our research
Transdiagnostic Trajectories Towards Sever Mental Illness
We have made substantial contributions to the idea that individual presentations and experiences are likely to shift diagnostic categories en route to a severe mental illness, and the implications of this for youth mental health services and systems. In psychosis, we mobilized multiple streams of data to challenge the assumption that all individuals with a full-blown first episode of psychosis invariably pass through an earlier stage of milder (sub-threshold) psychotic symptoms. This has now been taken up as a central piece of evidence that service development should be reorganized around variable (rather than solely linear) pathways to severe mental illnesses. We have also demonstrated that this distinction – between whether patients did or did not have early sub-threshold psychotic symptoms – in turn predicts a range of other outcomes, including differences in neurobiology, service engagement, and treatment delays. Overall, it reveals that early-stage features have important and unrecognized prognostic value for endpoints at later stages.
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Developing next-generation youth mental health service frameworks
We have been deeply involved in efforts to update the field’s understanding of how mental illness begins and evolves in young people. This includes the development of clinical staging as a framework for conceptualizing illness progression, the development of stages, and the articulation of what stage-based and transdiagnostic early intervention and youth mental health service systems should look and function like. We have also contributed to developing stepped care models in youth mental health, to match presentations and trajectories to appropriate interventions and services. We are involved in working groups and initiatives in each of these areas, and staging was incorporated as a central recommendation in the 2024 Lancet Psychiatry Commission on Youth Mental Health.Â
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Supporting and evaluating Canadian youth mental health service transformation
On-the-ground service and system transformation cannot be done by any one person or small group, and certainly not by researchers or clinicians alone. We have played a meaningful role in operationalizing on-the-ground youth mental health service reform in Canada, through projects that develop and implement novel services, economic evaluations of youth mental health service reform, and networks and knowledge translation regarding data and measurement in youth mental health.
Early Intervention Research and Clinical Care
We are deeply involved in Canadian and international service design and development. At the Douglas and McGill, we lead a joint clinical-research team at PEPP-Montreal, a widely recognized specialized early intervention service for psychosis with multicomponent patient-centered care. This has included examinations of the effects of outreach campaigns, the initial presentation and evolution of symptoms such as delusions and hallucinations but longitudinally and across successive cohorts, and the lessons these findings have for care provided during the early intervention window. More recently, we are pioneering the development of a transdiagnostic service for youth at-risk of severe mental illness.
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Previous Projects
Stress-Vulnerability and Emergence of PsychosisÂ
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We have explored the interface between neurobiological and socioenvironmental factors as they contribute to the risk, onset and course of psychotic disorders using a breadth of sociodemographic, clinical, ecological, cognitive, and imaging data. This work has adopted cross-sectional, stage-based and longitudinal perspectives on how stressful early-life risk factors may impact on neuroplasticity to produce psychobiological alterations (such as in the HPA axis) in varying populations
