Dec. 1, 2025
Unfinished Business
Forty years in, one of the most significant researchers and clinicians working to prevent suicide in young people wants to do still more.
TOPICS: Neuro & Cognitive Science | School of Medicine
Inspired By Life-Affirming Work
By Mark Roth and Erica Lloyd
Long before he became a world-renowned expert on teen suicide prevention, David Brent’s career was shaped by two men—his younger brother and the parent of one of his first patients.
In 1980, Brent’s 26-year-old brother, James, died suddenly from an apparent cardiac arrhythmia while playing basketball. James was a brilliant jazz pianist and composer, and Brent says his loss made one of their conversations indelible.
“I asked him one time what other composers he was listening to, and he said, ‘The music I want to hear hasn’t been written yet. And I’m going to write it.’”
And the parent’s comment? Early in his career, Brent sent one of his young patients with suicidal thoughts to the psychiatric ward. He let another patient go home. In a 2022 address about his career, Brent recalled that the “father of the first child said, ‘I’ve been watching these two kids, and I don’t see much of a difference. What made you decide that my daughter was the one who needed to go to the hospital?’ I muttered something about patient confidentiality but recognized that I really didn’t have a good answer. When I went to the library, I learned that this was not just my problem, it was the field’s as well. No one knew how to assess suicidal youth!”
From that point on, Brent decided to try to find systematic answers to why young people killed themselves and to find effective ways to keep those tragedies from happening. In his own way, he was determined to write the music that hadn’t yet been heard.
In a career of more than 40 years at the University of Pittsburgh, Brent has become one of the premier experts on teen depression and suicide, advancing many of the interventions now used around the world. In acknowledgement of that, Brent, Distinguished Professor of Psychiatry and Professor of Suicide Studies, School of Medicine, will receive the American College of Psychiatry’s 2026 Award for Leadership in Child, Adolescent and Young Adult Psychiatry.
Compared with many other areas of psychiatric research, the scientists who study suicide are a relatively small group, perhaps because of how stressful the discipline can be.
Suicide remains the second leading cause of death in the United States among teens and young adults, behind accidents. And after several years of declining rates, teen suicide has been climbing since 2005. It is a particular risk for Native American, Black and LGBTQ+ youths.
For young people between the ages of 10 and 24, the death rate from suicide is 11 per 100,000, according to the Centers for Disease Control and Prevention. Overall, that works out to about 7,000 young people killing themselves each year, or one every hour and 15 minutes. Although homicide rates also have been rising among young people in the United States, suicide has been a greater cause of death in recent years.
The rising suicide rates have contributed to Brent’s sense that he still has unfinished business and are part of the reason he is still an active researcher at a time when many colleagues in his generation have retired. A short list of Brent and his team’s accomplishments:
Psychiatric autopsies: To examine in granular detail why young people were killing themselves, Brent and his team began talking decades ago with family and friends to understand the context of those decisions at the individual level. Working with former Allegheny County Coroner Joshua Perper, Brent’s group was able to discern several common factors that existed in youth suicide cases.
If a young person had a substance abuse problem and a diagnosed psychiatric condition like bipolar disorder or depression, for instance, the combination made suicide more likely. Bipolar disorder on its own was shown to be a major risk factor.
They also learned that for young people without a history of psychological problems, access to firearms was a major risk factor, making an impulsive attempt much more deadly.
STAR: Brent and Mary Margaret Kerr, now emerita professor of psychology at Pitt, cofounded the Services for Teens at Risk (STAR) Center nearly 40 years ago to provide treatment to suicidal youths, training for clinicians and educators, and consultation and outreach to schools. The center has carried out dozens of research projects through the years.
One highly cited 2007 study by Brent and his colleagues showed that even though taking antidepressants increased the risk of suicide for some teens, the overall benefits of medication for depression, obsessive compulsive disorder and anxiety vastly outweighed that risk.
"If people ask why I work in this field, I say, what could be more life-affirming than to try to help people realize their own value and that we need them here."
David Brent, Distinguished Professor of Psychiatry and Professor of Suicide Studies
Another, published in 2002, showed that the children of parents who had a psychiatric disorder or had attempted suicide were much more likely to try to kill themselves than other youths.
Applications of cognitive behavioral therapy: STAR also looked for the most effective forms of psychotherapy for depression and was an early champion of treating those at risk of suicide with cognitive behavioral therapy (CBT), which works to reverse destructive thought patterns.
Today, STAR is co-led by Tina Goldstein, The Pittsburgh Foundation Professor of Psychiatry Research and one of Brent mentees, and the center is working on new ways of monitoring suicide risks and intervening to prevent tragedy.
The center’s BRITE mobile app encourages young people to check in regularly to report their mood and whether they’re thinking about harming themselves and is especially designed to help teens who have just been released from a psychiatric hospital, which is one of the riskiest periods for suicide.
A STAR study in 2025 showed that teens who used the app had fewer new suicide attempts than those who didn’t have the app, especially if they were hospitalized for a suicide attempt.
Another major initiative, in partnership with Children’s Hospital of Philadelphia and other institutions, is the ETUDES Center, directed by Brent. ETUDES pursues a series of studies using technologies designed to help pediatricians intervene with young people at risk for suicide. “The vast majority of kids don’t make it to specialty care, but most will make it to a pediatrician once a year,” Goldstein says. “We now recognize more mental health screening is happening in these pediatric visits.”
ETUDES has enrolled about 800 young people in Pennsylvania who scored high on an assessment of depression and thoughts of self-harm, she says, and is conducting several studies using this group. ETUDES uses mobile apps, text messaging and clinician decision-support tools for the electronic health record.
Through the years, Brent has mentored a constellation of researchers who study mood disorders and suicide in young people. Some have remained at Pitt. Some lead programs at other institutions. Most continue to be part of Brent’s professional family.
Nadine Melhem, professor of psychiatry, School of Medicine, and of clinical and translational science at Pitt, first met Brent when she was working on her doctoral dissertation about prolonged grief in children whose parents had died.
His mentorship inspired her to focus on the biological mechanisms that make some young people more likely to attempt suicide. She found that children who attempt suicide often have lower levels of the stress hormone cortisol than other teens. That might seem counterintuitive, but research shows those young people also react more strongly to stressful events; and since suicide is usually an impulsive decision, that can heighten their risk.
“David has made so many contributions,” she says. “He really has changed the field.”
Goldstein says one way Brent shaped her career was in showing how treating real-world patients could provide the ideas for research studies, and the studies in turn shape the best way of providing treatment. In most areas of adolescent psychiatry, doctors tend to either be clinicians or researchers but not both, which is part of what makes Brent and his trainees stand out. Goldstein is known for her contributions to understanding and treating bipolar disorder in youths; she leads UPMC Western Psychiatric Hospital’s bipolar youth service with Boris Birmaher, Distinguished Professor of Psychiatry and UPMC Professor of Early Onset Bipolar Disease, School of Medicine, as well as Services for Teens at Risk.
Throughout the past 15-20 years, the youth suicide rate has steadily escalated, wiping out the gains made during the 1990s and early 2000s. Brent wants to know what’s going on and how to reverse it.
He has speculated that an increase in “deaths of despair”—including opioid overdoses among parents—may be one factor fueling the increase in youth suicide. Other social stressors have also changed in recent decades, he says. Today, social media consumes teens’ attention far more than it used to. Cannabis has become legal. Guns are more widely available. For many, puberty begins earlier, and sleep deficits are worse.
For all those reasons, Brent thinks it’s high time to update the psychiatric autopsy research technique to try to discover what factors are driving the increase in suicides.
If there is a verifiable link to deaths of despair among parents, it may suggest that family therapy will be needed to lower the risk of suicide among children.
Brent also thinks poor sleep among teens is an underrecognized risk factor. “Sleep problems make everything else worse. The evidence is pretty clear that if you are sleep deprived, you tend toward more negative thoughts, and you’re more sensitive to slights.”
Looking ahead, Brent sees hope in the use of machine learning to, with permission, monitor young people’s social media accounts and their medical records to pick up on early signs of suicidal thoughts or plans.
The Beckwith Institute and the National Institute of Mental Health have funded a project at Pitt that is developing such an algorithm.
One comforting lesson Brent has learned from a lifetime in this field is that, for teens who were treated through STAR, very few went on to kill themselves. They got the help they needed to make it past those critical, fleeting moments that could have turned into tragedy.
“If people ask why I work in this field, I say, what could be more life-affirming than to try to help people realize their own value, and that we need them here,” he says.