We are a research team on teen and young adult suicide. With international experts, we identify risk and protective factors from large representative population samples in Canada, Europe, and Asia. We test the effectiveness of prevention programs using randomized controlled trials. We also inform public health policy on teen mental health issues.
The research team is led by Dr. Marie-Claude Geoffroy. She holds a Canada Research Chair Tier 2 in Youth Suicide Prevention. She is a professor in School and Applied Child Psychology and an Associate Member in the Department of Psychiatry, at McGill University. She is also a registered psychologist offering training in suicide risk assessment and brief interventions.
Suicide is increasingly a leading cause of death in teens and young adults in Canada and worldwide. Further, COVID-19 pandemic lockdowns have seen a 50% increase in hospital visits for adolescent suspected suicide attempts. There is unfortunately insufficient evidence to inform prevention. Teen suicidality is a challenging and complex issue.
Until recently, the field was hampered by short-term studies examining only the days/weeks preceding suicide. In accordance with the developmental origin of health and disease, our research focuses instead on longitudinal data: large epidemiological, representative population samples, followed from birth, in Quebec (Quebec Longitudinal Study of Child Development, Quebec Longitudinal Study of Kindergarten Children), Canada (National Longitudinal Survey of Children and Youth), UK (National Child Development Study, Avon Longitudinal Study of Parents and Children), and Asia (Korean Children and Youth Panel Survey). As a clinically trained psychologist-researcher in early career, Dr. Geoffroy leads our team of 11 graduate students and postdoctoral fellows, in partnership with multidisciplinary international clinician-scientists, in linking these databases to other administrative databases and to patients enrolled in randomized controlled trials. We further explore genetic and environmental interactions using a large genotype datasets. Our focus also extends to specific populations such as LGBTQ2S+ to inform personalized care. Results from these linkages, combined with heterogeneity in suicidal individuals, their unique developmental trajectories and unique risk/protective factors at multiple levels including individual, family, peer group, school, and community, will be key to developing and implementing successful preventive and therapeutic strategies.
Suicidal ideation and attempts – a call for action
Our team was the first to prospectively determine the prevalence of teen suicidal ideation and attempts: 22% reported thoughts about suicide, 10% seriously considered it, and 7% attempted (Orri et al., 2020). Half of attempters attempted again later in adolescence. They were more likely to have had symptoms of attention deficit and hyperactivity disorder (ADHD) in childhood or been exposed to someone’s suicide. Others, especially girls, attempted suicide only in adolescence and reported depressive symptoms in childhood. These two distinct groups would benefit from early, but differential, school/clinic intervention (Geoffroy et al., 2020). South Korea and UK are currently replicating our findings. We are now conducting the first systematic review documenting suicidality in preschool/elementary school children (ages 3-12 years).
Bullying, cyberbullying – suicide risk
We found higher rates of suicidal ideation and attempts in teens previously bullied (Geoffroy et al., 2016, JAACAP), particularly with chronic bullying by peers, independently of prior or concurrent mental health problems (Geoffroy et al., 2018, CMAJ). Cyberbullying was an even stronger determinant than face-to-face bullying (Perret et al., 2020, JCPP). A British cohort revealed associations with suicide up to 5 decades later (Geoffroy et al., 2021, submitted). For knowledge translation, we disseminated findings through international conferences (UK, Korea, US), podcasts (Canadian physicians), and lay articles (psychologists). Bullying/cyberbullying is common, often hidden from parents and teachers, modifiable through intervention, and requires vigilance to prevent scars months and years later.
Building resilience – community prevention
In Canada, the healthcare system lacks professional resources, psychotherapy is expensive and often not available in the public system, and mental health stigma can prevent youth from seeking care. While evidence-based interventions exist, many young people do not receive the care they need. Our search for alternate/complementary strategies demonstrated that physical activity (Pereira, et al., 2014), contact with nature (preliminary evidence), and strong social support (Perret et al., 2021, Scardera et al., 2020) can help coping and reduce suicidal ideation and attempts. Teens reporting higher levels of perceived social support were at 40% lesser risk the following year. We communicated findings to parents, teens, and professionals.
Early childhood problems – on pathway to suicide
In 2014, we linked information on 18,000 people born in UK in 1958, with death certificates to trace childhood origins of suicide (Geoffroy et al., 2014, 2018; Devantoy et al., 2020). This allowed identification, from birth, of people at highest risk of suicide. Notably, boys with severe disruptive problems at age 7 years were 4 times more likely to kill themselves 5 decades later. In subsequent studies with adolescents (Orri et al., 2018, 2019), we found attempted suicide risk 3-5 times higher in the presence of disruptive problems coupled with depression and anxiety. Disruptive behaviour, but not depression, predicted transitioning from ideation to attempts (Commissio et al., 2021). We are investigating whether a 1984 program for disruptive boys in Grades 1-2 in low-income neighbourhoods successfully reduced medical visits, costs, and suicide attempts by middle age (40-44 years).
Training psychologists in suicide assessment/intervention
Suicide assessment and intervention are some of the most complex processes psychologists face in their practice, but mandatory courses for Quebec and Canada licensing do not include such training. When offered, quality and quantity of training remain variable. To bridge the gap, we developed a comprehensive evidence-based workshop, with pedagogical clinical psychologists. After validation, if effective, this program should be widely implemented.
Informing policy on youth mental health
We advise governmental and non-governmental agencies on suicide prevention. Since 2017, we helped develop a Canadian Research and Knowledge Translation Agenda on Suicide and Prevention, co-led by the Public Health Agency of Canada and Mental Health Commission of Canada. With Wisdom2Action, we undertook a research and stakeholder engagement initiative to identify and confirm gaps in youth suicide prevention research. Dr. Geoffroy was recently named Director of the Mental Health Axis of the Observatory for Children’s Education and Health, a $5-million provincially funded centre on COVID-19 pandemic-related repercussions.
To summarize, in innovative and exciting research, we conduct prospective longitudinal cohort studies linked to administrative databases to discern trends and test hypotheses for teen suicide prevention. In addition to the Observatory, Dr. Geoffroy heads the McGill Division of the Research Unit on Children’s Psychosocial Maladjustment, an interdisciplinary research network of 50 researchers from 7 universities focusing on pediatric biopsychosocial development. Our team has authored 60 papers in high-impact peer-reviewed journals. We aim to collaborate widely with national and international experts and decision-makers from various spheres to strive for new advances and applications for day-to-day knowledge transfer in reducing teen death and improving mental health and quality of life.