Drawing on a landmark 25-year study that followed Quebec children into adulthood, McGill University researchers have identified two distinct patterns in how suicidal thoughts emerge and the early signs that are often missed.
Suicidal thoughts are increasingly common among youth, but how they begin and what mental health symptoms often precede them are poorly understood, the researchers said.
The study, published in JAMA Psychiatry, analyzed data from the Quebec Longitudinal Study of Child Development, one of only two studies in the world to follow a large group of young people over time and repeatedly track suicidal thoughts.
While most of the 1,600 youth in the study never or rarely reported suicidal thoughts, there were two clear pathways among those who did: about seven per cent began experiencing suicidal ideation in early adolescence (ages 12 to 13), while another five per cent first reported such thoughts for the first time as young adults (ages 20 to 25).
In the early-onset group, many had shown signs of mental health struggles in childhood. These included symptoms like disruptive behaviour, which tend to be more noticeable (external symptoms), and depression and anxiety, which are often harder to detect (internal symptoms).
"A striking finding is that parents and teachers often noticed the behavioural problems but overlooked the internal emotional distress," said lead author Marie-Claude Geoffroy, associate professor in McGill's Department of Psychiatry, researcher at the Douglas Research Centre and Canada Research Chair in Youth Suicide Prevention.
In contrast, those whose suicidal thoughts began in young adulthood typically showed only internal symptoms, starting in their teen years.
"When taken seriously, these warning signs can lead to early interventions that could help safeguard children's development," said co-author Charles-Édouard Notredame, a child and youth psychiatrist at Lille University Hospital.
Age-appropriate support, including mental health programs in schools, could be especially effective in reaching children and teens at the right time, before suicidal thoughts take hold, he added.
Suicide is the second leading cause of death among youth and young adults in Canada, according to national data.
"Suicidal ideation in youth is still too often dismissed as a 'phase' that will pass," said Geoffroy. "Our findings highlight the need to start suicide prevention early'
About the study
"Mental Health Antecedents and Correlates of 2 Distinct Developmental Pathways to Suicidal Ideation" by Marie-Claude Geoffroy, Sasha MacNeil and Vincent Paquin et al., was published in JAMA Psychiatry.
This research was supported by Quebec's ministries of Health, Families, Education and Higher Education, the Lucie and André Chagnon Foundation, the Institut de la statistique du Québec, the Fonds de recherche du Québec, the Social Sciences and Humanities Research Council of Canada and the Canadian Institutes of Health Research.
