AIMS/HYPOTHESES: This project uses epidemiological data from the 2019 Canadian Health Survey of Children and Youth (CHSCY) to study the intersection of physical illness, mental or neurodevelopmental disorder (MND), and suicide ideation and attempts (suicidality) in youth. Specifically, to 1–estimate prevalence of suicidality among youth with physical-MND comorbidity (H1: youth with physical-MND comorbidity will have the highest prevalence of suicidality compared to physical illness only, MND only, healthy); 2–quantify magnitudes of association between physical-MND comorbidity and suicidality, adjusting for sociodemographic/economic factors (H2: associations will remain robust after adjustment); 3–identify multilevel correlates (individual, family, neighborhood) of suicidality among youth with physical-MND comorbidity (H3: correlates of suicidality will include age, sex, transgender identity, disability, parent psychopathology, strained relationships, lower income, and neighbourhood disadvantage); 4–contrast patterns of psychiatric services use among youth with physical-MND comorbidity who have vs. have not experienced suicidality (H4: youth who experienced suicidality will have used more services and report more barriers); and, 5—test whether physical-MND comorbidity moderates associations between suicidality and health outcomes (H5: suicidality will be associated with poorer psychosocial and academic achievement and increased use of substances; effects will be larger for youth with physical-MND comorbidity).
METHODS: Conducted by Statistics Canada, the CHSCY collected data from 92,170 children (1-17 years) and their primary-caregiving parent, providing a large, representative sample of Canadian youth. Measures of child physical illness (e.g., asthma, diabetes, epilepsy), mental illness (e.g., anxiety, mood, eating disorders), and neurodevelopmental disorders (e.g., ADHD, autism), family environment, and sociodemographics are available using youth and parent informants. Neighborhood characteristics and psychiatric services use are available via linkage with Canadian Census and national administrative health data (e.g., consults, emergency department visits, hospitalizations). Questions about suicidality were restricted in the CHSCY to youth 15-17 years (n=15,670), which forms the analytic sample. Youth were asked, “In the past 12 months, did you ever seriously consider attempting suicide or taking your own life?” and “Have you ever attempted suicide or tried taking your own life?”. Regression-based analyses will account for the complex design of the CHSCY and best practices to understand sex-/gender-based effects will be applied across all models tested.
IMPACT/NEXT STEPS: Findings will provide estimates of suicidality among youth with physical-MND comorbidity, which will inform intervention planning to prevent suicidality in this understudied, but vulnerable population. Modelling correlates of suicidality will advance understanding of the relative and joint effects of factors at multiple levels—information needed to target prevention efforts. Understanding patterns of psychiatric service use among youth with physical-MND comorbidity who experienced suicidality is vital to understanding barriers to services access. This will inform whether use matches need, identifying opportunities to advise providers and policy makers about upstream resources to prevent suicidality. The CHSCY was recently funded for a longitudinal follow-up. When these data become available, targets for intervention identified in this study will be investigated (in future work) to examine the extent to which incidence of suicidality in youth with physical-MND comorbidity is reduced. This evidence is needed to support advocacy for resource allocation.
