: A total of 26 adult stakeholders participated in Aim 1 of the study, including 6 clients with SSPDs and recent suicide ideation or attempt, 7 peers, and 12 providers in CMH. Peers and providers were recruited by research staff attending virtual staff meetings and clients were recruited by providers who attended staff meetings. Interested clients were screened to confirm recent ideation or attempt and SSPD diagnosis. All stakeholders attended a 1-hour virtual qualitative in-depth interview with research staff to explore perspectives on the need for CBSPp, treatment barriers, sustainability facilitators, and areas for improvements. Qualitative interviews were transcribed, coded in Dedoose using an open-coding technique to generate themes across questions, and analyzed using grounded theory methods. Results: Clients, peers, and providers agreed there was a need for CBSPp in CMH, clients indicated they would want the treatment, and providers expressed interest in being trained to deliver the treatment. The following 3 treatment barrier themes emerged across participant groups: 1) logistic (e.g., technology barriers if virtual, provider training and delivery time), 2) client perceptions (e.g., readiness and motivation for treatment), and 3) co-occurring disorders (e.g., substance abuse). The following 4 sustainability facilitator themes emerged across participant groups: 1) buy-in (e.g., client, provider, agency buy-in to the utility of CBSPp), 2) client outcome data (e.g., CBSPp efficacy and client endorsement of helpfulness, 3) provider support (e.g., supervision, ongoing training, and inclusion of CBSPp into workload), and 4) treatment team collaboration. The following 3 areas for improvement themes emerged across participant groups: 1) increase self-esteem, 2) bolster social support, and 3) add tailoring options in the treatment manual (e.g., for trauma; per providers). Implications and Conclusions: Study findings highlight the logistic, perceptual, and clinical challenges perceived by clients, peers, and providers in the process of introducing CBSPp in a CMH setting. Consistent with prior literature, buy-in and support for the delivery of a new treatment emerged as important factors for sustainability and scalability over time. Findings were subsequently presented to a panel of scholarly experts in the fields of suicide and psychosis research, intervention research, and implementation science for additional feedback and to inform modification decisions. Stakeholder perspectives using community based participatory research approaches are essential to problem-solve challenges and barriers of new treatment delivery with an overall goal of improving access, feasibility, and quality of suicide prevention interventions.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study focuses on modifying a cognitive behavioral intervention specifically for suicide prevention in adults with psychosis, making suicide prevention the central substantive focus.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract explicitly describes collecting and analyzing qualitative data from stakeholder interviews using grounded theory methods to inform treatment modifications.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SWRD:61128", "input_index": 1435, "sample_group": "Qualitative", "title": "Healing from recurrent suicide attempts: the impact of being a peer facilitator", "abstract": "This paper presents findings of a phenomenological study entitled: Healing from Recurrent Suicide Attempts: The Impact of Being a Peer Facilitator. The study examined the impact of being a peer facilitator (PF) in the Skills for Safer Living: A Psychosocial/Psychoeducational Intervention for People with Recurrent Suicide Attempts (SfSL/PISA) group on the PFs' healing journey. Using eight semi-structured interviews, the study privileged the lived experience of participants. The results identified four themes in survivors' healing: new identity formation, navigating stigma, developing agency in the activation of personhood, and achieving personal mastery: skills and competencies.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study focuses on individuals with recurrent suicide attempts and analyzes their healing journey through peer facilitation, making suicide a central population and substantive focus.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract explicitly describes a phenomenological study using semi-structured interviews to analyze lived experiences, which constitutes primary qualitative data analysis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SWRD:62872", "input_index": 1546, "sample_group": "Qualitative", "title": "Clinician Perspectives of the Evidence Underpinning Suicide Risk Assessment: A Mixed Methods Study", "abstract": "In recent years, suicide risk assessment has become the subject of a vigorous academic debate, due in part to several meta-analyses that have cast doubt on the accuracy of risk categorisation. Little is known about how clinicians make sense of this academic debate. However, it is anticipated that it may pose a tension due to organisational expectations that multidisciplinary health professionals, including social workers, assess and manage suicide risk. As part of a larger mixed methods study to be reported elsewhere, we conducted a qualitative study aiming to explore clinician perspectives on the evidence underpinning suicide risk assessment before and after being presented with the results of two meta-analyses. Findings highlight three modes of reasoning: academic, emotive, and experiential. Perceptions of accuracy of assessing suicide risk at baseline interviews and after hearing the evidence were influenced by heuristics and cognitive biases. IMPLICATIONS Mental health practitioners, including social workers, employed in mental health settings may be more likely to use experiential reasoning to inform their practice in suicide risk assessment. Social work practitioners in general health settings may be more likely to use academic reasoning when making decisions about suicide risk assessment. Further research is required on how social workers and other mental health professionals can best respond to the crisis of suicide.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study centrally focuses on clinician perspectives and reasoning regarding suicide risk assessment, which is a specific component of suicide prevention and practice.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "Although described as part of a mixed methods study, the abstract explicitly states that 'we conducted a qualitative study' and reports findings derived from interviews (modes of reasoning, heuristics), making Qualitative the best-supported method for the reported data.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SWRD:62039", "input_index": 1589, "sample_group": "Qualitative", "title": "Understanding past experiences of suicidal ideation and behavior in the life narratives of transgender older adults", "abstract": "Transgender people (collectively referred to here as trans) experience disproportionate rates of suicidal ideation and behavior (plans and attempts) attributed to complex constellations of structural and individual factors. Interpretive methods in suicide research elucidate and contextualize intricate patterns of risk factors and strategies for recovery. The life narratives of trans older adults offer unique insights into past suicidal behavior and recovery after distress has diminished and perspective has been gained. This study aimed to illuminate the lived experiences of suicidal ideation and behavior in the biographical interviews of 14 trans older adults as part of the project To Survive on This Shore (N = 88). Data analysis was conducted using a two-phase narrative analysis. Trans older adults contextualized suicide attempts, plans, ideation, and recovery as navigating impossible to possible paths. Impossible paths were seen as hopelessness in their life direction, often after a significant loss. Possible paths were described as pathways to recovery from crises. Transitions from impossible to possible paths were narrated as a turning point or moment of strength combined with outreach to family, friends, or mental health professionals. Narrative approaches hold the potential to illuminate pathways to well-being among trans persons with lived experiences of suicidal ideation and behavior. For social work practitioners, therapeutic narrative work around past suicidal ideation and behavior with trans older adults holds promise for suicidal prevention by identifying important supportive resources and previously used coping skills in crises.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study centrally focuses on the lived experiences of suicidal ideation and behavior among transgender older adults, analyzing narratives related to suicide attempts, plans, and recovery.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract describes a primary data analysis using interpretive narrative methods on biographical interviews with 14 participants, which constitutes qualitative empirical research.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SSWR:2024-P-0639", "input_index": 1651, "sample_group": "Qualitative", "title": "Pathways to Resiliency and Empowerment: A Novel Approach to Understanding Adolescents Living with HIV", "abstract": "Background and Purpose : It is estimated that over thirty-five million people around the world live with Human Immunodeficiency Virus (HIV), and over 71% live in sub-Saharan Africa. Despite scientific gains in HIV prevention, Uganda is still one of the countries seriously affected by the HIV/AIDS epidemic. HIV is a highly stigmatized disease with social ridicule and discrimination, leading to depression, trauma, and severe mental health problems. Further, HIV/AIDS epidemic is often a component of related synergistically interacting epidemics that give rise to other poor health outcomes, food insecurity, unemployment, and adherence to antiretroviral therapy (ART). Despite the scientific discoveries and knowledge, we know very little about pathways to resilience and empowerment adolescents employ to manage the disease. Utilizing resilience theory, the study explored adolescents’ lived experiences and strategies to cope with a severe and highly stigmatized disease. Using the components of resilience, which involve the processes of responding to adversity, the study examines resilience’s empowering ability to uncover the individual’s capacity to bounce back after experiencing difficulties. Methods : Using a qualitative interpretive phenomenological approach (IPA), the study examines the lived experiences of youth ages 18 to 24 living with HIV in Uganda. Data were collected through partnerships with local health clinics after Institutional Review Board (IRB) requirements. Six focus groups (N=31) that met between December 2020 to May 2021 provided the data for analysis. Participants included young men, women, men having sex with men (MSM), sex workers, and perinatally infected young people who receive/d services at the local private and government run clinics. Participants were screened for eligibility, and informed consent was provided before the study. All focus group sessions were audio-recorded with approval from the participants, transcribed verbatim, and subsequently analyzed using the grounded theory approach. Data triangulation was conducted through checking and rechecking to ensure that the findings were corroborated. A follow-up focus group with the participants was done to strengthen the validity and reliability of the data. Results : The findings indicate that adolescents living with HIV went through several pathways in their HIV experiences: 1) denial, 2) despair, 3) suicidal ideation, and 4) substance use, 5) acceptance, 6) resilience, 7) empowerment, which were seldom linear. Resilience was arrived at after acceptance of the reality of HIV, their health, and physical needs, as well as receiving the needed support. Further, the youth had the resolve to educate and spread knowledge about HIV prevention, and muster the courage to advocate for their rights and the wellbeing of others. This point of empowerment was developed through various mechanisms of social support, familial support, social media, and health clinic support. Conclusions and Implications : HIV management is a complex web of synergistically interacting components within a social context involving fighting stigma, self-discovery, and an aptitude to beat the odds. Social work researchers, advocates and policymakers, and programs must develop interventions to bolster individuals’ inherent determination to be better and overcome the social, physical, and health headwinds that stand in the way.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "Suicidal ideation is explicitly identified as a distinct pathway/outcome in the results of adolescents living with HIV.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The study uses focus groups and qualitative interpretive phenomenological analysis to explore lived experiences, including suicidal ideation.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SWRD:536", "input_index": 1710, "sample_group": "Qualitative", "title": "Barriers to a trauma-informed approach to suicide: experiences of practicing clinicians", "abstract": "Many clients with suicidal thoughts and behaviors will also have a history of trauma. Little is known about the ways that mental health clinicians implement a trauma informed approach (TIA) with this population or the challenges they encounter in this work. This qualitative study of clinicians (N = 30) explored the use of TIAs to address suicidal thoughts and behaviors. Thematic analysis identified barriers to the use of a TIA with individuals with suicidal thoughts and behaviors: insufficient knowledge and skills (n = 30), systemic barriers (n = 28), and a lack of integration of the fields of trauma and suicide (n = 26). Implications for clinicians, educators, and organizations are discussed.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly focuses on clinicians' experiences and barriers regarding the implementation of trauma-informed approaches for clients with suicidal thoughts and behaviors, making suicide a central substantive focus.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract describes a qualitative study involving thematic analysis of data from 30 clinicians, which constitutes primary empirical research using qualitative methods.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SWRD:117119", "input_index": 1741, "sample_group": "Qualitative", "title": "Navigating Suicidal Crisis in a Traditional Setting of Kyrgyzstan", "abstract": "The Case Study of Azat (name is changed) represents a joint effort of data gathering from the Researcher, the Social Pedagogue and other community members from one of the remote local schools in Kyrgyzstan. By using phenomenological research methods including non-structured interviews (n=3), observations and field trips, the researcher strived to understand and describe the essence of the phenomenon of suicide in a conservative country, like Kyrgyzstan. The study highlights the challenging circumstances faced by Azat, a 14-year-old residing in a village in Kyrgyzstan. Azat's family grapples with financial instability, parent’s labor migration, and sibling abuse, all of which have led to distressing experiences for him, including two suicide attempts. The analysis emphasizes the significance of understanding ecological systems and societal constructs in social work practice. It underscores the vital role of social workers in advocating for marginalized individuals like Azat, with sugges", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study focuses on a specific case of suicidal crisis and suicide attempts, analyzing the phenomenon of suicide within a cultural context.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract explicitly describes using phenomenological research methods, including non-structured interviews and observations, to analyze primary data from a case study.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SWRD:56137", "input_index": 1762, "sample_group": "Qualitative", "title": "Trauma-Informed Practice with Individuals with Suicidal Thoughts and Behaviors", "abstract": "Trauma-informed practices are recommended when working with individuals with suicidal thoughts and behaviors due to the strong relationship between trauma and suicidality, but there is a dearth of information on how a trauma-informed approach is applied to work with this population. Practicing clinicians were recruited from professional networks, listservs, trainings, and through colleagues and word of mouth. This qualitative study (N = 30) explores clinicians' understanding of trauma-informed practice and identifies ways that clinicians apply SAMHSA's six principles of trauma-informed care to their work with clients with suicidal thoughts and behaviors. Using thematic analysis, the following themes emerged from the interviews with practitioners: the creation of a strong working alliance characterized by relational safety; the use of collaboration and client empowerment strategies; the need for awareness of cultural, gender, and historical factors; the use of transparency and informed consent about disclosures related to suicide; an understanding of the scope and impact of trauma, and the use of peer support. The implications of this work for practicing clinicians is discussed, including the role of continuing education, the need to develop more peer support programs, and the importance of building trauma-informed organizations and agencies.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly focuses on clinicians' practices with individuals experiencing suicidal thoughts and behaviors, making suicide a central population and substantive focus.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract describes a qualitative study involving interviews with 30 practitioners and thematic analysis of their responses.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SSWR:2025-U-0674", "input_index": 1799, "sample_group": "Qualitative", "title": "Co-Response to Psychiatric Emergencies in an Urban Setting: A Law Enforcement-Driven Response to Mental Health", "abstract": "Background In response to the incidence of police interaction with people navigating mental health symptoms and the increased risk for escalation during these encounters, many cities have adopted a co-response model (i.e., police officer and mental health clinician) to improve the management of behavioral health crises. Co-response teams are often housed in police departments and funded by foundation and/or government money. Co-response programs’ stated goals are to reduce injuries to police and citizens with psychiatric disorders and/or distress, divert these persons from the criminal justice system, and connect them with mental health services (Morabito et al., 2018). Co-response programs have demonstrated mixed effectiveness toward these ends (Marcus & Stergiopoulos, 2022). While cities across the country have ramped up these programs, little research has documented the array of individual and community events that elicit response from co-response teams. Using clinician notes from an urban program in the Northeastern US, we analyzed co-response encounters to understand who is involved in these encounters and under what circumstances. Methods Using a grounded theory approach (Strauss & Corbin, 1990), we analyzed clinical notes from 4,111 co-response encounters between July 2019 and March 2022. A two-step process, open coding followed by axial coding, allowed us to develop a codebook, categorize codes, and identify themes within the data. To validate our interpretation of our findings, we obtained feedback from an expert advisory team and utilized member checking with current co-response clinicians. Results The co-response clinicians documented the reason for the encounter, the encounter setting, the individuals involved in the encounter, and actions taken by the co-response team, clinically and, at times, legally. Co-response clinicians are invited only when an encounter is determined to have low potential for violence and may only interact with the individual after law enforcement determined the scene was safe, which included potential restraint. Co-response intervention happened in one of the following environments: a private home, in outside public space, in a place of commerce, or in a carceral/ police setting. We identified a series of archetypal characteristics of the recipients of co-response intervention: (1) vulnerable/marginalized identity; (2) psychiatric symptoms; and (3) perceived potential violence. In addition to vulnerabilities related to psychiatric distress, many individuals embodied one or more additional vulnerable and/or marginalized identities (e.g., youth, older adults, non-English speaking). The most common psychiatric symptoms included psychotic symptoms (e.g., paranoia, decompensation, disorganization), suicidality, and substance use (acute intoxication and substance use disorders). Lastly, encounters were described as either including perceived potential violence or not. Conclusions/Implications In this city in the northeast, co-response teams interact with individuals who are socially marginalized, often experiencing psychiatric distress in public, and who are perceived to be dangerous to the public. While co-response is intended as an alternative to police-only response to community members in psychiatric crises, in practice it remains a law-enforcement driven intervention that furthers interaction between law enforcement and some of the community’s most vulnerable individuals. The development of non-law enforcement models is critical to avoid the continuation of a carceral response to mental health crises.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": false, "relevance_rationale": "Although suicidality is mentioned as one of several psychiatric symptoms observed in co-response encounters, it is not a central focus, primary outcome, or distinctly analyzed component of the study, which primarily examines the demographics and circumstances of police-clinician co-response interactions.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "The record is classified as irrelevant because suicide is merely one item in a broad list of psychiatric symptoms rather than the substantive focus of the analysis.", "confidence": "High" }, "full_label_agreement": false, "adjudicated_screening": { "is_relevant": false, "relevance_rationale": "Suicidality is mentioned only as one item in a broad list of common psychiatric symptoms observed during co-response encounters. It is not a central focus, primary outcome, exposure, or distinctly analyzed component. The study's substantive aim is to characterize the demographics, circumstances, and law-enforcement dynamics of police-clinician co-response teams for general psychiatric emergencies.", "evidence_class": "Not applicable", "empirical_method": "Not applicable", "classification_rationale": "Per the rubric, records where suicide/suicidality appears merely as one unanalyzed item in a broad list or passing mention are classified as irrelevant. Consequently, evidence_class and empirical_method are set to 'Not applicable'.", "confidence": "High" }, "final_screening": { "is_relevant": false, "evidence_class": "Not applicable", "empirical_method": "Not applicable" } }, { "record_key": "SSWR:2026-P-0901", "input_index": 1907, "sample_group": "Qualitative", "title": "\"I Feel Contaminated in Some Way\": Stigma, Mental Health, and Suicidality Among Sexual and Gender Minority Young People Living with HIV in Lima, Peru", "abstract": "Background and Purpose: Sexual and gender minority (SGM) young people living with HIV (LWH) in Peru face profound mental health challenges, shaped by intersecting forms of stigma, marginalization, and systemic neglect. While the HIV care infrastructure in Peru offers accessible, low-cost treatment, less attention has been given to the psychological toll of living with HIV in a context where discrimination based on sexual orientation and gender identity remains pervasive. This study explores how SGM young people living with HIV in Lima, Peru navigate intersectional stigma and how it shapes their mental well-being, including experiences of suicidality amid family rejection, negative healthcare interactions, and broader social isolation. Methods: This qualitative study draws from in-depth interviews with SGM young people (n=20) aged 18–29 who are LWH in Lima, Peru. Participants were recruited through LGBTIQ+ community organizations and networks using purposive and snowball sampling. Interviews were conducted in Spanish, transcribed, and analyzed using reflexive thematic analysis informed by constructivist grounded theory and intersectionality. Coding focused on themes of stigma (enacted, internalized, anticipated), emotional well-being, and engagement with healthcare services. Participants also completed an identity mapping activity that helped contextualize identity-based stressors. Results: Many participants shared experiences of deep emotional distress and suicidality, particularly around the time of their HIV diagnosis. For some, these feelings were exacerbated by a lack of emotional support from family or providers, internalized blame, or fears of long-term social exclusion. Across these accounts, stigma, whether anticipated, enacted, or internalized, was a central thread shaping participants’ mental health trajectories. Abandoning HIV treatment was described by some as a method for attempting suicide. Even those actively engaged in HIV care reported ongoing mental health challenges, suggesting that adherence does not equate to mental wellness. At the same time, the study identified moments of resistance and coping, such as forging affirming friendships, or leaning on family (biological and chosen) for support. Disclosure of HIV status, though rare, sometimes led to unexpected support from peers or even employers, which improved participants’ sense of safety and belonging. Conclusions and Implications: This study highlights the urgent need to integrate mental health care into HIV services for SGM young people in Peru. While biomedical treatment is largely accessible, mental well-being remains fragile, particularly soon after initial diagnosis. Findings suggest that suicidality is not only linked to individual coping but also to broader structural and relational dynamics, including stigma, loneliness, and a lack of culturally competent psychosocial support. There is a need for community-rooted and identity-affirming mental health interventions that recognize the intersecting pressures SGM young people LWH face. Future work should explore how regional, gender, and class-based differences shape risk and resilience across the HIV care continuum.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly investigates suicidality as a central outcome among sexual and gender minority young people living with HIV, analyzing how stigma influences these experiences.", "evidence_class": "Empirical", "empirical_method": "Qualitative", "classification_rationale": "The abstract describes an original qualitative study using in-depth interviews and reflexive thematic analysis to explore participants' experiences.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Qualitative" } }, { "record_key": "SWRD:48483", "input_index": 392, "sample_group": "Review", "title": "Social Work with Older People-Reducing Suicide Risk: A Critical Review of Practice and Prevention", "abstract": "Although suicide remains an uncommon event among older people in most developed countries, suicide rates do increase with age, mainly accounted for by the higher incidence among older men. A critical interpretive synthesis review that emphasises practitioner perspectives reveals three problems: (i) a scarcity of research that takes a system-wide approach to suicide prevention in later life; (ii) a dearth of evidence about the social work contribution to reducing the risk of suicide in later life; and (iii) a noticeable absence of reference to social work practice in national guidelines for mental health practitioners. This absence of social work services from studies about later life suicide arises partly from concentration on medical, nursing and psychological literature and partly from the use of a hierarchy of evidence that grades research by quality of the science and stands to miss accounts of practice, let alone the experiences of older people. This article suggests that emphasis should be given to guideline development, and to improving sub-optimal care and support. These actions would use social work skills in opening channels of communication between other professionals; communicating with carers; advocating on behalf of individuals with mental health problems; and offering acceptable and accessible support.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The article focuses centrally on reducing suicide risk in older people through social work practice and prevention strategies.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The abstract explicitly identifies the study as a 'critical interpretive synthesis review,' which constitutes a systematic evidence synthesis method.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SWRD:42894", "input_index": 559, "sample_group": "Review", "title": "Systematic Literature Review Unemployment and psychological distress among young adults in the Nordic countries: A review of the literature", "abstract": "This article reviews Nordic research, published from 1995 and onwards, on the relationship between unemployment and mental health among young adults. Cross-sectional, longitudinal and time-series studies are included. Cross-sectional studies show that the unemployed experience more mental health problems than the non-unemployed. Leaving unemployment is associated with increased well-being. Economic problems, feelings of shame and poor social support increase the likelihood of psychological distress. The longitudinal studies show that unemployment increases the risk of psychological distress and attempted suicide, after initial mental health status and confounding factors are accounted for. The relationship remains significant when time-invariant characteristics of the individuals are controlled for. The time-series studies found no relationship between unemployment and suicide, but levels of psychological distress were found to vary with changes in the labour market. This relationship remained significant after excluding the non-employed, indicating that unemployment trends have effects beyond those directly associated with unemployment.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The abstract explicitly reports on suicide attempts and suicide rates as distinct outcomes analyzed in the reviewed studies regarding unemployment and mental health.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The title and abstract identify the work as a systematic literature review that synthesizes findings from cross-sectional, longitudinal, and time-series studies.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2018-P-0528", "input_index": 913, "sample_group": "Review", "title": "Suicide in Central Asia: Prevalence Rates, Risk and Protective Factors, and Interventions", "abstract": "Background and Purpose: An estimated 1.5 million people die by suicide each year, increasingly in developing countries. While most research on suicide has been studied in the western countries, the majority of completed suicides occur in Asia. Within Asia, Central Asian area, comprised of Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan experience the phenomenon of suicide in large numbers, yet very little research exists on the area of suicide in Central Asia, including the identification of risk and protective factors associated with suicide and effective treatments for prevention and intervention of suicides. However, in order to develop and adapt culturally appropriate and effective treatments in this area, an examination of the current state of the literature is needed. Thus this study addresses this gap in the literature on suicide in Central Asia by investigating the following objectives: 1) identify prevalence data on suicides in the Central Asian region, 2) examine the risk and protective factors for suicide in these countries; and 3) explore available treatments for suicide prevention and intervention. Methods: PsycINFO and MEDLINE databases were searched over across 30 years (January 1987 to December 2016) to identify research on suicide in the region of Central Asia. A keyword search was conducted using the following Boolean/phrase terms: Central Asia or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan AND suicid* or \"self-immolation\" or aintihar (the Arabic word for suicide) or samoubiystvo (the Russian word for suicide). The search was limited to peer-review journal articles. The initial search identified 35 eligible studies. A review of these articles by the research team resulted in the exclusion of 14 articles, resulting in the inclusion of 22 articles in the systematic review. Results : Research on suicide in this region are underdeveloped and results are mixed. Specifically, findings identify inconsistencies in the reporting and the recording of suicides at the national level across countries in Central Asia, making it difficult to effectively quantify accurate prevalence data for these countries. However, existing research does identify a series of informative risk and protective factors, such as physical and sexual violence for women and girls, lack of psychosocial support for children and families, unmet basic needs and dependence on the Russian labor market for basic livelihood, dependence on illicit drug production and trafficking, and a defunct mental health care system that may inform the adaptation and development of future treatment interventions. Conclusions and Implications: Suicide rates in Central Asia are higher than in developed countries, yet interventions to address this phenomenon remain absent. Despite limited research, core risk and protective factors have emerged that can facilitate the adaptation and translation of evidence-based suicide interventions in this area. This abstract will present a series of practice, policy and research findings designed to guide and promote initial steps for effective intervention.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The article focuses centrally on suicide prevalence, risk/protective factors, and interventions in Central Asia, making it highly relevant to the evidence corpus.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The abstract explicitly describes a systematic search strategy across databases, inclusion/exclusion criteria, and synthesis of findings from 22 included studies, identifying it as a systematic review.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2019-P-0127", "input_index": 970, "sample_group": "Review", "title": "Behavioral Health Interventions for LGBTQ+ Youth: A Systematic Review", "abstract": "Study Aims: LGBTQ+-identified individuals are at elevated risk for suicidal attempts and ideation, self-harm, substance use, and mental illness; this risk is magnified amongst LGBTQ+ adolescents (Liu and Mustanski, 2012; Marshal et al., 2008). Evidence-based behavioral interventions use skill acquisition and generalization as treatment for these mental health concerns, albeit there is limited existing research examining the effectiveness of these interventions specifically among LGBTQ+ adolescents. Thus, it is critical to synthesize extant literature assessing the efficacy of such interventions within this population. Methods: This systematic review examines behavioral interventions for LGBTQ+ adolescents with mental illness and substance use. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method, a screening process was used to assess eligibility for inclusion (Moher et al., 2009). Results:  Researchers consulted three electronic databases (Embase, PsycInfo, and Web of Science), yielding 621 results. Six additional references were identified through reference lists. During screening, 613 studies were excluded due to irrelevance. Fourteen articles were assessed via full text review. Three additional exclusions did not assess behavioral health outcomes in LGBTQ+ adolescents or were not delivered by a mental health professional. Eleven studies, ranging from a 3-session drug use prevention program to a 10-session school-counseling program, met inclusion criteria. Studies were evaluated for methodological quality and treatment outcomes. Outcomes included decreased suicidal behaviors, depressive symptoms, substance use, and social isolation. Significant design and methodological limitations were present across most included studies; five studies presented case reports and only one study used a randomized controlled trial design. Treatment models were evaluated to determine if they were implemented in standardized form, or if they were adapted for the specific needs of LGBTQ+ youth (e.g. minority stress). Conclusion: The review suggests limited and preliminary evidence supporting the use of interventions to reduce mental health problems specifically in LGBTQ+ adolescents. Given the methodological limitations of the studies, it is not yet possible to determine the effectiveness of specific adaptations addressing minority stress. More rigorous research is required to determine if interventions including minority stress of LGBTQ+ adolescents are more effective than standard treatment models. Despite the increased risk of suicide in the LGBTQ+ community, only two of the reviewed studies assessed changes in suicidal behavior. It is essential that future research examines the efficacy of interventions on mental health and self-harm within this demographic.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The abstract explicitly identifies elevated suicide risk in LGBTQ+ youth as a key context and reports that 'decreased suicidal behaviors' were among the outcomes assessed in the included studies, making suicide a distinctly analyzed component.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The record is explicitly identified as a systematic review following PRISMA guidelines with a defined search strategy and inclusion/exclusion process.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2019-U-0063", "input_index": 997, "sample_group": "Review", "title": "Gender Based Violence and Suicide in Central Asia: Research Findings and Clinical Recommendations", "abstract": "Background and purpose: Suicide is a major problem facing the world. About 1.5 million people die by suicide each year. Globally, most suicides occur in Asia, yet suicides are almost exclusively studied in the west. In Central Asian countries in particular, suicides are seen in large numbers. In low and middle income countries suicide is largely correlated with gender based violence and oppression of women in general. The present study is based on a systematic review of literature on suicide in Central Asia and its relation to gender based violence. The objectives of the study are to identify 1) risk and protective factors for suicide in the Central Asian countries 2) identify the relationship between suicide and gender based violence in these countries. Methods: In a systematic review four electronic databases (PsycINFO, MEDLINE, CINAHL, and SocINDEX) were searched across 30 years between 1987 and 2016 to identify studies that reported quantitative or qualitative data on suicide in Central Asia. The Boolean search strategy matched the following criteria: (1) Central Asia or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan; (2) suicid* or self-immolation or aintihar (Arabic for suicide) or samoubiystvo (Russian for suicide); (3) published in the English or Russian languages; and (4) published as peer-reviewed. The systematic search identified 44 eligible studies, resulting in a final inclusion of 15 articles in the systematic review according to established criteria. From the identified articles, risk and protective factors for suicide were investigated. Studies finding the risk factor of gender based violence for suicide were closely examined. Results: A slight majority, eight of 15 studies (53%) report on risk factors for suicide in Central Asia. A total of 31 distinct risk factors are identified. The category of Family and Community System factors and Socio-Economic factors captured gender specific data which were associated with suicidal behavior among women. The most researched risk factor identified for women suicides is marital abuse. A total of four studies (27%) report abuse by husband as a suicide risk factor and another four studies (27%) report abuse by family members as a risk factor. Abuse by mother-in-law is reported as an added risk factor for women. The other risk factors for women in this category are family conflict, forced marriage, and negative rumors with each being reported by one study (7%). Conclusions and Implications: A series of clinical, policy and research findings and implications are presented to guide the initial step for effective intervention. 11 specific risk factors center on martial and family violence and gender based oppression. Clinical recommendations suggested the development of victim support services, including specific medical care for abused women and training for medical care personnel regarding abused women, specific prevention and treatment methods developed to target females. Education and policy recommendations centered on improving awareness and education about marital violence as a contributor to suicide across healthcare providers, justice officials, and the public.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly focuses on suicide risk factors, specifically the relationship between gender-based violence and suicide in Central Asia, making suicide a central substantive focus.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The abstract describes a systematic review methodology with defined search strategies, inclusion criteria, and synthesis of findings from identified studies.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2019-P-0385", "input_index": 1018, "sample_group": "Review", "title": "Promising School-Based Interventions for Sexual and Gender Minority Youth Wellbeing: A Meta-Analysis", "abstract": "Background The victimization, harassment, and isolation that sexual and gender minority (SGM) youth often face in school settings are associated with poor mental health (e.g., depression, suicidal ideation and attempts, anxiety) as well as negative academic outcomes including lower academic performance and dropping out.  School-based supports, such as gay-straight alliances (GSAs), SGM-affirming school climates, and access to supportive individuals in schools have been associated with positive well-being among SGM students, yet this research is overwhelmingly cross-sectional and experimental designs remain exceedingly rare.  The purpose of this study was to use systematic review and meta-analysis to synthesize previous correlational research findings and identify which school-based supports are most strongly associated with SGM youth’s well-being and thus represent key targets for future intervention development and testing. This extends the work of previous meta-analyses and systematic reviews by attending specifically to the role of the school environment on the well-being of SGM youth. Methods Following PRISMA guidelines, we searched for all available published or unpublished school-based studies involving SGM adolescents by using key search terms and their variations. After reviewing studies for eligibility, 15 studies remained.  Predictor variables, outcome variables, statistics measuring the association between the two, sample sizes and other characteristics were gathered from the studies meeting the inclusion criteria.To maintain independence between effect sizes, when multiple effect sizes for a predictor-outcome pair came from the same study the effect sizes were aggregated. The effect size estimate from each study was converted to a common metric (Hedges’s g ). Given the small number of effect size estimates for each predictor-outcome pair, a fixed effects model was used. Results The final analysis included 34 effect size estimates for 18 predictor-outcome pairs drawn from 15 studies. Presence of a GSA was positively associated with a school attachment ( g = 0.52, 95% CI [0.19, 0.84]) and decreases in truancy ( g = 0.18, 95% CI [0.14, 0.23]) and victimization ( g = 0.11, 95% CI [0.08, 0.14]). An SGM-affirming school climate was positively associated with school attachment ( g = 0.67, 95% CI [0.32, 1.01]) and decreases in truancy ( g = 0.21, 95% CI [0.16, 0.25]), suicide ideation and attempts ( g = 0.10, 95% CI [0.08, 0.13]), and victimization ( g = 0.25, 95% CI [0.20, 0.29]). Supportive individuals in schools was positively associated with grade point average ( g = 0.47, 95% CI [0.30, 0.64]) and decreases in truancy ( g = 0.27, 95% CI [0.22, 0.31]), depression ( g = 0.56, 95% CI [0.52, 0.60]), and victimization ( g = 0.20, 95% CI [0.16, 0.25]). Discussion Employing effective interventions to address the exclusion, discrimination, and victimization SGM students face in school is a critical step toward addressing health and mental health disparities among SGM populations.  Our study suggests that future interventions should aim to develop and rigorously test the impact of GSAs, SGM-affirming school climates, and trainings to increase the cultural competence and supportive capacities of teachers and staff.  Overall, these findings encourage social workers to promote school-level interventions to help end community violence and promote positive wellbeing for SGM youth.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly analyzes the association between school-based supports and suicide ideation and attempts as a distinct outcome in its meta-analysis.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The abstract describes a systematic review and meta-analysis following PRISMA guidelines to synthesize quantitative data from multiple studies.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SWRD:68126", "input_index": 1051, "sample_group": "Review", "title": "A Culturally Informed Systematic Review of Mental Health Disparities Among Adult Indigenous Men and Women of the USA: What is known?", "abstract": "Related to a broader context of historical oppression, Indigenous peoples of the USA are overburdened with the mental health challenges that social workers tend to treat, including post-traumatic stress disorder (PTSD), depression, suicide and substance use disorders (SUD). The purpose of this systematic review is to use the Framework of Historical Oppression, Resilience and Transcendence (FHORT) to identify empirical research on risk and protective factors related to mental health and SUD amongst these populations. This systematic review includes peer-reviewed quantitative and qualitative research articles from 1980 to 2017 focusing on the mental health of US Indigenous adults. A total of thirty-eight peer-reviewed empirical articles met inclusion criteria. Results reveal adults within Indigenous populations are at a high risk for mental health outcomes, including PTSD, depression, suicide, SUD and comorbidity across these outcomes. Underlying risk factors across outcomes included historical oppression and loss, family problems and SUD. Protective factors tended to include family and social support and engagement with tribal cultural activities. Significant variability was identified based on gender and geographic regions. Given that protective factors tended to include cultural, familial and community tenets, holistic approaches are the most promising programmes for social workers to work towards.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "Suicide is explicitly listed as a central mental health outcome analyzed in this systematic review of Indigenous populations.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The abstract explicitly identifies the study as a systematic review that synthesizes empirical research articles.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SWRD:67207", "input_index": 1056, "sample_group": "Review", "title": "Clinical Interventions to Reduce Suicidal Behaviors in Hispanic Adolescents: A Scoping Review", "abstract": "Purpose: A significant portion of adolescents who engage in suicidal behaviors are of Hispanic origin, yet little is known regarding interventions to reduce suicidal behaviors among Hispanic adolescents. Through a culturally responsive framework, this study describes and systematically maps the existing research on interventions to treat suicidality among Hispanic adolescents. Method: Using Arksey and O'Malley's scoping review methodology, nine publications were selected for review from available peer-reviewed literature published between 2013 and 2017. Results: Eight interventions were identified. All were published in nonsocial work journals. Interventions were implemented in either mental health or after-school community settings and included a family focus. Discussion: The analysis revealed three themes: (1) There is scant research on this topic, (2) there is a void of social work scholarly literature regarding this issue, and (3) identified interventions generally include culturally responsive factors. Implications for social work research and practice are discussed.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study focuses on clinical interventions to reduce suicidal behaviors in Hispanic adolescents, making suicide prevention a central substantive focus.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The abstract explicitly identifies the use of Arksey and O'Malley's scoping review methodology to systematically map existing research, which classifies it as an empirical systematic evidence synthesis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2020-U-0464", "input_index": 1154, "sample_group": "Review", "title": "Mapping the Interventions for American Indian and Alaska Native Youth Mental Health", "abstract": "Background: Suicide is the second leading cause of death for Native youth aged 15-24. Similarly, Native youth have a suicide rate 1.5 times higher than the general population and are at higher risk for depression and substance use. Native youth are at higher risk for depression, substance abuse, and suicide due to high levels of economic and social disadvantage, acculturation stress, and the history of relocation, discrimination, and trauma. Mental and behavioral health issues, stressful life events, and substance use are associated with increases in suicide risk. A persistent need remains for culturally specific mental health interventions for American Indian youth. Methods: In response to the push for evidence-based practices, evidence mapping has emerged as systematic, rigorous, and replicable analysis of evidence. Preliminary search criteria yielded a total of 613 articles. The vast majority of the articles were excluded from the study based upon search criteria. As a result, a total of 9 interventions were included in the study. While our findings may appear to be based on a small number of articles, these results are similar to previous work examining mental health interventions for AI/AN populations. Results: A total of 9 interventions were mapped as evidence-based practices for American Indian mental health. The interventions fell into one or more of four main categories: school-based services, cultural adaptations, culture as treatment, and community involvement. While results are presented under four main headings, it is worth noting that considerable overlap existed among the interventions. Some studies included community involvement although they were administered in school-based settings. Most studies included cultural aspects and incorporations but were not solely focused on using culture as the entire intervention. Given the state of research within American Indian mental health, it is our recommendation to push for an increase in outcome studies evaluating evidence-based practices, practice-based evidence, and promising practices. It is also important to consider the restrictions of evidence-based practices and evaluate the actual evidence about the efficacy of interventions, rather than limiting practices solely to those measured in randomized control trials. Ultimately, it is of the utmost importance to honor tribal sovereignty and self-determination, especially in research practice, whether it be through the adaptation of other evidence-based practices or the creation of interventions utilizing culture as treatment. Conclusion and implications: Given the current state of mental health within Indian Country, it is vital for practitioners to not only be aware of prevalence statistics documenting the issues Native people face, but to actively seek to incorporate culturally-grounded population-specific interventions to address these disparities. Evidence mapping is important to bridge the gap between research and practice. Results of this study demonstrate the strength of culturally specific mental health interventions for American Indian youth. Future research should seek to evaluate promising practices for American Indian youth in order to increase available evidence-based practices. Future research should seek to combine Indigenous approaches with Western practices, focus on holistic wellness including co-occurring disorders, historical trauma, and poverty.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "Suicide is explicitly identified as a primary context and risk factor driving the need for mental health interventions in American Indian and Alaska Native youth, making it a central substantive focus of the evidence mapping.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The abstract describes an 'evidence mapping' process involving systematic search criteria, screening of 613 articles, and inclusion/exclusion rules to synthesize findings on interventions, which qualifies as a systematic evidence synthesis/review.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2021-P-0505", "input_index": 1318, "sample_group": "Review", "title": "Understanding Mental Health & Culturally Responsive Mental Health Interventions Among Bhutanese Refugee Population in the United States: A Systematic Scoping Review", "abstract": "Background: Bhutanese refugees constitute the largest group of Asian refugees resettled in the U.S. In addition to facing post-resettlement challenges, this population has been a subject of considerable psychological investigation due to alarming rates of anxiety symptoms, PTSD, depression, substance misuse and documented evidence of high suicide rates. Further, mental health concerns remain a huge stigma among the Bhutanese community, which is often unaddressed due to gaps in service delivery and utilization. There is an urgent need for an in-depth understanding of mental health and development of culturally responsive interventions that can promote mental well-being among this hidden population. Purpose : The purpose of our systematic scoping review is: to provide a scientific understanding of Bhutanese mental health; understand efficacy of intervention strategies that have been used in the Bhutanese context, and propose recommendations for advancing research and interventions to improve well-being of Bhutanese refugees resettled in the U.S. Methods: We created a six-staged overarching scoping review framework to guide our inquiry: research question; study identification; study selection; data synthesis; results collation and community consultation. Study search was conducted from February 2019 through February 2020 on seven databases. Inclusion criteria comprised empirical and conceptual studies: published in peer-reviewed journals; published in English; conducted among Bhutanese refugees in the U.S., focused on mental health outcomes and interventions. Grey literature, studies not focusing on mental health, and not conducted in the U.S. were excluded. The three-staged screening and selection process included: initial search and duplicate removal, title and abstract review, and full study review. Data synthesis included extraction of data—study purpose, methodological characteristics, and results—from each study to provide a numerical summary and an overall understanding of mental health and interventions. A thematic framework was used to index, annotate, code and reference study results to identify generic themes and group the studies into thematic clusters. Key results were then extracted from each study for an overview map. Results: Reviewed studies ( N =31) included empirical (27) and conceptual (4) studies. Majority of empirical studies used qualitative (48%), quantitative (40%) and mixed methods (11%) research approaches. Majority of the studies focused on Bhutanese youth and adults (85%), children and youth (7%), and older adults (7%). Theoretical frameworks included: ecological model; bio-ecological systems model; interpersonal psychological theory of suicidal behavior; cultural model of suicide; trajectory model; conservation of resources theory; cultural trauma and coping; social capital framework; PEN-3 cultural model and Nepali ethnopsychology. Most common mental health measures were: Harvard Trauma Questionnaire, the Hopkins Symptoms checklist and the Patient Health Questionnaire. Across studies, five overlapping thematic clusters were identified in relation to mental health: migration stressors; social convoy; suicide; culture, trauma and resilience, and mental health services and interventions. Conclusion and Implications . Study findings contribute to understanding the cultural context of mental health grounded in Bhutanese context, crucial for developing culturally tailored interventions and a foundation for future studies. Findings also highlight the importance of data disaggregation, which help establish the scope of the problem, unmask sub-population differences, and make vulnerable groups more visible.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "Suicide is explicitly identified as one of five central thematic clusters analyzed in the review, alongside other mental health outcomes, making it a distinct component of the study's focus.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The abstract explicitly describes a systematic scoping review methodology with defined search strategies, inclusion/exclusion criteria, and data synthesis processes.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SWRD:63690", "input_index": 1345, "sample_group": "Review", "title": "Suicide, Race, and Social Work: A Systematic Review of Protective Factors among African Americans", "abstract": "Purpose: Suicide among African Americans has increased significantly in the past 15 years, yet it remains a neglected topic in social work research. This systematic review examines social work's contribution to suicide research while focusing on the social context in which African Americans live. Method: Using a critical race theory, we examine protective factors specific to African Americans that may mitigate suicide risks. Results reveal that the social work profession has produced 20 suicide-related studies between 1980 and 2018. Results: Identify three types of protective factors against suicide among African Americans. These are: micro-level factors (private regard / strong African American identity and impulsive response to discrimination), mezzo-level factors (family support and the role of women), and macro-level factors (social support, poverty and lack of awareness, religion, access to care, and internal response to community violence). Conclusion: Finding demonstrate evidence of the relationship between protective factors and suicide among African Americans. Implications for the use of Critical Race Theory in Social Work research and practice are provided along with implications to advance suicide training in social work education programs.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The article is a systematic review explicitly focused on identifying protective factors against suicide among African Americans, making suicide prevention and risk mitigation the central substantive focus.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The title and abstract explicitly identify the study as a 'systematic review' that examines existing literature to synthesize findings on protective factors, fitting the definition of an empirical evidence synthesis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2023-P-0212", "input_index": 1468, "sample_group": "Review", "title": "(see Poster Gallery) Its Not Supposed to Happen This Way: What Helps Parents Who Have Lost a Child through Accidential or Violent Death", "abstract": "Background and Purpose: This study conducted a systemic review of what parents who lost a child through an accidental or violent death need in their grieving process. The death of a child is a devastating and incomprehensible loss (Arnold & Gemma, 2008) that has a significant impact on those around them and creates a unique and significant grieving process for parents. Sporren et al (2001) shared that losing a child in an accident increase the risk of long-term psychiatric distress. The depth of research investigating how to support parents grieving due to natural causes validates that knowledge on how to support bereaved parents in the grieving process is important in providing support and services (Titlestand et al., 2020). The literature generally concludes there needs to be additional research on how to support parents bereaved due to a sudden or unexpected loss (Andriessen et al., 2019; Floyd, et al., 2013; Kawashima & Kawano, 2019). Methods: The systemic review examined 55 peer-reviewed articles using key terms of parental bereavement; loss through suicide; loss through violence; loss through accidents; and loss of a child. Once the articles were identified they were analyzed and reduced to articles that included a minimum of parental bereavement and loss of a child through unnatural causes. This resulted in 55 articles dating from 1995 to 2022. A table was developed to capture the results of the study specifically identifying what the parents self-reported as useful in their grieving process. The table was analyzed for common themes. Results: The thematic analysis identified several key themes that were reported by parents’ bereavement of their child through accidents or violence included: connecting to others, self-forgiveness, finding meaning, carrying the child forward in the parent’s life, and the ability to say goodbye as vital in the healing process for these bereaved parents. Implications: Parents who experience the sudden death of a child will work with a variety of professionals to assist them in navigating the grief process and Jazen et al (2013) contended that understanding what parents need in the grief process is vital in their healing process. However, there is consensus that there are no clear guidelines on how to support parents facing the loss of a child through unnatural causes. This systemic review identified historical consistency in what parents’ self-report they need in their healing process and will provide insight to Social Workers on how to best support bereaved parents in a manner that is specific to losing a child in a tragic and sudden manner that is outside of traditional grief and bereavement. Further studies could compare the themes found in this study compared to grief and loss of a child due to natural causes.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The abstract explicitly identifies 'loss through suicide' as one of the key search terms and inclusion criteria for analyzing parental bereavement needs, making suicide loss a central component of the study population.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The authors describe conducting a 'systemic review' (likely meaning systematic) involving the identification, selection, and thematic analysis of 55 peer-reviewed articles, which fits the definition of an empirical evidence synthesis.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2023-P-0177", "input_index": 1505, "sample_group": "Review", "title": "Missing Pieces: Latino Immigrant Families and Adolescent Suicide Prevention", "abstract": "Background and Purpose: SSWR 2023 challenges us to address complex problems—such as Latinx adolescent suicide—and battle inequities. Adolescent suicidality is increasing among U.S. youth, and among Latinx specifically. Though there is a move towards more family-oriented prevention, Latinx families continue to be left out of most prevention and intervention efforts. To explore this gap, we systematically mapped the contours of the current empirical literature on family role and involvement in Latinx adolescent suicide prevention. Methods: In the absence of any systematic review on the role of Latinx families in adolescent suicide, a scoping study was designed to identify and map out the literature. Four online databases were selected to identify peer-reviewed articles written in English and published between 2000 and 2021 that focused on suicidal behavior(s) among Latinx adolescents living in the mainland US and mentioned family in the results or discussion sections. A total of 1,710 articles were screened. Screening left 592 non-duplicate full-text articles for researchers to assess for study eligibility. Of those, 107 articles met the criteria for inclusion. The first author developed an initial coding template, and data regarding publication, methodology, family role in suicide, and family involvement in suicide prevention were extracted and charted. The authors analyzed the full-text articles thematically, specifically employing a template analysis approach to code the data; they met throughout the analysis process to review and track coding decisions and analytic interpretations. A n interrater reliability rate of 80% or higher was reached on 75% of the codes. Results: Overall, most articles (74%; n = 79) focused on the etiology of Latinx adolescent suicide and also excluded family members in their data collection (72%; n = 77). Nonetheless, many articles accounted for family-related factors in their analysis (87%; n = 93). Among those articles, 19 suicide-related family factors were identified, most of which came from articles published in the last ten years (74%; n = 69). Few studies (19%; n = 20) included complex family-related factors (e.g., familial communication and familism). When the studies actively involved family members (28%; n = 30), they commonly used a risk lens (77%; n = 23). Mothers were the family members most often involved in the studies (83%; n = 25), with one study focusing on fathers. Conclusions and Implications: Suicide-related research with Latinx individuals has expanded in the last three decades, but there continues to be a focus on etiological studies rather than interventions. Existing research lacks within-group diversity (e.g., Mexican, Cuban, heterosexual, etc.) and rarely actively involves family members. Our results call attention to Latino families’ exclusion from the literature and highlight how these families are an undervalued resource in our fight against Latinx adolescent suicide. We used these findings to develop a mixed-method project actively involving Latinx caregivers to obtain a baseline of their suicide prevention communications and explore ways to encourage prevention behaviors. As social workers, as we work to address this complex problem, we are strategically positioned—and ethically required— to promote Latinx family inclusion in suicide prevention.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study focuses centrally on adolescent suicide prevention and the role of family involvement within the Latinx population, analyzing existing literature on these specific topics.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The abstract explicitly describes a scoping study with systematic database searching, screening, data extraction, and thematic analysis of included articles, which classifies it as an empirical review.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2024-U-0040", "input_index": 1679, "sample_group": "Review", "title": "The Associations between Intimate Partner Violence and Mental Health Among Sexual Minority Men: A Systematic Review and Meta-Analysis", "abstract": "Background and purpose A growing body of research highlights the high prevalence of intimate partner violence (IPV) among sexual minority men (SMM) with nearly one in three SMM experiencing IPV in their lifetime. Evidence also suggests that experiencing IPV is associated with adverse health outcomes including physical injuries, HIV/STIs, substance use, mental health distress, and even life-threatening consequences. This systematic review and meta-analysis aimed to synthesize evidence on the association between exposure to IPV and negative mental health outcomes (depressive symptoms, anxiety, stress, etc.) among SMM and provide pooled estimates to inform future IPV and mental health interventions and services. Methods Following the PRISMA guideline, we conducted a systematic literature search of electronic databases (PubMed, MEDLINE, Embase, PsycInfo, Web of Science, and CINAHL) for studies that examined the association between IPV and mental health outcomes among SMM. Studies were included if they: (1) assessed IPV, (2) reported at least one mental health outcome, (3) were conducted among SMM, and (4) were published in English. Three reviewers independently screened the titles and abstracts and extracted the data. Discrepancies were resolved by group consensus. Random effects meta-analysis was conducted to calculate pooled adjusted odds ratios (ORs) as summary measures of effect size with 95% confidence interval (CIs). We also assessed heterogeneity using I 2 statistics. All analyses were conducted using meta package in R version 4.2.1. Results Our search identified 21 studies that met eligibility criteria; over half were conducted in the United States ( n =11); the remainder were conducted in the United Kingdom, Guatemala, Kenya, Nigeria, China, Mexico, Gambia, Burkina Faso, and Togo. All studies were cross-sectional in design. There was inconsistency in IPV measures and IPV recall periods, and studies reported a wide range of mental health outcomes using PHQ-9/GAD-7, Perceived Stress Scale, and the Suicide Behaviors Questionnaire-Revised scale. Overall, included studies consistently suggested that experiencing IPV was associated with an increased risk of depression, anxiety, PSTD, and suicidal ideation. Meta-analysis among 12 studies of 18,454 SMM revealed a pooled OR of 1.69 (95%CI: 1.40-2.05) for depressive symptoms. The I 2 statistics suggested moderate heterogeneity ( I 2 =78.6%, p <0.01). Subgroup analysis on the effect of specific types of IPV on mental health and the associations between IPV and other mental health outcomes were not conducted due to the limited data available. Conclusion This systematic review and meta-analysis is the first to provide collective evidence on the association between IPV and mental health outcomes among SMM. The review identified critical gaps in understanding IPV and mental well-being among SMM in low- and middle-income countries. Additional research is needed to explore the effects of IPV in these settings using standardized tools to measure IPV, and the effects of different types of IPV on mental well-being among SMM. Future studies should also consider longitudinal and qualitative designs. Importantly, research that investigates mechanisms underlying the associations between IPV and mental health issues among SMM would lend itself to improved IPV screening in healthcare settings, and the identification of key targets for IPV prevention and treatment interventions with this population.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The abstract explicitly reports that the meta-analysis found an association between intimate partner violence and suicidal ideation among sexual minority men, making suicide a distinct analyzed outcome.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The study is identified as a systematic review and meta-analysis that synthesizes primary data to provide pooled estimates, fitting the definition of an empirical review.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SWRD:58690", "input_index": 1708, "sample_group": "Review", "title": "Addressing Suicide Risk: A Systematic Review of Motivational Interviewing Infused Interventions", "abstract": "Purpose: Brief interventions have been applied to the problem of suicide. This systematic review quantitatively and qualitatively examined the effectiveness of motivational interviewing (MI)-infused interventions. Methods: PRISMA guidelines were followed throughout. Results: 147 studies were initially identified, with nine meeting the final inclusion criteria. All studies blended MI with other interventions and were primarily located in triage settings. MI-infused interventions were not significantly stronger in lowering suicidal ideation or behavior. However, such interventions were significantly more likely to result in follow-up care post intervention. Discussion: MI-infused interventions are not linked to statistically significantly lowered risk for suicide ideation or behavior despite increased mental health-seeking behavior post intervention. However, MI-infused interventions may be valuable for suicidal behavior in hospital settings because they increase a key intervention target: following up with mental health care. The literature on MI-infused interventions for suicide is in an early stage with many unanswered questions.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The study explicitly focuses on the effectiveness of motivational interviewing interventions for reducing suicidal ideation and behavior, making suicide risk a central outcome.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The abstract identifies the work as a systematic review following PRISMA guidelines that synthesizes data from multiple studies to evaluate intervention effectiveness.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2025-P-0515", "input_index": 1796, "sample_group": "Review", "title": "Bridging Clinical and Scientific Gaps: A Systematic Review of Trauma-Informed Care for Transgender Individuals in India", "abstract": "Background and Purpose: This presentation summarises a systematic review that assesses healthcare disparities for transgender individuals in India, alongside insights into transgender mental health issues globally, particularly in the United States. In accordance with the Sustainable Development Goals' inclusivity principle of \"Leave No One Behind,\" it emphasises the widespread prevalence of trauma within transgender communities, notably severe socio-familial adversities in the U.S. that lead to homelessness and mental health crises among LGBTQ+ youth. This review highlights a critical shortage of specialised health services for transgender individuals in India, exacerbated by cultural and systemic barriers. There is an urgent need for enhanced research and understanding to develop policies and clinical practices that address the trauma experienced by this community. Implementing trauma-informed care is crucial for improving health outcomes and ensuring the full societal participation of transgender individuals, aligning with global human rights standards. Method: This systematic review focused on the trauma and mental health challenges of transgender individuals in India. We conducted a detailed search across multiple electronic databases including PsycINFO, ProQuest, Cochrane CENTRAL, and Medline, restricted to peer-reviewed journals in English. Search terms such as 'transgender,' 'trauma,' 'mental health,' 'discrimination,' 'abuse,' and 'healthcare access' were used to ensure comprehensive coverage of relevant studies. The inclusion criteria, based on the PICO framework, targeted societal discrimination, abuse, healthcare accessibility, and mental health outcomes. Initially, 19,200 records were identified and screened using Covidence software to facilitate data extraction and review management. Results : Seven pivotal studies were included in the review, focusing on mental health disparities among transgender individuals in India. These studies targeted trauma-informed care interventions in clinical settings, aiming to reduce discrimination, violence, and improve healthcare access. Analysis of a comprehensive survey involving 4,072 individuals, including 485 transgender respondents, revealed significant barriers to HIV services (aOR: 3.80), increased instances of gender-based violence (aOR: 2.63), and severe mental health symptoms. Additionally, a literacy study across Indian states highlighted pronounced disparities, with literacy rates varying from over 84% in Kerala and Mizoram to as low as 44.35% in Bihar, indicating substantial regional differences in health education accessibility. The review also reveals significant gaps in the clinical and academic understanding of transgender trauma in India, highlighted by alarming statistics such as a 50% suicide attempt rate by the age of twenty. Conclusion: The systematic review identifies significant challenges for transgender individuals in India, including pervasive trauma histories, mental health disparities, systemic discrimination, limited healthcare access, and a notable deficiency in specialised services and clinical understanding, necessitating urgent implementation of trauma-informed care and inclusive policy reforms. Such efforts could aim to establish a more inclusive and empathetic healthcare framework, thereby enhancing discourse on gender equality and mental health and highlighting the importance of trauma-informed care in improving the mental well-being of India's transgender population.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The abstract explicitly reports a '50% suicide attempt rate' as a key finding from the included studies, making suicidality a distinctly analyzed and reported component of the mental health outcomes.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The record is explicitly identified as a systematic review that conducted a structured search, screening, and synthesis of primary studies.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SWRD:54943", "input_index": 1879, "sample_group": "Review", "title": "Assessing for Firearm Risks: A Rapid Review of Clinical Assessment Measures", "abstract": "Purpose: Social workers play a crucial role in assessing risks for harm to self and others, including firearm access. Given the growing concern of firearm violence, standardized assessment tools addressing firearm risks could improve social workers' assessments. Method: This rapid review identifies and evaluates available clinical assessment tools that include items related to firearms. Result: After searching five electronic databases, 15 assessment measures were identified and categorized into five domains: aggressive and violent behaviors, delinquent behaviors, familial attitudes and beliefs, dating or partner violence, and suicide. Discussion: The review highlights the limitations of current tools and underscores the importance of standardized assessments in providing social workers with validated frameworks to inform clinical decision making, while also calling for the development of more comprehensive, culturally informed measures. The review concludes with recommendations and suggestions for incorporating antiracist practices and cultural humility into clinical practice to address firearm-related risks and enhance safety.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The abstract explicitly identifies suicide as one of the five distinct domains into which firearm risk assessment measures are categorized, making it a central component of the review's analysis.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The study is identified as a rapid review that involves searching electronic databases and evaluating specific clinical assessment tools, which constitutes a systematic evidence synthesis method.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2026-P-0431", "input_index": 1940, "sample_group": "Review", "title": "Dialectical Behavior Therapy Skills on College Campuses Scoping Review: State of the Evidence", "abstract": "Background and Purpose: College campuses are facing an unprecedented demand for mental health services due to rising suicide, depression, anxiety, and ADHD. The need for mental health treatment exceeds the capacity of counseling centers. Dialectical Behavior Therapy (DBT) includes skills training is an effective stand-alone evidence-based treatment which improves depression, anxiety, ADHD, eating disorders, emotion regulation, and coping. Although DBT skills have been used on college campuses from universal interventions in the form of a college course, to abbreviated skills training groups, and comprehensive DBT programs, no comprehensive review exists. This scoping review explores the effectiveness of DBT skills-based interventions on college campuses, identifying barriers and facilitators for future research, using data from a large study across education levels. Methods: The databases PubMed, Scopus, Web of Science, APA PsycINFO (via EBSCOhost), and ASSIA (via ProQuest) were searched for English-language articles on DBT skills interventions in school-based settings. Authors also searched reference lists, contacted DBT developers, and hand-searched Discover Psychology and Google Scholar. The search included quantitative, qualitative, mixed methods designs, as well as and case studies. Search results were imported into EndNote, duplicates removed, and then into Covidence for systematic review screening. Nine reviewers independently screened titles and abstracts, with three reviewers screening full-text articles. Two reviewers extracted data. The primary investigator resolved discrepancies at each stage. This study examined a subset of articles that examined the effectiveness of DBT skills implemented in college or university settings, including and implementation barriers and facilitators. Results: The search identified 10,386 abstracts, with 166 meeting the criteria for DBT skills interventions in school settings. After full-text review, 78 studies remained, 30 of which were conducted in higher education. Results indicated DBT skills effectiveness at multiple tiers of support in college settings. This included a universal credit-bearing college course available to all students (N=3), showing improved coping, life satisfaction, and emotion regulation, and distress tolerance. DBT skills groups (N=18) demonstrating outcomes including reduced depression, anxiety, and stress, and improved emotional well-being, functioning, interpersonal skills, coping, and problem solving. Comprehensive DBT (N=4) also showed reduced suicidality, non-suicidal self-injury, depression, and anxiety and improved social adjustment, emotion regulation and distress tolerance for high-risk populations. Implementation barriers and facilitators, as well as qualitative feedback from stakeholders are summarized. Conclusions and Implications: DBT skills when used on college campuses have the potential to address a variety of mental health problems and promote overall wellness and resilience for all students. Abbreviated DBT skills interventions have shown the most success and uptake on college campuses in order to meet competing demands and time constraints of students. Future research should explore effective methods for wide-spread implementation of DBT skills at multiple tiers of support on college campuses and with vulnerable populations in under-resourced settings.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The abstract explicitly reports that comprehensive DBT interventions resulted in reduced suicidality, making suicide risk a distinct and analyzed outcome within the scope of this review.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The record is identified as a scoping review with a systematic search strategy, screening process, and data extraction, which falls under the Empirical/Review category.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2026-P-0158", "input_index": 1977, "sample_group": "Review", "title": "Mental Health Outcomes, Associated Factors, and Help-Seeking Among Rural LGBTQ+ Populations in the United States: A Scoping Review", "abstract": "Background and Purposes LGBTQ+ individuals living in rural areas of the United States experience distinct mental health challenges due to geographic isolation, limited resources, and pervasive societal stigma. Restricted access to affirming care, coupled with conservative sociopolitical environments, can intensify psychological distress and create substantial barriers to accessing support. Although research on LGBTQ+ mental health has expanded, the majority of studies center on urban populations, leaving rural communities underrepresented in the literature. This scoping review aims to address this gap by synthesizing existing research on mental health outcomes and associated factors among rural LGBTQ+ populations, with a particular focus on understanding the barriers and facilitators to mental health help-seeking within these contexts. Methods This scoping review was conducted following the five-stage methodological framework developed by Arksey and O’Malley, along with the PRISMA Extension for Scoping Reviews reporting guideline. A systematic search of six electronic databases was performed to identify peer-reviewed articles. Studies were eligible for inclusion if they focused on LGBTQ+ individuals residing in rural areas of the United States and reported on mental health outcomes (e.g., depression, anxiety, suicidality), associated individual or contextual factors, and/or help-seeking behaviors. Titles, abstracts, and full texts were independently screened by five reviewers. Data were extracted using a standardized charting form that captured key study characteristics and findings, and then analyzed thematically to identify patterns, themes, and gaps in the literature. Results Of the 536 records initially identified, 46 studies met the inclusion criteria and were included in the final synthesis. Most studies did not specify the geographic region of focus; however, among those that did, nine (19.6%) were conducted in the South, seven in the Northeast (15.2%), four in the Midwest (8.6%), and one in the West (2.2%). The majority of studies employed quantitative methods (n = 36, 78.3%), followed by mixed-methods (n = 6, 13.0%) and qualitative approaches (n = 4, 8.7%). Included studies reported high rates of depressive symptoms and anxiety among rural LGBTQ+ individuals, while fewer studies addressed loneliness, suicidal ideation or suicide-related behaviors. Factors associated with poor mental health outcomes included internalized stigma, minority stress, family rejection, lack of LGBTQ+ community support, and inadequate access to care and limited provider availability. Help-seeking behaviors were hindered by fear of being outed, mistrust of healthcare providers, and lack of culturally competent care. Conversely, facilitators of help-seeking included affirming social networks, availability of telehealth services, and integrated care models. A small but growing number of studies explored the promise of eHealth and telehealth-based interventions in improving access and engagement among rural LGBTQ+ populations. Conclusions and Implications This scoping review highlights significant mental health disparities among rural LGBTQ+ populations and identifies key individual, social, and structural factors that influence mental health and help-seeking. Despite growing research interest, substantial gaps remain, particularly regarding suicidality, intervention research, and geographic specificity. Future studies should prioritize community-engaged approaches, develop culturally responsive interventions, and leverage technology-based solutions to address unmet mental health needs and improve access to affirming care in rural settings.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The abstract explicitly identifies 'suicidality' as a key mental health outcome analyzed in the included studies and reports on findings related to suicidal ideation and suicide-related behaviors.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The record is explicitly identified as a scoping review that follows a systematic methodological framework (Arksey and O'Malley) and PRISMA guidelines, which classifies it as an Empirical Review.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } }, { "record_key": "SSWR:2026-U-0607", "input_index": 2011, "sample_group": "Review", "title": "Suicide Prevention and Intervention with Military Personnel and/or Veterans: An Overview of Systematic Reviews", "abstract": "Background and Purpose Suicide is a persistent public health crisis among military personnel and veterans, who experience significantly higher rates of suicide than the general population. Despite legislative efforts such as the Joshua Omvig Veterans Suicide Prevention Act (2007), rates remain high. A variety of interventions—universal, selective, and indicated—have been implemented to reduce suicide risk among these populations. However, the effectiveness of these interventions remains unclear. This overview of reviews aims to synthesize findings from existing systematic reviews on suicide prevention and treatment interventions for military personnel and veterans, assess the quality and consistency of the evidence, and identify gaps to guide future research and policy. Methods We followed Cochrane’s methodological guidelines for conducting this overview of reviews. A protocol was published in PROSPERO prior to the start of the overview. We conducted a comprehensive search across eight bibliographic databases, relevant organizational websites, reference lists, and expert consultations to identify reviews published between 2004 and July 2024. Reviews were eligible if they examined suicide prevention interventions targeting suicide-specific outcomes in active - duty military personnel, National Guard/reserve members, or veterans. Two independent reviewers screened studies and extracted data using a structured form, resolving discrepancies by consensus. We examined study overlap across reviews and assessed quality included reviews using the AMSTAR 2 tool. Given the heterogeneity of review methods and findings, a narrative synthesis approach was used. Results were reported according to PRIOR standards. Results Twenty-three reviews encompassing 323 unique studies were included. Most of the included reviews used narrative synthesis (83%), did not indicate a geographical area of focus (65%), and were published in journal articles (74%). Interventions ranged from psychotherapy and multicomponent programs to the Collaborative Assessment and Management of Suicidality (CAMS) and safety/crisis planning. While some interventions, such as multicomponent universal programs and Cognitive Behavioral Therapy (CBT), showed promise, the overall findings were inconsistent. All but one of the included reviews were rated “critically low,” and one review was rated “low.” Many reviews lacked clear inclusion criteria, included low-quality studies, failed to assess the quality of included evidence, or lacked rigorous synthesis methods. There was substantial heterogeneity in study designs, intervention types, and outcome definitions. Meta-analyses were rare and often limited by methodological variability. Suicide-related outcomes were inconsistently defined and reported, with vague terms like \"suicidality\" often used without clarification, limiting the interpretability of findings. Conclusion and Implications Though findings should be interpreted with caution due to the quality of the reviews, interventions which showed the most promise included multicomponent universal programs, Cognitive Behavioral Therapy (CBT), and safety planning. Existing reviews have already laid a foundation by identifying a wide range of suicide prevention strategies available for military veterans. Looking ahead, future systematic reviews and primary studies have the power to meaningfully strengthen the evidence base by adopting standardized definitions, clearly outlining outcomes, and using robust synthesis methods. With continued effort and collaboration, we can identify the most effective suicide prevention strategies that deliver meaningful support to military personnel and veterans.", "primary_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" }, "blind_screening": { "is_relevant": true, "relevance_rationale": "The record focuses centrally on synthesizing evidence regarding suicide prevention interventions and outcomes for military personnel and veterans.", "evidence_class": "Empirical", "empirical_method": "Review", "classification_rationale": "The abstract explicitly describes a systematic 'overview of reviews' following Cochrane guidelines with a published protocol, comprehensive search strategy, and quality assessment, which classifies it as an empirical review.", "confidence": "High" }, "full_label_agreement": true, "adjudicated_screening": null, "final_screening": { "is_relevant": true, "evidence_class": "Empirical", "empirical_method": "Review" } } ] }