Working Together to Prevent Suicide: The CAMH Suicide Prevention Cohort Study

Funded by the CAMH Discovery Fund and led by Dr. Juveria Zaheer, the Working together to prevent suicide: The CAMH suicide prevention cohort study, proposes a novel, integrated cohort design which represents a key advancement in suicide prevention research. The team’s central question is, what are the characteristics, trajectories, perspectives, and outcomes of people experiencing suicidal ideation and behaviour who present to the CAMH Emergency Department (ED)? This study aims to characterize and understand these individuals by using a range of clinical, health services, qualitative, and biological data. Understanding the longer-term trajectories of a well-defined cohort will also provide the crucial infrastructure to develop and test future interventions. This four-year study will recruit approximately 500 participants who present to the CAMH ED and endorsed suicidal ideation and/or suicide-related behaviour at triage.

The study objectives are to gain understanding on the experiences of these participants through the following four integrated study projects:

1. Characterizing the cohort: What are the clinical, psychological, and social antecedents of people presenting to emergency care with suicidality, and their clinical trajectories after seeking care. This work will provide a foundation for future studies and establish a novel, systematized approach for capturing data among suicidal individuals.

2. Situating the cohort: How do the cohort characteristics and outcomes compare with other groups (i.e., people with suicidality presenting at CAMH who do not enrol in the cohort, all CAMH ED patients, and those who present to other EDs in Ontario with suicide-related behaviour)? This study will allow us to thoroughly assess the generalizability of the CAMH-SPCS cohort.

3. Understanding personal experiences and perspectives: What are the experiences of people who seek care for suicidality, proximal to the visit, and one year later? What are their perspectives and opinions on how to improve care? This study will identify evidence-based interventions and support the co-design of a suicide prevention intervention that can be piloted in the CAMH ED in the future.

4. Explore novel biological markers: What potential blood-based biomarkers modulate risk for suicidal ideation and suicide-related behaviour (e.g., analysis of proteins, protein complexes, changes in the RNA transcriptome, the epigenome, and future genetic analyses. This study will provide the basis for establishing molecular biomarkers to monitor suicidality in ED patients.

The CAMH Suicide Prevention Cohort Study (CAMH-SPCS) will represent a key advancement in suicide prevention research. While thousands of individuals with suicidal ideation and / or recent suicide-related behaviour receive care in the CAMH ED every year, we have not to this point been able to a) understand their outcomes and trajectories, or b) characterize these individuals from diverse perspectives (clinical, social, biological, experiential, health services). This study will achieve both outcomes, while also creating infrastructure for suicide prevention research at CAMH, mental health research in the ED setting, and the possibility to expand the suicide prevention cohort approach across Toronto, and across Canada. We will also include patients and families at all stages of the study process, foster the next generation of suicide prevention researchers, and engage in novel knowledge exchange strategies.

Open

In addition to her CAMH Discovery Fund project, Dr. Zaheer has also recently received funding from CIHR for her study, Suicide and the COVID-19 pandemic: Understanding Canadian stories. The study aims to understand the experiences of Canadians with suicidal ideation and behaviour during the pandemic, across the continuum of suicide risk according to health status, intensity and frequency of ideation and behaviour, diagnoses, and socio-demographics (age, economic status, rurality, gender identity, and ethnicity). Through qualitative interviews, Dr. Zaheer’s team will explore the extent and impact of the pandemic on people with suicide-related thoughts or behaviour to understand the complex interplay of biological, psychological, social, and cultural risk and protective factors.

This will be the first cross-national qualitative study of the experiences of suicidal ideation and
behaviour during the COVID-19 pandemic in Canada, across diagnoses and lifespan. It will have impact
in several important areas: 1) understanding of the consequences of the pandemic across diverse
subpopulations and service delivery contexts, 2) highlighting the needs and preferences of
marginalized populations to inform and tailor population-specific interventions that are acceptable to
those affected; and 3) exposing challenges in accessing care to inform service design in the recovery
phase and beyond. People experiencing suicide-related thoughts and behaviours are suffering,
but data available to date have not fully captured this picture. This study will make a major difference
in not only understanding but improving personal care delivery.

Open

Dr. Juveria Zaheer is a Clinician Scientist with the Institute for Mental Health Policy Research, and Education Administrator in the Gerald Sheff and Shanitha Kachan Emergency Department at CAMH. She has received numerous awards including being named to Canada’s Top 40 Under 40® list for 2020 and being recognized by peers and colleagues as CAMH’s Physician of the Year in 2019. Dr. Zaheer’s research focuses on suicide, gender and culture. She is also involved in mixed-methods program evaluation and health services research.