In this podcast, we are joined by Dr. Séverine Lannoy, postdoctoral researcher in the Department of Psychiatry at the Virginia Institute for Psychiatric and Behavioural Genetics.
Séverine is the first author of the Journal of Child Psychology and Psychiatry (JCPP) Open Access paper ‘Suicidal ideation during adolescence: The roles of aggregate genetic liability for suicide attempts and negative life events in the past year’ (doi.org/10.1111/jcpp.13653), which is the focus of today’s podcast.
Séverine sets the scene by sharing a brief overview of the paper and providing insight into the methodology used, before turning to the key findings.
With the paper’s results supporting the role of negative life events in suicidal ideation in both boys and girls, Séverine comments on what type of negative events stood out as being particularly impactful and what the implications of this paper are for professionals who work with young people.
Séverine then turns to the gender differences highlighted by the paper, including that for girls, suicidal ideation was associated with both negative life events and aggregate genetic liability (but not the latter for boys) and discusses how she accounts for this difference between boys and girls.
Furthermore, Séverine expands upon the interplay of genes and the environment in risk for suicidal ideation, as well as discusses how CAMH professionals might translate her findings into practice to improve risk assessment and screening procedures.
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PhD, Viginia Institute for Psychiatric and Behaviural Genetics
My research is broadly aimed at clarifying the risk factors involved in substance use and suicidal behaviors. Specifically, I am interested in delineating distinct and common pathways to substance use disorders and suicidal behaviors, by investigating aggregate genetic risks, their interaction with early adversity and proximal stressful life events, the subsequent development of psychological (resilience) and neuropsychological (impulsivity) characteristics, and their involvement in substance use disorders and suicidal behaviors. I am also interested in clarifying the causal influence of psychological and neuropsychological mechanisms by leveraging natural experiments (e.g., co-relative analysis).
- Feature paper ‘Suicidal ideation during adolescence: The roles of aggregate genetic liability for suicide attempts and negative life events in the past year’, (2022). Séverine Lannoy, Becky Mars, Jon Heron, Alexis C. Edwards
[00:00:31.899] Jo Carlowe: Hello welcome to the In Conversation Podcast series for the Association for Child and Adolescent Mental Health or ACAMH for short. I’m Jo Carlowe, a freelance journalist with a specialism in psychology. Today, I am interviewing Dr. Séverine Lannoy of the Department of Psychiatry at the Virginia Institute for Psychiatric and Behavioural Genetics. Séverine is the first author of the paper, ‘Suicidal ideation during adolescence: The roles of aggregate genetic liability for suicide attempts and negative life events in the past year’ recently published in the Journal of Child Psychology 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. ACAMH also produces JCPP Advances and the CAMH. If you’re a fan of our 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. Séverine, thank you for joining me. Can you start with a brief introduction about who you are and what you do?
[00:01:37.865] Dr. Séverine Lannoy: My pleasure. Thank you so much for having me. I’m a postdoctoral researcher at Virginia Institute for Psychiatric and Behavioural Genetics. My research work mainly focuses on alcohol and substance use disorder, as well as suicidal behaviours in adolescents and adults. I come from Belgium where I did a master in clinical psychology and a PhD in neuropsychology, and I moved to the US in 2019 to pursue my postdoc.
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’s complete my previous training in neuropsychology well. I think it’s also interesting to mention that when I was in Belgium, I did clinical internship 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 our findings might be useful for professionals. So, I’m glad I have the opportunity to talk with you today.
[00:02:48.110] Jo Carlowe: Thank you so much. Let’s turn to your paper, ‘Suicidal ideation during adolescence: The roles 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 of the paper to set the scene?
[00:03:08.450] Dr. Séverine Lannoy: So, this paper focuses on suicidal ideation. I think this is important to mention that suicidal thoughts and behaviour constitute a public health concern, especially in adolescence where suicide is a leading cause of death. And we know that there isn’t a clear linear trajectory between suicidal thoughts and behaviour. 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 wide prevalence phenotype in adolescence, which is suicidal ideation, and we worked with a sample of adolescents aged 17 years old. What do we know about suicidal thoughts and behaviour 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 triggered by specific life events. And this is especially true in adolescents, 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 event in the past year, and how genetic liability moderates the effect of negative life events.
[00:04:49.335] Jo Carlowe: Before we look at the findings, can you tell us a little about the methodology?
[00:04:54.015] Dr. Séverine Lannoy: We evaluated suicidal ideation as the outcome. It was measured at 17 years old in an adolescence cohort. 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 attempts from genetic data that have been collected at birth. We conducted univariable and multivariable regression to observe 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 suicidal ideation, distinct genetic risk according to age, and they may also present different reaction to negative life events.
[00:05:46.815] Jo Carlowe: And can you share some of the main findings?
[00:05:49.485] Dr. Séverine Lannoy: The prevalence of suicidal ideation was higher in girls than boys, so it supported that we needed to conduct sex-specific analysis. So, I’m going to describe 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 with the occurrence of specific life event, and that was high genetic liability. So, these life events were parental death, drug use, bullying, and failure to achieve something important.
[00:06:43.055] Jo Carlowe: Séverine, 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?
[00:07:04.272] Dr. Séverine Lannoy: 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 adolescents who only used it once in the past year. And we found that drug use has one of the strongest effect sizes.
So I think this is something we need to be aware of because we often see suicidal behaviour as associated with internalizing disorders such as depression. But it is also associated with externalizing disorders such as alcohol or drug use. This difference between internalizing and externalizing behaviours might be even more important in adolescents who may present depressive symptoms but show some externalized behaviour.
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 suicidal thoughts or even behaviours.
[00:08:12.630] Jo Carlowe: And did it matter what types of drugs? I mean, I assume cannabis is quite widely used amongst teenagers.
[00:08:19.793] Dr. Séverine Lannoy: In this study, we didn’t evaluate what kind of drug. We know that there is a strong association with alcohol use in adult with opioid use. But yeah, we didn’t evaluate that specifically in this study.
[00:08:34.470] Jo Carlowe: 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?
[00:08:50.205] Dr. Séverine Lannoy: 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 pubertal 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 behaviour appears. And then it usually increases before stabilizing or decreasing with age. So, it’s possible that the different developmental trajectories between boys and girls lead to observe the effect of aggregate genetic variability in girls only at 17 years old.
[00:09:35.550] Jo Carlowe: You also 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?
[00:09:54.100] Dr. Séverine Lannoy: This is a very important point. And I think the gene by environment interaction is also of interest for clinical 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 social support and a close relationship with parents has low risk of developing depression, even though it has a high genetic liability. However, if a negative life event 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 behaviours as well, are more sensitive to at risk environment. Now, in this 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 intervals 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 us something about the environment as well, such as more parental pressure for school grades, for example. But this second interaction definitely needs to be further investigated.
[00:11:52.080] Jo Carlowe: In your paper, you talk about the importance of taking genetic liability and family history into account when evaluating for suicidal thoughts and behaviours. Is this something that CAMH professionals already do?
[00:12:06.290] Dr. Séverine Lannoy: This is a good question. I think professionals tend to consider family history more and more in their risk assessment mainly to know what is running in the family 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 behaviour. But I think it’s important, I would add 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.
[00:12:45.910] Jo Carlowe: So how might CAMH professionals translate your findings into practice to improve risk assessment and screening procedures?
[00:12:55.020] Dr. Séverine Lannoy: 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 in this study, we focused on adolescents from a community sample, which means that they are not selected to be at higher risk of suicidal behaviour. And they don’t have a psychiatric diagnosis, but still, we 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 suicidal thoughts, and that genetic liability may also increase this risk.
[00:13:43.230] Jo Carlowe: So, who should be asking those questions or identifying kids at risk? Should it be teachers, health professionals?
[00:13:52.700] Dr. Séverine Lannoy: I think it depends– the relationship between the professional and the adolescent. Sometimes teachers have a good relationship and can observe like if a specific life event happened in an adolescent like they are aware of it. This is important, and teacher that are aware of specific life event knows whether this life event may lead to suicidal thoughts and behaviour. And then maybe offer that this adolescents see a professional that could do an evaluation about suicidal thoughts and behaviours.
[00:14:23.680] Jo Carlowe: Séverine, is there anything else in the paper that you would like to highlight?
[00:14:27.430] Dr. Séverine Lannoy: 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 as losing someone close, it might be the first experience of death among a family member. This is something we all have to deal with at some point, and it looks like most adolescents do it without questioning their own life.
This doesn’t mean that adolescent who lost a grandparent don’t need emotional support. Of course, they do. But they may not benefit from an extensive screening for suicidal thoughts and behaviours. And I think it’s good to know as well.
[00:15:14.067] Jo Carlowe: Are there any other events that don’t seem to have that link with suicidal ideation?
[00:15:19.220] Dr. Séverine Lannoy: Another event that we see that is not associated with suicidal thoughts and behaviour is parental divorce. And it is one of the result we discussed in the paper because usually, divorce is associated with some suicidal thoughts and behaviour, at least in child. But here, we are really in a sample of adolescents that have 17 years old, and we evaluate divorce that could occur in the past year. So, it means between 16 and 17 years old. Again, in this sample, it looks like adolescents can deal with that kind of life event at that age.
[00:15:52.250] Jo Carlowe: Are you planning some follow up research that you can share with us?
[00:15:56.892] Dr. Séverine Lannoy: 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 suicidal thoughts and behaviour in youth. There is preliminary evidence supporting the role of impulsivity and impaired decision making. And these processes could help us determine among youths who have suicidal ideation who is at risk 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 behaviour and how? So, this is what we are working on currently. And I think it’s pretty exciting because it’s exploring specific mechanism that could be modifiable.
[00:16:48.493] Jo Carlowe: Is there anything else in the pipeline that you’d like to tell us about?
[00:16:52.177] Dr. Séverine Lannoy: I think it’s interesting to share with you the results of another study that has just been accepted for publication. And in this research, we used Swedish population registry to evaluate similar research questions. So, the role of genetic liability and negative life events in suicide attempt risk. We included both adolescents and adults. And we evaluate the risk factors for having a first suicide attempt. And then repeating this behaviour, so having multiple suicide attempts.
And we saw that genetic liability was related to both first suicide attempt and having multiple suicide attempts. But we found that negative life events were mainly associated 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 personality traits 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 reinforced the result we have observed here among adolescents.
[00:18:02.600] Jo Carlowe: What are the implications of those findings for CAMH professionals?
[00:18:06.530] Dr. Séverine Lannoy: Again, I think this is important to know that some negative life event may trigger suicide attempt. I think this is also important to understand that genetic liability may influence how this life event is going to be impactful for adolescents. And again, this need to be further explored to understand which processes whether they have a genetic component or not. Explain who is at risk to attempt suicide and have multiple suicide attempts is really important for professional.
[00:18:40.952] Jo Carlowe: Finally, Séverine, what is your take home message for our listeners?
[00:18:44.956] Dr. Séverine Lannoy: So, I would say that understanding suicidal thought and behaviour is complex, so is the implementation of targeted prevention and 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 interplay 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 event. So here, I think the main life event that are highlighted in this result are bullying, drug use, and failure.
[00:19:26.457] Jo Carlowe: Fantastic. Thank you ever so much. For more details on Dr. Séverine Lannoy, please visit the ACAMH website, www.acamh.org and Twitter @acamh. ACAMH is spelled A-C-A-M-H. 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.