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， 自杀现在是全球15-29岁人群的第二大死因，显然是一种全球公共卫生危机。 重要的是，改进预防和干预措施取决于创新研究方法的发展。 它克服了现有研究的挑战，可以导致对 尚未确定的风险因素。我们把这些称为“隐形风险”。由于LMIC占全球自杀人数的80%， 他们是预防自杀努力的重要目标。低收入社区青少年自杀的危险因素包括 尤其是知之甚少，部分原因是在LMICs中进行流行病学研究的后勤工作，以及 部分原因是自杀研究有其众所周知的挑战，无论它在哪里进行。 这项关于青少年自杀的拟议研究，包括其轨迹和危险因素，将利用 年成人和青少年自杀率位居第二的圭亚那的特殊情况 全世界，以及卫生部致力于预防自杀，并积极与我们的团队合作 调查成人自杀事件。圭亚那在民族、种族、宗教和经济阶层方面具有显著的异质性， 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是为我们目前由NIMH资助的圭亚那而开发的 正在学习。综合起来，这些因素使圭亚那成为本研究目标的非常合适的地点，包括 审查经常被忽视或分类错误的因素，例如，当青年与 伤害、事故或其他临床表现，实际上可能有看不见的自杀成分。 这项研究的目标将通过三个不同的青年队列实现：1)具有全国代表性的 将对10-24岁(N=5000)的社区样本进行彻底评估，以确定一系列 自杀行为(构思、企图和完成)和风险因素的存在，使用独特的 定量和定性(小插曲)措施。此队列还将用作 另外两组。2)临床未遂者样本将包括所有已确定的自杀未遂者(估计 N=400)，将接受评估并与病例对照设计中的社区和急诊室样本进行比较，以 揭示影响自杀行为轨迹的因素。3)急诊室样本：要发现 “隐形”风险因素的额外来源，我们将筛查出现在急诊室的年轻人表面上没有自杀倾向 原因(N=720)，并采用与社区样本和尝试样本相同的方式进行评估。评估 将在随后的两波中纵向跟踪。总而言之，这些队列分析了 单独的、纵向的和病例对照比较，将提高对自杀轨迹的理解 并揭示迄今为止看不见的特定发育阶段自杀行为的危险因素。因此，这一点 调查应产生有年龄和背景的有针对性的预防战略。

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.