Current Studies

Developing Data-Driven Clinical Signatures for People Who Experience Hallucinations

Award Date: 04/2024

Co-Investigator: Benjamin Buck
Principal Investigators: Dror Ben-Zeev and Trevor Cohen (University of Washington)

Hallucinations affect 10% of the general population and are common features of a number of mental health disorders. At the same time, a large proportion of the population of individuals who experience hallucinations do not have a mental health diagnosis and are otherwise healthy. Assessment strategies – that were largely developed for already-diagnosed clinical populations – are limited in their predictive capacity to distinguish between hallucinations that will lead to significant negative outcomes and those that will not. Our team uses novel multi-modal data collected through participant smartphones – including brief surveys, verbal memory tasks, and audio diaries – to develop novel signatures to predict outcomes for individuals experiencing hallucinations.

mHealth for Early Psychosis Caregivers in Statewide Program Outreach (Bolster-NC)

Award Date: 07/2025

PI: Benjamin Buck, PhD

Early intervention is critical for youth at risk for psychosis. A key component of specialty interventions for early psychosis is family psychoeducation for caregivers, who are critical to supporting treatment engagement and recovery. The involvement of a supportive caregiver is robustly associated with increased treatment engagement, improved symptoms, and reduced risk of relapse. Caregivers often lack support and many – especially those from rural and low-resource communities – face unique barriers to services. Digital health can remove barriers to family interventions, and mobile health (mHealth) is optimized for scalable delivery. Our team previously conducted a user-centered design and development process to build Bolster, an MHealth intervention designed to provide psychoeducation, communication coaching, and coping support for caregivers to young adults with early psychosis. In a previous trial, Bolster demonstrated efficacy in improving caregiver communication skills, reducing caregiver distress, and increasing treatment engagement for the identified patient. This pilot study integrates Bolster into the outreach activities of Early Psychosis Interventions of North Carolina (EPI-NC), a clinical training and technical assistance initiative focused on supporting the network of evidence-based coordinated specialty care programs around the state of North Carolina. In addition to providing Bolster to a sample of caregivers, this study collects data on recruitment, outreach and implementation to inform planned future studies focused on the delivery of digital mental health for family caregivers.

Neurobiological mechanisms of susceptibility to estradiol fluctuation in female adolescents at risk of suicide: An experimental approach

Award Date: 04/2025

PI: Elizabeth Andersen, PhD

Rates of suicidal ideation and attempts increase dramatically at the adolescent transition, particularly among females, yet remarkably little is known about why. With suicide being a leading cause of death in adolescents, identifying early risk factors is critical for informing prediction and prevention efforts and will have a major health impact. This study examines depressive symptoms and underlying brain circuitry involved in emotional processing during naturally fluctuating estradiol change, and during the experimental stabilization of estradiol in female adolescents at risk of suicide.

The long arm of grief: A longitudinal study of mental health and support-seeking among bereaved parents and children

Award Date: 05/2025

PI: Natalie O’Brien, PhD

Parental bereavement following the death of a co-parent can profoundly disrupt family functioning, yet very little is known about how grief, mental health, and parenting evolve over the long term or how these changes shape children’s adjustment. This project builds on the largest national study of widowed parents to date to examine long-term trajectories of grief, depression, PTSD, and parenting self-efficacy among surviving caregivers five to ten years after their loss. The study also investigates how these caregiver experiences influence and are influenced by the well-being of their children. Through a nationwide survey of more than 500 widowed parents and in-depth qualitative interviews with suicide-bereaved caregivers, this work will identify the social, psychological, and structural factors that hinder recovery or promote resilience and posttraumatic growth. Findings will inform future intervention development and policy efforts aimed at improving long-term support for bereaved families.

Neural networks underlying preteen social motivation: A novel risk factor for preteen suicide

Award Date: 04/2025

MPIs: Adam Bryant Miller and Andrea Pelletier Baldelli

Every preteen will face interpersonal stress, however, only a very small number of them will begin to think about suicide and make a suicide attempt. Puberty leads to brain changes that specifically orient youth towards feedback from their peers and motivate them for social relationships. Earlier onset of puberty relative to peers is thought to disrupt this normative developmental process and generate increased risk for mental health challenges, including suicide. This project investigates how the timing of puberty in preteen girls may influence how their brains develop and support their motivation to engage in social relationships. We also will investigate whether their brain functioning during the pubertal transition helps us understand who will develop self-injurious thoughts and behaviors (STBs). To do so, this study recruits 80 preteen girls between the ages of 8-11 from a larger study of 200 girls already underway at UNC. Girls in this proposed investigation will participate in a neuroimaging scan. We will combine their brain data with hormone data from saliva and behavioral assessments to map early suicide risk trajectories.

Community-driven Approaches for Resilient and Empowered Youth

Award Date: 03/2025

Leadership Team: Danielle Roubinov, Cope Feurer, Michael Welker (UNC School of Government), Abigail Holdsclaw (UNC School of Government)

Half of all chronic mental illness begins by age 14, and more than 1 out of every 10 children will experience a severe mental health disorder. In North Carolina, approximately 300,000 young people will develop a psychological health problem before adolescence. This challenge is underscored by the number of youth experiencing acute psychiatric crises: In the last 12 months, 10% of North Carolina high

school students attempted suicide. Although communities are committed to improving youth mental health, implementation of evidence-based approaches remains a significant issue. In other words, it may be clear what to do, but difficult to determine how to do it. This grant creates CARE4Youth (Community-driven Approaches for Resilient and Empowered Youth), a cohort of 10 communities in North Carolina across 18 counties that will learn practices for engaging with vulnerable youth and aligning local behavioral health resources to create supportive systems of care designed for, and with the participation of, young people in North Carolina.

Comparative Effectiveness of Two School-Based Suicide Prevention Programs in Rural and Urban School Systems in the United States

Award Date: 12/2025

PI: Dorothy Espelage and Marisa Marraccini (UNC School of Education)
Co-Investigators: Drs. Adam Miller and Danielle Roubinov

Suicide is the second leading cause of death in U.S. adolescents. Schools are optimal environments for implementing universal suicide prevention, as programs can reach youth equitably and can be delivered in a critical developmental period: before or early in the typical onset period of mental illnesses. Several school-based suicide prevention programs have been shown to significantly reduce suicide attempts among middle and high school students, but the most promising evidence-based programs, Signs of Suicide (SOS) and Youth Aware of Mental Health (YAM), have never been directly compared. This project compares SOS and YAM to determine which evidence-based universal suicide prevention approach works best to reduce suicide attempts in middle and high school students. The research team also engages partners, including youth with lived experience, parents, healthcare providers, educators, school administrators, and policy makers in study design, implementation, analysis, dissemination, and sustainability, and will assess student, teacher, and administrator satisfaction with the interventions.

Developing a Scalable Digital Program to Treat Youth Anxiety

Award Date: 03/2025
PI: Danielle Roubinov, PhD
Anxiety disorders are prevalent and impairing mental health conditions during childhood. Although anxiety is effectively treated with exposure therapy, stark shortfalls in the availability of trained mental health providers mean that many youth cannot access care. The current project will adapt a face-to-face treatment program for youth anxiety into a scalable, self-paced digital program in which youth can engage regardless of geographic area.

Peripubertal social motivation as a novel risk factor linking childhood threat exposure and suicidal ideation and behavior in preteen girls.

Award Date: 09/2024
PI: Andrea Pelletier-Baldelli, PhD; Adam Bryant Miller, PhD
Suicide is the second leading cause of death in youth aged 10-12, and recent years indicate a particular rise in suicidal thoughts and behaviors in girls. This research study is among the first to examine risk trajectories and mechanisms that increase risk for preteen suicide in girls. Findings will help link distal risk factors (i.e., childhood abuse) and potential proximal risk factors (i.e., maladaptive social motivation and advanced pubertal timing) to inform a better understanding of the developmental pathways to suicide risk.

Stress Trajectories and Anhedonia in Adolescence Research Study (STAARS)

Award Date: 07/2024
PI: Danielle Roubinov, PhD; Ayse Belger, PhD
Anhedonia (the loss of interest or pleasure in things that were previously enjoyable) is a potent risk factor for depression and other mental health problems that emerge in adolescence. This study will collect biological, psychological, social, and neuroimaging data repeatedly across a two-year period from adolescents who experience higher or lower levels of anhedonia and their caregivers to better understand how to prevent and intervene in the onset and trajectory of anhedonia.

Identifying Novel Biological Profiles of Early Risk and Intervention for Mood Disorders in Adolescents: Mapping Stress-Responsive Changes in Electrocortical Indices in Adolescent Anhedonia

Award Date: 04/2024
PI:Cope Feurer, PhD; Danielle Roubinov, PhD; Ayse Belger, PhD
Anhedonia is a core symptom of depression that often emerges in adolescence and predicts future depression onset and severity. Interpersonal stress plays a key role in the development of anhedonia, yet not all youth exposed to stress develop anhedonia. Thus, there is a critical need to identify mechanisms that increase risk for anhedonia when youth are exposed to interpersonal stress. This study will identify novel biological profiles that reflect distinct patterns of neural and physiological responses to stress and will examine which biological profiles predict increased risk for adolescent anhedonia.

Identifying Modifiable Risk Factors Associated with Suicidality in Adolescents Following Acute Psychiatric Hospitalization

Award Date: 04/2024
PIs: Adam Miller, PhD and Danielle Roubinov, PhD
Youth who experience an acute inpatient hospitalization are at particularly high risk of suicide in the weeks and months following hospital discharge. However, there is limited information about the factors that heighten or reduce risk for suicide during the post-hospitalization period. This study will collect critical data on suicidal thoughts and behaviors, psychiatric symptoms, and perceptions of the hospital experience from youth during and after an inpatient stay at the recently opened UNC Youth Behavioral Health (YBH) hospital. This information will further our understanding of modifiable factors that reduce youth risk for suicide following hospital discharge.

Resilience through Interventions for Successful Early Outcomes (RISE)

Award Date: 01/2024
PI: Danielle Roubinov, PhD
Adversity exposure in childhood is one of the most significant predictors of poor health and development. Early trauma impacts children’s stress-sensitive biological systems, resulting in “wear and tear” on the body, with effects that may persist across the life course. With partners from the UNC Child Medical Evaluation Program (https://www.med.unc.edu/pediatrics/cmep/) and Center for Child and Family Health (https://www.ccfhnc.org/), this project will deliver an evidence-based intervention to children and their families who have been exposed to adversity. Before and after treatment, we will collect non-invasive measures of children’s stress functioning to understand how treatments may “repair” the biological harms of adversity exposure and explore factors that make some children more likely to respond to treatment.

For more information about this study and to see if you may be eligible, click here.

Supporting Healthy Individuals through Nurturing Environments (SHINE)

Award Date: 12/2023
PI: Danielle Roubinov, PhD
Children whose parents were exposed to severe trauma – including sexual violence – are at elevated risk for posttraumatic stress disorder. Current research on trauma is narrowly siloed into two categories: 1) research on adult trauma exposure and its effects on adult mental health 2) research on child trauma exposure and its effects on child mental health. Scarce research bridges these two literatures to examine how exposure to parental trauma impacts parenting and mental health risk in offspring. The present study will recruit 100 mother-child dyads consisting of an adult woman who received emergency care after sexual assault and her offspring ages 8-14 years. Families will be followed for 6 months and will provide data on parent and child mental health, coping, parenting, and other aspects of the family environment. Results will be used to identify modifiable risk factors for youth mental health problems after caregivers are exposed to traumatic stress and develop prevention and intervention programs.

The Life Experience and Emotion Development Study (LEED)

Award Date: 09/2023
PI: Adam Bryant Miller, PhD; Caroline Oppenheimer, PhD
For some youth, risk factors for suicide may emerge early in life. This research study is among the first to explore how and when self-injurious thoughts and behaviors (STBs) emerge in young children during middle childhood. Findings will help identify potential risk factors and mechanisms that may serve as intervention targets for preventing STBs and reducing distress early in development.

Implementing and Evaluating a New Evidence-Based Intervention for Youth Anxiety and Depression into a Pediatric Primary Care Setting

Award Date: 09/2023
PI: Danielle Roubinov, PhD
Child and adolescent mood and anxiety disorders are common and there is a shortage of trained mental health care providers who can provide care. Brief, research-backed programs that are delivered in primary care settings can increase access to effective services. A brief intervention may be a “stand alone” approach to treating symptoms, or may the first step before more intensive care is delivered. First Approach Skills Training (FAST) is a suite of brief interventions that have been adapted from longer evidence-based programs to treat pediatric anxiety and depression. In partnership with two UNC pediatric primary care clinics we are conducting a proof-of-concept study to test the feasibilty and preliminary effects of FAST for anxiety (FAST-A) and depression (FAST-D). Results will be used to refine and expand FAST programs to other settings within and outside of UNC.

Learn more information about the FAST program.

Does Social Motivation in Adolescence Differentially Predict the Impact of Childhood Threat Exposure on Developing Suicidal Thoughts and Behaviors?

Award Date: 09/2023
PI: Andrea Pelletier-Baldelli, PhD
Childhood threat exposure (e.g., family/community violence) is a key risk factor for developing suicidal thoughts and behaviors; yet, not all adolescents with childhood threat exposure develop these symptoms. Disruptions to social motivation – the motivations driving the desire and effort to socially interact – may play a role in differentiating suicide risk. The current study will identify whether maladaptive social motivation presentations during adolescence moderate the link between childhood threat exposure and suicidal thoughts/behaviors in an effort to improve risk identification and mechanistic targets for interventions.

Teens, Emotions, and Social Interactions Study

Award Date: 09/2022
PI: Cope Feurer, PhD

Risk for major depressive disorder (MDD) dramatically increases during adolescence, particularly for females, and although interpersonal stress generation is an established risk factor, it is essential to clarify the underlying mechanisms to improve early detection and prevention of depression risk. The current study will utilize a multi-wave prospective design to examine neural and real-world affective reactivity to negative social interactions as prospective predictors of interpersonal stress generation and subsequent increases in depression symptoms in female adolescents at elevated risk for depression. Ultimately, the elucidation of brain and behavioral mechanisms underlying interpersonal stress generation and subsequent depression risk in female adolescents may contribute to greater understanding of the etiology of adolescent depression and aid in identifying novel targets for intervention.

For more information about this study and to see if you and your teen may be eligible, click here.

Autistic Adults and other Stakeholders Engage Together – Suicide Prevention

Award Date: 08/2022
PI: Shari Jager-Hyman, PhD; Danielle Roubinov, PhD
Suicide is the second leading cause of death among young people. Autistic individuals are at elevated risk for experiencing suicidal ideation and are more likely to die by suicide as compared to the general population. This multi-site cluster radnomized controlled trial compares the effectiveness of two tailored approaches to suicide prevention among autistic youth: SPI-A delivered in a single encounter and SPI-A+, a multi-component intervention.

Learn more information about this project.