Social Change, Health Care Intervention and Suicidality. - A Longitudinal Prospective Study of Suicidal behaviour.

1) Background Due to the lack of national statistics on suicide attempts in Norway, few studies have been published regarding the development of suicide attempts in the population. Since a main suicide prevention strategy in Norway is to provide follow-up for suicide attempters, there is a need for longitudinal studies of attempters. Few follow-up models have been scientifically evaluated. 3) Aims: 1) To document the epidemiological development of suicidal behaviour in Bærum in a 22 year period. 2) To ex amine and measure if suicide-related structural changes in the period have affected the suicidal behaviour. 3) To measure possible effects of a community based suicide prevention team on the suicide attempt repetition rates and suicide rates among attempt ers in Bærum. 2) Methods. The main data set has been collected over a 22-year period and comprises information of 1535 unique suicide attempters and 2260 suicide attempts. Statistical measurements will be preformed using survival analysis. Trends over tim e will initially be estimated non-parametric using the Nelson-Aalen estimator. Trends over time adjusted for changes in risk factors will be estimated using proportional hazard models (Cox regression and Poisson regression) 4) Scientific relevance: By adr essing both descriptive epidemiological data, data on social explanations, and follow-up data, the present study aims to expand the knowledge base of suicidal behaviour on several levels. Further, due to the scarcity of well-conducted studies evaluating e ffects from systematic follow-up of suicide attempters on repetition of non-fatal suicide attempts as well as on suicide among suicide-attempters, the present study will be of great scientific as well as clinical value. Additionally, the investigation of mortality consequences of health care system changes will be of scientific as well as clinical importance for the establishment of national guidelines on treatment of suicidal patients in mental health care.