Developing a measure to characterize suicide-related disclosure processes in adolescents and caregivers

The National Institute of Mental Health awarded Rutgers, The State University $149,190 on August 20, 2026, under the Mental Health Research Grants program (CFDA 93.242) to develop and pilot a multi-informant, self-report measure characterizing direct and indirect suicide-related disclosure in adolescents and their caregivers.

The project will refine a preliminary assessment tool and conduct qualitative research with parent-adolescent dyads recruited from a psychiatric inpatient unit following a recent suicidal crisis. Participants will complete interviews assessing disclosure content, function, and consequences in the period preceding the crisis, including caregivers' detection of and response to disclosure. Participants will provide feedback on the disclosure measure, which will be revised accordingly. The research addresses a critical gap: existing literature captures only explicit disclosure of suicidal thoughts, overlooking indirect or euphemistic disclosure that may serve as a proximal risk factor for suicide and represent an intervention opportunity.

Performance occurs in Piscataway, New Jersey, with a period of performance through June 30, 2028. The assistance type is a project grant.

Abstract

Current estimates hold that only 50% of individuals who DIE by suicide disclose their suicidal thoughts to anybody before death, making detection of high-risk individuals challenging. However, past research has only assessed direct forms of disclosure (i.e., explicitly telling somebody about thoughts of suicide), and may not capture indirect disclosure, whereby disclosure occurs euphemistically or vaguely (e.g., "i'm worried i might do something stupid"). Evidence has shown that indirect disclosure may serve as a proximal risk factor for suicide, indicating its importance as a potential point of intervention. However, indirect disclosure has not been previously characterized in the literature, and its prevalence is unknown. Most critically, no standardized assessment tool exists to detect or characterize indirect suicide-related disclosure. The field's limited understanding of suicide- related disclosure critically limits clinicians' and loved ones' ability to detect risk, meaning that vital "cries for help" may go unnoticed and opportunities for prevention missed. The proposed project will refine and pilot a multi- informant, self-report measure to dyadically characterize direct and indirect suicide-related disclosure in adolescents and their caregivers. Adolescents and their caregivers will be recruited from a psychiatric inpatient unit on the basis of a recent suicidal crisis. Parent-adolescent dyads will complete qualitative interviews assessing disclosure in the period preceding the suicidal crisis, providing information about the content, function, and consequences of disclosure as well as caregivers' detection of disclosure and response to IT. Participants will also provide feedback on a preliminary, multi-informant measure characterizing disclosure processes. The measure will be revised in response to participant feedback and piloted in a new sample of parent-adolescent dyads, who will also complete one month of ecological momentary assessment probing family support. Analyses will test whether disclosure predicts improvements in family support over time, and whether this effect is moderated by parents' detection of an adolescent's disclosure. Results may ultimately inform interventions to both promote more adaptive help-seeking in suicidal adolescents, and to train caregivers to respond appropriately. A training plan has been developed that consists of coursework and mentorship in qualitative research methods, research conduct with suicidal individuals, measure development, and statistics for intensive longitudinal methods to build the applicant's expertise in carrying out research in suicidal populations.