Investigating Predictive Factors of Suicidal Re-attempts in Adolescents and Young Adults After a First Suicide Attempt, a Prospective Cohort Study. Study Protocol of the SURAYA Project

Abstract

Introduction: Suicide is the fourth leading cause of death in youth. Previous suicide attempts are among the strongest predictors of future suicide re-attempt. However, the lack of data and understanding of suicidal re-attempt behaviors in this population makes suicide risk assessment complex and challenging in clinical practice. The primary objective of this study is to determine the rate of suicide re-attempts in youth admitted to the emergency department after a first suicide attempt. The secondary objectives are to explore the clinical, socio-demographic, and biological risk factors that may be associated with re-attempted suicide in adolescents and young adults.

Methods: We have developed a single-center prospective and naturalistic study that will follow a cohort of 200 young people aged 16 to 25 years admitted for a first suicide attempt to the emergency department of Lyon, France. The primary outcome measure will be the incidence rate of new suicide attempts during 3 months of follow-up. Secondary outcomes to investigate predictors of suicide attempts will include several socio-demographic, clinical and biological assessments: blood and hair cortisol levels, plasma pro- and mature Brain-Derived Neurotrophic Factor (BDNF) isoforms proportion, previous infection with toxoplasma gondii, and C-Reactive Protein (CRP), orosomucoid, fibrinogen, interleukin (IL)-6 inflammatory markers.

Discussion: To our knowledge, the present study is the first prospective study specifically designed to assess the risk of re-attempting suicide and to investigate the multidimensional predictive factors associated with re-attempting suicide in youth after a first suicide attempt. The results of this study will provide a unique opportunity to better understand whether youth are an at-risk group for suicide re-attempts, and will help us identify predictive factors of suicide re-attempt risk that could be translated into clinical settings to improve psychiatric care in this population.

Clinical trial registration: ClinicalTrials.gov, identifier: NCT03538197, first registered on 05/29/2018. The first patient was enrolled 05/22/2018.

Keywords: Brain-Derived Neurotrophic Factor; cortisol; inflammation; predicting; suicide attempt; toxoplasmosis; young adults.

Figure 1

Study design. On day 1, first-time suicide attempters aged 16 to 25 will be included in the SURAYA prospective cohort study upon their hospitalization in a psychiatric crisis unit. During their stay, socio-demographic, clinical and biological data will be collected. Three months later, participants will be contacted to retrieve the primary outcome: the presence or absence of a second suicide attempt (re-attempt) within the first 3 months. C-SSRS, Columbia Suicide Severity Rating Scale; CRP, C-Reactive Protein; BDNF, Brain-Derived Neurotrophic Factor; Ig, immunoglobulin; IL-6, interleukin-6; SURAYA, SUicide Re Attempts in Young Adults.