An international effort to understand suicidal behavior
Postado as 17/12/2021 08:30:01
Por Lucas George Wendt
The University of Vale do Taquari - Univates is responsible for articulating, in Brazil, a study coordinated by Karolinska Institutet, in Sweden, and by the Swedish Center for Suicide Research and Prevention of Mental Ill-Health (NASP, its acronym in English). The research is led by Professor Danuta Wasserman, a world authority on suicide research, president-elect of the World Psychiatric Association (WPA) and coordinator of the NASP. Karolinska Institutet is located in Stockholm and has one of the leading Faculties of Medicine in Europe, accounting for the single largest share of all academic medical research in the country. It was created in 1810 and, since 1901, the Nobel Assembly at Karolinska Institutet selects the Nobel Prize laureates in Physiology or Medicine.
The COVID-19 Brief Motivational Intervention and Long-term regular follow-up Contact (COVID-19 BIC) study seeks to understand the added effectiveness of a brief motivational and follow-up contact, carried out within 24 hours after a suicide attempt, in reducing suicide at 18-months follow-up compared to standard care. In addition, it also aims to educate patients about the risk of suicide after they are discharged from the hospital or the emergency room, provide support and help them to remain engaged in the treatment of psychological symptoms related to suicidal behavior during and after the Covid-19 pandemic. The international research is funded by the European Development Bank. An additional study is planned at Univates seeking to understand the role of genetics in people's predisposition to suicidal behavior.
In Brazil, the study is carried out in Lajeado, through the participation of Univates, from the Center for Translational Research on Mood Disorders and Suicide (CEPETTHS, acronym in Portuguese), linked to the Graduate Program in Medical Sciences (PPGCM, acronym in Portuguese) and coordinated by psychiatrist Professor Flávio Shansis. Shansis believes that this is the first of many partnerships that can be established between Univates and internationally renowned institutions in the area of the study of suicidal behavior, given the relevance of the theme for the Taquari and Rio Pardo Valleys, which concentrate high suicide rates among its population. According to the most recent official data, from 2017, of the five cities with the highest prevalence of suicide in Brazil, three are in Rio Grande do Sul, two in Vale do Taquari - those occupying the first and third positions.
“Univates is embracing this theme, which here has a community relevance,” says Shansis, the study's Brazilian coordinator. “It's a scientific approach to issues that, so far, are conjecture. This work is fundamental for us to understand what happens to people who attempt suicide. In the long term, it is expected that we can contribute to the reduction of suicide rates in the Taquari and Rio Pardo Valleys, perhaps with the implementation of public prevention policies”. For the researcher, the research data can also, in the future, contribute to expanding the training of human resources in the area of suicide treatment.
COVID-19 BIC is adapted from athe Suicide prevention Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS) study, a pilot study conducted by Karolinska Institutet and the World Health Organization (WHO) in the early 2000s with the aim of reducing mortality associated with suicide. The SUPRE-MISS at the time was held in five countries: Brazil (in the city of Campinas, through Campinas State University, in São Paulo), India, Sri Lanka, Iran and China. The efficacy of SUPRE-MISS was evaluated and shown to have a significant effect in reducing suicide rates in the treatment group that received BIC in addition to standard care, compared to the control group that received standard care only.
According to WHO data, updated in 2019, every year it is estimated that around 700,000 people commit suicide, around 1 every 40 seconds. The number of attempts, however, is much higher than completed suicides. In Brazil, the Taquari and Rio Pardo Valleys regions have the highest suicide rates, almost 3 times the national average.
The COVID-19 BIC study has been planned to be conducted in four continents and is expected to take place in several different countries. In Africa: South Africa. In the Americas: United States, Mexico, Uruguay and Brazil. In Europe: Romania, Spain, Russia and Italy. In Asia: India, Kazakhstan, Vietnam and China.
How is the research carried out in the Vale do Taquari?
The study began its data collection in March 2021 and is expected to run until 2024. The research includes two main components: a brief motivational intervention carried out by professionals in the field of psychiatry during the period of hospitalization and, afterwards, through nine regular contacts made from remotely, a long-term follow-up will be carried out by trained volunteers, over 18 months after the discharge of patients who attempted suicide.
For this, researchers who collect data in the Urgency and Emergency areas of the Bruno Born Hospital (HBB, acronym in Portuguese) and the 24-hour Emergency Care Unit (UPA, acronym in Portuguese) in Lajeado have already been selected and hired, through a notice from Univates, with funding from the European Development Bank. The study will involve the follow-up of 250 people with a suicide attempt and another 500 people in the control group - that is, those who did not make any suicide attempt. This control group are people who will be drawn to be interviewed using their National Health System card (SUS, acronym in Portuguese). This part of the study has the support of the City of Lajeado, through the Municipal Health Department. Based on these characteristics, it will be possible, in the following stages of the research, to establish comparisons between behavioral and genetic components of these two populations locally, in the region, and also, internationally, with populations from other parts of the world where the research is being carried out. The study has already been approved by the Research Ethics Committee (COEP, acronym in Portuguese) of Univates.
“The study with those who attempted suicide is a randomized clinical trial, meaning that when hospitalized, patients receive one of two different types of psychological intervention,” explains Shansis. The researchers then evaluate and compare the data generated from these different interventions. “After discharge, through an application on the smartphone, the patient is monitored by the Univates team”, he details. In addition, the population portion of the study - the control group - serves to compare the suicide attempt group and the general population.
The data collected from the interviews will be sent from different parts of the world to Sweden, where the team led by professor Danuta Wasserman integrates and consolidates the material. The data will be uploaded on LimeSurvey. The part referring to biological material concerns only the study carried out nationally and will not be sent outside of Brazil. Just as Univates articulates a network of national partnerships to develop the study locally, other organizations, in each of the countries, act in a similar way. Networked together are dozens of educational and research organizations working in this international effort to better understand suicidal behavior.
International Research Coordinating Team:
General Coordination (Sweden):
Nuhamin Gebrewold Petros
Flavio Milman Shansis