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Suicide Prevention and Intervention in Spain: the SURVIVE Study (SURVIVE)

Primary Purpose

Suicide, Suicide, Attempted, Depression

Status
Unknown status
Phase
Not Applicable
Locations
Spain
Study Type
Interventional
Intervention
Telephone-based management
iFightDepression for Suicide
Treatment as Usual
Self Awareness of Mental Health
Sponsored by
Parc de Salut Mar
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Suicide focused on measuring suicide, suicide attempted, depression, secondary prevention, mental health

Eligibility Criteria

12 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

General Inclusion Criteria:

  • Female and males, age >= 12 years
  • Having attended a hospital emergency department due to a suicide attempt
  • Willing and able to comply with study procedures and to give written informed consent

Specific inclusion criteria for iFD-S:

  • Minimum knowledge of internet use and availability of an internet device (tablet, computer, smartphone)
  • Depressive symptoms according to PHQ-9 scores above 5

Specific inclusion criteria for SAM:

  • Age between 12-17
  • Informed consent of legal guardians

General Exclusion Criteria:

  • Incapacity to give informed consent
  • Lack of fluency in Spanish
  • Currently taking part in another clinical study which, in the opinion of the investigator, is likely to interfere with the objectives of the SURVIVE study.

Sites / Locations

  • Hospital Universitario Virgen del Rocio
  • Hospital Universitario Central de Asturias
  • Hospital Santiago de Áraba
  • Hospital Germans Trias i Pujol
  • Institute of Neuropsychiatry and Addictions, INAD, Parc de Salut Mar
  • Hospital de la Santa Creu i Sant Pau
  • Hospital Clinic
  • Corporació Sanitaria Parc Tauli
  • Hospital Clínico San Carlos
  • Hospital Universitario La Paz

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Active Comparator

Experimental

Arm Label

Telephone-based management

iFightDepression for Suicide

Treatment as Usual

Self Awareness of Mental Health

Arm Description

Telephone-based management will consist of a three-phase intervention: 1) An initial 15-20 min call at 1 week of enrollment in which the cases manager introduces him/herself, and does a short assessment of the current suicide risk, 2) A 5-10 min telephone follow-up at 1, 3, 6, 9 and 12 months, 3) If suicide risk is detected, a 15-45 min crisis intervention call will be done, tailored to the participant's characteristics and context. If deemed necessary, an emergency face-to-face appointment will be scheduled. At each phone call information regarding the current treatment, adherence to mental health services, and current life stressors will be collected.

The iFightDepression-Survive (iFD-S) program is a cognitive-behavioral, internet-based self-management tool, developed by the European Alliance Against Depression (EAAD). The iFD is intended to address mild-to-moderate depressive symptoms. The iFD tool is structured in seven core modules focused on: behavioral activation, cognitive restructuring, sleep regulation, mood monitoring, and healthy lifestyle habits. The content of each module is intended to be followed over 1 week and consists of written information, tasks to do over the week and worksheets. All of these aims to consolidate learning and promote self-monitoring. For this study, an additional module (iFD-S) will be developed. To that end, the expertise of a panel of mental health experts in suicide and cognitive-behavioral interventions will be asked. The iFD-S also provides telephone guidance (2h per participant) during the use of the program.

Treatment as Usual (TaU) will vary across sites, however it generally implies a combination of case management strategies (including telephone calls, visits by mental health services) and pharmacotherapy. For this study, any nonspecific intervention to address suicidal behavior or to prevent suicide will be considered as treatment as usual. TaU will consist of any routine procedures applied at each participating site.

The Self Awareness of Mental Health (SAM) is an adaptation of the Youth Awareness of Mental Health program, originally developed for the Saving and Empowering Young Lives in Europe (SEYLE) study. The SAM aims to raise mental health awareness about risk and protective factors associated with suicide, provide knowledge about depression and anxiety, and enhance the skills needed to cope with adverse life events and suicidal behavior. The intervention is delivered by trained clinical psychologists in five, 45-60 minutes, face-to-face sessions.

Outcomes

Primary Outcome Measures

Suicide repetition (or death by suicide)
The primary outcome is subsequent suicide attempts (and/or suicide mortality) captured across assessment points. Is a binary variable (yes/no).

Secondary Outcome Measures

Brief Symptoms Inventory
The BSI is a 53-item self-report scale designed to evaluate psychopathological and psychological symptoms, measuring nine dimensions (i.e.,somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism) that can be summed up to reflect three global indices. These synthetic indices are the General Severity Index (GSI), the Positive Symptom Distress Index, and the Positive Symptom Total. In more detail, the BSI uses a 5-point Likert scale, ranging from 0 ("not at all") to 4 ("extremely"). Scores range from 0 to 212, higher scores mean a worse outcome.
Patient Health Questionnaire 9-items
The PHQ-9 measures depressive symptoms in a scale from 0 (not at all) to 3 (nearly every day). Scores range from 0 to 27 and higher scores mean a worse outcome. The PHQ-9 A will be used for participants aged 12-17.
Generalized Anxiety Disorder 7-items
GAD-7 consists of seven items measuring worry and anxiety symptoms. Each item is scored on a four-point Likert scale (0-3) with total scores ranging from 0 to 21 with higher scores reflecting greater anxiety severity.
EuroQol 5D
Part one provides a self-reported description of health problems into five dimensions. Patients have to rate the severity of each dimension in a 5-point scale. For part one, higher scores represent a worse outcome (less quality of life).Part two consist of a Visual Analogue Scale corresponding to the current state of the subject's health. The lowest extreme (0) corresponds to the worst imaginable state, and the highest extreme (100) represents the best imaginable health state.
Barrat Impulsivity Scale
The BIS is a 30-item widely used questionnaire that measures three aspects of impulsivity: 1) motor impulsiveness (acting without forethought), 2) attentional impulsiveness (tendency to make quick, non-reflexive decisions), and 3) non-planned impulsiveness (failure to prepare for future events). Each item is rated in a 4 point scale (0-4). Total scores range from 0 to 44, higher scores represent higher impulsivity.
Acquired capability of suicide Scale -Fearlesness about Death
Acquired Capability for Suicide Scale-Fearlessness about Death (ACSS-FAD) is a seven-item self-report measure which uses a 5-point Likert scale ranging from 0 (not at all like me) to 4 (very much like me). Scores range from 0 to 32, and higher scores represent a worse outcome (higher levels of the acquired capability for suicide).
Reflective Functioning Questionnaire
The 8-item version of the Reflective Functioning Questionnaire is a self-reported instrument that measures reflective functioning, an expression of mentalizing processes. The instrument separately addresses the levels of both certainty and uncertainty about one's own mental processes. Items are scored in a 7 point-scale (1 to 7), meaning that the total score ranges from 8 to 56, higher scores represent a higher capacity of mentalizing, and therefore a better outcome.
Columbia Suicide Rating Scale
The Columbia Suicide Rating Scale is a suicidal ideation and behavior rating scale that evaluates suicide risk.It rates an individual's degree of suicidal ideation on a scale, ranging from "wish to be dead" to "active suicidal ideation with specific plan and intent and behaviors. It contains 6 "yes" or "no" questions in which respondents are asked to indicate whether they have experienced several thoughts or feelings relating to suicide over the past month and behaviors over their lifetime and past 3 months. An answer of "yes" to any of the six questions may indicate a need for referral and an answer of "yes" to questions 4, 5 or 6 indicate high-risk.
The International Neuropsychiatric Interview (MINI)
Clinician-rated scale to screen for mental disorders. The MINI KIDs will be used for participants between 12-17 years of age.
Strengths and Difficulties Questionnaire (SDQ)
Emotional and behavioral screening questionnaire designed for youths.

Full Information

First Posted
April 8, 2020
Last Updated
May 6, 2020
Sponsor
Parc de Salut Mar
Collaborators
Instituto de Salud Carlos III
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1. Study Identification

Unique Protocol Identification Number
NCT04343703
Brief Title
Suicide Prevention and Intervention in Spain: the SURVIVE Study
Acronym
SURVIVE
Official Title
Suicide Prevention and Intervention (SURVIVE): Cohort Study and Nested Randomized Controlled Trials of Secondary Prevention Programs for Suicide Attempts
Study Type
Interventional

2. Study Status

Record Verification Date
April 2020
Overall Recruitment Status
Unknown status
Study Start Date
June 1, 2020 (Anticipated)
Primary Completion Date
January 1, 2023 (Anticipated)
Study Completion Date
September 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Parc de Salut Mar
Collaborators
Instituto de Salud Carlos III

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Suicide is one of the leading causes of avoidable death worldwide. Gathering population-representative data on the incidence of suicidal behavior, as well as developing effective secondary prevention strategies are imperative parts of evidence-based public health policies, currently lacking in Spain. The Suicide Prevention and Intervention Study (SURVIVE) is a multi-site-cohort study with nested randomized-controlled clinical trials. The principal aims of the SURVIVE study are to determine the incidence of suicide attempts in Spain and to investigate the efficacy of two secondary prevention programs.
Detailed Description
Suicide is the leading cause of avoidable death worldwide, demanding urgent attention. Collecting national-representative data is the first step towards developing effective evidence-based public-policies. The SURVIVE study presents four inter-connected objectives: To determine the incidence of suicide attempts in Spain To follow up suicide attempters with the aim of studying the probability of them re-attempting To identify influential risk factors to explain suicide attempts and an increased risk of re-attempting To determine the efficacy of secondary prevention programs to prevent suicide re-attempts in comparison to treatment as usual (TAU). Study design: Multi-site-coordinated cohort study with nested randomized controlled trials. Participants will be recruited at mental-health sites distributed across Spain. Participants: A cohort of 2.000 individuals presenting a suicide attempt will be established. Individuals would be followed for 1-year, and assessed every 3 months. Participants (age >18) that meet inclusion/exclusion criteria will be randomly allocated to: 1) telephone-based management, or 2) iFightDepression for Suicide (iFD-Survive), a web-based-self-management tool. These interventions will be tested against TAU. Participants (age between 12-17) that meet inclusion/exclusion criteria will be randomly allocated to: 1)a face-to-face individual intervention designed for youths Specific Aware of Mental Health Intervention for adolescents (SAM) or 2) TAU.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Suicide, Suicide, Attempted, Depression
Keywords
suicide, suicide attempted, depression, secondary prevention, mental health

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Investigator
Allocation
Randomized
Enrollment
2000 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Telephone-based management
Arm Type
Experimental
Arm Description
Telephone-based management will consist of a three-phase intervention: 1) An initial 15-20 min call at 1 week of enrollment in which the cases manager introduces him/herself, and does a short assessment of the current suicide risk, 2) A 5-10 min telephone follow-up at 1, 3, 6, 9 and 12 months, 3) If suicide risk is detected, a 15-45 min crisis intervention call will be done, tailored to the participant's characteristics and context. If deemed necessary, an emergency face-to-face appointment will be scheduled. At each phone call information regarding the current treatment, adherence to mental health services, and current life stressors will be collected.
Arm Title
iFightDepression for Suicide
Arm Type
Experimental
Arm Description
The iFightDepression-Survive (iFD-S) program is a cognitive-behavioral, internet-based self-management tool, developed by the European Alliance Against Depression (EAAD). The iFD is intended to address mild-to-moderate depressive symptoms. The iFD tool is structured in seven core modules focused on: behavioral activation, cognitive restructuring, sleep regulation, mood monitoring, and healthy lifestyle habits. The content of each module is intended to be followed over 1 week and consists of written information, tasks to do over the week and worksheets. All of these aims to consolidate learning and promote self-monitoring. For this study, an additional module (iFD-S) will be developed. To that end, the expertise of a panel of mental health experts in suicide and cognitive-behavioral interventions will be asked. The iFD-S also provides telephone guidance (2h per participant) during the use of the program.
Arm Title
Treatment as Usual
Arm Type
Active Comparator
Arm Description
Treatment as Usual (TaU) will vary across sites, however it generally implies a combination of case management strategies (including telephone calls, visits by mental health services) and pharmacotherapy. For this study, any nonspecific intervention to address suicidal behavior or to prevent suicide will be considered as treatment as usual. TaU will consist of any routine procedures applied at each participating site.
Arm Title
Self Awareness of Mental Health
Arm Type
Experimental
Arm Description
The Self Awareness of Mental Health (SAM) is an adaptation of the Youth Awareness of Mental Health program, originally developed for the Saving and Empowering Young Lives in Europe (SEYLE) study. The SAM aims to raise mental health awareness about risk and protective factors associated with suicide, provide knowledge about depression and anxiety, and enhance the skills needed to cope with adverse life events and suicidal behavior. The intervention is delivered by trained clinical psychologists in five, 45-60 minutes, face-to-face sessions.
Intervention Type
Behavioral
Intervention Name(s)
Telephone-based management
Intervention Description
The intervention consists of a series of phone calls aimed at providing follow up care of individuals at risk. At each phone call the case manager collects information regarding the current treatment, adherence to mental health services, and current life stressors.
Intervention Type
Behavioral
Intervention Name(s)
iFightDepression for Suicide
Other Intervention Name(s)
iFD-S
Intervention Description
The iFD-Survive is a cognitive-behavioral, internet-based self-management tool, developed by the European Alliance Against Depression (EAAD). The iFD is intended to address mild-to-moderate depressive symptoms. The iDF tool is structured in seven core modules focused on: behavioral activation, cognitive restructuring, sleep regulation, mood monitoring, and healthy lifestyle habits. The content of each module is intended to be followed over 1 week and consists of written information, tasks to do over the week and worksheets. All of these aims to consolidate learning and promote self-monitoring. For this study, an additional module (iFD-S) will be developed. The iFD-S also provides telephone guidance (2h per participant).
Intervention Type
Behavioral
Intervention Name(s)
Treatment as Usual
Other Intervention Name(s)
TaU
Intervention Description
Treatment as Usual (TaU) will vary across sites, however it generally implies a combination of case management strategies (including telephone calls, visits by mental health services) and pharmacotherapy. For this study, any nonspecific intervention to address suicidal behavior or to prevent suicide will be considered as treatment as usual.
Intervention Type
Behavioral
Intervention Name(s)
Self Awareness of Mental Health
Other Intervention Name(s)
SAM
Intervention Description
The SAM consist of five, face-to-face, individual sessions designed to raise awareness about depression, anxiety and suicidal behaviors as well as to enhancing skills to effectively cope with stressful life events and mood.
Primary Outcome Measure Information:
Title
Suicide repetition (or death by suicide)
Description
The primary outcome is subsequent suicide attempts (and/or suicide mortality) captured across assessment points. Is a binary variable (yes/no).
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Brief Symptoms Inventory
Description
The BSI is a 53-item self-report scale designed to evaluate psychopathological and psychological symptoms, measuring nine dimensions (i.e.,somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism) that can be summed up to reflect three global indices. These synthetic indices are the General Severity Index (GSI), the Positive Symptom Distress Index, and the Positive Symptom Total. In more detail, the BSI uses a 5-point Likert scale, ranging from 0 ("not at all") to 4 ("extremely"). Scores range from 0 to 212, higher scores mean a worse outcome.
Time Frame
1 month
Title
Patient Health Questionnaire 9-items
Description
The PHQ-9 measures depressive symptoms in a scale from 0 (not at all) to 3 (nearly every day). Scores range from 0 to 27 and higher scores mean a worse outcome. The PHQ-9 A will be used for participants aged 12-17.
Time Frame
2 weeks
Title
Generalized Anxiety Disorder 7-items
Description
GAD-7 consists of seven items measuring worry and anxiety symptoms. Each item is scored on a four-point Likert scale (0-3) with total scores ranging from 0 to 21 with higher scores reflecting greater anxiety severity.
Time Frame
2 weeks
Title
EuroQol 5D
Description
Part one provides a self-reported description of health problems into five dimensions. Patients have to rate the severity of each dimension in a 5-point scale. For part one, higher scores represent a worse outcome (less quality of life).Part two consist of a Visual Analogue Scale corresponding to the current state of the subject's health. The lowest extreme (0) corresponds to the worst imaginable state, and the highest extreme (100) represents the best imaginable health state.
Time Frame
1 day
Title
Barrat Impulsivity Scale
Description
The BIS is a 30-item widely used questionnaire that measures three aspects of impulsivity: 1) motor impulsiveness (acting without forethought), 2) attentional impulsiveness (tendency to make quick, non-reflexive decisions), and 3) non-planned impulsiveness (failure to prepare for future events). Each item is rated in a 4 point scale (0-4). Total scores range from 0 to 44, higher scores represent higher impulsivity.
Time Frame
2 weeks
Title
Acquired capability of suicide Scale -Fearlesness about Death
Description
Acquired Capability for Suicide Scale-Fearlessness about Death (ACSS-FAD) is a seven-item self-report measure which uses a 5-point Likert scale ranging from 0 (not at all like me) to 4 (very much like me). Scores range from 0 to 32, and higher scores represent a worse outcome (higher levels of the acquired capability for suicide).
Time Frame
2 weeks
Title
Reflective Functioning Questionnaire
Description
The 8-item version of the Reflective Functioning Questionnaire is a self-reported instrument that measures reflective functioning, an expression of mentalizing processes. The instrument separately addresses the levels of both certainty and uncertainty about one's own mental processes. Items are scored in a 7 point-scale (1 to 7), meaning that the total score ranges from 8 to 56, higher scores represent a higher capacity of mentalizing, and therefore a better outcome.
Time Frame
2 weeks
Title
Columbia Suicide Rating Scale
Description
The Columbia Suicide Rating Scale is a suicidal ideation and behavior rating scale that evaluates suicide risk.It rates an individual's degree of suicidal ideation on a scale, ranging from "wish to be dead" to "active suicidal ideation with specific plan and intent and behaviors. It contains 6 "yes" or "no" questions in which respondents are asked to indicate whether they have experienced several thoughts or feelings relating to suicide over the past month and behaviors over their lifetime and past 3 months. An answer of "yes" to any of the six questions may indicate a need for referral and an answer of "yes" to questions 4, 5 or 6 indicate high-risk.
Time Frame
1 month
Title
The International Neuropsychiatric Interview (MINI)
Description
Clinician-rated scale to screen for mental disorders. The MINI KIDs will be used for participants between 12-17 years of age.
Time Frame
Varies on the diagnosis
Title
Strengths and Difficulties Questionnaire (SDQ)
Description
Emotional and behavioral screening questionnaire designed for youths.
Time Frame
1 month

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
General Inclusion Criteria: Female and males, age >= 12 years Having attended a hospital emergency department due to a suicide attempt Willing and able to comply with study procedures and to give written informed consent Specific inclusion criteria for iFD-S: Minimum knowledge of internet use and availability of an internet device (tablet, computer, smartphone) Depressive symptoms according to PHQ-9 scores above 5 Specific inclusion criteria for SAM: Age between 12-17 Informed consent of legal guardians General Exclusion Criteria: Incapacity to give informed consent Lack of fluency in Spanish Currently taking part in another clinical study which, in the opinion of the investigator, is likely to interfere with the objectives of the SURVIVE study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Víctor Pérez, PhD
Phone
933160784
Email
vperezsola@parcdesalutmar.cat
First Name & Middle Initial & Last Name or Official Title & Degree
Matilde Elices, PhD
Phone
933160784
Email
melices@imim.es
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Víctor Pérez, PhD
Organizational Affiliation
Parc de Salut Mar
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital Universitario Virgen del Rocio
City
Sevilla
State/Province
Andalusia
ZIP/Postal Code
41013
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Miguel Ruiz-Vegilla, PhD
Email
mruizveguilla@yahoo.com
Facility Name
Hospital Universitario Central de Asturias
City
Oviedo
State/Province
Asturias
ZIP/Postal Code
33011
Country
Spain
Facility Name
Hospital Santiago de Áraba
City
Vitoria
State/Province
Basque Country
ZIP/Postal Code
01004
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Itxaso Gonzalez Ortega, PhD
Email
ITXASO.GONZALEZORTEGA@osakidetza.eus
First Name & Middle Initial & Last Name & Degree
María Purificación López-Peña, PhD
Facility Name
Hospital Germans Trias i Pujol
City
Badalona
State/Province
Catalonia
ZIP/Postal Code
08916
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Manuel Canal-Rivero, PhD
Email
mcanalri.germanstrias@gencat.cat
Facility Name
Institute of Neuropsychiatry and Addictions, INAD, Parc de Salut Mar
City
Barcelona
State/Province
Catalonia
ZIP/Postal Code
08003
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Víctor Pérez, PhD
Phone
933160784
Email
vperezsola@parcdesalutmar.cat
First Name & Middle Initial & Last Name & Degree
Matilde Elices, PhD
Phone
933160784
Email
melices@imim.es
Facility Name
Hospital de la Santa Creu i Sant Pau
City
Barcelona
State/Province
Catalonia
ZIP/Postal Code
08025
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dolors Puigdemont, MD
Email
mpuigdemont@santpau.cat
Facility Name
Hospital Clinic
City
Barcelona
State/Province
Catalonia
ZIP/Postal Code
08036
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Iria Grande, PhD
Email
igrande@clinic.cat
Facility Name
Corporació Sanitaria Parc Tauli
City
Sabadell
State/Province
Catalonia
ZIP/Postal Code
08208
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Clara López-Sola, PhD
Email
clopezs@tauli.cat
Facility Name
Hospital Clínico San Carlos
City
Madrid
ZIP/Postal Code
28040
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Marina Diaz-Marsá
Email
marinadiaz.marsa@salud.madrid.org
Facility Name
Hospital Universitario La Paz
City
Madrid
ZIP/Postal Code
28046
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Beatriz Rodriguez-Vega, PhD

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
33884617
Citation
Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev. 2021 Apr 22;4(4):CD013668. doi: 10.1002/14651858.CD013668.pub2.
Results Reference
derived
PubMed Identifier
33301997
Citation
Perez V, Elices M, Toll A, Bobes J, Lopez-Sola C, Diaz-Marsa M, Grande I, Lopez-Pena P, Rodriguez-Vega B, Ruiz-Veguilla M, de la Torre-Luque A; SURVIVE Group. The Suicide Prevention and Intervention Study (SURVIVE): Study protocol for a multisite cohort study with nested randomized-controlled trials. Rev Psiquiatr Salud Ment (Engl Ed). 2020 Dec 7:S1888-9891(20)30127-0. doi: 10.1016/j.rpsm.2020.11.004. Online ahead of print. English, Spanish.
Results Reference
derived

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Suicide Prevention and Intervention in Spain: the SURVIVE Study

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