e e e e e e e e e e e this podcast is brought to you by the Association for Child and Adolescent mental health aam for short you can find more podcasts and other resources on our website www.ac amh.org and follow us on social media by searching AC amh hello welcome to the in conversation podcast series for the association for child and adolescent mental health or aam for short I'm Joe Carlo a freelance journalist with a specialism in Psychology today I'm interviewing Dr sine lanoir of the Depart
ment of Psychiatry at the Virginia Institute for psychiatric and behavioral genetics sine is the first author of the paper suicidal ideation during adolescence the role of aggregate genetic liability for suicide attempts and negative life events in the past year recently published in the Journal of child Psych ol ology and Psychiatry this paper will be the focus of today's conversation the jcpp is one of the three journals produced by the Association for Child and Adolescent mental health aam al
so produces jcpp advances and the cam if you're a fan of in conversation series please subscribe on your preferred streaming platform let us know how we did with a rating or review and do share with friends and colleagues sine thank you for joining me can you start with a brief introduction about who you are and what you do my pleasure thank you so much for having me I'm a postdoctoral researcher at Virginia Institute for psychiatric and behavioral genetics and my research work mainly focuses on
alcohol and substance use disorder as well as um suicidal behaviors in adolescents and adults I come from Belgium where I did a master in Clinical Psychology and a PhD in N psychology and I moved to the Us in 2019 to pursue my P do I spent first year at Stanford University and two years at VCU here at VCU I have started a new training in genetics and I think it complete my previous training in neur Psychology uh well I think it's also interesting to mention that when I was in Belgium I did clin
ical intership in Psychiatry and worked with people who presented alcohol use disorders mood disorders and anxiety disorders I'm mainly doing research right now but I care a lot about how or findings uh might be useful for professional so I'm glad I have the opportunity to talk with you today thank you ever so much let's turn to your paper suicidal ideation during adolescence the role of aggregate genetic liability for suicide attempts and negative life events in the past year this was recently
published in the jcpp can you start with a brief overview the paper to set the scene so this paper focuses on suicidal ideation I think this is important to mention that suicidal thought and behavior constitute Public Health concern especially in adolescence where suicide is a leading cause of death and though we know that there isn't a clear linear trajectory between suicidal thought and behavior we know that suicidal ideation increases the risk of suicide attempt and suicide attempt increases
the risk of suicide death so here we focused on quite prevalent phenotype in adolescence which is suicidal ideation and we worked with a sample of adolescence age 17 years old what we know about suicidal thought and behavior is at least three things first they are moderately heritable which means that they are transmitted in family with a role of genetic factors and a role of the environment second they can be be triggered by specific life events and this is especially true in adolescence where
the ability to cope with negative life even is not fully mature and third there is existing evidence for example in the field of depression that our genetic liability May influence the way we react to negative life events so with that knowledge in mind we explored three research question we evaluate suicidal ideation at 17 years old and investigate the role of aggregate genetic risk the role of negative life events in the past year and how genetic liability moderates the effect of negative life
events before we look at the findings can you tell us a little about the methodology we evaluated suicide ideation as the outcome it was measured at 17 years old in an adolescence cour for the predictors we assessed the occurrence of negative life events in the past year so the year preceding suicidal ideation and we compute a measure of aggregate genetic liability for suicide attempt from genetic data that have been collected at Birth we conducted univariable and multivariable regression to obs
erve which variable predict later suicidal ideation and we stratify our analysis by sex which means that we conducted separate analysis for boys and girls as we know that they have different prevalence of sual ideation distinct genetic risk according to Ag and they may also present different reaction to negative life events and can you share some of the main finding the prevalence of suicidal ideation was higher in girls than boys so it's supported that we needed to conduct sex specific analysis
so I'm going to describe the the result by sex so in girls we found that suicidal ideation was associated with high genetic liability for suicide attempt and also specific life event which were bullying drug use and different type of failures so failure to achieve something important but also failure at school and we also found that drug use was more strongly associated with suicide ideation in girls who have a high genetic liability in boys we found that suicidal ideation was only associated w
ith the occurrence of specific life event and not with high genetic liability so these life events were parental deaths drug use bullying and failure to achieve something important sine your results support the role of negative life events in suicidal ideation in both boys and girls you've already mentioned some what negative events stood out as being particularly impactful and what are the implications of this for professionals who work with young people one of the results that stood me out was
the role of drug use this is one of the topics I'm working on so I know that there is a large association between drug use and suicidality in adults but in the current study we measured whether youths have initiated drug in the past year which may include adolescent who only used it once in the past year and we found that drug use has one of the strongest F sizes so I think this is something we need to be aware of because we often see toadal behavior is associated with internalizing disorders s
uch as depression but it is also associated with externalizing disorders such as alcohol or drug use this difference between internalizing and externalizing behaviors might be even more important in adolescence who may present depressive symptoms but show some externalized Behavior so for example drug use instead of hopelessness so yeah as a professional I would be careful when seeing adolescent initiating drug because they could also present some susal Al thoughts or even behaviors and and did
it matter what types of drugs I mean I assume cannabis is quite widely used amongst teenagers in this study we didn't evaluate what kind of drug we know that there is strong association with alcohol use in adult with opioid use but yeah we didn't evaluate that specifically in this study as you stated earlier for girls suicidal ideation was associated with both negative life events and aggregate genetic liability but the latter not for boys how do you account for this difference between boys and
girls this is a great Point thanks for asking a possible explanation for this difference is the difference of maturation between boys and girls so there are many studies showing that girls mature early than boys and I'm talking about veral development but also emotional and cognitive development and we also know that genetic influences shift over time so we start to observe genetic influence at the time the behavior appears and then it usually increases uh before stabilizing or decreasing with a
ge so it's possible that the different developmental trajectories between boys and girls lead to observe the effect of aggregate genetic liability in girls only at 17 years old you o found indications that genetic liability May interact with drug use and failure at school among girls in Lay terms can you say more about the interplay of genes and the environment in risk for suicidal ideation this is very important point and I think the Gene B environment interaction is also of interest for for cl
inical workers so this means that genetic factors can impact how sensitive people are to the environment so let's take the example of major depression because there are a lot of evidence in the literature we know that genetic liability influences the likelihood to have a major depression not only from genetic transmission but also according to the level of negative life event so an adolescent with high genetic liability for depression who is raised in a protective environment with a social suppo
rt and a close relationship with parents has low risk of developing depression even though he has a high genetic liability however if a negative life events occurs this adolescent will be much more at risk to develop depression than a peer who doesn't have a genetic liability in a few words people with genetic liability for depression and this is true for suicidal behaviors as well are more sensitive to at risk environment now in the study we saw that girls with a high genetic liability are even
more at risk for suicidal ideation when they have initiated drug that tells us something about potentially harmful environment that could be characterized by risk taking peer deviance and less emotional and social support about failure at school this is more difficult to interpret because the confidence interval in in the paper are wide but the results suggest that failure at school would be more associated with suicidal ideation in girls who doesn't have a genetic liability and it might tell u
s something about the environment as well such as more parental pressure for for school grades for example but this second interaction definitely needs to be further investigated in your paper you talk about the importance of taking genetic liability and family history into account when evaluating for suicidal thoughts and behaviors is this something that can professionals already do this is a good question I think professionals tend to consider family history more and more in their risk assessm
ent mainly to know what is running infamity and whether the same difficulties can be expressed by a patient I know this is true for psychiatric disorders such as bipolar disorders or alcohol use disorder I would think it's less common for suicidal Behavior but I think it's important I would add as we as we just discussed that even though genetic liability is not deterministic it may also influence the way people react to the environment so it's important to have this information for an accurate
risk assessment so how might C professionals translate your findings into practice to improve risk assessment and screening procedures I would say that risk assessment and prevention should be a team effort so this need to be done at several level and even at school and I'm saying that because because in this study we focus on adolescent from a community sample which means that they are not selected to be at higher risk of suicidal behavior and they don't have a psychiatric diagnosis but still w
e observe a prevalence of suicidal ideation and a meaningful role of negative life events and genetic liability at least for girls in this sample so I think we all need to be aware that some negative life events are particularly impactful and may lead to adolescent who adult thoughts and that genetic liability may also increase this risk so so who should be asking those questions or or identifying kids at risk should it be teachers health professionals I think it depends the relationship um betw
een the the the professional and and the Adolescent sometime teacher have a good relationship and can observe like if a specific life even happen in an adolescent life they are aware of it this is important and teacher that are aware of specific life even knows whether this life even may lead to suad alent behavior and then maybe offer that this adolescence see a professional that could do an evaluation about sus Al and behaviors so is there anything else in the paper that you'd like to highligh
t it is also important to keep in mind that some negative life events are not associated with suicidal ideation in this sample and this means we have to be specific when monitoring life even in those with a high genetic liability for example losing a grandparent may be a very difficult event it's losing someone close it might be the first experience of death among a family member um this is something we all have to deal with at some point and it looks like most adolescents do it without question
ing their own life this doesn't mean that adults and host the grandparent don't need emotional support of course they do but they may not benefit from an extensive screening for suicide Al and behaviors and I think it's good to know as well are there any other events that don't seem to have that link with suicidal ideation another event that we see that is not associated with suad and behavior is Parental divorce and it is one of the result we discussed in the paper because usually divorce is as
sociated with some social and behavior at least in charge but here we are really in a sample of adolescent that have 17 years old and we evaluate divorce that could occur in the past year so it mean between 16 and 17 years old again in this sample it looks like adolescence can deal with that kind of life even at that age are you planning some follow-up research that you can share with us actually one of our goals after evaluating the effect of the proximal environment as we did in this paper is
to evaluate the mechanism that explain suicid Al and behavior in use there is preliminary evidence supporting the role of impulsivity and impaired decision making and these processes could help us determine among you who have suicidal ideation who is at risk um to attempt suicide so we would like to dig more into this question and also explore the role of genetic liability does having a high genetic liability for impulsivity leads to higher suicidal behavior and how so this is what what we are w
orking currently and I think it's pretty exciting because it it's exploring specific mechanism that could be modifiable is there anything else in the pipeline that you'd like to tell us about I think it's interesting to share with you the result of another study that has just been accepted for publication and in this research we used Swedish population registry to evaluate similar search question so the role of genetic liability and negative life events in suicide attempt risk we included both A
dolescent and adults and we evaluate the risk factors for having a first suicide attempt and then repeating this Behavior so having multiple um suicide attemps and we saw that genetic liability was related to both first suicide attempt and having multiple suicide attempt but we found that negative life events were mainly ass assciated with the first suicide attempt so the hypothesis would be that negative life events May trigger the first suicide attempt while some genetic predispositions or per
sonality trait uh may explain why some people have multiple suicide attempts it's also interesting to observe the role of genetic liability and negative life event in another sample because I believe it reinforc the result we we have observed here among adolesence what what are the implications of those findings for professionals again I think this is important to know that some negative life even May trigger suicide at them I think this is also important to understand that genetic liability May
influence how this life even is going to be impactful for adolescence and again this need to be further explored but to understand which processes whether they are they have a genetic component or or not explain who is at risk to attempt to and have multiple suicide attempt is really important for professional finally s what is your take-home message for our listeners so I would say that understanding suicidal thought and behavior is complex so is the implementation of targeted uh prevention an
d intervention I believe in this study we Illustrated one of these complexities by showing that it's not only genetic or environmental but it's both and the inter play at least in girls sex difference is another complexity that we need to take into account in risk assessment I think we also need to be specific in the attention we pay to specific life events so here I think the main life event that are highlighted in this result are bullying drug use and failure fantastic thank you ever so much f
or more details on Dr sine lanoir please visit the aam website www . acam.org and Twitter atacam aam is spelled AC MH and don't forget to follow us on your preferred streaming platform let us know if you enjoyed the podcast with a rating or review and do share with friends and colleagues this podcast was brought to you by the Association for Child and Adolescent mental health aam for short
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