The Catalonia Suicide Risk Code Epidemiology Study: an Epidemiological Study of Suicide Attempts in Catalonia, Spain

Study Overview
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Brief Summary
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Suicide attempts (SA) constitute a major public health issue worldwide. Research suggests that 2.7% of adult people ever attempt suicide; among children and adolescents this is estimated to be 6.0%. SA are related to subsequent suicide which represents an annual loss of 34.6 million years of life worldwide. Suicide attempts are also related to persistent physical and mental health issues, psychiatric hospitalizations, impaired academic performance, unemployment, partner abuse victimization and perpetration, having children removed by social services, loneliness, relationship difficulties, impaired social functioning and low life satisfaction. Despite this considerable societal impact, there is a lack of epidemiological research focussing on providing suicide attempt surveillance in the population, to inform public health action aimed at reducing risk for suicide attempts in the population, and to provide data-driven support for suicide risk assessment across healthcare settings. To address this shortcoming, the investigators designed the Catalonia Suicide Risk Code Epidemiology study. Using centralized Electronic Healthcare Record data from the entire public healthcare system of Catalonia, Spain, the CSRC-Epi study aims to estimate reliable suicide incidence rates, identify suicide attempt risk factors, and develop validated suicide attempt risk prediction tools.

Official Title
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The Catalonia Suicide Risk Code Epidemiology Study: a Two-Stage Exposure-Enriched Nested Case-Control Study of Suicide Attempts in Catalonia, Spain

Conditions
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Suicide, Attempted, Suicide, Suicide and Self-harm

Intervention / Treatment
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* Other: sociodemographic variables, somatic conditions, mental disorders, treatment and drug use


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Catalan residency during 2014-2019 age 10 or more at end of observation period Exclusion Criteria: none

Ages Eligible for Study
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Minimum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Catalan population<br>The target population consists of the dynamic cohort of all Catalan residents during the 6-year period 2014-2019. Annual total population of Catalonia is between 7.5-7.6 million, with annual rates for immigration, emigration, birth and death being  2.5%,  1.9%,  0.9%, and  0.8%, respectively. Based on these figures, we expect a maximum of  9.1 million individuals with Catalan residency status on at least one point in time over the 2014-2019 period. However, we expect SA in Catalonia to be extremely rare before the age of 10, in line with findings that self-injurious behaviour generally occurs as from the adolescent period. We will therefore exclude cases and controls that have not reached age 10 by the end of the 2014-2019 period (i.e.,  10.9%), lowering the total expected target population to  8.1 million. | Other: sociodemographic variables, somatic conditions, mental disorders, treatment and drug use<br>* sociodemographic variables history of self-injurious behaviours; all types of somatic conditions; neurodevelopmental, mental, behavioural, personality and substance use disorders; all types of medical procedures performed; and number and type of healthcare contacts. prescriptions for psychopharmacological products the Suicidal Scale of the Mini-International Neuropsychiatric Interview, the type and lethality of the attempt that warranted evaluation, presence and type of mental disorder, hopelessness, impulsivity, aggressiveness, altered state of conscience, use or dependence of alcohol, use or dependence of illicit drugs, serious somatic disease (including chronic diseases, chronic pain, and disabilities), living status, presence of family or social support, social problems, stressful life events, access to lethal means, and family history of suicide<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of catalan residents with suicide attempt (incidence) | Suicide attempt is a nonfatal, self-directed, potentially injurious behaviour with a non-zero degree of intent to die as a result of the behaviour, even if the behaviour does not result in injury | 2014-2019 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Catalan residents committing suicide (incidence) | Suicide is a fatal, self-directed, injurious behaviour with a non-zero degree of intent to die as a result of the behaviour | 2014-2019 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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public health, nested case-control study, electronic healthcare records, register-based study, incidence, risk factors, risk prediction, machine learning techniques, inverse probability weighting, surveillance, population-attributable risk proportions