Predictive models for suicidal thoughts and behaviors among Spanish University students: rationale and methods of the UNIVERSAL (University & mental health) project.

Maria Jesús Blasco,Gemma Vilagut,Randy P Auerbach,Enrique Echeburúa,José Almenara,Victoria Soto-Sanz,Miquel Roca,Pere Castellví,Jesús Rodríguez-Marín,Carolina Lagares,José Antonio Piqueras,Albert Sesé,Andrea Miranda-Mendizábal,Ronald C Kessler,Ana Isabel Cebrià,Jordi Alonso,Andrea Gabilondo,Ronny Bruffaerts

doi:10.1186/s12888-016-0820-y

Abstract

BackgroundSuicide is a leading cause of death among young people. While suicide prevention is considered a research and intervention priority, longitudinal data is needed to identify risk and protective factors associate with suicidal thoughts and behaviors. Here we describe the UNIVERSAL (University and Mental Health) project which aims are to: (1) test prevalence and 36-month incidence of suicidal thoughts and behaviors; and (2) identify relevant risk and protective factors associated with the incidence of suicidal thoughts and behaviors among university students in Spain.MethodsAn ongoing multicenter, observational, prospective cohort study of first year university students in 5 Spanish universities. Students will be assessed annually during a 36 month follow-up. The surveys will be administered through an online, secure web-based platform. A clinical reappraisal will be completed among a subsample of respondents. Suicidal thoughts and behaviors will be assess with the Self-Injurious Thoughts and Behaviors Interview (SITBI) and the Columbia-Suicide Severity Rating Scale (C-SSRS). Risk and protective factors will include: mental disorders, measured with the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) and Screening Scales (CIDI-SC), and the Epi-Q Screening Survey (EPI-Q-SS), socio-demographic variables, self-perceived health status, health behaviors, well-being, substance use disorders, service use and treatment. The UNIVERSAL project is part of the International College Surveys initiative, which is a core project within the World Mental Health consortium. Lifetime and the 12-month prevalence will be calculated for suicide ideation, plans and attempts. Cumulative incidence of suicidal thoughts and behaviors, and mental disorders will be measured using the actuarial method. Risk and protective factors of suicidal thoughts and behaviors will be analyzed by Cox proportional hazard models.DiscussionThe study will provide valid, innovative and useful data for developing prevention programs for youth suicide and for improving early identification for high-risk students. The longitudinal design of this study will improve causal interpretation of analyzed associations, needed for generating and validating predictive models. It will represent the first results about suicidal thoughts and behaviors in the Spanish university population. The World Mental Health Survey collaboration will permit accurate cross-national comparisons.

Highlights

Suicide is a leading cause of death among young people
The longitudinal design of this study will improve causal interpretation of analyzed associations, needed for generating and validating predictive models. It will represent the first results about suicidal thoughts and behaviors in the Spanish university population
The study will address the following issues: i) test prevalence of suicidal thoughts and behaviors among first-year university students in Spain; ii) test incidence of suicidal thoughts and behaviors up to 36 months; iii) identify relevant risk associated with a higher incidence of suicidal thoughts and behaviors, and iv) delineate protective factors associated with less incidence of suicidal thoughts and behaviors

Summary

Methods

Study design As a part of the World Mental Health International College Student (WMH-ICS) project (see http://www.hcp.med.harvard.edu/wmh/college_student_survey.php), the UNIV ERSAL project is an ongoing multicenter, observational, and prospective cohort study of first-year university students followed over 36 months. 12, 24 and 36 months after completion of the baseline survey (T0), respondents will be invited to complete follow-up questionnaires (T2T3-T4, respectively), with an estimated administration time of 30 min. For the participants responding “yes” to any of the screening items for suicidal thoughts and behavior (i.e., ideation, plan or intent) or NSSI in the last 12 month, a specific alert will provide information for consulting with a health professional. Clinical calibration Diagnostic accuracy of the scales of mental disorder included in the questionnaire will be carried out with ROC curves analysis, including the area under the ROC curve (AUC) and the estimation of diagnostic performance indices for different cut off points (i.e., sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios and diagnostic odds ratio)

Discussion

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