ABSTRACT
Background: Suicide is a relevant public health problem in Chile. This is the first Chilean study with the psychological autopsy method (PA). Aims: a) to identify risk factors for suicide in Chilean victims; b) to identify risk indicators for early intervention; c) to assess acceptability of the PA method by informants. Method: Sample consisted of 30 subjects (24 males, six females) who commited suicide in the IV Region of Chile (December 2008-September 2010). Data was collected from informant interviews. Main instrument was the Psychological Autopsy Interview Protocol. Results: Mean age at suicide was 35.8 years. Most victims communicated suicidal intent before consummation. Almost all experienced negative life events, in many cases shortly before suicide. One half had attempted suicide previously, some during the preceding month. Thirty-six percent were in mental health treatments at time of death. A quarter had recently visited mental health professionals. Psychiatric disorders (ICD-10) were identified in 90 percent, mainly depressive and substance use disorders. Personality disorders were evident in eight victims (33 percent): dissocial (4), emotionally unstable (2), paranoid (1), and anxious (avoidant) (1). Conclusions: A high rate of psychiatric disorders was confirmed. Previous suicide attempts are sensitive predictors of completed suicide. Communication of suicide intent is frequent, and may be an opportunity for intervention. Suicide is often preceded by negative life events. Prevention of suicide may be improved by effective treatment of psychiatric disorders, and focused psychosocial interventions. Intensive follow-up of attempters seems highly relevant. PA is an acceptable method for informants.
Introducción: El suicidio es un problema de salud pública relevante en Chile. Este es el primer estudio chileno con el método de la autopsia psicológica (AP). Objetivos: a) identificar factores de riesgo de suicidio en víctimas chilenas; b) identificar indicadores de riesgo para la intervención temprana; c) evaluar la aceptabilidad del método de la AP por los informantes. Método: La muestra consistió en 30 sujetos (24 hombres y 6 mujeres) que cometieron suicidio en la IV Región de Chile (diciembre de 2008-septiembre de 2010). La información fue recogida de entrevistas a informantes. El instrumento principal fue el Protocolo de Entrevista para Autopsia Psicológica. Resultados: La edad promedio fue 35,8 años. La mayoría comunicó intención suicida antes de consumarlo. Casi todos experimentaron eventos negativos, frecuentemente poco antes del suicidio. La mitad había intentado suicidarse previamente, algunos durante el mes precedente. El 36 por ciento estaba en tratamientos de salud mental al fallecer y un cuarto había visitado recientemente a profesionales de salud mental. Se identificó trastornos psiquiátricos (CIE-10) en el 90 por ciento, principalmente trastorno depresivo y por uso de sustancias. Los trastornos de personalidad fueron evidentes en ocho víctimas (33 por ciento): disocial (4), emocionalmente inestable (2), paranoide (1) y ansioso (evitativo) (1). Conclusiones: Se confirmó una elevada tasa de trastornos psiquiátricos. El antecedente de intentos previos es un predictor sensible de suicidio. La comunicación de intención suicida es frecuente y puede ser una oportunidad de intervención. El suicidio es frecuentemente precedido por eventos vitales negativos. La prevención del suicidio puede mejorar mediante el tratamiento efectivo de trastornos psiquiátricos e intervenciones psicosociales focalizadas. El seguimiento intensivo de intentadores parece altamente relevante. La AP es aceptable para los informantes.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Child , Young Adult , Middle Aged , Forensic Psychiatry , Suicide/psychology , Autopsy , Chile , Interviews as Topic , Risk FactorsABSTRACT
Background: Anxiety symptoms and anxiety disorders are common among medical patients, however few studies differentiate both and consider the psychiatric comorbidity of anxiety disorders among such patients. Aim: To evaluate the presence of anxiety disorders among patients admitted to a medical ward. Patients and methods: Random selection of 406 patients (mean age 56 years, 203 female), hospitalized in a medical ward of a public hospital, mainly for cardiovascular, genitourinary and digestive diseases. All were assessed using an structured interview for DSM-III-R. Results: Twenty six percent of women and 13% of men had anxiety disorders. Fifteen percent of women and 6% of men had specific phobias, 7% of women and 4% of men had generalized anxiety, 5% of women and 0.5% of men had agoraphobia, 3% of women and 0.5% of men had social phobia, 1% of men and 0.5% of women had panic disorders and 0.5% of women had a post traumatic stress. Specific phobias and social phobias started during childhood. Anxiety and agoraphobia started during adulthood. Among patients with anxiety disorders, 43% of women and 34% of men did not have other psychiatric ailment, 34% of women and 19% of men had an associated depression and 34% of men had disorders due to use of alcohol. Conclusions: A high proportion of patients hospitalized in medical wards have anxiety disorders, that once identified it may help to treat the medical ailments.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anxiety Disorders/diagnosis , Hospitalization , Anxiety Disorders/epidemiology , Chile/epidemiology , Comorbidity , Diagnostic and Statistical Manual of Mental DisordersABSTRACT
Background: Studies done in Chile and abroad report a high frequency of substance abuse among patients hospitalized in general medical services. Aim: To report the frequency of substance abuse in a sample of patients hospitalized in a public hospital of Santiago. Material and methods: A structured psychiatric interview for the Third Revised Version of The Diagnostic and Statistical Manual (DSM-III-R) was applied to 203 males, aged 58.5 years and 203 females, aged 52,9 years, hospitalized in an internal medicine Service of a public hospital. All subjects had a low educational and income level. Results: The discharge diagnoses of studied patients were digestive diseases in 32 percent, circulatory diseases in 19 percent, cancer, diabetes mellitus and genitourinary diseases in 11 percent respectively and mental or behavioral diseases in 5 percent. Thirty eight percent of males and 6 percent of females qualified for alcohol dependency or abuse in some moment of their lives. The figures for benzodiazepine dependency were 1 percent among males and 6 percent among females. The figures for cannabis, cocaine or stimulant abuse were 1.5 percent for males and 1 percent for females. Other conditions of the axis 1 of DSM-IIIR were diagnosed in 47 percent of males and 65 percent of females with substance abuse. Conclusions: Substance abuse underlies medical conditions in a high proportion of patients admitted to medical services in general hospitals
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Anxiety Disorders , Alcoholism , Depression/epidemiology , Cocaine-Related Disorders/epidemiology , Bipolar Disorder , Comorbidity , Marijuana Abuse , Prevalence , Alcoholism , Substance Abuse Detection , Socioeconomic Factors , Phobic Disorders/epidemiology , Cocaine-Related Disorders/psychologyABSTRACT
Background: Mental disorders may interfere, aggravate or mimic medical conditions. Aim: To study the prevalence of psychiatric disorders among patients hospitalized in a medical ward of a general hospital. Patients and methods: A structured interview for DSM-III, devised for "non patients", was applied to 203 men and 203 women, aged 11 to 90 years old, hospitalized in an internal medicine service of a public hospital. Thirty four psychiatric conditions that can be discriminated with the instrument and others that complied with DSM-III criteria, were investigated. Results: There was a 60 percent prevalence of mental disorders among men (alcohol dependency in 26 percent, delirium or dementia in 10.8 percent, anxiety disorders in 10.4 percent, major depression in 7.8 percent and adaptation disorders in 3 percent). Among women, the prevalence of mental disorders was 65 percent (major depression in 23.2 percent, anxiety disorders in 14.3 percent, adaptation disorders in 8.4 percent, dementia in 5.6 percent, delirium in 3 percent and alcohol dependency in 2.5 percent). Most conditions were of moderate or mild intensity. Two or more conditions coexisted in 40 percent of cases. Only in 8 percent of these subjects, a psychiatric consultation was requested. Conclusions: There is a high frequency of psychiatric disorders among medical patients. These must be adequately diagnosed and treated