December Research Roundup 2025: Recently Published Findings From AFSP-Funded Studies

The Research Roundup is a regular update of recently published findings in suicide prevention research. AFSP-funded studies included in this roundup examined how…

• Gender-related social stress impacts transgender and gender diverse people
• Autopsy information can help distinguish deaths by accidental overdose from suicides
• Young adults are helped by hopeful stories of people who have lived through suicidal crises, and
• Certain changes in brain development during early adolescence may be related to suicidal behavior

Researcher: Amanda Thompson, PhD
Institution: The Research Institute at Nationwide Children’s Hospital
Grant Type: 2024 Postdoctoral Fellowship — $138,400
Grant Title: A Person-Centered Approach to Identifying the Characteristics of Young Children Who Self-Harm and Die by Suicide

Research has consistently shown that transgender and gender diverse (TGD) youth experience higher rates of nonsuicidal self-injury (NSSI), suicidal ideation, and suicide attempts compared to their cisgender peers. Importantly, this elevated risk does not come from gender identity itself, but from the gender-related social stress many TGD youth experience. Gender-related social stress can be experienced at home, in school, or in the community and can range from misgendering or bullying to rejection or discrimination. Understanding how these stressors influence self-injurious thoughts and behaviors (SITB) over time, and identifying potential protective factors, is essential for designing interventions that support resilience. Longitudinal studies that follow youths over several years are especially valuable, because they can capture early warning signs and highlight which environments (e.g., family, school, or peer contexts) play the biggest role in shaping risk and wellbeing for TGD youth.

Drawing on four years of data from more than 11,000 participants in the Adolescent Brain Cognitive Development (ABCD) Study, Dr. Amanda Thompson used her AFSP grant to compare cisgender youth with two groups of TGD youth (high versus low levels of gender-related social stress). Across the study period, both TGD groups accounted for 4% (N=490) of the participants and were more likely than cisgender youth to report nonsuicidal self-injury and suicidal ideation, even when accounting for psychological symptoms and prior self-harm. When it came to suicide attempts, however, only TGD youth facing high levels of gender-related stress showed elevated risk, underscoring how social environment may shape vulnerability to suicidal behavior. Several factors stood out across all youth: higher internalizing symptoms (like anxiety and depression) and family conflict were linked with greater risk of NSSI and ideation, while school involvement (i.e., feeling engaged in school life) was the clearest protective factor. Parental acceptance offered additional protection against suicidal ideation. Taken together, these findings point to the powerful influence of family climate, school connectedness, and the broader social environment in shaping SITB trajectories, and highlight the need for supportive, affirming spaces that reduce gender-related stress for TGD youth during this formative stage.

Citation: Thompson AJ, Abel AN, Huang R, Sarkisian K, Schreiner MW, Rife F, Ruch DA, Bridge JA, Trajectories of Self-Injurious Thoughts and Behavior: Risk and Resilience Among Cisgender and Gender Diverse Youth, JAACAP Open (2025), doi: https://doi.org/10.1016/j.jaacop.2025.10.006     

Researcher: Paul Nestadt, MD
Institution: Johns Hopkins Bloomberg School of Public Health
Grant Type: 2019 Young Investigator Grant — $90,000
Grant Title: Characterizing Suicides among Opioid-Related Deaths

Understanding how and why deaths are classified as suicide is essential for accurate public health surveillance and effective prevention. Yet determining intentionality in overdose deaths is uniquely challenging as medications with different lethality potential can appear together, scene information may be limited, and medical examiners vary in how they classify ambiguous cases. In many states, large proportions of opioid-related deaths are labeled as “undetermined intent,” meaning it is unclear whether the death was accidental or intentional. Because overdose deaths and suicide often overlap, this uncertainty can lead to significant undercounting of suicide deaths. Improving how we identify probable suicides within this group could help states better understand the true burden of suicide and lead to allocating prevention resources more effectively, and ensuring families receive clearer information.

With support from AFSP, Dr. Paul Nestadt analyzed more than 10,000 opioid-related overdose deaths in Maryland between 2016 and 2020 to see whether information already available in standard autopsies, such as toxicology results and basic demographic data, could help identify suicides that may have been misclassified. Using cases that had been clearly labeled as either accidental or suicide, the researchers built a statistical model that learned to distinguish between the two. Along with other factors, certain substances were more common in suicides (including antidepressants, oxycodone, benzodiazepines, neuroleptics, and acetaminophen), while others (especially fentanyl, cocaine, and morphine) were far more common in accidental overdoses. When the model was applied to the large number of cases labeled as “undetermined,” it identified 58 additional deaths likely to be suicides, representing a 43% increase in suicide cases within this population. Although this does not replace the nuanced judgment of medical examiners, the findings show that routinely collected autopsy information can help flag cases that may warrant further review. Over time, this approach, especially when paired with additional clinical information, could strengthen surveillance systems and provide a more accurate picture of suicide within the overdose crisis.

Citation: Flores, J. P., Desjardins, M. M., Kitchen, C., Belouali, A., Kharrazi, H., Wilcox, H. C., & Nestadt, P. S. (2025). Use of Vital Records to Improve Identification of Suicide as Manner of Death for Opioid-Related Fatalities. Crisis, 10.1027/0227-5910/a001033. Advance online publication. https://doi.org/10.1027/0227-5910/a001033          

Researchers: Jane Harness, D.O.
Institution: University of Michigan
Grant Type: 2022 Young Investigator Grant — $90,000
Grant Title: Development and Preliminary Testing of a "Papageno" Story Interview Intervention

Stories of people who have lived through suicidal crises and found their way to safety, often referred to as Papageno stories, can play a meaningful role in suicide prevention. Rather than focusing on danger or despair, these narratives highlight coping, help-seeking, connection, and hope. Decades of communication science research show that media portrayals emphasizing recovery can reduce distress and increase help-seeking, especially for young people. Filmed interviews that share real stories of survival may offer a promising, low-cost, and relatable tool if they are safe, acceptable, and emotionally supportive for the young people viewing them. Understanding how young adults respond to this kind of content is a crucial first step before testing whether it can have a protective influence in a larger trial.

With support from AFSP, Dr. Jane Harness developed a set of filmed interviews featuring young adults (ages 18–24) sharing their personal stories of overcoming a suicidal crisis. In this uncontrolled pilot study, 16 participants with past-month suicidal ideation watched one of five “Papageno” story videos and provided feedback. Participants rated the videos as acceptable and appropriate, reporting that they felt understood, more hopeful, or more likely to reach out for help after viewing. No one reported feeling less willing to seek help. Qualitative feedback emphasized that the stories felt genuine, relatable, and encouraging, though many suggested shortening the videos and including multiple perspectives in a single piece to increase identification. These insights will guide the creation of a streamlined version featuring all interviewees, which will then be tested in a randomized controlled trial. Early responses suggest that filmed Papageno interviews may be a promising, emotionally safe format for reaching young adults experiencing suicidal thoughts.

Citation: Harness, J., Gardner, K., Schleider, J. L., & King, C. A. (2025). A "Papageno" Story Interview Suicide Prevention Intervention for Young Adults With Past-Month Suicidal Ideation: Uncontrolled Single-Group Pilot Study of Feedback and Acceptability. JMIR formative research, 9, e71368. https://doi.org/10.2196/71368       

Researcher: Yi Zhou, MSc
Institution: Virginia Commonwealth University
Grant Type: 2022 Pilot Research Grant — $30,000
Grant Title: Investigation of the Neural Correlates of the Acquired Capability for Suicide in Child and Adult Brains

As children move into early adolescence, their brains and behavior undergo rapid changes that shape how they respond to emotions, stress, and reward. For most youth, this is simply part of growing up, but for some, these shifts may play a role in the emergence of suicidal thoughts or behaviors. Understanding which developmental patterns signal vulnerability is an important step toward earlier, more supportive interventions. Large longitudinal studies that follow children over several years offer a unique window into how brain development and emotional health interact over time. By examining these patterns before a crisis occurs, researchers can begin identifying early indicators in young people might need extra support during this sensitive transitional period.

Using data from more than 11,000 participants in the Adolescent Brain Cognitive Development (ABCD) Study, Dr. Yi Zhou tracked changes in brain structure and behavior over two years from ages 10 to 12, comparing three groups of youth: those who later developed suicidal behaviors, those who experienced suicidal thoughts only, and those with no suicide-related experiences. The youth who went on to engage in suicidal behavior showed the fastest reductions in cortical gray matter volume, a sign that their brains were maturing at a different pace than their peers. They also showed the largest increases in depression symptoms over time. One behavioral pattern stood out as well: while most children show a natural decline in reward-seeking behavior (e.g., desire for novelty, impulsivity, spontaneity) as they move through early adolescence, the group that later engaged in suicidal behavior did not show this decline. When Dr. Zhou looked across the broader sample, he also found that lower gray matter volume at baseline predicted higher reward-seeking behavior two years later, suggesting a meaningful link between early brain development and later behavioral tendencies. Taken together, the findings point to a combination of factors that may help identify youth on a pathway toward suicidal behavior before those behaviors begin.

Citation: Zhou, Y., & Neale, M. C. (2025). Adolescent suicide behaviors associate with accelerated reductions in cortical gray matter volume and slower decay of behavioral activation Fun-Seeking scores. Scientific reports, 15(1), 32886. https://doi.org/10.1038/s41598-025-16856-y      

Learn more about the AFSP research grants featured in this monthly roundup, as well as others, here.