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Miranda-Mendizábal A, Castellví P, Parés-Badell O, Almenara J, Alonso I, Blasco MJ, Cebrià A, Gabilondo A, Gili M, Lagares C, Piqueras JA, Roca M, Rodríguez-Marín J, Rodríguez-Jiménez T, Soto-Sanz V, Vilagut G, Alonso J. Sexual orientation and suicidal behaviour in adolescents and young adults: systematic review and meta-analysis. Br J Psychiatry 2017; 211:77-87. [PMID: 28254960 DOI: 10.1192/bjp.bp.116.196345] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 11/21/2016] [Accepted: 11/27/2016] [Indexed: 11/23/2022]
Abstract
BackgroundResearch suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.AimsTo assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.MethodA systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12-26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.ResultsSexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60-3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21-4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.ConclusionsSexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.
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Affiliation(s)
- A Miranda-Mendizábal
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - P Castellví
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - O Parés-Badell
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - J Almenara
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - I Alonso
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - M J Blasco
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - A Cebrià
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - A Gabilondo
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - M Gili
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - C Lagares
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - J A Piqueras
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - M Roca
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - J Rodríguez-Marín
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - T Rodríguez-Jiménez
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - V Soto-Sanz
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - G Vilagut
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - J Alonso
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
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