Implementing a Suicide Audit in Montreal: Taking Suicide Review Further to Make Concrete Recommendations for Suicide Prevention.

OBJECTIVE: A suicide audit was pilot implemented in order to generate recommendations on how to improve suicide prevention. METHODS: Thirty-nine consecutive suicides that occurred in Montreal, Canada from January to October 2016 were audited. A retrospective analysis of their life trajectory and service utilization was conducted using the psychological autopsy method, which included interviewing suicide-bereaved survivors and examining health and social services records and the coroner's investigation file. A psychosocial and service utilization profile was drawn for each decedent. A multidisciplinary panel reviewed each case summary to identify gaps in terms of individual intervention, provincial public health and social services, and regional programs. RESULTS: Five main suicide prevention recommendations were made to prevent similar suicides: (1) deploy mobile crisis intervention teams (short-term, high-intensity, home-based treatment) in hospital emergency departments; (2) train primary and specialized mental health care professionals to screen for and manage substance use disorders; and (3) implement public awareness campaigns to encourage help seeking for depression and substance use disorders; (4) access for all, regardless of age, to an effective psychosis treatment program; and (5) provide universal access to a general practitioner, especially for men. CONCLUSIONS: The suicide audit procedure was implemented effectively and targeted recommendations were generated to prevent similar suicides. However, resistance from medical and hospital quality boards arose during the process, though these could be allayed if regional and provincial authorities actively endorsed the multidisciplinary and multi stakeholders suicide audit process. HighlightsA bottom-up approach to generate recommendations for suicide prevention.Implementation was challenging with resistance to our interdisciplinary approach.The audit needs the support of the regional health department to lift barriers.

Being pro-active in meeting the needs of suicide-bereaved survivors: results from a systematic audit in Montréal.

BACKGROUND: Suicide is a major public health concern. In 2017, the suicide rate in Canada was 11 per 100,000 inhabitants. According to literature, 1 in 5 people have experienced a death by suicide during their lifetime. The aim of this study was to describe the met and unmet needs of suicide-bereaved survivors and to provide postvention recommendations. METHODS: Further to an exploratory mixed-method audit of 39 suicides that occurred in Montreal (Canada) in 2016, suicide-bereaved survivors (n = 29) participated in semi-structured interviews and completed instruments to discuss and assess potential pathological grief, depression (PHQ-9), and anxiety (GAD-7), as well as health and social services utilization. A panel then reviewed each case and provided recommendations. The mean age of participants was 57.7 years and 23 were women. RESULTS: Although help was offered initially, in most cases by a health professional or service provider (16/29), 22 survivors would have liked to be contacted by telephone in the first 2 months post suicide. Four categories of individual unmet needs (medical/pharmacological, information, support, and outreach) and one collective unmet need (suicide pre/postvention training and delivery) emerged. CONCLUSIONS: Although Quebec provincial services have been developed and offered to suicide-bereaved survivors in the past decade, many dwindled over time and none has been applied systematically. Recommendations for different stakeholders (Ministry of Health and Social Services, coroners, NGOs, and representatives of suicide-bereaved survivors) outlined in this study could be an interesting first step to help develop a suicide pre/postvention strategy.

Predictive links between genetic vulnerability to depression and trajectories of warmth and conflict in the mother-adolescent and father-adolescent relationships.

The present study used a genetically informed design of twins raised in the same family (375 monozygotic and 290 dizygotic twins; 50.2% girls) to examine the association between adolescents' genetic risk for depressive symptoms and the course of the parent-child relationship quality throughout adolescence. Depressive symptoms and the quality of the parent-adolescent relationships were measured through adolescents' self-reports from ages 13 to 17. Group-based trajectory modeling revealed that most adolescents experienced high-quality relationships with both of their parents, characterized by high levels of warmth and low levels of conflict, and marked by gradual changes over adolescence. However, 3% of adolescents showed a trajectory of high and increasing conflict with their mothers and 16% of adolescents showed a trajectory of low warmth with their fathers, which decreased until mid-adolescence before increasing thereafter. Moreover, in line with an evocative gene-environment correlation process, a higher genetic vulnerability to depressive symptoms increased the likelihood of following a more problematic relationship trajectory with parents. This rGE was mediated by adolescents' actual depressive behavior symptoms. Results also suggest that adolescents' depression symptoms may affect girls' and boys' relationship with their parents in a similar way, with specific sex-patterns revolving more around the sex of the parent. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Links Between the Mother-Adolescent and Father-Adolescent Relationships and Adolescent Depression: A Genetically Informed Study.

This study examined the unique roles of support and conflict in the relationship with the mother and the father in predicting changes in adolescents' depressive symptoms over a 1-year period. Potential moderating effects of genetic factors (Gene × Environment interaction) and sex were also investigated. This study utilized a design of twins raised in the same family, based on a sample of 121 monozygotic and 88 dizygotic same-sex twin pairs (418 individuals; 52.2% girls) assessed in Grade 8 (M = 14.09, SD = .29) and in Grade 9 (M = 15.07, SD = .26). Depressive symptoms and the parent-adolescent relationship quality were measured with self-report questionnaires. Multilevel regressions revealed that a lack of support in the father-adolescent relationship predicted increased depressive symptoms among all adolescents, whereas conflict in the father-adolescent relationship predicted increased depressive symptoms more strongly as adolescents' genetic vulnerability for depressive symptoms increased. Moreover, a high level of support in the relationship with the mother predicted increased depressive symptoms in boys-but not girls-with a high genetic risk for such problems. In line with a diathesis-stress model of psychopathology, these findings suggest that relationship quality with both parents might impact girls' and boys' depressive symptoms but that these associations depend to some extent on adolescents' genetic vulnerabilities.