Attempted Suicide Intervention Treatment and Prevention (SAMIT Program)

The recurrence of the suicide attempt will be monitored by two mechanisms:

• During follow-up evaluations at 3, 6, and 12 months through a telephone call to the patient
• Reviewing the patient's medical history through the hospital's public health system program.

The variable will be recorded by a dicotomic answer: "YES" if the patient had an intent during the follow-up period (3, 6, and 12 months) and "NO" if the patient did not have an intent. In cases of reattempt, the C-SSRS, SCS, and SALSA scales will be administered. In case of consummated attempts, information will be collected through clinical history and family interviews if it's required.

We expected that the "case-intervention group" would have fewer re-attempts than the control group.

The investigators will evaluate the suicide severity through the C-SSRS scale in the pre-treatment phase only if the patient makes a suicide attempt or has a suicide ideation during the study pre and post-treatment and follow up perios (3,6 and 12 months) .

Columbia Suicide Severity Rating Scale (C-SSRS) is a semi-structured interview with dicothomic answers (yes or no) that captures the occurrence, severity, and frequency of suicide-related behaviour and thoughts during the assessment period.

The investigators evaluated the suicide attempt trought the SCS scale in pre treatment phase and only if the patient makes a suicide attempt or has a suicide ideation during the study pre and post-treatment and follow up perios (3,6 and 12 months) .

Suicidal Crisis Syndrome (SCS): This is an interview with dichotomous responses that assess conditions linked to imminent suicidal behavior characterized by (a) affective disturbance, loss of cognitive control, hyperarousal and social withdrawal (Criterion B) and (b) a generalized sense of entrapment in which leaving an intolerable life situation is perceived as both urgent and impossible.

In the baseline phase, before treatment, we assess the lethality of the suicide attempt through the Scale for Assessment of the Lethality of the Suicide Attempt (SALSA). The investigators will only administer the scale again in case of re-attempt during the follow-up.

SALSA consists of two parts: The first component has four items indicating seriousness of the attempt and its likely consequences and the second component is the global impression of lethality. All the items are scored from 1 to 5, higher scores suggestive of increased lethality

After psychotherapeutic intervention, the investigators expected to improve the well-being of the patients. We compared between pre- and post-treatment. This variable will be mesured through the Quality of life test (QoL) in the follow-up (3, 6, and 12 months).It consists of 21 items that are grouped into the following 4 categories or factors: Intrapsychic functions: cognition, cognition and affectivity (items 13-17, 20-21).Interpersonal relationships: interpersonal and social experience (items 1-8).Instrumental role: work, study, parental duties (items 9-11).Use of common objects and daily activities (items 18-19).Item 12 (satisfaction) does not score in any of the factors. Each item is scored according to a 7-value Likert scale, ranging from 0 (highest degree of dysfunction in that item) to 6 (normal). The time frame of reference is the previous 4 weeks.

The higher the score, the higher the quality of life in each dimension.

After psychotherapeutic intervention, the investigators expected to improve the psychological pain of the patients. This variable will be compared between pre- and post-treatment through the Psychological Pain Scale (PS-E) and will also be assessed in the follow-up (3, 6, and 12 months).

The scale evaluates psychological pain as a subjective experience. It is composed of 13 items with a Likert-type response format (1-5) from lowest (1) to highest pain score (5).

The higher scores higher psychological pain.

After psychotherapeutic intervention, the investigators expected to improve the anxiety and depression symptoms. This variable will be compared between pre- and post-treatment and also assessed through the Hospital Anxiety and Depression Scale (HADS) in the follow-up (3, 6, and 12 months).

Anxiety and Depression Scale (HADS) : consists in 14 items on a 4-point Likert scale (range 0-3) with three denoting highest anxiety or depression level. Its seven items for each subscale (anxiety and depression). The sum of the 14 items makes up the overall score.

After psychotherapeutic intervention, the investigators expected to decrease the impulsivity of the patients. This variable will be compared between pre- and post-treatment and also assessed through the Barrat Impulsiveness Scale (BIS-11) in the follow-up (3, 6, and 12 months).

BIS-11 is a widely used 30 question self-report measure of impulsiveness. It includes six first-order factors (attention, motor, self-control, cognitive complexity, perseverance, and cognitive instability impulsiveness) and three second-order factors (attentional, motor, and non-planning impulsiveness). It is rated on a four-point Likert scale of 1 = Rarely/Never to 4 = Almost Always/Always. The total scores can range from 30 to 120. However, higher scores on the BIS-11 reflect higher levels of impulsiveness.

The change in a set of IL-6 (pg/mL) will be assessed from baseline to the end of the intervention at week 4.

In the baseline phase, before treatment, we assess the suicide intentonality through the Beck suicidal intentionality scale (SIS). The investigators will only administer the scale again in case of re-attempt during the follow-up.

SIS: is a semi-structured scale consisting of 20 items, which are rated on a 3-point scale (0 to 2 points). Scores can range from 0 to 38, with higher values indicating a greater risk of suicide.

After psychotherapeutic intervention, the investigators expected to improve the reflective functioning of the patients. This variable will be compared between pre- and post-treatment and also assessed through the Reflective Functioning Questionnaire (RFQ-8) in the follow-up (3, 6, and 12 months).

RFQ-8 is a self-administered questionnaire that consists of 8 items. It provides responses for each item on a seven-point scale between "strongly disagree" and "strongly agree" response options. The higher the score, the worse the reflective capacity.

After psychotherapeutic intervention,the investigators expected to decrease and/or eliminate the suicide ideation. This variable will be compared between pre- and post-treatment and during follow-up evaluations at 3, 6, and 12 months through the the Scale for Suicide Ideation (SSI).

SSI evaluates the presence and intensity of suicidal thoughts in a week before evaluation. It is composed of 19 items that are scored from 0 to 2, where 0 corresponds to moderate to strong, 1 to weak, and 2 to no suicide ideation.

After psychotherapeutic intervention, the investigators expected to improve the anxiety and depression symptoms. This variable will be compared between pre- and post-treatment and also assessed through the Beck Hopelessness Scale (BHS) tests in the follow-up (3, 6, and 12 months).

Beck Hopelessness Scale (BHS): is a 20-item with true-false test answers. Scores ranging from: 0 to 3 as are considered within the normal range, 4 to 8 identify mild hopelessness, scores from 9 to 14 identify moderate hopelessness, and scores greater than 14 identify severe hopelessness.

The change in a set of C-reactive protein (mg/dL) will be assessed from baseline to the end of the intervention at week 4:

The change in a set of White Blood Cell count (x10E9/L) will be assessed from baseline to the end of the intervention at week 4:

The change in a set of Cholesterol, will be assessed from baseline to the end of the intervention at week 4.

The change in a set of HDL (mg/dL) will be assessed from baseline to the end of the intervention at week 4.

The change in a set of LDL will be assessed from baseline to the end of the intervention at week 4.

The change in a set of tryglycerides will be assessed from baseline to the end of the intervention at week 4.

In the pre-treatment phase, the investigators will assess the attachment of the patient with the CAMI-R short version test in order to study the relationship between the type of attachment and suicide behaviour.

Short version of CaMir questionnaire (CaMir-R)(65)) is a self-questionnaire that measures attachment representations. It is based on the subject's evaluations of past and present attachment experiences and family functioning. It consists of 32 items to be answered by the participant on a 5-point Likert-type scale (1 = strongly disagree, 5 = strongly agree). The questionnaire consists of seven dimensions, five of which refer to attachment representations (security: availability and support of attachment figures; family preoccupation; parental interference; self-sufficiency and resentment against parents; and childhood trauma), and the remaining two refer to representations of family structure (value of parental authority and parental permissiveness).

Before starting the treatment, the patient will undergo the Montreal Cognitive Assessment (MOCA) to control for cognitive impairment. MOCA will be administered again in the post-treatment phase.

The MoCA Test, also known as the Montreal Cognitive Assessment, has been proven to be an extremely sensitive method for identifying moderate cognitive impairment (MCI) in its early stages. The MoCA exam is scored, with a maximum of thirty being possible. It takes ten to twelve minutes to finish. The MoCA test uses a total of 11 distinct exercises and tasks to assess seven domains (aspects) of cognitive function: attention and executive function, language domains, memory, abstraction, calculation, and orientation.