Illustration by Gary Neill

The impact of both nature and nurture on youth mental health is a complex field that has commanded Anne Duffy’s attention throughout the course of her career as a psychiatrist. She joined Queen’s Faculty of Health Sciences just two years ago, but part of her current work builds on two decades’ worth of ground-breaking investigations into the genetic roots of serious conditions such as bipolar disorder. She and her University of Ottawa colleague Paul Grof launched the Flourish Canadian high-risk study in 1996 to consider the question of whether the children of parents diagnosed as bipolar might themselves be susceptible to this condition.

"These studies are meant to help people, but they’re also meant to describe the onset of illness and what that looks like in people at confirmed genetic risk," says Duffy.

She had initially thought this work would last no more than a couple of years, but it grew into an engaging, intimate interaction with participating families as these young people matured and faced the challenges of navigating the transition to early adulthood. The long-term findings have shed valuable light on many of the mental health indicators that point to trouble, such as sleep or anxiety difficulties. And, more recently, the resulting insights led Duffy to consider the impact of one of modern life’s most demanding episodes — the transition to university.

"It's a fascinating and important time," she explains. "It’s a point of transition, not only from child to adult but from home to more independence."

In 2018, Duffy successfully applied to the Canadian Institutes of Health Research (CIHR) for funding for a novel initiative that would work with the university’s incoming class in order to understand what factors are important to support students’ mental health and their academic success during this critical phase of their lives. The grant, which was matched by The Rossy Foundation, became the basis of the Queen’s-led U-Flourish Student Well-Being and Academic Success study.

This research aims to assemble reliable data from students as they begin and proceed through their undergraduate studies, describe mental health factors that might lend themselves to suitable intervention, identify any barriers or gaps affecting the delivery of mental health care, and evaluate the link between mental health, access to care, and an individual’s academic performance.

In collaboration with colleagues across campus in the Departments of Public Health, Psychology, and Psychiatry, as well as Student Wellness Services, U-Flourish has spearheaded the use of screening scales with links to academic and medical record data that can be compared with information from students on other campuses. The project has also featured an engagement outreach plan built on a combination of social media engagment, invited in-class presentations, and incentives donated by independent community business and in part supported by the university’s Division of Student Affairs.

These efforts bore fruit, as some 58 per cent of first-year students chose to take part in the research — about triple the response rate usually obtained for this kind of undertaking. Just this summer Duffy, learned that she will be able to continue following this sizeable cohort of students for two more years with renewed competitive funding from the CIHR.

Duffy and her Queen’s U-Flourish investigators have been partnering with colleagues and students at Oxford University, who collaborated with her on the high-risk research and are now active partners in the U-Flourish student mental health research initiative. Oxford is a leader in psychiatry research, employing “remote capture” methods and digitalized mental health interventions. This approach takes the form of apps that students readily use on their ubiquitous mobile devices to monitor sleep cycles, substance use, and exercise patterns, as well as observations about daily and weekly levels of anxiety or depression.

Preliminary findings from the first wave of the U-Flourish study revealed fewer than 10 per cent of the students entering university were receiving any form of mental health treatment, but one-third of them screened positively for clinically significant anxiety and depressive symptoms, one-quarter engaged in binge-drinking weekly, and one-fifth had sleep problems.

"This is not diagnostic," Duffy emphasizes. "I’m not suggesting more than 30% of the student population have a mental illness, but what it means is that you should really pull those young people in and see them, to determine what’s going on and what is needed to help. There is a significant unmet need for student mental health assessment and care. Most institutions do not have the capacity to screen students and do these kinds of assessments. If you were going to be pro-active and targeted, that’s the kind of thing one needs to think about setting up — an accessible system of evidence-based triage and rapid assessment in the context of a coordinated system of care."

Illustration by Gary Neill

In 2019, students at Oxford issued an open letter to the institution’s vice-chancellor, pointing out that as the public stigma around mental health problems has been removed, the demand for services to deal with them has increased. In Canada, a 2015 White Paper drafted by the Coordinating Committee of Vice-Presidents (Students) of Colleges Ontario offered a similar assessment and request. Duffy adds that such calls are coming from practically all postsecondary institutions. And while the administrators in those systems have typically made substantial investments in reducing stigma, promoting wellness, and developing supportive counselling programs, the growing pressure to provide accessible and evidence-based clinical assessment and care makes it imperative to learn more about what is happening to determine an effective and helpful way forward.

“Why not integrate research and have evidence drive the development of those resources?” she asks, suggesting that universities have incentives and an obligation to ensure that students have access to appropriate mental health services and that society is obtaining a proper return on the public investment in higher education.

“University students are an important sector of the emergent adult population, full of promise and potential to make a significant contribution to the growth and development of our society,” Duffy adds. “But this depends on maintaining their emotional stability and mental health. We need to support those in distress, which means we need data to inform the development of an effective system of care. And while there are many stakeholders to take responsibility for this endeavour, the university is in the best position to take a lead role in developing the campus resources for such a model.”

Part of her inspiration has stemmed from the hundreds of families with children at high risk of depression and suicide she worked with over two decades, as well as the families of university students.  Duffy cited the poignant example of the Queen’s Student Initiative Fund, which was championed by Eric Windeler and Sandra Hanington after their son Jack tragically died by suicide. The fund supported the activities of students as they raised the profile of mental health needs on campus. After speaking with Windeler, who has called for more detailed information to support the design and implementation of university mental health services, Duffy strengthened her resolve to provide just that kind of information if it could prevent the unfathomable loss marked by the death of a young person.

"When you work with young people struggling with mental illness and their families, you just think you’ve got to do something — especially if you’re a child adolescent psychiatrist," she says. "You just want to make a difference."