Suicidal Behaviour Protective Factors in Adolescents

This supplement provides The Canadian Journal of Psychiatry readers with 6 articles in clinical research about protective factors of suicidal behaviours in adolescents, while also considering depression and borderline personality disorder (BPD), 2 psychopathologies commonly associated with these behaviours. Wishing to disseminate their research findings in North America, authors from France and Quebec wrote their papers in English. This supplement is the result of a Franco–Quebecer academic cooperation started in 2005 at the Clinique des troubles de l’humeur of Rivière-des-Prairies Hospital (Université de Montréal). It was carried out in France with the Service de psychiatrie de l’enfant et de l’adolescent of l’Hôpital Pitié-Salpêtrière (Université Pierre et Marie Curie), Centre Hospitalo-Universitaire in Rouen (Université de Rouen), Centre Hospitale in Rouvray, and Centre Hospitalo-Universitaire in Amiens (Université de Picardie Jules Verne) and in Quebec with the Depressive Disorders Program of Douglas Mental Health University Institute (McGill University) and Clinique réseau jeunesse of Institut Philippe-Pinel (Université de Montréal).

This child psychiatry network dealing with suicidal behaviours and associated pathologies was funded, from 2006 to 2012, by the Commission permanente de coopération Franco-Québécoise (Franco–Quebecer cooperation standing commission). It was managed in Quebec and France by Professors Jean-Jacques Breton, David Cohen, Réal Labelle, and Jean-Marc Guilé. This network allowed for student exchanges, measure instrument sharing and validation, national and international scientific communications, and finally, a research data collection in Quebec and France, where it was facilitated by Professor Priscille Gérardin.

But why this interest for protective factors in depression, BPD, and suicidal behaviours in adolescents? Three reasons guided this search:

1. a concern for promoting a more valid approach in child psychiatry, which would target all factors affecting mental disorder, as protective factors and risk factors are closely related¹;

2. depression has become the main cause of incapacity worldwide²;

3. and depressive disorders chronicity raises a concern about recurrence as early as illness onset, anticipating a positive impact from interventions on protective factors, although we do not yet have conclusive findings.

A stress-vulnerability-resilience model, where risk factors contribute to stress vulnerability while protective factors promote resilience is proposed in the first article³ by the Clinique des troubles de l’humeur team at Rivière-des-Prairies Hospital. Risk variables are stressful life events depression, hopelessness, and nonproductive coping strategies, while protective variables include productive coping strategies, reasons for living, and spirituality. This first article based on Quebec data outlines the present pattern of interactions between different risk and protective factors in adolescents experiencing stressful events, taking sex into account. Results are generally as expected but are meaningful only when protective factors measure instruments are valid.⁴ The work done on psychometric qualities in French versions of the Adolescent Coping Scale, the Reasons for Living Inventory for Adolescents, and the Spirituality Scale is the subject of the second article⁴ by Quebec colleagues, which addresses the rationale for choice of instruments, as well as the construct reliability and validity, and the convergence validity that have shown to be appropriate.

Our French colleagues have conducted 3 studies of inpatient adolescents with a suicide attempt in 5 French pediatry units. This is a high-risk clinical population. The multicentre study is part of a longitudinal perspective, specifically relevant for appraising the suicidal risk evolution, as well as the post-hospitalization impact of management strategies. The evaluation of these strategies will be presented in later publications. Colleagues in Groupe Hospitalier Pitié-Salpêtrière propose an explanatory model predicting suicidal risk, 6 months after hospitalization for a suicide attempt.⁵ Beyond the risk factors burden, a protective factor emerges: working hard to succeed. Findings on spirituality differ from those observed in Quebec, which raises an interesting discussion on this concept between France and Quebec authors.

Two articles^6,7 where coping is targeted as a protective factor for inpatient adolescents with a suicide attempt follow. The team at Centre Hospitalo-Universitaire de Rouen shows clearly that productive coping strategies are associated with lower depression scores. Focusing on a positive strategy is protective of depression and suicidal ideas, as it is in Quebec. Moreover, colleagues at Centre Hospitalo-Universitaire d’Amiens shed new light on suicidal adolescents with a BPD. Results meet expectations for adolescents with or without a BPD, but the problem-solving strategy is associated with the presence of suicidal ideas immediately following the suicide attempt.

The supplement ends with a research paper on a fundamental aspect of clinical research, conducted at the Depressive Disorders Program of Douglas Mental Health University.⁸ The inter-informant agreement on internationally used measures detecting mental health problems is evaluated. These measures are the Child Behaviour Checklist (CBCL) and the Youth Self-Report (YSR). The agreement between adolescents (YSR) and their parents (CBCL). Our colleagues show that this agreement between them varies based on sex, age, and skill type.

To conclude, the clinical reality of a depressed and suicidal adolescent is indeed complex. The supplement authors wish that their contribution from different angles of protective factors will allow readers to increase their knowledge, deepen their thoughts, and be inspired.

Both Guest Editors sincerely thank The Canadian Journal of Psychiatry Editors-in-Chief and Canadian Psychiatric Association Director of Scientific Publication for their understanding and their constant support in the making of this supplement.