BackgroundMetasynthesis—the systematic review and integration of findings from qualitative studies—is an emerging technique in medical research that can use many different methods. Nevertheless, the method must be appropriate to the specific scientific field in which it is used. The objective is to describe the steps of a metasynthesis method adapted from Thematic Synthesis and phenomenology to fit the particularities of psychiatric research.MethodWe detail each step of the method used in a metasynthesis published in 2015 on adolescent and young adults suicidal behaviors. We provide clarifications in several methodological points using the latest literature on metasyntheses. The method is described in six steps: define the research question and the inclusion criteria, select the studies, assess their quality, extract and present the formal data, analyze the data, and express the synthesis.ConclusionMetasyntheses offer an appropriate balance between an objective framework, a rigorously scientific approach to data analysis and the necessary contribution of the researcher’s subjectivity in the construction of the final work. They propose a third level of comprehension and interpretation that brings original insights, improve the global understanding in psychiatry, and propose immediate therapeutic implications. They should be included in the psychiatric common research toolkit to become better recognized by clinicians and mental health professionals.

Breaking bad news is a balancing act that requires oncologists to adapt continually to different factors: their individual relationships with the patient, the patient's family, the institutional and systemic environment, and the cultural milieu. Extending the development of the ability to personalize and adapt therapeutic treatment to this realm of communications would be a major step forward from the stereotyped way that oncologists are currently trained in communication skills.

Children with high irritability and depressive/anxious mood and, to a lesser extent, with moderate irritability only had a higher suicidal risk during adolescence compared with children with low symptom levels. Early manifestation of chronic irritability during childhood, especially when combined with depressive/anxious mood, may be associated with an elevated risk for adolescent suicidality. The putatively causal role of irritability should be investigated.

The onset of adult psychopathologic disorders can be traced to behavioral or emotional symptoms observed in childhood, which could be targeted in early interventions to prevent future mental disorders. The network perspective is a novel conceptualization of psychopathologic disorders that could help to identify target symptoms with a distinct role in the emergence of mental illness. OBJECTIVE To assess whether the network structure of emotional and behavioral symptoms among elementary school girls is associated with anxiety disorders or major depression in early adulthood. DESIGN, SETTING, AND PARTICIPANTS The Quebec Longitudinal Study of Kindergarten Children is an ongoing, prospective, population-based study of kindergarten children attending French-speaking state schools in the Canadian province of Quebec in 1986-1988. This study included 932 girls whose parents completed the Social Behavior Questionnaire when the girls were ages 6 (baseline), 8, and 10 years; 780 participants were interviewed to assess the presence of mental disorders at age 15 and/or 22 years. Data analysis was conducted from December 2016 to April 2018. MAIN OUTCOMES AND MEASURES Gaussian graphical models were estimated for 33 symptoms (eg, internalizing, externalizing, and prosocial behaviors) assessed using the Social Behavior Questionnaire to evaluate the temporal stability of the symptom network through childhood. At follow-up time points, mental disorders were assessed using the DSM-III-R, and symptom networks were reestimated at ages 6 to 10 years, this time including a variable indicative of future diagnosis. RESULTS At baseline, the mean (SD) age of the 932 girls was 6.0 (0.3) years. Among the 780 women assessed at follow-up, 270 (34.6%) and 128 (16.4%) had developed anxiety disorders and major depression, respectively. Symptoms clustered in internalizing and externalizing communities. Five symptoms-irritable, blames others, not liked by others, often cries, and solitary-emerged as bridge symptoms between the disruptive and internalizing communities. These symptoms were those that were connected with the highest regularized edge weights (from 0.015 to 0.076) to future anxiety disorders once added to the network. Bootstrapped 95% CIs ranged from (95% CI, −0.063 to 0.068) to (95% CI, 0.561 to 0.701) for positive edges and from (95% CI, −0.156 to 0.027) to (95% CI, −0.081 to 0.078) for negative edges included in the regularized network. CONCLUSIONS AND RELEVANCE Bridge symptoms between disruptive and internalizing communities are identified for the first time in childhood, and these findings suggest that these symptoms could be central in indicating probable later anxiety disorders. The study suggests that bridge symptoms should be investigated further as potential early targets in disease-prevention interventions.

Purpose. The Quebec Longitudinal Study of Child Development (QLSCD) was designed to examine the long-term associations of preschool physical, cognitive, social, and emotional development with biopsychosocial development across childhood, adolescence, and young adulthood.Methods. QLSCD is an ongoing prospective cohort including 2120 singletons born in 1997/1998 in the Canadian province of Quebec. So far, data has been collected annually or every two years from child ages 5 months to 21 years. The cohort currently includes 1245 participants. Data available include a range of environmental (e.g., family characteristics, child behaviour, educational attainment, mental health), biological (e.g., hair cortisol, genetic, epigenetic), and administrative data.Results. QLSCD has contributed to the understanding of children's psychosocial development, including the development of physical aggression and anxiety. QLSCD articles have advanced scientific knowledge on the influence of early childhood factors on childhood, adolescent, and young adult mental health, including the effect of participation in early childcare on cognitive and behavioural development, the developmental origins of adolescent and young adult mental health problems and suicide risk, and the development of interpersonal difficulties (e.g., peer victimisation) from preschool years to adolescence. Conclusion.QLSCD has given major contributions to our understanding of the link between different aspects of child development and biopsychosocial development during the first two decades of life. Unique features include the presence of environmental, biological, and administrative data, long-term follow-up with frequent data collections, and use of data from multiple informants, including teachers, mothers, fathers, and the children themselves.

BackgroundSuicide by adolescents and young adults is a major public health concern, and repetition of self-harm is an important risk factor for future suicide attempts.ObjectiveOur purpose is to explore the perspective of adolescents directly involved in suicidal acts.MethodsQualitative study involving 16 purposively selected adolescents (sex ratio1∶1) from 3 different centers. Half had been involved in repeated suicidal acts, and the other half only one. Data were gathered through semistructured interviews and analyzed according to Interpretative Phenomenological Analysis.ResultsWe found five main themes, organized in two superordinate themes. The first theme (individual dimensions of the suicide attempt) describes the issues and explanations that the adolescents saw as related to themselves; it includes the subthemes: (1) negative emotions toward the self and individual impasse, and (2) the need for some control over their lives. The second main theme (relational dimensions of attempted suicide) describes issues that adolescents mentioned that were related to others and includes three subthemes: (3) perceived impasse in interpersonal relationships, (4) communication, and (5) revenge.ConclusionsAdolescents involved in suicidal behavior are stuck in both an individual and a relational impasse from which there is no exit and no apparent way to reach the other. Revenge can bridge this gap and thus transforms personal distress into a relational matter. This powerful emotion has been neglected by both clinicians and researchers.

BACKGROUND: Obtaining recent estimates of the prevalence of suicide-related outcomes across adolescence and its associated mental health problems (MHPs) is important for clinical practice. We estimated the prevalence of suicide-related outcomes at ages 13, 15, 17, and 20 years (2011-2018) in a contemporary population-based cohort and documented associations with MHPs throughout adolescence. METHODS: Data came from 1618 participants in the Québec Longitudinal Study of Child Development. Internalizing (depression and anxiety) and externalizing (oppositional/ defiance, conduct issues, and attention deficit and/or hyperactivity) MHPs were assessed with validated questionnaires. Outcomes were self-reported past-year passive and serious suicidal ideation and suicide attempt. RESULTS: Lifetime prevalence of passive suicidal ideation (13-17 years old), serious suicidal ideation, and suicide attempt (13-20 years old) were 22.2%, 9.8%, and 6.7%, respectively. Prevalence was twice as high for females as for males. Overall, rates of passive (15-17 years old; 11.8%-18.4%) and serious ideation (13-20 years old; 3.3%-9.5%) increased over time but were stable for attempt (13-20 years old; 3.5%-3.8%). In univariable analyses, all MHPs were associated with suicide-related outcomes at all ages (risk rate ratio range: 2.57-3.10 [passive ideation] and 2.10-4.36 [suicide attempt]), and associations were similar for male and female participants (sex interaction P. .05). Magnitude of associations were generally stronger for more severe suicide-related outcomes (passive ideation , serious ideation , attempt). In multivariable analyses, internalizing problems were associated with suicidal ideation, whereas both depressive and conduct symptoms were associated with attempt. CONCLUSIONS: Suicidal ideation and attempt were common, especially for females and youth presenting with depressive and conduct problem symptoms. Clinicians should systematically assess suicidal risk in teenagers, especially in those presenting with MHPs. WHAT'S KNOWN ON THIS SUBJECT: Suicide-related outcomes are associated with a range of mental health problems (MHPs) in adolescence, but the importance of different internalizing and externalizing MHPs may vary across adolescence and for different suicide-related outcomes (passive ideation, serious ideation, and suicide attempt). WHAT THIS STUDY ADDS: Suicide-related outcomes are common in adolescence, with stable rates of suicide attempt and increasing rates of suicidal ideation. Internalizing MHPs are independently associated with suicidal ideation (passive and serious), whereas externalizing and internalizing MHPs are independently associated with suicide attempt.

In-utero and perinatal influences on suicide risk: a systematic review and meta-analysis Summary Background. Adverse in-utero and perinatal conditions may contribute to a heightened suicide risk throughout the lifespan, however existing evidence is sparse and contradictory. We did a systematic review and meta-analysis to investigate in-utero and perinatal exposures associated with suicide, suicide attempt, and suicidal ideation. Methods. We searched MEDLINE, Embase, and PsycINFO from inception to January 24, 2019 for population-based prospective studies investigating the association between in-utero and perinatal factors and suicide, suicide attempt, and suicidal ideation. We calculated pooled odds ratio (ORs) with 95% CIs using random-effects models and used meta-regression to investigate heterogeneity. Findings. We identified 42 studies; they had a low risk of bias (median quality score 9/9; range 5-9). Family/parental characteristics, such as high birth order (eg, pooled ORs fourth or later born vs first born 1.