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

世界卫生组织（WHO）报告称，全球约有80万人死于自杀。 每年，每10万人的死亡率从0.3（巴巴多斯）到34.6（斯里兰卡）不等，圭亚那为30.6， 世界上自杀率第二高的国家;大约是全球平均水平的三倍。在世界范围内，自杀是 这是15 - 29岁人群的第二大死因。美国的失业率（13.4） 尽管付出了巨大努力，但仍显著上升，仍略低于法国（12.3）。精神病理学， 贫穷，压力，年龄和性别是最常被引用的与自杀有关的风险因素。然而，在这方面， 因为自杀是一种罕见的事件，自杀研究往往缺乏足够的统计能力来有效地检查 即使是最常见的风险因素的关联和相互作用。另一方面， 自杀率很高，缺乏足够的基础设施来支持良好的研究和/或 同质人群，从而限制了风险因素关联和相互作用的分析。此外，委员会认为， 由于其罕见性，获得足够的样本量以有效调查自杀的成本是 一般禁止。为了克服这些局限性并推动自杀风险研究，我们 与圭亚那公共卫生部、圭亚那国家卫生局和圭亚那卫生部建立了伙伴关系。 统计、泛美卫生组织和国际卫生组织的合作 公认的自杀专家组织有了这个团队，我们建议，研究自杀风险因素在一个独特的， 多管齐下的方法首先，我们将彻底评估一个具有全国代表性的社区队列， 最近和一生的自杀行为，以及表征他们的个人和社区层面的风险因素。 然后，我们将在另外两波评估中以纵向设计跟踪这一队列， 自杀行为的前瞻性分析。第二，我们会确定和评估所有自杀者， 第三，我们将对一部分自杀完成者进行心理解剖。我们 还将收集唾液并进行生物样本库，用于未来的DNA分析。这些样本一起将允许病例对照 分析，区分主要种族/民族和 宗教团体。最后，圭亚那的自杀率在10个地理区域中各不相同， 主要宗教团体（印度教、基督教和穆斯林）和四个主要种族/民族之间的关系， 还有待解释这项研究旨在帮助了解如何关键的关系， 特征，与个体风险因素相互作用，影响自杀行为。通过一个合作 设计，利用培训和数据驱动的输入贯穿始终，这项研究有可能作出批判性的 为在任何环境中制定更有针对性的自杀预防计划做出了重要贡献， 特别是在圭亚那和美国等多种族/族裔和多宗教环境中。

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.