The Catalonia Suicide Risk Code: A secondary prevention program for individuals at risk of suicide.

BACKGROUND: Suicide prevention is an emerging priority for public health systems. Here, we present the Catalonia Suicide Risk Code (CSRC), a secondary suicide prevention program that provides a systematic approach to follow-up care for patients at risk. We describe the care pathway of the CSRC and characteristics of the patients enrolled in the program. METHODS: Observational study based on data extracted from the Catalan health care system between the years 2014 and 2019. The following patient-related data were obtained: sociodemographic and clinical characteristics, characteristics of suicidal behaviour, and pathway of care. RESULTS: A total of 12,596 individuals (64.1% women) were screened for suicide risk and 8,403 (66.7%) were subsequently enrolled in the CSRC. Adherence data show that most patients (81.9%) attended a face-to-face appointment and most (67.1%) were successfully contacted by telephone afterwards. Most face-to-face appointments were performed within 10 days of enrolment for adults and 72 h for minors. Psychiatric disorders were significant risk factors for both men and women. Females were significantly more likely to report stressful life events, while males were more likely to report social problems. Compared to men, women were more likely to use poisoning. LIMITATIONS: Adherence to the CSRC care pathway might reflect obstacles to its implementation. Due to the observational study design, it is not possible to determine the effectiveness of the CSRC to reduce suicide re-attempts. CONCLUSIONS: Although the CSRC successfully provided follow-up care for many individuals at high risk of suicide, greater adherence to the CSRC care pathway is needed.

Assessing outcomes in liver disease patients: reliability and validity of the Spanish version of the Liver Disease Quality of Life Questionnaire (LDQOL 1.0).

OBJECTIVE: To assess the reliability and validity of a Spanish version of the LDQOL 1.0 (Liver Disease Quality of Life questionnaire). METHODS: Observational, cross-sectional study in Spanish patients awaiting liver transplantation (LT). Feasibility was assessed by analyzing administration times and missing responses. Ceiling and floor effects were calculated and reliability was tested by examining internal consistency (Cronbach's alpha). Convergent validity was tested by examining correlations between LDQOL disease-specific and Short Form health survey with 36 questions (SF-36) dimensions. Known groups' validity was tested by examining the LDQOL's capacity to discriminate between groups defined by etiology and Child-Turcotte-Pugh (CTP) scores. RESULTS: A total of 200 patients were included for analysis. Mean age (SD) was 52.6 (9.8) years and 73% of the sample were male. The most common indication for LT was liver cancer (34%). Mean (SD) time to complete the questionnaire was 35.8 minutes (21.2 minutes). Missing responses were highest on the dimensions of sexual functioning and symptoms of liver disease. Ceiling effects were over 20% on 7 of the LDQOL's 12 disease-specific scales. Cronbach's alpha coefficients were over 0.70 on all but 2 dimensions. Correlations between SF-36 and LDQOL disease-specific dimensions generally fulfilled the hypotheses, with 35 of the 40 highest and lowest correlations (87.5%) being in the expected direction. The LDQOL discriminated well between patients in CTP class A and C, and as hypothesized, hepatocarcinoma and alcoholic cirrhosis patients scored better on most dimensions than patients with hepatitis C virus or other etiologies. CONCLUSIONS: The Spanish version of the LDQOL 1.0 has shown satisfactory reliability and validity.

What is the relative importance of self reported psychotic symptoms in epidemiological studies? Results from the ESEMeD--Catalonia Study.

Different prevalence of non-affective psychosis has been reported in general population surveys. The objectives of this study were to describe lifetime prevalence of non-affective psychosis in Catalonia, Spain; and to analyze the use of the CIDI psychosis module as a screening instrument for psychotic disorders. As part of the ESEMeD project in Catalonia, 1645 respondents were assessed with the CIDI. Respondents who scored positively to any of the CIDI psychosis screen questions, who had been hospitalised for a psychiatric reason or had received antipsychotic medication were re-assessed with the SCID-I by a clinician. The results showed that 11.18% people of the sample had lifetime self reported psychotic symptoms using the CIDI. After a clinical interview with the SCID-I, between 0.85 and 2.37% of the sample had a psychotic disorder, and 0.48%-1.58% had schizophrenia. The most frequent reported psychotic symptoms in individuals without a psychotic disorder were those related with hearing or seeing something missing during a bereavement period. Experiencing mind control, feeling that your mind was being controlled by strange forces, experiencing attempts of communications (CIDI questions) and taking medication were the items that discriminate between non-affective psychosis cases and negatives. Only experiencing mind control was associated with psychotic disorders in a logistic regression analysis. The main conclusions are that the use of lay-administered interviews should only be used as a screening instrument in the detection of psychosis in general population surveys because the majority of self reported psychotic symptoms have not been found to be associated with a psychotic disorder.