The Catalonia Suicide Risk Code Epidemiology Study: an Epidemiological Study of Suicide Attempts in Catalonia, Spain (CSRC-Epi)

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

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.

Study Overview

• Status: Unknown
• Conditions: Suicide, Attempted; Suicide; Suicide and Self-harm
• Intervention / Treatment: Other: sociodemographic variables, somatic conditions, mental disorders, treatment and drug use

• Study Type: Observational
• Enrollment (Anticipated): 186000

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 10 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

The target population consists of the dynamic cohort of all Catalan residents during the 6-year period 2014-2019.

Description

Inclusion Criteria:

• Catalan residency during 2014-2019
• age 10 or more at end of observation period

Exclusion Criteria:

• none

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Control
• Time Perspectives: Other

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Catalan population; 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; 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

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Hospital del Mar Research Institute (IMIM)
• Collaborators: Harvard Medical School (HMS and HSDM); Catalan Agency for Health Information, Assessment and Quality; National Centre for Suicide Research and Prevention, Norway

Publications and helpful links

General Publications

• Mortier P, Vilagut G, Puertolas Gracia B, De Ines Trujillo A, Alayo Bueno I, Ballester Coma L, Blasco Cubedo MJ, Cardoner N, Colls C, Elices M, Garcia-Altes A, Gene Badia M, Gomez Sanchez J, Martin Sanchez M, Morros R, Prat Pubill B, Qin P, Mehlum L, Kessler RC, Palao D, Perez Sola V, Alonso J; CODIRISC Epidemiology Study Group. Catalonia Suicide Risk Code Epidemiology (CSRC-Epi) study: protocol for a population-representative nested case-control study of suicide attempts in Catalonia, Spain. BMJ Open. 2020 Jul 12;10(7):e037365. doi: 10.1136/bmjopen-2020-037365.

Helpful Links

• Related Info

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2014
• Primary Completion (Actual): December 1, 2019

Study Registration Dates

• First Submitted: January 16, 2020
• First Submitted That Met QC Criteria: January 16, 2020
• First Posted (Actual): January 21, 2020

Study Record Updates

• Last Update Posted (Actual): January 28, 2020
• Last Update Submitted That Met QC Criteria: January 24, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Keywords: risk factors; incidence; surveillance; public health; nested case-control study; electronic healthcare records; register-based study; risk prediction; machine learning techniques; inverse probability weighting; population-attributable risk proportions
• Additional Relevant MeSH Terms: Behavioral Symptoms; Suicide; Suicide, Attempted; Self-Injurious Behavior
• Other Study ID Numbers: CSRC-EPI (2017/7431/I)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No