Uncovering the Risk Architecture of Suicidal Behaviors: a Representative Sample at High Risk

点击翻译按钮获取中文摘要

The World Health Organization (WHO) reports that approximately 800,000 people die by suicide every year, with rates per 100,000 varying from 0.3 (Barbados) to 34.6 (Sri Lanka), with Guyana at 30.6, the second highest suicide rate of any country; about three times the global average. Worldwide, suicide is the second leading cause of death among those 15 - 29 years of age. The United States rate (13.4) has been rising significantly, in spite of great effort, and remains slightly worse than France (12.3). Psychopathology, poverty, stress, age and gender are among the most often cited risk factors associated with suicide. However, because it is a rare event, suicide research often lacks adequate statistical power to effectively examine the associations and interactions of even the most common risk factors. On the other hand, most countries that have very high suicide rates also lack adequate infrastructure to support good research and/or have homogenous populations, thus limiting analysis of risk factor associations and interactions. Furthermore, because of its rarity, the cost of obtaining an adequate sample size to effectively investigate suicide is generally prohibitive. To overcome these limitations and to move suicide risk research forward, we have developed a partnership with the Guyanese Ministry of Public Health, the Guyanese National Bureau of Statistics, the Pan American Health Organization (PAHO-WHO) and the collaboration of an internationally recognized group of suicidologists. With this team, we propose, to study suicide risk factors in a unique, multipronged approach. First, we will thoroughly assess a nationally representative community cohort for recent and lifetime suicidal behviors, as well as characterize their individual and community level risk factors. We will then follow this cohort in a longitudinal design over two additional waves of assessment, allowing for prospective analyses of suicidal behviors. Second, we will ascertain and assess all suicide attempters who present clinically, and, third, we will conduct psychological autopsies on a subset of suicide completers. We will also collect and biobank saliva for future DNA analysis. Together these samples will allow for case-control analyses, differentiating risk factors specific to attempts and completions across major racial/ethnic and religious groups. Finally, suicide rates in Guyana vary across the 10 geographic regions, among the three major religious groups (Hindu, Christian and Muslim) and among the four major races/ethnicities, in ways that have yet to be explained. This study is designed to help understand how the relationships of key characteristics, interact with individual risk factors to influence suicidal behaviors. Through a collaborative design that utilizes training and data-driven input throughout, this study has the potential to make critically important contributions to the development of more targeted suicide prevention programs in any setting, particularly in multi-racial/ethnic and multi-religious settings, such as Guyana and the United States.