Most Youth Seeking Help at Canada’s First Integrated Youth Centres Report Suicidal Thoughts

When young people walk through the doors of Foundry, British Columbia’s pioneering integrated youth services initiative, they are often carrying far more than the visible reasons that brought them there. A new retrospective cohort study published in BMC Pediatrics reveals the sheer scale of suicidal thinking among the youth who seek care at these centres: of 8,347 individuals who accessed Foundry between 2018 and 2023, 72.1 percent reported a lifetime history of suicidal ideation, and 35.6 percent reported having such thoughts within the past month. The findings, drawn from linked health survey and service utilization data, offer one of the most detailed portraits to date of who is reaching out for help at an integrated youth services site and what their needs actually look like.

Integrated youth services, often abbreviated as IYS, represent a growing model of care in which young people can access a range of youth-friendly health and social services within a single location. Rather than forcing adolescents and young adults to navigate fragmented primary care, mental health clinics, substance use programs, and social services on their own, IYS centres consolidate these supports under one roof. Foundry, located in British Columbia, was the first such initiative established in Canada, and it has since become a testing ground for understanding how this model performs in practice. The new study, led by Katherine G. Hastings of the University of British Columbia’s School of Population and Public Health, together with colleagues across UBC, Foundry, and Providence Research, examined service utilization patterns and characteristics of youth reporting suicidal ideation to better understand and address their care needs.

The methodological backbone of the study is a retrospective analysis of linked health survey and service data collected at Foundry from 2018 to 2023. The researchers compared two groups: youth who reported having suicidal ideation within the past month at their initial visit, and youth who reported never having suicidal ideation at that time. To quantify differences between these groups, the team calculated standardized mean differences, or SMDs, alongside conventional p-values. Standardized mean differences are a statistical tool that expresses the gap between two groups in units of pooled standard deviation, which makes them particularly useful for comparing variables measured on different scales and for detecting imbalances in cohort studies. Values above roughly 10 percent, expressed here in the study’s convention as SMDs in the tens, typically signal a meaningful difference between groups, independent of sample size.

The results paint a stark picture of inequity. Youth with past-month suicidal ideation were substantially more likely to identify as gender diverse, at 13.3 percent compared with 4.9 percent among youth reporting no suicidal ideation, yielding a standardized mean difference of 29.7. They were also far more likely to identify as LGBTQ+, at 45.2 percent versus 22.3 percent, an SMD of 52.7. These are not marginal statistical artifacts; they represent a doubling or tripling of representation relative to their peers without recent suicidal thoughts. The findings align with a broader body of evidence that gender and sexually diverse youth face elevated risks of psychological distress and suicidality, and they underscore that integrated youth services are serving a population in which sexual and gender minority youth are heavily represented.

Perhaps the most striking quantitative signal in the entire study concerns psychological distress. Youth with past-month suicidal ideation scored 36.7 on the Kessler Psychological Distress Scale, a widely used ten-item screening instrument that measures symptoms of anxiety and depression over the preceding month, compared with a mean score of 27.0 among youth who reported never having suicidal ideation. The standardized mean difference of 138.5 is enormous by any epidemiological standard, indicating that the two groups occupy almost entirely different regions of the distress distribution. For clinicians and service planners, this suggests that the youth presenting with recent suicidal thoughts at Foundry are not merely experiencing transient worry but profound, clinically significant psychological suffering that demands immediate and intensive response.

Service utilization data add another layer of nuance. Counterintuitively, youth with past-month suicidal ideation had fewer contacts with the integrated youth services initiative than those without suicidal ideation, averaging 7.0 visits with a standard deviation of 16.8, compared with 11.2 visits with a standard deviation of 23.2 among youth without suicidal ideation, a difference that was statistically significant at p less than 0.0001. The large standard deviations reveal enormous variability in how many times individual youth return, with some attending dozens of visits and others only one or two. At the same time, youth with recent suicidal ideation were more likely to have accessed other mental health or substance use services in the preceding year, at 43.4 percent versus 20.9 percent, an SMD of 49.7. Taken together, these patterns suggest that many youth with recent suicidal thoughts arrive at Foundry already known to other parts of the health system, yet their engagement with the integrated model itself may be less sustained, raising questions about whether the model is fully retaining the youth who need it most.

Tracking the monthly proportion of youth reporting suicidal ideation across the five-year study period, the researchers found no substantial change overall. This temporal stability is itself informative: it suggests that the burden of suicidal thinking among youth seeking integrated services neither worsened dramatically nor eased during a window that included the COVID-19 pandemic and its aftermath, a period widely associated with heightened strain on youth mental health. However, when the team disaggregated the trends by subpopulations, they observed a slight increase among females in the last two years of the study. This sex-specific uptick, though modest, echoes concerns raised by clinicians and public health officials in multiple countries about deteriorating mental health indicators among adolescent girls and young women, and it signals a group that may warrant targeted monitoring and intervention.

The study’s implications extend beyond British Columbia. Suicidal ideation in adolescence and young adulthood is one of the strongest known predictors of subsequent suicide attempts, and early identification is a cornerstone of suicide prevention strategy. The fact that nearly three-quarters of youth accessing Foundry reported some lifetime history of suicidal thoughts, and more than a third reported thoughts within the past month, transforms these centres into critical detection sites. As the authors conclude, the sheer prevalence of suicidal ideation among service users indicates an important opportunity for early intervention. A young person who comes to an integrated youth centre for what seems like a routine concern may, on systematic screening, disclose recent suicidal thinking, and that moment represents a chance to intervene before ideation progresses to action.

The findings also shed light on health inequities in self-reported suicidal ideation, particularly among gender and sexually diverse youth. The overrepresentation of LGBTQ+ and gender-diverse youth among those with recent suicidal thoughts is consistent with minority stress frameworks, which attribute elevated mental health risk among sexual and gender minorities to experiences of stigma, discrimination, and social exclusion rather than to any intrinsic vulnerability. For integrated youth services, this means that culturally safe, affirming care is not an optional enhancement but a core requirement. Services that fail to create welcoming environments for these youth risk losing contact with precisely the group at highest risk, and the data on lower visit counts among youth with recent ideation hint that engagement itself may be fragile.

Methodologically, the study has the strengths and limitations inherent to its design. As a retrospective cohort analysis of youth who voluntarily accessed a single integrated youth services initiative, it captures the population that reaches care, not the broader population of youth with suicidal ideation who never seek help. Survey responses at the initial visit are self-reported and may be shaped by willingness to disclose sensitive information, although the voluntary consent process and the youth-centred culture of Foundry likely support honest reporting. The research ethics approval was obtained by the University of British Columbia and Providence Health Care Research Ethics Board, and participants consented to research use of their data. Notably, the authors acknowledge the contribution of Foundry’s youth and family engagement team, who reviewed the study and assisted with co-interpretation of the results, an approach that reflects the participatory ethos of the integrated youth services movement itself. The work was funded by the Canadian Institutes of Health Research, with the funder playing no role in study design, analysis, interpretation, or writing. As integrated youth services continue to expand across Canada and beyond, this study provides a rigorous baseline for understanding who these services reach, how deeply their users are suffering, and where the greatest opportunities for suicide prevention lie.

Subject of Research: Suicidal ideation and service utilization among youth accessing integrated youth services in British Columbia

Article Title: Characteristics of youth reporting suicidal ideation in an integrated youth services initiative in British Columbia, Canada (2018–2023): a retrospective cohort study

Article References: Hastings, K. G., Liu, G., Marchand, K., Gadermann, A., Sutherland, J. M., Jenkins, E., & Barbic, S. P. (2026). Characteristics of youth reporting suicidal ideation in an integrated youth services initiative in British Columbia, Canada (2018–2023): a retrospective cohort study. BMC Pediatrics, 26(1), Article 870. https://doi.org/10.1186/s12887-026-07543-6

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07543-6

Keywords: suicidal ideation, integrated youth services, Foundry, adolescent mental health, LGBTQ+ youth, health equity, psychological distress, suicide prevention, retrospective cohort study, British Columbia, service utilization, gender diversity