title: Predictive models for suicidal thoughts and behaviors among Spanish University students: rationale and methods of the UNIVERSAL (University & mental health) project.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|Pompeu Fabra University (UPF), Barcelona, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Maria Jesús
authors.initials: MJ
authors.lastname: Blasco
authors.affiliation: Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Castellví
authors.affiliation: University of Cadiz (UCA), Cádiz, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Almenara
authors.affiliation: University of Cadiz (UCA), Cádiz, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Lagares
authors.affiliation: Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands (UIB), Palma de Mallorca, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Roca
authors.affiliation: Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands (UIB), Palma de Mallorca, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Sesé
authors.affiliation: Miguel Hernandez University of Elche (UMH), Alicante, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Piqueras
authors.affiliation: Miguel Hernandez University of Elche (UMH), Alicante, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Soto-Sanz
authors.affiliation: Miguel Hernandez University of Elche (UMH), Alicante, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Marín
authors.affiliation: University of the Basque Country (UPV-EHU), San Sebastian, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Echeburúa
authors.affiliation: Outpatient Mental Health Care Network, Osakidetza-Basque Health Service. Biodonosti Health Research Institute, San Sebastian, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gabilondo
authors.affiliation: Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell, Spain.
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Cebrià
authors.affiliation: Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Miranda-Mendizábal
authors.affiliation: Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|Pompeu Fabra University (UPF), Barcelona, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Vilagut
authors.affiliation: Universitair Psychiatrisch Centrum, KULeuven (UPC-KUL), Leuven, Belgium.
authors.forename: Ronny
authors.initials: R
authors.lastname: Bruffaerts
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA.|Center for Depression, Anxiety and Stress Research, McLean Hospital, Boston, MA, USA.
authors.forename: Randy P
authors.initials: RP
authors.lastname: Auerbach
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.affiliation: Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. jalonso@imim.es.|Pompeu Fabra University (UPF), Barcelona, Spain. jalonso@imim.es.|CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. jalonso@imim.es.|IMIM (Hospital del Mar Medical Research Institute), PRBB Building, Doctor Aiguader 88, 08003, Barcelona, Spain. jalonso@imim.es.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008960:Models, Psychological; D011446:Prospective Studies; D065840:Protective Factors; D013030:Spain; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology*; D014495:Universities; D055815:Young Adult
keywords: Cohort studies; Mental health; Predictive modelling; Protective factors; Risk factors; Suicide; University students