Objectives This scoping review examines randomised controlled trials (RCTs) for young people with depression to explore three key questions: (1) Do RCTs for young people with depression exclude participants based on risk of suicide or self-harm? (2) How is this risk monitored throughout the course of the trial?
and (3) When risk is identified, how is this risk managed throughout the RCT? Design This project used a scoping review methodology and was conducted in accordance with guidance in the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement.
Data sources Four electronic databases (PsycINFO, Ovid MEDLINE, PsychARTICLES and Embase) were searched with sets of search terms. Eligibility Included studies were RCTs evaluating interventions for depressive symptoms in young people (age 18 or under).
Studies published between 1988 and 2025, and in English, were included. Data extraction Papers retrieved were independently screened by two reviewers, first by title and abstract and then full text, in accordance with eligibility criteria.
Relevant data were then extracted. Results 89 studies were included.
This scoping review mapped how randomised controlled trials (RCTs) of interventions for depression in young people address suicidal behaviour and non‑suicidal self‑injury (NSSI).
The authors aimed to determine whether trials exclude participants on the basis of suicide/NSSI risk, how trials monitor such risk during the trial, and how identified risk is managed within trial procedures.
The work used a scoping review methodology aligned with PRISMA guidance.
Four electronic databases (PsycINFO, Ovid MEDLINE, PsychARTICLES and Embase) were searched with predefined terms.
The protocol was registered on the Open Science Framework before conducting the search.
Included studies were RCTs of interventions targeting depressive symptoms in young people aged 18 years or under, published in English between 1988 and 2025.
Two reviewers independently screened titles/abstracts and full texts against these criteria; relevant data were then extracted from eligible reports.
Eighty‑nine trials met inclusion.
Across these trials, just over half excluded potential participants at screening or baseline because of suicide or self‑harm risk (49/89; 55.06%), and a small subset reported that exclusions on this basis accounted for more than 10% of screened participants (four studies).
Less than half of trials reported any monitoring of suicide/NSSI risk during the study period (36/89; 40.45%).
Among trials that reported monitoring, psychometric instruments were the dominant method (24/36; 66.67%).
Where risk was identified, most trials that monitored risk implemented active management strategies.
These included referral to external clinical services (12/36; 33.33%) and additional clinical involvement from trial personnel (9/36; 25%).
The review presents these proportions but does not provide details of specific instruments, thresholds, or algorithms used.
The authors interpret these findings as indicating variability and limited transparency in how RCTs for youth depression handle suicide/NSSI risk.
They argue that clearer, more consistent reporting of exclusion criteria, monitoring procedures, and management pathways is needed to foster replicability and to align trial conduct with expectations for safety and applicability to clinical settings.
The source provides proportions and broad categorizations but does not report detailed content of trial risk protocols, consistency across settings, or the effectiveness of the management approaches.