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Clinical research

This is a prospective longitudinal study, with a nested case-control substudy, of a cohort of persons aged 18 years or older (n~900) with a prior suicide attempt, registered in the Catalonia Suicide Risk Code Pprogramme (CSRC Programme) by five hospitals participating in the study: Consorci Hospitalari del Parc Taulí de Sabadell (Barcelona), Consorci MAR Parc de Salut de Barcelona, Hospital de Sant Pau i la Santa Creu de Barcelona, Institut d'Assistència Sanitària de Girona and Institut Pere Mata de Reus (Tarragona). Participants will be followed up for 12 months. The catchment areas of these hospitals encompass a population of approximately 2.5 million inhabitants in Catalonia (33%).

 

The nested case-control substudy in the cohort will analyse the sociodemographic, clinical, neuropsychological and biological differences among persons making a repeat suicide attempt (n~100), and control participants (n~100): (1) healthy persons (with no prior suicide attempts or a family history of suicide attempts) and (2) persons with a single suicide attempt. A repeat suicide attempt will be defined as any further suicide attempt occurring a minimum of 30 days after the first suicide attempt registered in the CSRC Programme.

Persons making a suicide attempt and repeat suicide attempt will be assessed within 10 days after hospital discharge, using clinical and neuropsychological tests. We will also gather sociodemographic information and collect biological samples of blood and hair. The sample of healthy controls will be evaluated with the same assessment tests.

Clinical assessments:

  • Psychiatric disorders: MINI International Neuropsychiatric Interview.
  • Sociodemographic characteristics and personal and family history: Brief protocol for suicide assessment.
  • Depression: Hamilton Depression Rating Scale-17 items (HDRS-17).
  • Medical severity: Medical Damage Scale (MDS).
  • Characteristics and severity of suicidal behaviour: Suicide Intent Scale (SIS).
  • Traumatic experiences at a young age: Childhood Trauma Questionnaire - Short Form (CTQ-SF).
  • Impulsivity: Barratt Impulsiveness Scale - 11 (BIS-11).
  • Aggressivity: Brown-Goodwin Lifetime History of Aggression (BGLHA).
  • Health-related quality of life: EUROQoL-5D.
  • Personality disorder and history of self-harm: Personality and Life Event Scale -Short version (S-PLE).

 

Neuropsychological tests:

  • Declarative memory: Rey Auditory Verbal Learning Test (RAVLT).
  • Working memory: Digits subtest (forward and backward) of the WAIS-IV.
  • Attention, processing speed and cognitive flexibility: Trail Making Test (Part A and B).
  • Attention and processing speed: Stroop test.
  • Verbal fluency: Semantic and phonemic fluency.
  • Verbal comprehension: Vocabulary subtest of the WAIS-IV.

 

Biological samples:

  • Blood samples: To evaluate (1) markers of inflammation: interleukin-6, interleukin-1-beta, tumour necrosis factor (TNF)-alpha, interferon gamma (INF) and C reactive protein, using the Luminex ELISA kit; (2) genetic parameters related to stress regulation by the hypothalamic-pituitary-adrenal axis (HPA): NRC3, FKBP5, BDNF, CRHR1, SK2A, 5-HT2A, 5-HTT and TPH2.
  • Hair samples: Hair samples (3-cm long) will be taken from the posterior vertex of the parietal region. Cortisol concentrations will be measured by ELISA to determine stress exposure.
  • To establish the structural and functional neuroanatomic correlates of the clinical and biological measures, a subsample of persons (n~60) attended for suicidal behaviour in the province of Barcelona and of persons without prior suicidal behaviour (n~60) will undergo neuroimaging tests (Philips 3 Tesla magnetic resonance) in the Fundació Pasqual Maragall research centre (Barcelona).

 

Nueroimaging tests

A magnetic resonance imaging (MRI) study will be performed including several sequences: (1) a three-dimensional (3D) structural sequence; (2) a T2 sequence and FLAIR sequence to assess possible structural findings; (3) a resting state MRI, and (4) a functional stress task, consisting of the Montreal imaging stress task (MIST), which is an adaptation of the “Trier Mental Challenge Test” comprising a computerized series of arithmetic tasks with an induced failure component (time limit for performance) and an additional social stress component aiming to measure the stress response pattern in the brain in laboratory conditions.  

 

References

  1. Palao D, Gómez N, Montoro M, Guinovart M, Isabel P, Cebrià A, et al. Clinical Predictors and Biomarkers of Suicide Attempts in Patients Registered Under the Suicide Risk Protocol : The CODIRISC Project. J Depress Anxiety. 2019;8:1–7