Suicide: it's on the minds of between one-third and one-half of adults who experience an initial psychotic episode, known as "first-episode psychosis," and who seek treatment to overcome the urge.
Roxanne Sicotte, who in January joined Université de Montréal's School of Psychoeducation as an assistant professor, wants to help alleviate the distress of these individuals and their loved ones.
She's also working to avert suicidal behaviour, in part by establishing specific prevention targets.
Started in high school
“I started to get involved with mental-health intervention back in high school,” Sicotte recalled.
At one point, she worked as a monitor in a day camp, assisting children with difficulties such as intellectual disabilities and autism spectrum disorders. “That fueled my dream of supporting people who are more vulnerable,” she said.
But her desire to help stretches even further back: “I am the second oldest in a family of six children. Collaboration, cooperation, mutual support and respect were among the core values I grew up with.”
After earning her bachelor's and master's degrees in psychoeducation at Université de Sherbrooke, Sicotte worked as a psychoeducator helping adults with severe and persistent mental health issues, mainly psychotic disorders.
“I hoped to undertake a research career, but first I wanted to gain some real-world experience to get a firmer grasp of the realities involved and find out what interested me most.”
During that time, she came into contact with patients suffering from first-episode psychosis – for many, a deeply disturbing experience. “It triggers intense emotions such as confusion, fear and despair – it can even be traumatic,” Sicotte explained.
As part of her work with people at risk of suicide, she sees up close the distress that patients and their loved ones feel.
'Huge repercussions for so many'
“Suicide has such a wide-ranging impact," she said. "As well as the victim's individual distress, each death has huge repercussions for so many others, including families, communities and professionals."
In her early days as a psychoeducator, Sicotte felt ill-equipped to deal with such situations. “I wanted to hone my knowledge and skills in this area. And that's what led me to become a suicide prevention trainer.”
Drawing on her experience in the field, she decided to do a doctorate in UdeM's Department of Psychiatry and Addictology.
“I'm still interested in understanding suicide risks among youths experiencing first-episode psychosis," she said. "One of my goals is to put adapted support measures in place for them."
Since suicide remains one of the leading causes of death among young people, Sicotte wants to deepen her understanding of this phenomenon.
“Does psychosis exacerbate functional difficulties, cognitive difficulties, social isolation, etc., and does this combination of factors raise the suicide risk?" she said. "Or do symptoms of psychosis directly increase the risk?”
Other hypotheses point to risk factors common to suicidal behaviours and to psychosis, which may explain why these patients are over-represented in suicide statistics.
A lack of information
“Individuals presenting psychotic disorders are often excluded from studies on suicide prevention best practices, so there is a lack of information on the effectiveness of crisis intervention,” Sicotte noted.
This raises a number of questions, she added: Should interventions for the general public be adapted to meet the needs of psychosis patients, or should a completely different approach be considered? And if so, what is the best way forward?
“I'd like to move on from seeking understanding to implementing and evaluating best practices,” Sicotte said. For instance, she'd like to explore the topic of suicide safety plans, a prevention tool used for the general public.
Sicotte also highlights the importance of developing collaborative research projects. “Regardless of whether we're dealing with individuals with psychotic disorders, their loved ones or their social services and healthcare providers, everyone has a relevant lived experience to share.”
From winning multiple scholarships and awards as a student, as a new faculty member at UdeM Sicotte now wants to make her research findings accessible so they can, as she puts it, “be helpful to others."
“It's very important to share our research findings with clinical teams, families, loved ones and the patients themselves. Ultimately, I want to help improve our practices and the situation for individuals at risk.”
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