title: Exploring the Determinants of Suicidal Behavior: Conventional and Emergent Risk (DISCOVER): a feasibility study.
abstract: BACKGROUND
  Suicidal behavior is a growing public health concern resulting in morbidity and premature death. Although certain factors such as age, sex, and psychiatric disorders have been consistently reported to be associated with suicidal behavior, other factors including biological markers, diet, and physical activity may also influence suicidal behavior. The purpose of this pilot study was to evaluate the feasibility of conducting a full-scale study to identify the conventional and novel risk factors of suicidal behavior in individuals who made a recent suicide attempt.
  
  
  METHODS
  This pilot study was a case-control study of participants with recent (within 1 month of admission) suicide attempts admitted to hospital and compared to two control groups: 1) psychiatric inpatient participants without a history of suicide attempts and 2) community-based controls. We collected information on demographic variables, circumstances of suicide attempts (for cases), medical and psychiatric diagnoses, behavioral patterns, physical measurements, and social factors. Blood and urine samples were also collected for biological markers. Feasibility outcomes are as follows: 1) 50 % of all eligible cases will consent to participate, 2) 50 cases and 100 controls per year can be recruited, and 3) at least 80 % of the participants will provide blood samples for DNA and biological markers.
  
  
  RESULTS
  We recruited 179 participants in total; 51 cases, 57 psychiatric controls without suicide attempt, and 71 non-psychiatric controls in Hamilton, Ontario. Recruitment rate was 70 % (213/304), and we obtained urine and blood specimens from 90 % (191/213) of participants. Questionnaire completion rates were high, and data quality was very good with few data-related queries to resolve. We learned that cases tended to be hospitalized for long periods of time and the suicide attempt occurred more than a month ago in many of the cases; therefore, we expanded our inclusion criterion related to timing of suicide attempt to 3 months instead of 1 month.
  
  
  CONCLUSIONS
  The study procedures needed certain modifications including extending the time between suicide attempt and date of recruitment, and more detailed questionnaires related to diet were necessary while other questionnaires such as social support needed to be shortened. Overall, this study showed that it is feasible to conduct a larger-scale study.
authors.affiliation: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON Canada ; MiNDS Neuroscience Program, McMaster University, Hamilton, ON Canada ; Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada ; St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samaan
authors.affiliation: Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON Canada ; MiNDS Neuroscience Program, McMaster University, Hamilton, ON Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Bawor
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON Canada.
authors.forename: Brittany B
authors.initials: BB
authors.lastname: Dennis
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada.
authors.forename: Wala
authors.initials: W
authors.lastname: El-Sheikh
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: DeJesus
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada.
authors.forename: Sumathy
authors.initials: S
authors.lastname: Rangarajan
authors.affiliation: St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada.
authors.forename: Judith
authors.initials: J
authors.lastname: Vair
authors.affiliation: St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Sholer
authors.affiliation: St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Hutchinson
authors.affiliation: St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Iordan
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada.
authors.forename: Pam
authors.initials: P
authors.lastname: Mackie
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada.
authors.forename: Shofiqul
authors.initials: S
authors.lastname: Islam
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada.
authors.forename: Mahshid
authors.initials: M
authors.lastname: Deghan
authors.affiliation: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ; St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brasch
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada ; Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada ; St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada ; Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, ON Canada ; System Linked Research Unit, Hamilton, ON Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
keywords: Biomarkers; Pilot study; Risk factors; Social determinants; Suicidal behavior; Suicide