Filtered Publications

Under-diagnosis or delayed diagnosis of depression results in worse patient outcomes. Screening instruments help to address diagnosis but are underused in clinical practice. The use of different screening instruments by providers and by researchers makes it more difficult to assemble population-level data or interpret research findings in clinically useful ways. “Crosswalks” can be created that reliably allow the conversion of scores in one instrument to scores in another. The current report assessed the psychometric properties of the Patient Health Questionnaire – Adolescent (PHQ-A), 16-item self-reported Quick Inventory of Depressive Symptoms (QIDS-SR16), and its 5-item version, VQIDS-SR5, and established crosswalks between the measures. The three measures were found to be psychometrically sound in our sample, and each was sensitive to change over a one-month time period. Each measure could be reliably converted into the others. The 5-item VQIDS-SR5 holds promise as an effective tool for screening or repeated assessment due to its short length.

Nandy, K., Rush, A. J., Carmody, T., Kennard, B. D., Emslie, G. J., Slater, H., Mayes, T. L., DeFilippis, M., Garza, C., Storch, E. A., Wakefield, S. M., & Trivedi, M. H. (2023). A comparison of depressive symptom self-reported measures in the Texas Youth Depression and Suicide Research Network (TX-YDSRN). The Journal of Clinical Psychiatry, 85(1). https://doi.org/10.4088/jcp.23m14861

• Depression
• Measurement-Based Care

Read More

Attention-deficit hyperactivity disorder (ADHD) is commonly found co-occurring in youth with depression, but few studies on ADHD have focused on a clinical sample of depressed youth. In this study, clinical features associated with depression plus ADHD were compared to those with depression alone to determine how co-occurring ADHD impacts youth with depression. Results showed that youth with depression and ADHD reported more severe depression, more suicidality, greater impulsivity, greater irritability, and worse school performance compared to youth with depression alone. However, ADHD diagnosis did not directly impact the relationship between depression and these outcomes, suggesting other factors may be more important predictors of mental health and related outcomes.

Upshaw, B. M., Spencer, S. D., Pinciotti, C. M., Zhyrov, V., Minhajuddin, A., Castillo, A. A., Abacan, A., Slater, H., Walker, R. A., Blader, J. C., Martin, S. L., Shahidullah, J. D., Soares, J. C., Harper, R. A., Guerra, M., Goodman, L. C., Goodman, W. K., Wakefield, S. M., Trivedi, M. H., & Storch, E. A. (2025). ADHD in Youth With Major Depressive Disorder in the Texas Youth Depression and Suicide Research Network (TX-YDSRN): Clinical Correlates and Moderators. Journal of Attention Disorders, 29(13), 1231-1246. https://doi.org/10.1177/10870547251353392

• Irritability
• Suicidality
• Depression

Read More

One of the main goals of TX-YDSRN is to expand the use of measurement-based care (MBC) in the state of Texas. To assess the current use of standardized measurement across the sites participating in TX-YDSRN, a dedicated committee developed a data collection tool designed to describe whether and how the patients were assessed for depression, anxiety, treatment side effects, and adherence. A subsequent chart review of clinical visits indicated that 71% of sites used standardized depression measures and 64% used anxiety measures. When it came to measures assessing medication adherence and side effects, those were limited to less than 6% for both (despite medication changing in nearly half of the participants), with the majority of the sites using clinical interviews to gauge adherence and side effects. Considering that the use of MBC has been linked to better outcomes in mental health treatment, it is crucial to continue to increase the use of standardized tools.

Slater, H., AlZubi, Y., Rezaeizadeh, A., Hughes, J. L., Gorman, A., Mayes, T. L., Elmore, J. S., Storch, E. A., Wakefield, S. M., & Trivedi, M. H. (2025). Characterizing Measurement-Based Care in the Texas Youth Depression and Suicide Research Network (TX-YDSRN). Child Psychiatry and Human Development, 56(5), 1214–1224. https://doi.org/10.1007/s10578-023-01653-3

• Measurement-Based Care
• Depression
• Anxiety
• Suicidality

Read More

There are multiple evidence-based therapy treatment options for youth with depression and/or suicidality, yet youth seeking treatment do not always receive these recommended treatments. Understanding the types of treatments received and patient understanding of their therapy experience is the first step to help track care in order to improve treatment received. To that end, TX-YDSRN assessed the validity of a new measure, the Depression Treatment Experiences Questionnaire (DTEQ), to better understand the youth experience with therapy. The measure showed promise as a useful tool for understanding therapy experiences, with two main domains identified by the measure. Lifestyle changes, such as changes to exercise and sleep, were found as a common addition to therapy. While almost half of participants reported receiving evidence-based therapy, the other half could not identify their therapy type, indicating a large gap in patient-provider communication.

Drummond, K. N., Guzick, A. G., Spencer, S. D., Pinciotti, C. M., Bivins, E. J., Minhajuddin, A., Slater, H., Gorman, A., Goodman, L. C., Walker, R. A., Wakefield, S. M., Wang, T., Chanoi, C., LaGrone, J. M., Soares, J. C., Smith, M., Lambie, F., Hughes, J. L., Snyder, S. A., Storch, E. A. (2025). Characterizing therapy experiences in youth with depression and suicide via the Depression Treatment Experiences Questionnaire. Clinical Psychology and Psychotherapy, 32(3). https://doi.org/10.1002/cpp.70088

• Measurement-Based Care
• Rating scales
• Depression

Read More

Anxious depression has been identified as a prevalent subtype of Major Depressive Disorder (MDD), though research has mainly focused on adult samples. In this study, we sought to identify the prevalence of anxious depression in a youth sample and to investigate the clinical correlates of anxious depression. Of youth in our baseline sample with depression diagnoses, 59.5% were identified as having anxious depression. Youth with anxious depression had increased depression symptom severity, anxiety symptom severity, suicidality, and rates of comorbid anxiety disorders compared to youth with non-anxious depression. Greater impairments in physical and social functioning were also measured in those with anxious depression. Given the clinical features associated with anxious depression in youth, this study demonstrates the utility of anxious depression as a diagnostic subtype of depression, in addition to demonstrating its high prevalence in youth.

Ayvaci, E. R., Nandy, K., Gorman, A., Minhajuddin, A., Riddle, D., Storch, E. A., Soutullo, C. A., Hettema, J. M., Slater, H., Wakefield, S. M., & Trivedi, M. H. (2024). Clinical correlates of anxious depression in youth from the Texas Youth Depression and Suicide Research Network (TX-YDSRN). Journal of Affective Disorders, 362, 510–517. https://doi.org/10.1016/j.jad.2024.07.035

• Depression
• Anxiety

Read More

One common obstacle to the effective treatment of mental health disorders is the fact that multiple people with identical diagnoses might experience different combinations of symptoms. This study set out to define subgroups of depressed youth using PROMIS, a self-report scale covering domains of physical function/mobility, anxiety, depressive symptoms, fatigue, peer relationships, interference of pain on one's life, and pain intensity. By using a statistical technique called latent class analysis, the authors were able to separate the participants into four subgroups: 1.) youth with less severe depression and higher physical functioning; 2.) youth with more severe depression, higher pain, and lower physical functioning; 3.) youth with more severe depression and higher pain, but with higher physical functioning; 4.) youth with more severe depression, lower pain, and lower physical functioning. Importantly, subgroup 3 demonstrated higher resilience compared to subgroup 2, possibly contributing to the higher functioning found in these youth. Identifying existing subgroups of patients with the same diagnoses may allow us to learn more about the variability found in depression and help find ways to promote better functioning in depressed youth.

Minhajuddin, A., Jha, M. K., Slater, H., Mayes, T. L., Storch, E. A., Shotwell, J., Soutullo, C., Wakefield, S. M., & Trivedi, M. H. (2024). Data-driven subgrouping of youths with depression reveals that resilience is associated with higher physical functioning despite high symptom burden in the Texas youth depression and suicide research network (TX-YDSRN). Journal of Affective Disorders, 348, 353–361. https://doi.org/10.1016/j.jad.2023.12.031

• Measurement-Based Care
• Depression

Read More

Suicide is one of the leading causes of death in young people, so there is a critical need for valid, easy-to-administer, and easy-to-interpret assessments of suicidal risk. The 9-item Concise Health Risk Tracking – Self Report (CHRT-SR9) scale was developed by the CDRC to address this issue. This study used CHRT-SR9 scores from several large samples to identify clinically relevant categories of suicidal risk. Comparing percentile scores from CHRT-SR9 to response categories for Patient Health Questionnaire for Adolescents item 9 concerning suicide, ranges for four risk categories were identified. Our results demonstrate that CHRT-SR9 scores may be categorized as none (0-14), mild (15-21), moderate (22-26), and severe (27-36) suicidal risk. Placing CHRT-SR9 scores in context through identification of meaningful and clinically actionable categories will allow for increased understanding of suicidal risk and therefore aid suicide prevention efforts.

Nandy, K., Nandy, R. R., Rush, A. J., Mayes, T. L., & Trivedi, M. H. (2024). Evidence-based guidelines for the interpretation of the 9-item Concise Health Risk Tracking – Self-Report (CHRT-SR9) measure of suicidal risk. Journal of Psychopharmacology, 38(9), 784-788. https://journals.sagepub.com/doi/10.1177/02698811241268875

• Suicidality
• Measurement-Based Care
• CHRT-SR9
• Rating scales

Read More

Hokelekli, F.O., Ayvaci, E.R., Minhajuddin, A., Walker, R.A., Goodman, L.C., Soares, J.C., Storch, E.A., Wakefield, S.M., & Trivedi, M.H. (in press). Examining Antidepressant Side Effect Burden in Youth: The FIBSER-C Scale in the Texas Youth Depression and Suicide Research Network Study. Journal of Child and Adolescent Psychopharmacology, 35(8), 463-470. https://doi.org/10.1089/cap.2025.0018

• Antidepressant
• Measurement-Based Care
• Rating scales
• Treatment
• Depression

Read More

With many available options, selecting a treatment for depression in youth can be a complex process influenced by many factors, including treatment preferences. This paper investigated treatment groups in the TX-YDSRN sample and how patient characteristics and treatment preferences aligned with treatment received over the first month of enrollment. While over half of the sample was receiving combined psychotherapy and medication treatment, a smaller portion was receiving medication alone, and relatively few were receiving psychotherapy only or no current treatment. Youth receiving combined treatment tended to have more severe depression and suicide risk compared to those only receiving medication, and a large portion of youth receiving medication alone actually preferred combined treatment. Youth in the medication only group tended to come from households with lower income, suggesting there may be barriers to combined treatment.

Ayvaci, E. R., Nandy, K., Becker, R., Stone, L., Minhajuddin, A., Slater, H., Goodman, L. C., Wakefield, S. M., Storch, E. A., Blader, J. C., Soutullo, C. A., Emslie, G. J., & Trivedi, M. H. (2025). Examining Treatment Options in Youth With Major Depressive Disorder: Observations From the TX‐YDSRN Registry Study. Psychiatric Research and Clinical Practice. https://doi.org/10.1176/appi.prcp.20240117

• Antidepressant
• Treatment

Read More

Measurement-based care (MBC), the use of formal symptom measurements to guide care, has long been used in medicine (i.e., blood sugar for diabetes, or cholesterol for heart disease). However, MBC has not been widely adopted in psychiatry. This review summarizes the available evidence and shows that utilizing MBC to guide clinical decision-making results in better treatment outcomes in patients with treatment-resistant depression. Self-report scales are easily implemented, allowing healthcare providers without extensive psychiatric training, such as primary care physicians, to use valid, reliable, and easy-to-access measurement tools. The use of MBC to implement depression screening, particularly within primary care, likely leads to earlier detection, better treatment adherence, minimization of side effects, and quicker remission.

Mayes, T. L., Deane, A. E., Aramburu, H., Yagnik, K., & Trivedi, M. H. (2023). Improving identification and treatment outcomes of treatment-resistant depression through measurement-based care. Psychiatric Clinics of North America, 46(2), 227–245. https://doi.org/10.1016/j.psc.2023.02.002

• Measurement-Based Care
• Depression
• Treatment-Resistant Depression

Read More

Psychometrically sound measures, ease of administration and scoring, integration with electronic health records, and data-driven suggestions for clinical decision-making are some of the factors that lead to the successful implementation of measurement-based care (MBC) in depression treatment. This study evaluated VitalSign6, a software tool designed to achieve these goals. Almost two thousand youths were screened using VitalSign6 over the course of a year, with almost half of the youth having at least one follow-up assessment. About one quarter achieved remission 4 months after initial screening. Teenagers had higher depression scores, higher suicidality, and more follow-up assessments than younger patients (<12 years of age), while younger patients had higher rates of remission. The process of collecting data and navigating treatment showed that VitalSign6 allows for quick and easy screening of patients, displays clear visual data for providers, and produces tailored treatment recommendations for diverse intervention options. Implementing VitalSign6 eases the MBC rollout process, potentially leading to better outcomes in youth getting treatment for depression.

Mitchell, T. B., Wakefield, S. M., Rezaeizadeh, A., Minhajuddin, A., Pipes, R., Mayes, T. L., Elmore, J. S., & Trivedi, M. H. (2025). Integration of Measurement-Based Care for Youth Depression and Suicidality Using Vitalsign6. Child Psychiatry & Human Development, 56(5), 1206–1213. https://doi.org/10.1007/s10578-024-01680-8

• Measurement-Based Care
• Depression
• Suicidality

Read More

Youth in the US experience trauma events at high rates, and many report experiencing more than one type of adverse childhood event before they turn 18. Exposure to these traumatic experiences is known to be linked to adverse mental and physical health outcomes. This study investigated the nature of the relationship between trauma exposure and symptoms of depression, anxiety, and suicidal ideation. To study the dose-response nature of traumatic experiences, the sample was divided into four groups: No Traumatic Exposure Categories (No TEC), 1 TEC, 2-3 TEC, and 4 or more TEC. Using PHQ-A to measure depression and GAD-7 to measure anxiety, the investigators found that the depression scores were lower in the No TEC group than in the 2-3 TEC and the ≥4 TEC groups, with cis-gendered participants having significantly lower scores than their trans/non-binary counterparts. Similarly, significantly lower anxiety scores were found in the No TEC group compared to the other groups. In the role of suicidality, measured by CHRT-SR, only specific trauma types were significantly different from the no-trauma group, suggesting that these trauma types may be unique predictors of suicidal risk. It is important to continue investigating the role of trauma in suicidal youth to potentially develop new treatment protocols.

Goodman, L. C., Elmore, J. S., Mayes, T. L., Minhajuddin, A., Slater, H., Blader, J. C., Liberzon, I., Baronia, R. B., Bivins, E. J., LaGrone, J. M., Jackson, S., Martin, S. L., Brown, R., Soares, J. C., Wakefield, S. M., & Trivedi, M. H. (2024). Linking trauma to mental health in the statewide Texas Youth Depression and Suicide Research Network (TX-YDSRN). Psychiatry Research, 331, 115620. https://doi.org/10.1016/j.psychres.2023.115620

• Trauma
• Depression
• Anxiety
• Suicidality

Read More

With alarming rates of suicide among youth, the use of valid and reliable suicidality screening tools is vital. Many youths who end up screening positive for suicidal ideation display no apparent mental health challenges, thus screening plays an important role in helping to manage this mental health crisis. This review proposes that primary care is an optimal setting to detect suicidality early and provide appropriate monitoring and care. While the preferred tools used to assess suicidality can vary drastically among providers, with some preferring self-report questionnaires and others relying on clinician-administered forms, they all involve similar questions concerning suicidal thoughts, behaviors, and plans. The authors also provide an overview of available measures of youth suicidality, discussing their psychometric characteristics as well as clinical feasibility.

Busby, D. R., Hughes, J. L., Walters, M., Ihediwa, A., Adeniran, M., Goodman, L., & Mayes, T. L. (2025). Measurement Choices for Youth Suicidality. Child Psychiatry & Human Development, 56(5), 1250–1266. https://doi.org/10.1007/s10578-023-01627-5

• Measurement-Based Care
• Suicidality

Read More

Many youth struggle with anxiety disorders, which are often debilitating and co-occurring with depression. To ensure accurate assessment of and intervention for youth anxiety, it is critical that clinicians have access to valid anxiety measurement tools. The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a frequently used measure to address anxiety, but its use has not been validated for diverse populations. To determine the validity of the SCARED for a wider range of youth, the measure was assessed in distinct groups based on age, sex, and ethnicity in TX-YDSRN youth. SCARED measurement performance was consistent across groups upon test. Younger children and females tended to endorse higher levels of anxiety compared to older children and males, respectively. These findings support the use of SCARED in more diverse populations of youth based on age, sex, and ethnicity, expanding clinicians' ability to measure youth anxiety.

Silva, T., Spencer, S. D., Higham, M., Castillo, A. A., Minhajuddin, A., Gorman, A., Goodman, L. C., Pinciotti, C. M, Hernandez, S., Slater, H., Soutullo, C. A., Hettema, J. M., Azhar, N. A., Goodman, W. K., Trivedi, M. H., & Storch, E. A. (2024). Measurement invariance of the Screen for Child Anxiety Related Emotional Disorders (SCARED) across ethnicity, age, and sex among youth with depression. Personalized Medicine in Psychiatry, 47-48, 100134. https://doi.org/10.1016/j.pmip.2024.100134

• Anxiety
• Measurement-Based Care
• Rating scales

Read More

Despite the growing understanding of youth depression, there remains a need for a more precise diagnosis and more effective symptom management. In this article, the authors argue for the use of a variety of research-backed measurements and rating scales to assess depression. The use of these scales produces a more reliable diagnosis and allows healthcare providers to objectively track treatment progress. In addition to measuring depressive symptoms, rating scales can be used to assess related mental health features (e.g. anxiety) and other important outcomes (e.g. quality of life). For some families, completing a depression measure is the first time they hear language that describes their symptoms. This aids in the recognition of at-risk individuals and helps overcome stigma by normalizing discussion of mental health, ultimately leading to more equitable mental health care.

Garza, C., Chapa, D., Hernandez, C., Aramburu, H., Mayes, T. L., & Emslie, G. J. (2025). Measurement-Based Care for Depression in Youth: Practical Considerations for Selecting Measures to Assess Depression, Associated Features and Functioning. Child Psychiatry and Human Development, 56(5), 1235–1249. https://doi.org/10.1007/s10578-023-01652-4

• Measurement-Based Care
• Depression

Read More

Depressive disorders have high comorbidity with other psychiatric diagnoses. And while much is known about co-occurrences of depression and anxiety, the relationship between depression and obsessive-compulsive disorder (OCD) is not well-explored, despite depression being common in those with OCD. This study investigates the differences in symptoms between depressed youth with no comorbidities, depressed youth with anxiety, and depressed youth with OCD. Depressed youth with comorbid anxiety or OCD had higher depression severity, irritability, and insomnia. Similarly, those with comorbid OCD or anxiety had lower physical functioning, resilience, and greater difficulty in school. Further research is needed on the unique challenges presented by the comorbidity of OCD and depression.

Riddle, D. B., Guzick, A., Minhajuddin, A., Smárason, O., Armstrong, G. M., Slater, H., Mayes, T. L., Goodman, L. C., Baughn, D. L., Martin, S. L., Wakefield, S. M., Blader, J., Brown, R., Goodman, W. K., Trivedi, M. H., & Storch, E. A. (2023). Obsessive-compulsive disorder in youth and young adults with depression: Clinical characteristics of comorbid presentations. Journal of Obsessive-Compulsive and Related Disorders, 100820. https://doi.org/10.1016/j.jocrd.2023.100820 

• Obsessive Compulsive Disorder
• Depression
• Anxiety

Read More

Irritability is a common characteristic of psychiatric disorders in children and adolescents but is often overlooked by scientific literature and screening tools. This study explores the psychometric value of the five-item irritability domain of the Concise Associated Symptom Tracking (CAST-IRR) scale for male and female youth. Adolescents completed the self-report version of the CAST-IRR, and the authors created an “informant” version of CAST-IRR, which was completed by a parent/guardian. Both versions of CAST-IRR had strong internal consistency and found similar associations for irritability with depression, anxiety, and functional impairment in males and females, indicating the appropriateness of use for both sexes. Similar to other studies where parent-child irritability was compared, there was poor agreement between self- and informant-report versions of CAST-IRR. Self-report CAST-IRR had a stronger association with self-report measures of depression and anxiety, while the informant-report CAST-IRR had a stronger association with informant-report measures of depression and anxiety. Given the ability to capture distinct features of irritability between the two versions, the results suggest that clinicians may consider using both self- and informant-report CAST-IRR scales to comprehensively assess irritability in male and female youth.

Jha, M.K., Minhajuddin, A., Baronia, R.B., Blader, J.C., Mayes, T.L., Petrosky, M.A., Slater, H.M., Wakefield, S.M., & Trivedi, M.H. (2025). Parent/Guardian- and Self-Report Versions of the Irritability Domain of the Concise Associated Symptom Tracking Scale: Evaluation of Psychometric Properties and Potential Clinical Utility in the Texas Youth Depression and Suicide Research Network. JAACAP Open. https://doi.org/10.1016/j.jaacop.2024.04.002 

• Measurement-Based Care
• Concise associated symptom tracking
• Irritability
• Rating scales

Read More

Accurately measuring depression symptom severity is important for understanding patient trajectories and aiding treatment decisions. To provide increased awareness of depressive symptoms in youth, a particularly vulnerable population, it is helpful to survey both the youth themselves and a parent/guardian. Past research, however, has shown that parent-child agreement can vary widely depending on the survey used and may be influenced by demographic factors. Here, we studied TX-YDSRN parent-child agreement on the Patient Health Questionnaire-9 modified for adolescents (PHQ-A), a commonly used scale to assess severity of depression. Our results showed little agreement between PHQ-A scores reported by the youth and the youth’s parent/guardian on the youth’s depression severity. Agreement was not influenced by the youth’s age, sex, ethnicity, or parental depression history, but agreement was higher when youth were receiving psychotherapy treatment. Our findings highlight the importance of recognizing how reports of youth depression symptom severity may be influenced by who completes the assessment, and such discrepancies may need to be considered during assessment and subsequent treatment decisions.

Bivins, E.J., Buckland, E.K., Pinciotti, C.M., Riddle, D.B., Minhajuddin, A., Slater, H., Soutullo, C.A., Lambie, F., Saxena, K., Goodman, W.K., Onigu-Otite, E., Wakefield, S.M., Goodman, L.C., Trivedi, M.H., Guzick, A.G., & Storch, E.A. (2025). Parent-child agreement on depressive symptoms in depressed and suicidal youth. Journal of Child and Family Studies, 34, 2358-2368. https://doi.org/10.1007/s10826-025-03159-z

• Rating scales
• Depression

Read More

As youth mental health has steadily degraded across the country, social media use has risen, even becoming problematic in some users. We sought to determine how problematic social media use related to mental health in youth with depression and/or suicidal ideation. Findings indicated that over forty percent of youth endorsed problematic social media use, defined as feeling disconnected/disappointed/upset when not using. Problematic users not only reported poorer wellness factors, but they also tended to report more depression, anxiety, and suicidal thoughts. While problematic users also had higher screen time, problematic use was a better predictor of mental health impairments. Our research highlights the potential negative impact of heavy social media use in at-risk youth, especially when it becomes a problematic habit.

Kennard, B. D., Hughes, J. L., Minhajuddin, A., Jones, S. M., Jha, M. K., Slater, H., Mayes, T. L., Storch, E. A., LaGrone, J. M., Martin, S. L., Hamilton, J. L., Wildman, R., Pitts, S., Blader, J. C., Upshaw, B. M., Garcia, E. K., Wakefield, S. M., & Trivedi, M. H. (2025). Problematic social media use and relationship to mental health characteristics in youth from the Texas Youth Depression and Suicide Research Network (TX-YDSRN). Journal of Affective Disorders, 374, 128-140. https://doi.org/10.1016/j.jad.2025.01.046

• Depression
• Suicidality
• Anxiety

Read More

Suicide attempts and ideation along with depression are rising amongst young people, with suicide the third leading cause of death in adolescents. Because of this urgent mental health crisis, it is important to understand the factors associated with suicide risk and depression. Substance use is one factor that has been previously linked to increased suicide risk. Here, we studied the relationship between suicidality, depression, and substance use. In a sample of youth with depression, those with problematic substance use tended to have increased suicidal ideation or history of attempts, be older, and have more problems with school functioning compared to those without problematic use. However, problematic substance use did not impact the relationship between severity of depression and suicidality. These findings show an increased suicide risk in youth with problematic substance use, highlighting the need to identify and intervene in youth substance use.

Armstrong, G. M., Anderberg, J. L., Gorman, A. R., Spencer, S. D., Minhajuddin, A., Ecker, A. H., Spofford, J., Guzick, A. G., Slater, H., Aloor, F. Z., Flores, A. M., Lagrone, J. M., Marino, E. N., Soutullo, C. A., Wakefield, S. M., Goodman, W. K., Trivedi, M. H., & Storch, E. A. (2025). Problematic Substance Use in Depressed Youth: Associations with Suicidal Ideation and Suicide Attempt History. Journal of Dual Diagnosis, 21(1), 35–48. https://doi.org/10.1080/15504263.2024.2434219

• Depression
• Suicidality

Read More

With the number of adolescent suicides rising at an alarming rate over the last decade, there is a stark need for reliable and easily used screening tools. This study analyzes the properties of the 9-item Concise Health Risk Tracking - Self-Report (CHRT-SR9), a suicidality scale derived from its well-established 16-item predecessor the CHRT-SR16. When compared to CHRT-SR16 and item 9 of the PHQ-A (a commonly used screening question for suicidal thoughts), the CHRT-SR9 is a valid and reliable scale for measuring suicidal tendencies and, importantly, is sensitive to changes over time. All main elements that are represented in the CHRT-SR16 that contribute to the increased risk of suicide (pessimism, helplessness, despair, etc.) are still accounted for despite the shorter format of the CHRT-SR9. The CHRT-SR9 is an efficient and user-friendly tool that could be used for depression screening in various clinical settings.

Nandy, K., Rush, A.J., Slater, H., Mayes, T.L., Minhajuddin, A., Jha, M., Blader, J.C., Brown, R., Emslie, G., Fuselier, M.N., Garza, C., Gushanas, K., Kennard, B., Storch, E.A., Wakefield, S.M., & Trivedi, M.H. (2023). Psychometric evaluation of the 9-item Concise Health Risk Tracking - Self-Report (CHRT-SR9) (a measure of suicidal risk) in adolescent psychiatric outpatients in the Texas Youth Depression and Suicide Research Network (TX-YDSRN). Journal of Affective Disorders, 329, 548–556. https://doi.org/10.1016/j.jad.2023.02.018

• Measurement-Based Care
• Depression
• Suicidality

Read More

The Concise Associated Symptom Tracking (CAST) is a 16-item scale that was developed over a decade ago to measure changes in depression-associated symptoms of irritability, anxiety, mania, panic, and insomnia. Despite being validated in adults, this study is the first attempt to assess its utility in youth and young adult populations. Confirmatory factor analysis supported a scale with 12 items in this population, dropping the mania items from the scale. Correlations to symptom-specific items on other validated instruments such as the PHQ-A, GAD-7, IDS-SR, CHRT, PROMIS, and SCARED showed the CAST-12 to be a valid scale for measuring these symptoms in those aged 8-20 years. Given that these symptoms may be associated with depression treatment outcomes, it is crucial to measure them throughout the treatment process, and the CAST-12 is one such tool for doing so.

Jha, M.K., Minhajuddin, A., Slater, H., Mayes, T.L., Blader, J.C., Brown, R., Garza, C., Kennard, B.D., Riddle, D., Storch, E.A., Shotwell, J., Soutullo, C.A., Wakefield, S.M., & Trivedi, M.H. (2023). Psychometric properties of Concise Associated Symptom Tracking (CAST) scale in youths and young adults: Findings from the Texas youth depression and suicide research network (TX-YDSRN). Journal of Psychiatric Research, 161, 179–187. https://doi.org/10.1016/j.jpsychires.2023.03.020

• Depression
• Anxiety
• Measurement-Based Care

Read More

While risk factors for poor mental health often receive much attention, factors that protect or promote mental health deserve increased attention. Resilience, or the ability to adapt to life's challenges, has been identified as one protective factor, but there is a need for reliable and valid measures of resilience for research. In this study, we sought to test whether the CD-RISC-10, a brief measure of resilience, is appropriate for use within youth with depression and/or suicidal ideation. Results demonstrated that the CD-RISC-10 is valid and reliable, including over one-month follow up, for this youth population. This work will support future research efforts on understanding resilience and its impact on mental health by supporting the use this brief measure of resilience in at-risk youth.

Jeevarajan, J. R., Theodorou, A., Nandy, K., Guerra, M., Madia, N. D., Claassen, C., Goodman, L. C., Farmer, D., Wakefield, S. M., Minhajuddin, A., Slater, H., Mayes, T., Soutullo, C. A., Rosenberg, A., Ladd, S., Ahumada, N., Jackson, S., Rush, A. J., & Trivedi, M. H. (2025). Psychometric properties of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) in adolescent and young adult psychiatric outpatients in the Texas Youth Depression and Suicide Research Network (TX-YDSRN). Journal of Affective Disorders, 375, 155-164. https://doi.org/10.1016/j.jad.2025.01.091

• Rating scales
• Measurement-Based Care
• Depression
• Suicidality

Read More

Anxiety disorders are the most common psychiatric comorbidity in youth with depression, with clinically significant anxiety occurring in half of all depressed youth. This combination is usually associated with more severe symptoms creating a need for clinically sound tools for measuring anxiety. This study assessed two such tools: Generalized Anxiety Disorder 7-item Scale (GAD-7) and the Patient-Reported Outcomes Measurement Information System (PROMIS)-Anxiety-4a. While both of these scales have been tested in adults and showed promise in adolescent populations, they have been minimally tested in large clinical samples and have not been studied specifically within depressed and/or suicidal youth. Statistical analyses showed that both the GAD-7 and PROMIS-Anxiety-4a had high internal consistency and good test-retest reliability. Additionally, when compared to other well-established measures of anxiety, they showed appropriate convergent and divergent validity. These findings indicate that either of these brief, freely available scales can be used to screen and monitor treatment response in research and clinical settings while working with depressed and suicidal youth.

Guzick, A., Storch, E. A., Smárason, O., Minhajuddin, A., Drummond, K., Riddle, D., Hettema, J. M., Mayes, T. L., Pitts, S., Dodd, C., & Trivedi, M. H. (2024). Psychometric Properties of the gad-7 and promis-anxiety-4a among youth with depression and suicidality: Results from the Texas Youth Depression and Suicide Research Network. Journal of Psychiatric Research, 170, 237–244. https://doi.org/10.1016/j.jpsychires.2023.12.033

• Measurement-Based Care
• Anxiety

Read More

There is a large unmet need for mental healthcare in the United States, where depression is one of the most common psychiatric illnesses. Measurement-based care (MBC) is a strategy that can be implemented in primary care settings to improve patient outcomes over care as usual, and MBC can be applied toward the detection and tracking of depression symptoms. The two components of MBC are 1) the repeated, systematic measurement of symptoms for screening and monitoring and 2) using those measurements to guide treatment. This paper provides an overview of MBC and details the benefits and barriers to implementation in the context of depression treatment. Making MBC standard practice can lead to earlier detection and intervention, increase access to care, and help decrease high rates of untreated depression.

Deane, A. E., Elmore, J. S., Mayes, T. L., Robinson, S., AlZubi, Y., Wakefield, S. M., & Trivedi, M. H. (2025). Shifting From Best Practice to Standard Practice: Implementing Measurement-Based Care in Health Systems. Child Psychiatry & Human Development, 56(5), 1225–1234. https://doi.org/10.1007/s10578-024-01715-0

• Measurement-Based Care

Read More

Depression and substance use have a bi-directional relationship, but research in youth has focused on single substances and ignored comorbidities. We sought to gain a wider perspective by considering substance use of any kind, psychiatric symptoms, and demographic features together. Advanced grouping techniques identified three patterns of past-year substance use in depressed youth: non-use; moderate likelihood of using alcohol, nicotine, and cannabis; and high likelihood of using all substances. We then considered whether any demographic or psychiatric factors might predict substance use group. Compared to non-users, moderate and high likelihood users tended to be older. Youth in the high likelihood group were more likely to have a substance use disorder, ADHD, and higher suicidality. These findings suggest universal screening for substance use among depressed youth would help increase early intervention and customized care.

Clark, S. L., Dodd, C. G., Mitchell, T. B., Ingram, S. J., Armstrong, G. M., Jha, M. K., Soares, J. C., Smith, M., Minhajuddin, A., Slater, H., Wakefield, S. M. & Trivedi, M. H. (2024). Substance use patterns and mental health comorbidities in youth with a history of depression or suicidality: Findings from TX-YDSRN. Journal of Affective Disorders, 366, 210-216. https://doi.org/10.1016/j.jad.2024.08.128

• Depression
• Suicidality

Read More

Youth suicidality is a public health crisis. The Texas Youth Depression and Suicide Research Network (TX-YDSRN) was established to, among other things, assess the prevalence and severity of youth Suicidality in the state of Texas. This report characterizes the baseline prevalence and correlates of suicidal ideation and suicide attempts within the TX-YDSRN sample. Nearly 90% of the sample reported suicidal ideation, and nearly half (48.2%) had at least one lifetime suicide attempt. Youth with ideation or attempts were more depressed and anxious and were less resilient than non-suicidal youth. Additionally, they experienced more traumatic events, were more likely to use recreational drugs, participated in fewer social activities, and displayed poorer peer relationships and school adjustment than their non-attempting counterparts. This report should allow researchers to better understand the relationship of suicidality with a variety of behavioral and physical health outcomes in Texas youth.

Kennard, B. D., Hughes, J. L., Minhajuddin, A., Slater, H., Blader, J. C., Mayes, T. L., Kirk, C., Wakefield, S. M., & Trivedi, M. H. (2023). Suicidal thoughts and behaviors in youth seeking mental health treatment in Texas: Youth Depression and Suicide Network research registry. Suicide and Life-Threatening Behavior, 00, 1–16. https://doi.org/10.1111/sltb.12980

• Suicidality

Read More

Suicide risk management protocols (SRMPs) are necessary for clinical research on subjects at risk for suicide, but few studies explicitly describe the steps taken to mitigate those risks and whether they have proven effective. In addition to that, there were previously no detailed published SRMPs for use with child and adolescent populations. This paper addresses this gap in the literature by detailing the process of arriving at the TX-YDSRN SRMP and describing the various tools used for data collection. The authors emphasize the importance of extensive training of clinical personnel, collaboration across care providers and institutions, and the dissemination of public suicide prevention resources to participants endorsing suicidal thoughts. Protocol documents were included in the publication.

Hughes, J. L., Trombello, J. M., Kennard, B. D., Slater, H., Rezaeizadeh, A., Claassen, C., Wakefield, S. M., & Trivedi, M. H. (2023). Suicide risk assessment and suicide risk management protocol for the Texas youth depression and suicide research network. Contemporary Clinical Trials Communications, 33, 101151. https://doi.org/10.1016/j.conctc.2023.101151

• Suicidality
• Measurement-Based Care

Read More

Funded by the Texas State Legislature as a part of the Texas Child Mental Health Care Consortium, TX-YDSRN was created to gain a deeper understanding of depression and suicidality in Texas youth. This article summarizes the purpose of TX-YDSRN, details its start-up procedures, and describes the baseline data collected from the first 1000 participants. By leveraging the 12 major health-related academic institutions across Texas, TX-YDSRN recruited an ethnically and racially diverse pool of participants between 8 and 20 years of age. After initial screening, qualified participants completed a baseline appointment, a 1-month follow-up, and 12 bi-monthly follow-ups that included self-report measures and clinician clinician-guided assessments. Most (79.7%) of the participants had a primary diagnosis of depression, while 7.6% had bipolar disorder, 4.6% had suicidality or suicide behavior disorder, and 5.2% had primary anxiety, OCD, or PTSD. Just under half of all participants reported having at least one suicide attempt in their lifetime. The next steps for the TX-YDSRN project are also discussed. The collected data will help to create a valuable body of knowledge that will be used to create screening tools and treatment protocols that address persistent mental health concerns of Texas youth.

Trivedi, M. H., Minhajuddin, A., Slater, H., Baronia, R., Blader, J., Blood, J., Brown, R., Claassen, C., DeFilippis, M., Farmer, D., Garza, C., Hughes, J., Kennard, B. D., Liberzon, I., Martin, S., Mayes, T. L., Soares, J. C., Soutullo, C. A., Storch, E. A., & Wakefield, S. M. (2023). Texas youth depression and suicide network (TX-YDSRN) research registry and learning healthcare network: Rationale, design, and baseline characteristics. Journal of Affective Disorders, 340, 88-99. https://doi.org/10.1016/j.jad.2023.07.035

• Depression
• Suicidality

Read More

Youth with obsessive-compulsive disorder (OCD) often also struggle with comorbid major depressive disorder (MDD), however, it is unclear if the OCD symptoms impact the intensity of their depression. In this study, the depression severity of participants (measured by PHQ-A) with comorbid OCD and MDD was compared to those with MDD but no OCD. The statistical analyses revealed that the youth with a combination of MDD and OCD had more severe MDD and more of them dealt with moderate to severe depression (75%) compared to their MDD-only counterparts (61%). Additionally, those with comorbid OCD also reported lower levels of anhedonia (loss of pleasure from things one used to enjoy) and more severe psychomotor issues. These findings point to the unique combination of symptoms in youth with comorbid mental health disorders, stressing the importance of accounting for these comorbidities when approaching symptom monitoring and treatment.

Strouphauer, E., Valenzuela-Flores, C., Minhajuddin, A., Slater, H., Riddle, D. B., Pinciotti, C. M., Guzick, A. G., Hettema, J. M., Tonarelli, S., Soutullo, C. A., Elmore, J. S., Gushanas, K., Wakefield, S., Goodman, W. K., Trivedi, M. H., Storch, E. A., & Cervin, M. (2024). The clinical presentation of major depressive disorder in youth with co-occurring obsessive-compulsive disorder. Journal of Affective Disorders, 349, 349–357. https://doi.org/10.1016/j.jad.2024.01.070

• Depression
• Obsessive Compulsive Disorder

Read More

Youth obesity rates have been increasing along with rates of depression and suicidality in youth. Previous research has shown that obese youth have increased rates of depression compared to healthy-weight youth, but the factors associated with poorer outcomes remain uncertain. In this report, associations with variables related to depression, other mental health challenges, and physical health were considered between different weight categories. Obese youth had more severe depression than overweight youth and worse physical function compared to healthy and overweight youth. Perceived weight and appetite changes were generally associated with worse clinical symptoms, with appetite more consistently associated with poorer health. Overweight and obese youth were more likely to come from low-income households, suggesting that children from lower-income families may be at greater risk for weight gain.

Zhyrov, V., Gorman, A., Walker, R.A., Slater, H., Ayvaci, E.R., Snyder, S.A., Goodman, L.C., Ableman, E., Minhajuddin, A., Elmore, J.S., AlZubi, Y., Drummond, K.N., Baughn, D., Wakefield, S.M., Trivedi, M.H. (2025). The Relationships Between Body Weight, Appetite, Depression, and Anxiety: Findings from the Texas Youth Depression and Suicide Research Network (TX-YDSRN). Health Psychology Open, 12, 1-14. https://doi.org/10.1177/20551029251359056

• Anxiety
• Depression

Read More

Highlighting the need to tackle ongoing mental health issues faced by Texas youth, this report presents a descriptive overview of the framework established by the Texas Child Mental Health Care Consortium (TCMHCC), including TX-YDSRN. The consortium has emphasized the use of a “learning healthcare system,” which promotes implementation of measurement-based care, a critical goal of TX-YDSRN. This paper presents the operational framework of TX-YDSRN alongside current status of registry enrollment, sample features, and network achievements to increase visibility and understanding of TX-YDSRN and the broader TCMHCC.

Tamminga, C. A., Trivedi, M. H., Wagner, K. D., Wakefield, S., Newport, D. J., Norcross, J., Lakey, D. L., & Nemeroff, C. B. (2024). The Texas child mental health network: A child and adolescent research registry. Personalized Medicine in Psychiatry, 45, 100124. https://doi.org/10.1016/j.pmip.2024.100124

• Depression
• Suicidality
• Trauma
• Measurement-Based Care

Read More

Trauma is known to contribute to the potential development of Post-Traumatic Stress Disorder (PTSD), yet little research has explored how health-related social needs might impact PTSD or the relationship between trauma type and PTSD. Here, we examined the impact of trauma type and health-related social needs, such as housing instability or food insecurity, on PTSD symptoms in TX-YDSRN youth with trauma experience. Interpersonal trauma, but not health-related social needs, predicted PTSD symptoms. Lower interpersonal safety was linked to greater likelihood of interpersonal trauma, suggesting this could be an important risk factor to target in future interventions. Overall, our findings highlight the need to treat the psychological impacts of interpersonal trauma to help prevent or decrease PTSD symptoms in youth.

Morgan, M., Dodd, C. G., Gorman, A., Drummond, K., Minhajuddin, A., Goodman, L. C., Hettema, J. M., Slater, H., Wakefield, S. M., Trivedi, M. H. (2025). Type of trauma exposure and subsequent mental health symptoms: Examining the role of social needs in TX-YDSRN youth. Journal of Psychiatric Research, 186, 416-422. https://doi.org/10.1016/j.jpsychires.2025.04.049

• Trauma
• Anxiety

Read More