Uncovering the Invisible Risks for Suicide: Nationally Representative Samples of Youth in Guyana

几十年来，全球年轻人的自杀率一直在上升。尽管研究取得了进展， 自杀现在是全世界15-29岁人群的第二大死亡原因，显然是一场全球公共卫生危机。 重要的是，预防和干预措施的改进取决于创新研究方法的发展 克服现有研究的挑战，并可以导致更广泛和更深入的理解， 尚未确定的风险因素。我们称之为“隐形风险”。由于中低收入国家占全球自杀人数的80%， 他们是预防自杀工作的重要目标。中低收入国家青少年自杀的风险因素包括 特别是知之甚少，部分原因是在中低收入国家进行流行病学研究的后勤工作， 部分原因是自杀研究有其众所周知的挑战，无论在哪里进行。 这项关于青少年自杀的研究，包括其轨迹和风险因素，将利用 圭亚那的特殊情况，该国的成年人和青年自杀率第二高， 世界卫生部致力于预防自杀，并积极与我们的团队合作， 研究成人自杀圭亚那在民族、种族、宗教和经济阶层方面有着显著的异质性， 使其成为自杀研究的重要示范国家。此外，这项拟议的研究将利用 人力，智力和行政基础设施的发展，为我们正在进行的NIMH资助圭亚那好- 正在学习。这些因素加在一起使圭亚那成为实现本研究目标的一个非常合适的地点，包括 检查经常被忽视或错误分类的因素，例如，当青年向急诊室提出 伤害、事故或其他临床表现，实际上可能有一个无形的自杀成分。 这项研究的目标将通过三个不同的青年群体来实现：1）全国代表性 社区样本年龄10-24岁（N=5000），将进行全面评估，以确定一系列的患病率， 自杀行为（意念，企图和完成）和风险因素的存在，使用独特的混合， 定量和定性（插图）措施。该队列还将作为比较/对照， 另外两个队列。2)临床未遂者样本将包括所有已识别的自杀未遂者（估计 N=400），将在病例对照设计中评估并与社区和ER样本进行比较， 揭示影响自杀行为轨迹的因素。3)急诊室样本：为了发现一个 另外一个“看不见的”危险因素的来源，我们将筛选那些在急诊室出现的年轻人，看起来没有自杀倾向。 原因（N=720），并以与社区和企图者样本相同的方式对其进行评估。评估 将在随后的两个波中纵向随访每个队列。总之，这些队列，分析 个体、纵向和病例对照比较，将提高对自杀轨迹的理解 并揭示了迄今为止尚未发现的特定于发育阶段的自杀行为的风险因素。因此， 调查应产生针对年龄和背景的预防战略。

Rates of suicide among the young have been rising globally for decades. Despite research advances, suicide is now the second leading cause of death worldwide for those 15-29, clearly a global public health crisis. Importantly, improved prevention and intervention depend on development of innovative research approaches that overcome the challenges of existing research and that can lead to a broader and deeper understanding of the yet unidentified risk factors. We call these “invisible risks”. As LMICs represent 80% of the worldwide suicides, they are an important target for suicide prevention efforts. The risk factors for youth suicide in LMICs are especially poorly understood, in part due to the logistics of conducting epidemiologic research in LMICs, and in part because suicide research has its own well-known challenges, regardless of where it’s conducted. This proposed study of youth suicide, including its trajectories and risk factors, will take advantage of the special circumstances of Guyana, the country with the second highest rate of both adult and youth suicides in the world, and a Ministry of Health committed to suicide prevention and actively cooperating with our team to investigate adult suicide. Guyana has notable heterogeneity in ethnicity, race, religion and economic class, making it an important model country for suicide research. In addition, this proposed study will leverage the human, intellectual, and administrative infrastructure developed for our ongoing NIMH funded Guyana Well- Being Study. Taken together these factors make Guyana a well-suited site for the goals of this study, including examining factors that have often been ignored or misclassified, for example when youth present to the ERs with injury, accidents, or other clinical presentations, that may actually have an invisible suicide component. The goals of this study will be realized through three different youth cohorts: 1) A nationally representative Community Sample ages 10-24 (N=5000), will be thoroughly assessed to determine prevalence of a range of suicidal behaviors (ideation, attempt and completion) and the presence of risk factors, using a unique blend of quantitative and qualitative (vignettes) measures. This Cohort will also serve as comparisons/controls for the other two Cohorts. 2) The Clinical Attempters Sample will include all identified suicide attempters (estimated N=400), who will be assessed and compared to the Community and ER samples in a case-control design, to uncover factors influencing trajectories of suicidal behaviors. 3) Emergency Room Sample: To uncover an additional source of “invisible” risk factors, we will screen youth who present at the ER for ostensibly non-suicidal reasons (N=720) and assess them in the same way as the Community and Attempter samples. The assessment of each Cohort will be followed longitudinally in two subsequent waves. Taken together, these Cohorts, analyzed individually, longitudinally, and in case-control comparisons, will improve understanding of suicide trajectories and uncover the hitherto invisible risk factors for suicidal behaviors specific to developmental stages. Thus, this investigation should generate age and context targeted prevention strategies.