Gender commonalities and differences in risk and protective factors of suicidal thoughts and behaviors: A cross-sectional study of Spanish university students.

AIM: To assess gender differences in the association between risk/protective factors and suicidal thoughts and behaviors (STB); and whether there is any gender-interaction with those factors and STB; among Spanish university students. METHODS: Data from baseline online survey of UNIVERSAL project, a multicenter, observational study of first-year Spanish university students (18-24 years). We assessed STB; lifetime and 12-month negative life-events and family adversities; mental disorders; personal and community factors. Gender-specific regression models and gender-interactions were also analyzed. RESULTS: We included 2,105 students, 55.4% women. Twelve-month prevalence of suicidal ideation (SI) was 10%, plans 5.7%, attempts 0.6%. Statistically significant gender-interactions were found for lifetime anxiety disorder, hopelessness, violence between parents, chronic health conditions and family support. Lifetime mood disorder was a common risk factor of SI for both genders (Females: OR= 5.5; 95%CI 3.3-9.3; Males: OR= 4.4; 95%CI 2.0-9.7). For females, exposure to violence between parents (OR= 3.5; 95%CI 1.7-7.2), anxiety disorder (OR= 2.7; 95%CI 1.6-4.6), and alcohol/substance disorder (OR= 2.1; 95%CI 1.1-4.3); and for males, physical childhood maltreatment (OR= 3.6; 95%CI 1.4-9.2), deceased parents (OR= 4.6; 95%CI 1.2-17.7), and hopelessness (OR= 7.7; 95%CI 2.8-21.2), increased SI risk. Family support (OR= 0.5; 95%CI 0.2-0.9) and peers/others support (OR= 0.4; 95%CI 0.2-0.8) were associated to a lower SI risk only among females. CONCLUSIONS: Only mood disorder was a common risk factor of SI for both genders, whereas important gender-differences were observed regarding the other factors assessed. The protective effect from family and peers/others support was observed only among females. Further research assessing underlying mechanisms and pathways of gender-differences is needed.

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

BACKGROUND: Suicide 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. METHODS: An 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. DISCUSSION: The 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.

Suicidal ideation risk among LGB Spanish university students: The role of childhood and adolescence adversities and mental disorders.

BACKGROUND: Childhood/adolescence adversities and mental disorders are higher among LGB youths. AIMS: To evaluate the role of childhood maltreatment, bullying, and mental disorders on the association between sexual orientation and suicidal ideation (SI); and the role of mental disorders on the association between sexual orientation discrimination and SI. METHODS: Baseline and 12-month follow-up online surveys of Spanish first-year university students (18-24-year-olds). Multivariable logistic regression models assessed the effects of childhood/adolescence adversities and mental disorders in the relationship between sexual orientation, discrimination and SI. RESULTS: A total of 1224 students were included (16.4 % LGBs). Risk factors of lifetime SI were sexual orientation (OR 2.4), any bullying (OR 2.4), any childhood maltreatment (OR 4.0), and any mental disorders (OR 3.8). Final model Area Under the Curve (AUC) 0.78. Among homosexual and bisexual students, discrimination showed increased risk of 12-month SI (OR 2.2), but this effect was no longer statistically significant when any 12-month mental disorder was added (OR 7.8). Final model AUC 0.72. LIMITATIONS: Sample of interest was relatively small. But it was similar to comparable studies and statistical adjustments have been performed. Assessment of mental disorders and SI was not based on clinical assessment. However, validated scales showing good diagnostic agreement with clinical judgement were used. CONCLUSIONS: Childhood/adolescence adversities and mental disorders interact in the association between sexual orientation and SI. Mental disorders may mediate the association between sexual orientation discrimination and SI. Further research using larger samples and causal modelling approach assessing the mediators of SI risk among LGBs is needed.

Having any mental health condition before the COVID-19 pandemic as a risk factor of COVID-19 contagion during the first year of pandemic: A Spanish adult cohort.

Numerous studies suggest that subjects suffering from a mental health condition before the COVID-19 pandemic were at higher risk of contagion, but mostly are cross-sectional or retrospective. The BIOVAL-D-COVID-19 is a longitudinal cohort study design with 922 subjects who full filled two evaluations from an online survey of Spanish residents before and during the pandemic. Mental health conditions assessed were: Major Depressive Episode (MDE), Generalised Anxiety Disorder (GAD), Suicidal Thoughts and Behaviours (STB) and subthreshold of panic and bipolar disorder (BD). Mental health screening instruments used were: the Spanish version of the Composite International Diagnostic Interview (CIDI) version 3.0 for the evaluation of MDE, the GAD-7 scale to evaluate GAD; STB was evaluated with four items from the CIDI questionnaire. Panic Disorder and BD were screened from a modified and self-reported version of the CIDI. A bivariate plus five logistic regression models were developed for each mental health condition adjusted by socio-demographic variables; employment status; general and physical health; comorbidity; and including all previous variables and the other mental health conditions. We found in bivariate model that MDE; GAD and STB were statistically significant risk factors of contagion of COVID-19. The logistic regression models developed reveal that having a previous GAD (aOR 3.30 1.31-8.31) or STB (aOR 2.16 CI 95% 1.01-4.62) was statistically significant associated with COVID-19 contagion, independently of all variables included. MDE was not a risk factor of contagion when it was adjusted by comorbidity (aOR 0.99 CI 95% 0.47-2.09). It is recommended to detect those subjects with previous GAD or STB as vulnerable groups of infection to reduce contagion rates.

Factors associated with high and low mental well-being in Spanish university students.

BACKGROUND: Previous studies conducted in various nationally representative samples of the general population show that positive mental health is related to social prosperity. However, specific studies in university populations are scarce. In this study, we set out to explore factors associated with mental well-being (MWB) in a representative sample of first-year university students in Spain. METHODS: MWB was assessed with the short version of the Warwick-Edinburgh Mental Well-Being Scale. Multinomial logistic regressions were performed to explore the association between different blocks of factors, including relational, adversity, stress, lifestyle, spiritual, health, and self-perceived health variables with high and low MWB, controlling for sociodemographic and university-related variables. RESULTS: Data from 2082 students (18.6 ± 1.2 years; 56.6 % females) were analysed. Being male, being born in a foreign country, "high" self-perceived support, and "high" self-perceived mental health increased the odds of high MWB. Growing up in the suburbs, stressful experiences, and anxiety disorders reduced the odds of high MWB. Mood and anxiety disorders increased the odds of low MWB. "Middle" self-perceived support, sleeping ≥8 h per day, and "high" self-perceived mental health reduced the odds of low MWB. LIMITATIONS: The cross-sectional design precludes establishing causal relationships. Data were collected in the 2014-15 academic year using self-reported online surveys. CONCLUSION: The factors associated with high and low MWB do not always mirror each other, so specific plans are needed to successfully address each of the two poles. Interventions and policies targeting these factors for health promotion and disease prevention would improve the MWB of university students.

Effectiveness of resilience-based interventions in schools for adolescents: a systematic review and meta-analysis.

Introduction: Resilience has been identified as a dynamic process that provides capabilities to face adversity. Considering the many protective factors involved in resilience and that the school is a key context to promote resilience, this review aimed to examine the effect of school-based interventions on resilience in adolescents. Methods: A systematic literature review and meta-analysis were conducted in July 2021 on four databases. The risk of bias was assessed using the Cochrane risk of bias tool. Random-effects meta-analysis was used to obtain pooled estimates. Stratified analyses were done according to population type (general, at risk), intervention type, and follow-up assessments. Results: Of the 1,667 articles obtained, 27 were included in the systematic review and 16 in the meta-analysis. The random effects indicated a significant increase in resilience after the intervention [SMD = 0.58, 95% CI (0.29-0.87)]. Subgroup analysis showed effectiveness only in the population at risk [SMD = 1.28, 95% CI (0.53-2.03)] and early adolescence [SMD = 1.28, 95% CI (0.42-2.14), PI (-7.44 to 10.33)]. Multicomponent intervention [SMD = 1.45, 95% CI (0.11-2.80)] and Cognitive Behavioural Therapy (CBT) [SMD = 0.20, 95% CI (0.06-0.34)] demonstrated substantial effectiveness. Significant results were observed within 8-week follow-ups or less [SMD = 1.55, 95% CI (0.61-2.48)]. Discussion: These findings provide evidence that multicomponent and CBT interventions increase resilience in early at-risk adolescents only in the short term. Developing resilience interventions is useful in schools exposed to unfavourable socioeconomic contexts. Furthermore, long-term interventions should be redesigned to improve their effectiveness. Systematic review registration: PROSPERO [CRD42021277493].

Physical and mental health impact of the COVID-19 pandemic at first year in a Spanish adult cohort.

The COVID-19 pandemic and the political and health measures have profoundly affected the health of our populations. However, very few studies have been published assessing its impact using a prospective cohort. The aim of this study is to describe the impact on physical and mental health due to the COVID-19 pandemic in the general population in Spain, and according to COVID-19 clinical status, during the first year of the pandemic. A longitudinal cohort study with two online surveys were performed on a representative sample of the adult Spanish population before (N = 2005, October/November 2019) and during the pandemic (N = 1357, November/December 2020). We assessed disability using the World Health Organisation Disability Assessment Schedule (WHODAS), major depressive episode (MDE) and suicidal thoughts and behaviours (STB), using an adapted version of the Composite International Diagnostic Interview (CIDI 3.0); generalised anxiety disorder (GAD) using the GAD-7 scale; post-traumatic stress disorder (PTSD) symptoms using the PTSD checklist for DSM-5 (PCL-5). For physical health, there was a statistically significant loss of weight (mean/SD) (T0, 73.22/15.56 vs. T1, 71.21/11.94), less use of tobacco (T0, 11.4% vs. T1, 9.0%) and decreased disability (mean/SD) (T0, 21.52/9.22 vs. T1, 19.03/7.32). For mental health, there was a significant increase in MDE (T0, 6.5% vs. T1, 8.8%) and in the prevalence of GAD (T0, 13.7% vs. T1, 17.7%). The prevalence of STB (T0, 15.1% vs. T1, 7.1%) significantly decreased. Individuals who declared they had been diagnosed with COVID-19 (3.6%) showed a worsening in physical health and an increase in mental health problems and PTSD symptoms. Although suicide risk during the first year of the pandemic was significantly less, many suicide risk factors increased: such as the incidence and persistence of MDE and GAD, the presence of PTSD symptoms in those diagnosed with COVID-19, and a worsening in self-assessed health status. We expect an increase in STB in the population in the long-term. Future research should gather information about the long-term impact of the pandemic.

Fostering Resilience in Adolescents at Risk: Study protocol for a cluster randomized controlled trial within the resilience school-based intervention.

Introduction: Resilience is considered of high relevance when developing interventions to cope with stressful situations. Schools are one of the key settings to promote resilience among adolescents. The purpose of this cluster randomized controlled trial is to assess the effectiveness of an intervention in adolescents at risk, aged 12-to-15 years old, to increase resilience and emotional regulation strategies. Methods: The recruitment period started in January 2022. Schools will be randomly allocated to control and intervention groups by an external researcher using computer-generated random numbers. The minimum sample size was estimated to be 70 participants per group. Primary health care nurses will carry out the intervention during the school period (January to June 2022). Students will follow a specific training consisting of six 55-min sessions, for 6 weeks. Each session will consist of 5 min of mindfulness, followed by 45 min of the corresponding activity: introducing resilience, self-esteem, emotional regulation strategies, social skills, problem-solving, community resources, social and peer support, and 5 min to explain the activity to do at home. Data will be collected at baseline, 6 weeks, and 24 weeks after the intervention. The child youth resilience measure-32 (CYRM-32) scale will be used to assess the effectiveness of the intervention. This study received a grant in June 2021. Discussion: The intervention is intended to improve mental health through resilience. Different factors related to resilience will be promoted, such as self-esteem, emotional regulation, social and communication skills, problem-solving and peer support, among others. As it has been designed as a cluster-randomized school-based intervention, we will directly ameliorate the participation and engagement of the target population. With the present intervention, we expect to improve coping skills in adolescents by enhancing resilience capacities.

COVID-19 Pandemic Psychological Impact and Volunteering Experience Perceptions of Medical Students after 2 Years.

Undergraduate healthcare students were mobilized to support healthcare systems during the COVID-19 pandemic, but we have scarce information regarding their experience and its impact on their wellbeing. An anonymous online survey was conducted among undergraduate students and recently graduated physicians of a medical university in Spain, regarding their symptoms and volunteering experience during the initial months of the Spanish COVID-19 pandemic. Respondents showed a high prevalence of perceived stress, anxiety, and depressive symptoms, measured by the PHQ-9 and GAD-7. 14.5% reported healthcare-related volunteering tasks. Volunteering was a satisfactory experience for most of the respondents and the majority felt ready to do volunteering tasks (66.6%). Yet, 16.6% acknowledged not getting appropriate specific-task education before starting, 20.8% reported not having appropriate supervision, and 33.3% feel they did not have proper protective equipment. More than half of volunteers feared getting infected, more than 70% feared infecting their relatives or friends, and 54.2% reported stigmatization. Volunteers showed significantly higher stress, anxiety, and depression scores than the rest of the respondents, and 32% reported a highly traumatic event during volunteering, with high scores on the IES-R in the 16% of volunteers. Our results should help guide future potential volunteering processes in emergencies, enhance academic programs at medical schools and provide valuable data for psychological support services.

Socio-economic and psychological impact of COVID-19 pandemic in a Spanish cohort BIOVAL-D-COVID-19 study protocol.

OBJECTIVE: SARS-CoV-2 outbreak has a negative psychological impact among general population. Data comparing mental health status before and during the outbreak is needed. The BIOVAL-D-COVID-19 study assess the socio-economic and psychological impact of the COVID-19 pandemic and lockdown in a representative sample of non-institutionalized Spanish adult population, and estimate the incidence of mental health disorders, including suicidal behaviours, and possible related factors. METHOD: Observational longitudinal study including two online surveys: baseline survey (T0) performed during 2019 and follow-up survey (T1) conducted 12-month later. The latter included nine sections: socio-demographic, health status, mental health, employment conditions and status, material deprivation, use of healthcare services, intimate partner violence and resilience. Four of the nine sections are administered in T0 and T1 assessments. Longitudinal data analyses will estimate adjusted incidence rates of mental health disorders using Poisson regression models. Risk and protective factors will be analysed through multiple logistic regression models.

Low Resilience Was a Risk Factor of Mental Health Problems during the COVID-19 Pandemic but Not in Individuals Exposed to COVID-19: A Cohort Study in Spanish Adult General Population.

BACKGROUND: The aim is to analyze whether people with low resilience are at higher risk of mental health problems during the COVID-19 pandemic in Spanish adults. METHODS: a longitudinal cohort study was carried out. Resilience was measured with the CD-RISC. Mental health problems that were assessed included: Major Depressive Episode (MDE), Generalized Anxiety Disorder (GAD), Suicidal Thoughts and Behaviors (STB), and Posttraumatic Stress Disorder (PTSD) symptoms. RESULTS: we found statistically significant differences between groups and resilience scores in MDE [F (3; 48.40) = 19.55], GAD [F (3; 19.63) = 6.45] and STB [F (3; 111.74) = 31.94]. Multivariable analyses showed individuals with very low resilience were at a 5-fold risk of Incidence of MDE and a 4-fold risk of STB. Persistent group presented a 21-fold risk of MDE and 54-fold risk of STB. No evidence of higher risk was found for GAD. Individuals with low resilience and exposed to COVID-19 were not at higher risk. Individuals with low resilience were at higher risk of PTSD in general population [ß(95% CI) = -3.25 (-3.969 to -2.54)], but not for individuals with COVID-19. CONCLUSIONS: in the general population, having low or very low resilience increases the risk of suffering MDE, STB, and PTSD, but not GAD during the COVID-19 pandemic, and not in the population with COVID-19.

Evaluating the effectiveness of care coordination interventions designed and implemented through a participatory action research process: Lessons learned from a quasi-experimental study in public healthcare networks in Latin America.

BACKGROUND: Despite increasing recommendations for health professionals to participate in intervention design and implementation to effect changes in clinical practice, little is known about this strategy's effectiveness. This study analyses the effectiveness of interventions designed and implemented through participatory action research (PAR) processes in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay to improve clinical coordination across care levels, and offers recommendations for future research. METHODS: The study was quasi-experimental. Two comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys of a sample of primary and secondary care doctors (174 doctors/network/year) were conducted using the COORDENA® questionnaire. Most of the interventions chosen were based on joint meetings, promoting cross-level clinical agreement and communication for patient follow-up. Outcome variables were: a) intermediate: interactional and organizational factors; b) distal: experience of cross-level clinical information coordination, of clinical management coordination and general perception of coordination between levels. Poisson regression models were estimated. RESULTS: A statistically significant increase in some of the interactional factors (intermediate outcomes) -knowing each other personally and mutual trust- was observed in Brazil and Chile INs; and in some organizational factors -institutional support- in Colombia and Mexico. Compared to CNs in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors. In distal outcomes, care consistency items improved in Brazil, Colombia and Uruguay INs; and patient follow-up improved in Chile and Mexico. General perception of clinical coordination increased in Brazil, Colombia and Mexico INs. Compared to CNs in 2017, only Brazil showed significant differences. CONCLUSIONS: Although more research is needed, results show that PAR-based interventions improved some outcomes regarding clinical coordination at network level, with differences between countries. However, a PAR process is, by definition, slow and gradual, and longer implementation periods are needed to achieve greater penetration and quantifiable changes. The participatory and flexible nature of interventions developed through PAR processes poses methodological challenges (such as defining outcomes or allocating individuals to different groups in advance), and requires a comprehensive mixed-methods approach that simultaneously evaluates effectiveness and the implementation process to better understand its outcomes.

Predictive models for first-onset and persistence of depression and anxiety among university students.

BACKGROUND: Depression and anxiety are both prevalent among university students. They frequently co-occur and share risk factors. Yet few studies have focused on identifying students at highest risk of first-onset and persistence of either of these conditions. METHODS: Multicenter cohort study among Spanish first-year university students. At baseline, students were assessed for lifetime and 12-month Major Depressive Episode and/or Generalized Anxiety Disorder (MDE-GAD), other mental disorders, childhood-adolescent adversities, stressful life events, social support, socio-demographics, and psychological factors using web-based surveys; 12-month MDE-GAD was again assessed at 12-month follow-up. RESULTS: A total of 1253 students participated in both surveys (59.2% of baseline respondents; mean age = 18.7 (SD = 1.3); 56.0% female). First-onset of MDE-GAD at follow-up was 13.3%. Also 46.7% of those with baseline MDE-GAD showed persistence at follow-up. Childhood/Adolescence emotional abuse or neglect (OR= 4.33), prior bipolar spectrum disorder (OR= 4.34), prior suicidal ideation (OR=4.85) and prior lifetime symptoms of MDE (ORs=2.33-3.63) and GAD (ORs=2.15-3.75) were strongest predictors of first-onset MDE-GAD. Prior suicidal ideation (OR=3.17) and prior lifetime GAD symptoms (ORs=2.38-4.02) were strongest predictors of MDE-GAD persistence. Multivariable predictions from baseline showed AUCs of 0.76 for first-onset and 0.81 for persistence. 74.9% of first-onset MDE-GAD cases occurred among 30% students with highest predicted risk at baseline. LIMITATIONS: Self-report data were used; external validation of the multivariable prediction models is needed. CONCLUSION: MDE-GAD among university students is frequent, suggesting the need to implement web-based screening at university entrance that identify those students with highest risk.

[Knowledge and use of clinical coordination mechanisms in healthcare networks in Latin America]. / Conocimiento y uso de mecanismos de coordinación clínica de servicios de salud de Latinoamérica.

OBJECTIVE: To analyze the level of knowledge and use, and the characteristics of use, of care coordination mechanisms in public healthcare networks of six Latin America countries. METHOD: Cross-sectional study based on a survey using the COORDENA® questionnaire with primary and secondary care doctors (348 doctors/country) of public healthcare networks in Argentina, Brazil, Chile, Colombia, Mexico and Uruguay (May-October 2015). Analyzed variables: degree of knowledge and use of information coordination (referral/reply letter, discharge report, phone, e-mail) and of clinical management coordination (shared clinical guidelines, joint meetings) mechanisms. Descriptive analyses were conducted. RESULTS: Knowledge of clinical information coordination mechanisms was high in both care levels and analyzed networks as was the use of referral/reply letter. There was greater variability in the use of discharge reports (from 40.0% in Brazil to 79.4% in Mexico) and, except for Argentina, a low reception reported by primary care doctors stands out (12.3% in Colombia and 55.1% in Uruguay). In contrast, knowledge of clinical management coordination mechanisms was limited, especially among secondary care doctors. It is noteworthy, however, that adherence to clinical guidelines was high (from 83.1% in Mexico to 96.8% in Brazil), while participation in joint meetings varied widely (from 23.7% in Chile to 76.2% in Brazil). The difficulties reported in the use of the mechanisms are related to structural and organizational factors. CONCLUSIONS: The limited knowledge and use of coordination mechanisms shows insufficient diffusion and implementation. Strategies to increase its use are needed, including the related factors.

Self-esteem and suicidal behaviour in youth: A meta-analysis of longitudinal studies.

BACKGROUND: Previous literature suggests that low self-esteem is a risk factor for suicide attempts, but no meta-analyses have been conducted to assess this association in adolescents/young adults. The present study examined the relationship between low self-esteem and suicide attempts in young people (12-26 years old). METHOD: Meta-analyses were performed using random-effects models (ES) and odds ratio (OR). Heterogeneity and sensitivity analyses were performed. RESULTS: From 26,883 initial titles, 22 studies met the inclusion criteria, of which 9 studies had data that could be included in the meta-analysis. The meta-analysis showed that youths with lower self-esteem were more likely to have future suicide attempts, with an effect size (self-esteem as continuous variable) of d = .58 (95% CI = .44 - .73) and, for low self-esteem (categorical variable) an OR = 1.99 (95% CI = 1.39-2.86; p < .001). CONCLUSION: A low level of self-esteem is a risk factor for suicide attempts in adolescents/young adults.

Measures of frequency used in cohorts studies to evaluate the suicidal behaviour in young people (12-26 years): A systematic review. / Medidas de frecuencia utilizadas en estudios de cohortes para evaluar el comportamiento suicida en jóvenes (12-26 años): una revisión sistemática.

INTRODUCTION: A priority for the WHO by 2020 is to have reduced the rates of suicide; they indicate difficulties in giving precise estimations due to a wide variety of factors, which include aspects related to the statistical measurements themselves of suicidal behaviour. The proportion of deaths from suicide is 8.5% among young people between 15-29 years of age. OBJECTIVE: To review the methodology used to express the frequency of suicidal behaviour in young people and to describe the methodological characteristics of the studies reviewed. METHOD: A systematic review of longitudinal studies registered on PROSPERO. The extracted information included the following: year of publication, journal, population size, sample, country, design, age, percentage of men, follow-up time and losses, suicidal behaviour, risk factors, ethical aspects, fundamentally, evaluating the measures of frequency used. RESULTS: Eighty-two articles were selected from 37,793 documents. None of the studies define the measure of frequency used for suicidal behaviour, there are currently up to 9 different ways of measuring it. The populations are students or the general population (66%), birth cohorts (16%) and specific groups. Follow-up was from 24 weeks to 30 years. Only 24.1% of the studies took ethical aspects into consideration. CONCLUSIONS: Researchers must make an effort to reach an agreement on the measures of frequency used in suicidal behaviour studies, as the methodological and terminological variability currently used impedes making any comparisons between different studies or understanding the real dimension of the problem.

Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies.

OBJECTIVES: To assess the association between gender and suicide attempt/death and identify gender-specific risk/protective factors in adolescents/young adults. METHODS: Systematic review (5 databases until January 2017). Population-based longitudinal studies considering non-clinical populations, aged 12-26 years, assessing associations between gender and suicide attempts/death, or evaluating their gender risk/protective factors, were included. Random effect meta-analyses were performed. RESULTS: Sixty-seven studies were included. Females presented higher risk of suicide attempt (OR 1.96, 95% CI 1.54-2.50), and males for suicide death (HR 2.50, 95% CI 1.8-3.6). Common risk factors of suicidal behaviors for both genders are previous mental or substance abuse disorder and exposure to interpersonal violence. Female-specific risk factors for suicide attempts are eating disorder, posttraumatic stress disorder, bipolar disorder, being victim of dating violence, depressive symptoms, interpersonal problems and previous abortion. Male-specific risk factors for suicide attempt are disruptive behavior/conduct problems, hopelessness, parental separation/divorce, friend's suicidal behavior, and access to means. Male-specific risk factors for suicide death are drug abuse, externalizing disorders, and access to means. For females, no risk factors for suicide death were studied. CONCLUSIONS: More evidence about female-specific risk/protective factors of suicide death, for adolescent/young adults, is needed.

Polimorfismo C677T del gen Metilentetrahidrofolato Reductasa como posible factor de riesgo materno para la presentación de síndrome de Down en la población guayaquileña / C677T Polymorphism of the Methylenetetrahydrofolate Reductase gene as a possible maternal risk factor for the presentation of Down syndrome in the population of Guayaquil

Objetivo: evaluar la presencia del polimorfismo C677T del gen de la enzima MTHFR como posible factor de riesgo materno para la presentación de síndrome de Down, en la población guayaquileña. Metodología: se realizó un estudio de casos y control que incluyó 51 madres de niños o niñas con síndrome de Down y 52 mujeres que tuvieron en su último embarazo un producto de cualquier sexo sano. Se recolectaron muestras de sangre venosa periférica entre los meses de diciembre 2010 y mayo 2011 posteriora lo que se realizó extracción de ADN y genotipificación del polimorfismo C677T del gen de la enzima MTHFR. Para el análisis estadístico se utilizó Chi cuadrado de Pearson (X2), odds ratio (OR) con intervalo de confianza de 95 por ciento (95 por cientoIC). Valores de p<0.05 fueron considerados estadísticamente significativos. Resultados: se incluyeron 51 mujeres madres de hijos/as con síndrome deDown y 52 madres control. La frecuencia del alelo T fue mayor en el grupo casos (X2=0.944, p=0.331). En el análisis simultáneo de las variantes genotípicas heterocigota y homocigota del gen MTHFR 677 (CT y TT) en los grupos casos y control, no se observó aumento de riesgo para el síndrome (OR=0.87 [IC 95 por ciento 0.34 – 2.20]; p=0.772). Conclusión: no se encontró relación entre la presenciadel polimorfismo C677T MTHFR y aumento en el riesgo materno para síndrome de Down. Es necesario realizar mayores investigaciones en la población ecuatoriana en general que determinen la asociación de diversos polimorfismos en diferentes genes.

Aim: to assess the presence of the C677T polymorphism of the MTHFR gene as a possible maternal risk factor for Down syndrome in the population of Guayaquil. Methodology: a case study and control research involving 51 mothers of boys and girls with Down syndrome and 52 women who delivered a healthy offspring of either sex in their last pregnancy. Venous blood samples were collected in the months of December 2010 and May 2011 after that, a DNA extraction and genotyping of the C667T polymorphismof the MTHFR gene were performed. Pearson’s Chi-squared test (X2), and odds Ratio (OR) with confidence interval of 95 percent (95 percent CI) were used for the statistical analysis. Values of p<0.05 were considered statistically significant. Results: 51 women mothers of sons / daughters with Down syndrome and 52 control mothers were included. The T-allele frequency was higher in the cases (X²=0.944, p:0.331). In the simultaneous analysis of heterozygous and homozygous genotype variant of MTHFR 667 (CTand TT) in the case and control groups, no risk increase for the syndrome (OR=0.87 [IC 95 percent 0.34 – 2.20]; p=0.772) was observed. Conclusion: no relationship was found between the presence of MTHFR C677T polymorphism and increased maternal risk for Down syndrome. It is necessary to perform further research on the general Ecuadorian population to determine the association of various polymorphisms in different genes.