Artificial intelligence is a useful tool for examining suicidality on social media, where people share their thoughts. However, existing research has primarily focused on text analysis to predict risk in single posts and raised privacy concerns. This study aimed to use text, images, and user features on Instagram to predict the risk of each user in Hawaii with user permission. One hundred forty-two participants completed online questionnaires about their current suicidal ideation. With their consent, their Instagram data were collected to train Artificial intelligence model to predict suicidal ideation of each user. Thirty-three (23.2%) participants reported having current suicidal ideation. The best model predicts suicidal ideation with 52% sensitivity, 92% specificity, 65% positive predictive value, and 82% accuracy. The significant predictors were negative description, lower hue and more red in an image, fewer nature and sky images, more art, fashion, a close-up of a body part, and spoof content in an image. These findings highlight the potential of suicide prediction on social media, which help mental health providers plan patient online interventions and appointments. Additionally, the influence of Hawaii's unique social-cultural context on significant predictors, helping gatekeepers to recognize signs of suicide on the social media of people in Hawaii. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The Brief COPE (Coping Orientation to Problems Experienced) Inventory is a standardized and widely used scale that enables researchers to measure coping responses of persons in relation to stressors. The psychometric properties of this scale, however, have not been assessed for communities in Hawai'i. This study investigated the psychometric properties of the Brief COPE for diverse women from a rural community on the island of O'ahu in Hawai'i. This study was conducted in a federally qualified health center (FQHC) with 161 women who were of a childbearing age between the ages of 18 to 38 years. Contrary to previous research, the factor structure of the final model suggested six factors: Behavioral Disengagement, Denial, Venting, and Self-Blame; Action Coping, Positive Reframing, Acceptance, and Planning; Humor; Substance Use; Social Support; and Religion. The final model demonstrated good model fit with an RMSEA of .07 and CFI of .95. The reduced factor structure may be a more robust measure of coping strategies, which may allow for better resources and interventions that adequately address the way women of childbearing ages from rural communities respond to stressful situations. Exploring coping mechanisms of diverse women will better our understanding of the way people respond to stress and develop strengths and mechanisms that mediate stressors including those that are linked to social and cultural determinants of health. Findings from this study may also inform future research and policy that aim to foster coping, and thus, resiliency of diverse women, particularly in rural settings.

The Prevent Suicide Hawaiʻi Taskforce is a state, public, and private partnership of individuals, organizations, and community groups that leads statewide suicide prevention efforts in Hawaiʻi. The purpose of this evaluation was to identify the progress and barriers of the Taskforce to inform the upcoming 2025 Hawaiʻi Suicide Prevention Strategic Plan in the following areas: Hope, Help, Heal, Research and Evaluation, and Policy and Advocacy. Utilizing a sequential exploratory mixed-methods approach, 18 key informants were interviewed, followed by a 13-question survey sent to the Taskforce member listserv. Results were analyzed using qualitative coding techniques and descriptive statistics. Interview findings contained six themes: importance of community relationships, interconnection of suicide prevention efforts, progress in diversifying training, organizational challenges, adaptations to the COVID-19 pandemic, and funding challenges. Of the 34 survey respondents, most were involved in the area of Hope (91%). The respondents reported the area with most progress was Hope (87%), and the most important area to address was Help (41%). The majority (82%) of the respondents characterized the level of Taskforce communication as Excellent or Good. Interview and survey data corroborated each other and revealed new insights about the successes and barriers of the Taskforce and their progress in implementing the Strategic Plan. Recommendations included advocating for long-term funding for suicide prevention and building community relationships.

Suicide is a serious public health issue and is a leading cause of death worldwide. Suicidal ideation is a common presentation in emergency department (ED) settings, with many nuanced complications. Therefore, understanding screening, assessment, and mitigation is paramount to successful encounters with individuals presenting to emergency settings in psychiatric crises. Screening helps to identify the few people at risk within a large group. Assessment seeks to decide whether a specific individual is at significant risk. Mitigation aims to reduce the risk of suicide or of a serious attempt for a person at risk. These aims cannot be achieved with perfect reliability, but some approaches are more effective than others. Suicide screening specifics are important, even to individual practitioners, because a positive screen triggers assessment. Most practitioners understand assessment well: beginning with early psychiatric training, they are taught signs and symptoms suggesting that a patient might be at risk of suicide. Mitigating suicide risk is increasingly important to reduce the misery of ED boarding for patients awaiting psychiatric admission. For many patients, hospital admission is unnecessary if support, monitoring, and contingency plans are workable. For any individual patient, there may be a complicated mix of findings, risks, and interventions. Evidence-based screening and assessment tools are inadequate for the possible complexities, making care of individual patients dependent on good clinical assessment. The authors review the available evidence and offer experienced recommendations for challenges not yet thoroughly researched.

Background Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been established as an effective screening tool for providing interventions for patients with risky substance use. Objectives The objectives of this project were to train and coach staff nurses in the use of SBIRT, offer SBIRT to all admissions of a brief psychiatric inpatient unit, and decrease readmission rates. Design Using the Iowa Model for Implementing Evidence-Based Practices, SBIRT was implemented on the unit. Data were collected on the frequency of patients offered SBIRT and readmission rates. Results Fifty-nine percent of all admissions were offered SBIRT. The average readmission rates decreased by 18.3% for the first 2 months of implementation and by 67.5% for Days 16–31 postdischarge. Conclusions SBIRT is an effective tool for nurses on psychiatric units to address substance use and to decrease readmission rates.

This column describes what it means to be "in" a community and how to create a leading role for community partners in shaping research. It highlights essential components for conducting clinical and translational research in the community, including: (1) invitation to share history and purpose; (2) community-initiated collaboration and engagement; (3) focus on social and cultural determinants of health; (4) community-driven measures and frameworks; (5) application of Indigenous methods and approaches; and (6) implementation of Indigenous and adaptable interventions. Partnering with a community entails building relationships and positioning research around community interests, using methodologies and interventions right for the community.

OBJECTIVES/GOALS: Aim 1: To explore methodologies to identify gender minorities, and Filipinos, separately, in an electronic health record system. Aim 2: To characterize the similarities and differences in demographic, socioeconomic, and mental health of Filipinos gender minorities compared to Native Hawaiian Pacific Islanders, and White/ European Americans. METHODS/STUDY POPULATION: This study was approved by the University of Hawaii Institutional Review Board. Cross-sectional retrospective data were obtained from a collaborative community clinic’s electronic health record system. Patients were age 18 and older with a clinical diagnosis for gender dysphoria and from Native Hawaiian Pacific Islander, White/ European American, and Filipino backgrounds. RESULTS/ANTICIPATED RESULTS: Preliminary data revealed that 11% of the clinical population were diagnosed with gender dysphoria (N=373) with 57.6% (n=215) who met the inclusion criteria with complete health registration forms. Patients were from Filipino (21.8%), Native Hawaiian Pacific Islander (23.3%), White/ European American (31.6%), and multiethnic (23.3%) backgrounds. Most patients reported mental health (e.g., depression) conditions (50.6%-64.7%). Further statistical analyses will reveal if Filipinos have higher or lower levels of anxiety, depression, and suicide risks than Native Hawaiian Pacific Islander, and White/ European American gender minority individuals. DISCUSSION/SIGNIFICANCE: In Hawaii, one person dies by suicide every two days; suicide is the lead cause of fatal injuries. Study findings can inform future methodology studies to identify gender minorities and develop culturally relevant gender affirming mental health programs for gender minorities.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Suicide death rates for Indigenous Hawaiians and other Pacific Islanders are amongst the highest in the world for youth, taking a tremendous toll on local communities (Else et al., 2007; Goebert, 2014). Comprehension of community perspectives of suicide and well-being can enhance suicide prevention interventions. This community-initiated project aimed to culturally adapt the components of an evidence-based youth suicide prevention intervention and refine the intervention methodology to align with these adaptations. Formative qualitative work was conducted with community members to obtain information on community strengths and program fit. Narrative analyses were emergent and emphasized components for suicide prevention, incorporating cultural auditing to ensure information reflected group views. Participants highlighted cultural aspects pertaining to the program philosophy, the importance of cultural protocol, local innovation in suicide prevention, and culturally grounded advancements that give back to their community. This insight was applied to two adjacent but distinct communities to integrate suicide prevention in a sustainable way by culturally adapting the program. Effective suicide prevention for rural and Indigenous youth requires a broad-based community commitment, connection, and network.

Hawai'i's Pacific Islander (PI) population has suffered a higher burden of coronavirus disease 2019 (COVID-19) infections, hospitalizations, and deaths compared to other groups in the state. The Hawai'i Emergency Management Agency Community Care Outreach Unit conducted an assessment across the state to gain an understanding of the impact of the COVID-19 pandemic on the health and social welfare of households. Survey data was collected from individuals across the state during a period of 3 weeks (August 12-September 5, 2020). The following are resulting recommendations from the Pacific Island community to mitigate the impact and disparities of the pandemic as immediate and medium-term structural requests: (1) ensure that Pacific Island communities are proactively represented in state and county committees that develop health interventions to ensure that relevant language and culturally tailored communications and strategies are included, (2) provide consistent funding and community centered support to ensure consistent COVID-19 impact services for the Pacific Island families, (3) enhance the capacity of PI health care navigators and interpreters through increased funding and program support, and (4) engage state policy makers immediately to understand and address the systemic structural barriers to health care and social services for Pacific Islanders in Hawai'i. These recommendations were developed to address the generational inequities and disparities that exist for Pacific islanders in Hawai'i which were exacerbated by the COVID-19 pandemic.

Background: Although many risk factors for adolescent suicidal behavior have been identified, less is known about distinct risk factors associated with the progression from suicide ideation to attempts. Based on theories grounded in the ideation-to-action framework, we used structural equation modeling to examine risk and protective factors associated with the escalation from suicide ideation to attempts in adolescents. Methods: In this cross-sectional study, data from the 2013 and 2015 Hawaii High School Youth Risk Behavior Surveys (N = 8,113) were analyzed. The sample was 54.0% female and racially/ethnically diverse. Risk factors included depression, victimization, self-harm, violent behavior, disinhibition, and hard substance use, and protective factors included adult support, sports participation, academic achievement and school safety. Results: One in 6 adolescents (16.4%) reported suicide ideation, and nearly 1 in 10 (9.8%) adolescents had made a suicide attempt. Overall, disinhibition predicted the escalation to attempts among adolescents with suicide ideation, and higher academic performance was associated with lower suicide attempt risk. Depression and victimization were associated with suicide ideation. Limitations: This study examined data from the Youth Risk Behavior Survey, and other known risk factors such as anxiety and family history of suicide were not available in these data. Conclusions: Findings provide guidance for targets for clinical interventions focused on suicide prevention. Programs that incorporate behavioral disinhibition may have the greatest potential for reducing suicide attempt risk in adolescents with suicidal thoughts.

Nikogosyan, Gregory DO; Orias, Daniella BS; Goebert, Deborah PhD; Takeshita, Junji MD; Wang, Michele MDAuthor Information

BACKGROUND:There are few evidence-informed guidelines and findings to show that the use of sitters improves patient safety; overall, it is a costly intervention to address patients with disruptive behaviors.OBJECTIVE:The purpose of this article is to demonstrate that the creation of a multidisciplinary consultation-liaison (C-L) team, integrated with a psychiatric C-L team, together can decrease sitter use and improve outcomes using nonpharmacologic interventions.METHODS:This retrospective study describes the planning, implementation, and data collection using in creating an multidisciplinary C-L team to collaborate with the psychiatric C-L team and outcomes to support the approach. The multidisciplinary C-L team was composed of advanced practice registered nurses and creative art therapists. The teams worked closely with the medical units to develop and monitor criteria for sitter use. The key outcomes of the intervention improved patient safety and reduced overall cost.RESULTS:In the first year of implementation of a multidisciplinary C-L approach, sitter use decreased by 72%. Nonpharmacologic interventions improved patient outcomes by providing education to medical staff that enhanced the assessment and implementation of enhanced observer use across all the medical units. Subsequent data also reflect a sustained reduction in cost over the next 2-year period, saving the institution nearly $70K a month.CONCLUSION:An multidisciplinary C-L and psychiatric C-L team collaborated on the need for psychiatric medications, or nonpharmacologic interventions to address behaviors and decrease the need for an enhanced observer. The teams worked together to make policy revisions and algorithms and provide education, the result of which was significant financial savings and improved patient safety.

The authors present the development of the field of psychiatry with the evolution of patient safeguards. They address the recent publicized events involving sexual harassment and abuse perpetrated by mental health service providers who have harmed youth who were under their direct psychiatric care. Recommendations are provided for primary care physicians and parents and legal guardians to further ensure patient safety.

Suicide is a serious public health issue, particularly for Native Hawaiians and Other Pacific Islander youth living in rural communities in Hawai'i. The Hawai'i's Caring Communities Initiative (HCCI) for Youth Suicide Prevention was implemented to address these concerns and used a strength-based, youthleadership approach to suicide prevention. A qualitative study was completed with youth leaders and adult community coordinators to evaluate the impacts of participating in HCCI. Participants included 9 adult community coordinators and 17 youth leaders ages 13-18 years. Coordinator interviews took place at a location of the interviewee's convenience, and youth leader focus groups were conducted at 1 of 6 rurally-based community organizations. A team of university staff members coded transcripts using a narrative approach and grouped codes into themes. Five themes emerged that fit with an adapted socio-ecological model framework, which included increased knowledge in suicide risk, pride in leadership identity, sense of positive relationships, positive affirmation from community members, and sustainability. Future efforts that focus on youth-related issues are encouraged to integrate a youth leadership model and preventive approach while considering implications such as long-term funding and capitalizing on community strengths and resources.

Mental health continues to be a significant concern both globally and locally in Hawai'i, with nearly half of all mental illness beginning in childhood or adolescence. A shortage of mental health providers has led to less than a third of patients receiving appropriate and timely care. Primary care providers are often the first-line responders to untreated mental health conditions, but they are often underprepared to address these conditions. To help provide guidance to primary care providers and other first-line responders, a child and adolescent mental health resource manual was developed, that is tailored to Hawai'i. This manual was presented at several pediatric didactic sessions and general conferences to describe its evolution, utility, to elicit feedback, as well as for an initial distribution. While feedback was overall positive, future manual development and strategic updates will be made to insure its suitability and timeliness, while continuing circulation efforts to primary care providers will ultimately benefit a greater proportion of children in need.