Abstract
<title>Abstract</title> <p>Background Youth suicidal thoughts and behaviors (STBs), non-suicidal self-injury (NSSI; Curtin, 2020), and psychiatric hospitalization have risen nationwide (CDC, 2025). Youth with an anxiety disorder are eight times more likely to experience STBs than the general population (Boden et al., 2007). A downstream effect of this trend is that youth with a history of STBs/NSSI are more likely to present to outpatient settings for treatment of anxiety and obsessive-compulsive disorders (OCD). However, little empirical data exist on the prevalence and characteristics of youth with these safety concerns who are admitted to specialty outpatient anxiety clinics, including intensive outpatient anxiety programs (IOPs). This gap limits clinicians specializing in youth anxiety and OCD to meet the needs of this growing population. Methods Intake data from patients (N = 123; 2020–2023) at an anxiety cognitive behavioral therapy (CBT) IOP for youth with a primary anxiety disorder or OCD was coded and analyzed. Frequency analyses were conducted on patient-reported STBs, NSSI, and psychiatric hospitalization. Correlational analyses were conducted to better understand relationships between these presenting problems and diagnoses. Results 57.91% of patients endorsed STBs, 34.95% endorsed past psychiatric hospitalization, and 39.83% endorsed NSSI. Significant positive correlations were found between hospitalization and a higher number of diagnoses as well as between STBs and NSSI. Chi-squared tests found that social anxiety disorder (SAD) was significantly associated with higher STBs and NSSI. Panic disorder (PD) was trending significant in terms of associations with STBs and NSSI. Hospitalization was significantly correlated with STBs and NSSI. Conclusion In this study, the majority of youth presenting for anxiety disorder or OCD treatment in an IOP setting endorsed a history of STBs, over one-third reported prior hospitalization and 39.5% reported NSSI, documenting a trend towards elevated clinical complexity and increasing functional interference in patients presenting with anxiety and related disorders. These results also support prior research with adults on the association between PD and SAD with STBs and NSSI. Collectively, they highlight the importance of training clinicians working in anxiety outpatient settings to effectively identify and treat STBs/NSSI among youth with anxiety disorders and suggest avenues for future research to modify and evaluate evidence-based treatments to better meet the needs of today’s anxious youth.</p>