Estratégias de cuidado a pessoas que tentaram suicídio segundo a literatura / Care strategies for individuals who have attempted suicide according to literature / Estrategias de atención a personas que intentan suicidio según la literatura

O suicídio representa um problema de saúde pública e o cuidado desenvolvido com pessoas que tentam suicídio pode ser determinante para evitar a ocor-rência de novas tentativas. Este trabalho teve como objetivo identificar as estra-tégias de cuidado às pessoas que tentam suicídio e mais especificamente seus alcances e limites. Foi realizada uma revisão da literatura a partir de buscas nas bases Google Scholar, Scielo e Pepsic com a palavra-chave "tentativa de suicídio". Foram selecionados e lidos na íntegra oito artigos publicados entre 2006 e 2017. Destaca-se a importância do acolhimento, ações com a família, trabalho em equipe multiprofissional e encaminhamento para outros serviços da rede. Observam-se dificuldades do trabalho em rede, ausência de diálogo entre as equipes, dificuldades no cuidado de pessoas que tentam suicídio, falta de capacitação e problemas de infraestrutura. Ressalta-se a necessidade da educação permanente em saúde e o oferecimento de suporte psicossocial para os profissionais. (AU)

Suicide represents a public health issue, and the care provided to individuals who attempt suicide can play a crucial role in preventing further attempts. This study aimed to identify the care strategies for individuals who attempt suicide, specifically examining their effectiveness and limitations. A litera-ture review was conducted using searches in the Google Scholar, Scielo, and Pepsic databases with the keyword "suicide attempt." Eight articles published between 2006 and 2017 were selected for in-depth review. The importance of providing support, involving families, fostering multidisciplinary teamwork, and referring individuals to other network services is emphasized. Challenges in establishing effective networks, fostering communication among teams, addressing the complexities of caring for suicide attempt survivors, addressing training gaps, and overcoming infrastructure issues are observed. The need for ongoing health education and the provision of psychosocial support for healthcare professionals is underscored. (AU)

El suicidio es un problema de salud pública y la atención a las personas que intentan suicidarse puede ser determinante para prevenir nuevos intentos. Este trabajo tuvo como objetivo identificar las estrategias de atención a las personas que intentan suicidarse, su alcance y límites. Se realizó una revisión de la literatura a partir de búsquedas en las bases de datos Google Scholar, Scielo y Pepsic con la palabra clave "intento de suicidio". Se seleccionaron ocho artículos publicados entre 2006 y 2017. Se destaca la importancia de la acogida, las acciones con la familia, el trabajo en equipo multiprofesional y la derivación a otros servicios de la red. Existen dificultades en el trabajo en red, ausencia de diálogo entre equipos, dificultades en la atención, falta de formación y problemas de infraestructura. Se enfatiza la necesidad de educación permanente para la salud y la provisión de apoyo psicosocial a los profesionales. (AU)

Sobredosis de acetaminofén y comportamientos relacionados con suicidio / Acetaminophen overdose and suicide-related behaviors / Overdose de paracetamol e comportamentos suicidas

Objetivo: este trabajo busca caracterizar el comportamiento relacionado con el suicidio en la población admitida al Hospital San Vicente Fundación, Rionegro, con sobredosis de acetaminofén entre enero 2019 y diciembre 2020 y detectar factores asociados con la dosis tóxica. Metodología: análisis descriptivo con información obtenida de historias clínicas. Resultados: 63 individuos presentaron ingestión aguda de dosis tóxica de acetaminofén como comportamiento relacionado con suicidio. Cuarenta y tres eran mujeres, 60% tenía antecedente de enfermedad psiquiátrica, 35% reportó al menos un intento suicida previo y 22% consumieron 25g o más. La lesión hepática aguda se asoció con una dosis tóxica. Conclusiones: evidenciamos una alta prevalencia de antecedente de enfermedad psi­quiátrica y comportamiento relacionado con suicidio y casi un tercio de los pacientes ingirió dosis mayores al umbral de riesgo para falla hepática. Además, la impulsividad e ingesta en casa sugiere que políticas públicas restrictivas pueden no impactar en la reducción de estos eventos en la población.

Objective: this work seeks to characterize the behavior related to suicide in the po­pulation admitted to the Hospital San Vicente Fundación, Rionegro, with an overdose of acetaminophen between January 2019 and December 2020, and to identify factors associated with the toxic dose. Methodology: descriptive analysis with information obtained from medical records. Results: 63 individuals presented acute ingestion of a toxic dose of acetaminophen as behavior related to suicide. Forty-three were women, 60% had a history of psychiatric illness, 35% reported at least one previous suicide attempt, and 22% consumed 25g or more. Acute liver injury was associated with a toxic dose. Conclusions: we evidenced a high prevalence of a history of psychiatric illness and beha­vior related to suicide; almost a third of the patients ingested doses greater than the risk threshold for liver failure. In addition, impulsiveness and eating at home suggests that res­trictive public policies may not have an impact on reducing these events in the population.

Objetivo: Este trabalho busca caracterizar o comportamento relacionado ao suicídio na população internada no Hospital San Vicente Fundación, Rionegro, com overdose de acetaminofeno entre janeiro de 2019 e dezembro de 2020 e detectar fatores associados à dose tóxica. Metodologia: análise descritiva com informações obtidas dos prontuários. Resultados: 63 indivíduos apresentaram ingestão aguda de dose tóxica de paracetamol como comportamento relacionado ao suicídio. Quarenta e três eram mulheres, 60% tinham histórico de doença psiquiátrica, 35% relataram pelo menos uma tentativa de suicídio anterior e 22% consumiram 25g ou mais. A lesão hepática aguda foi associada a uma dose tóxica. Conclusões: evidenciamos alta prevalência de história de doença psiquiátrica e com-portamento relacionado ao suicídio e quase um terço dos pacientes ingeriu doses superiores ao limiar de risco para insuficiência hepática. Além disso, a impulsividade e a alimentação em casa sugerem que políticas públicas restritivas podem não ter impacto na redução desses eventos na população.

Tobacco Use: Quitting Plan, Attempts and Obstacles for Cessation- A Cross-Sectional Study from A Sub-Urban Neighbourhood of Chennai-Tamil Nadu

Introduction: Tobacco consumption is a preventable public health problem. GATS -2 survey in Tamil Nadu shows that 20% of adults use tobacco, 40% had plans to quit and 48% had made quit attempts. The purpose of the study was to assess factors associated with tobacco use; quitting plan, attempts and identify obstacles for tobacco cessation. Methods: A Cross-sectional study was done among 300 tobacco users in a suburban neighbourhood of Chen-nai and data was analysed using SPSS software. Results: Ninety five percent were smokers and 86% smoked cigarettes. 70% knew that it causes cancer and respiratory diseases. 60% planned to quit, 69% made quit attempts. Those with quit plans and health prob-lems had an increased odds (AOR of 1.02 and 1.004 respectively) of making quit attempts. Advice from health professionals (48%) and family (52%) triggered quit attempts. Stress and work pressure were obstacles for quitting (70%). Availability of therapy and professional help for tobacco cessation was known only to 49% and 14.7% respectively and none availed it. Conclusion: Awareness of health hazards of tobacco use was high. Quit attempts have increased but with high failure rates due to lack of information and access to tobacco cessation services. Provision of community and facility-based tobacco cessation services and integration with existing health programmes is the present need.

Assessing suicide risk in patients with obsessive-compulsive disorder: a dimensional approach

Objectives: Although an association has been found recently between obsessive-compulsive disorder and an increased risk of suicide, the prevalence of both suicidal ideation and attempts vary considerably and are generally assessed categorically. Our aims were to evaluate the prevalence of suicidal ideation and behaviors using a dimensional approach. Methods: The sample included 129 patients with obsessive-compulsive disorder. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic and linear regressions were used to examine predictors of suicidal ideation, severe suicidal ideation, and suicidal behavior. Results: The lifetime prevalence of suicidal ideation and behaviors were 64.3% and 16.3%, respectively. Lifetime suicidal ideation was associated with the number of stressful life events, duration of illness, Hamilton Rating Scale for Depression scores, and family history of mood disorders. A family history of obsessive-compulsive disorder was associated with a lower probability of lifetime suicidal ideation. Severe suicidal ideation was related to greater severity of the most stressful life event, Hamilton Rating Scale for Depression scores, and longer duration of untreated illness. The probability of lifetime suicidal behavior was related to Hamilton Rating Scale for Anxiety scores, symmetry obsessions, and washing and checking compulsions. The probability of lifetime non-suicidal self-injurious behaviors was related to Hamilton Rating Scale for Anxiety scores. Conclusions: Recognizing predictors of suicidal ideation/behavior is crucial to identifying patients at greater risk.

Caracterización clínica y sociodemográfica del intento suicida en la Región de Los Ríos, Chile

Introducción: El intento suicida es uno de los factores de riesgo suicida más relevantes, conocer variables asociadas y estrategias de seguimiento post-intento suicida contribuye a prevenir el suicidio. Objetivos: el objetivo de este trabajo fue describir características clínico-sociodemográfica de las personas que presentan intento de suicidio, y dar a conocer una estrategia de vigilancia clínicoepidemiológica que se activa posterior al intento suicida. Método: Se utilizó un diseño transversal, participaron 170 personas de 15 y más años ingresados a la Unidad para Personas con Intento suicida entre los años 2015 al 2018 en la Región De Los Ríos, Chile. Se evaluaron estadísticamente datos de carácter sociodemográfico y clínicos, previos y posterior al intento suicida. Resultado: Los resultados sociodemográficos muestran predominancia de intentos de mujeres, con una muestra que tiene su lugar de residencia principalmente en sectores urbanos. Además, se observó que la pertenencia religiosa católica o evangélica, podría asociarse a mayor riesgo de reintento suicida (p=0,014). Conclusiones: Los factores clínicos muestran que presentar intentos suicidas previos, depresión en curso al momento del intento suicida y los conflictos de pareja son factores relevantes a considerar. La frecuencia de suicidio y los reintentos suicida en vigilancia fue baja, por lo que fortalecer la continuidad de cuidados podría tener un rol preventivo en el fenómeno suicida.

Introduction: Suicidal attempt is one of the most relevant suicide risk factors, knowing associated variables and post-suicide attempt follow-up strategies contributes to preventing suicide. Objective: the objective of this work was to describe the clinical-sociodemographic characteristics of people who present a suicide attempt, and to present a strategy of clinical-epidemiological surveillance that is activated after the suicide attempt. Methods: A cross-sectional design was carried out, involving 170 subjects aged 15 and over admitted to the Unit for People with a suicide attempt between 2015 and 2018 in the Los Ríos region, Chile. Sociodemographic and clinical data, before and after the suicide attempt, were statistically evaluated. Results: The sociodemographic results show a predominance of attempts by women, with a sample that has its place of residence mainly in urban areas. In addition, it was observed that Catholic or evangelical religious affiliation could be associated with a higher risk of suicidal retry (p = 0.014). Conclusions: The clinical factors show that having previous suicide attempts, ongoing depression at the time of the suicide attempt, and partner conflicts are relevant factors to consider. The frequency of suicide and suicide retries in surveillance was low, so strengthening the continuity of care could play a preventive role in the suicide phenomenon.

Effect of rumination on suicide attempts in adolescents with depressive disorder / 中华行为医学与脑科学杂志

Objective:To explore the relationship between rumination and depression and suicide attempts, and the mediating effect of rumination between depression and suicide attempts in adolescents with depressive disorder.Methods:Clinical interviews and questionnaires were conducted on 331 adolescents aged 11-18 with depressive disorders.Depressive symptoms were assessed with patient health questionnaire-9 (PHQ-9). Rumination was assessed with ruminative responses scale-10 (RRS-10), and Chinese version of the sociality module of MINI5.0 was used to assess suicide.SPSS 23.0 software was applied to descriptive statistics, Chi-square test, t-test, Spearman correlation analysis and hierarchical regression analysis, and the SPSS macro program PROCESS V 3.4 was used for Bootstrap mediating effect. Results:The incidence of suicide attempts in adolescents with depressive disorder was 53.78%, which was significantly higher in girls (59.48%) than that in boys (40.40%), and the difference was significant ( χ2=10.16, P<0.01). In contrast to the non-suicide attempt group, suicide attempt group had higher scores on PHQ-9((11.08±9.26) vs (14.43±7.49), t=-3.634, P<0.01), brooding ((10.76±3.89) vs (12.44±3.87), t=-3.926, P<0.01), reflection ((10.05±3.54) vs (11.20±3.33), t=-3.044, P<0.01) and rumination total score ((20.81±6.78) vs (23.64±6.42), t=-3.898, P<0.01). Regression analysis revealed that girl ( β=0.175, t=3.228, P=0.001), depressive symptoms ( β=0.168, t=3.082, P=0.002), rumination ( β=0.138, t=2.364, P=0.019) were risk factors for suicide attempts.Rumination played a complete mediating effect between depressive symptoms and suicide attempts (effect value=0.013, 95% CI=0.003-0.027). Depression symptoms significantly and positively predicted rumination ( P<0.01), and rumination significantly and positively predicted suicide attempts ( P<0.05). Conclusion:The incidence of suicide attempts was high in adolescents with depressive disorders.Depressive symptoms affect suicide attempts mainly through rumination.Clinicians should assess the rumination of adolescents with depressive disorders.In addition, clinicians should implement concurrent psychotherapy to adjust the cognitive response and reduce rumination, in order to improve the mental health and reduce suicide attempts.

Impacto do estresse de minoria em sintomas depressivos, ideação suicida e tentativa de suicídio em pessoas trans / Impact of minority stress in depressive symptoms, suicide idea and try suicide in trans

Resumo O estresse de minoria aborda a relação entre preconceito (percebido, antecipado e internalizado) e saúde mental em pessoas pertencentes a grupos minoritários, assim como fatores de proteção aos estressores. Este trabalho avaliou a prevalência de sintomas depressivos, ideação suicida e tentativa de suicídio em pessoas trans brasileiras, e sua relação com estresse de minoria, passabilidade, apoio social e apoio à identidade trans. Participaram 378 pessoas, por meio de questionário respondidos on-line e nos serviços hospitalares a que frequentavam. Desses, 67,20% apresentaram sintomas depressivos, 67,72% ideação suicida e 43,12% tentativa de suicídio. Foram realizadas três análises de regressão de Poisson, em dois passos, conforme os desfechos. Nos três desfechos houve associação positiva com o preconceito internalizado e negativa com o apoio social, sendo essas as únicas associações na tentativa de suicídio. Nos sintomas depressivos e na ideação suicida, também se associou positivamente o preconceito antecipado e negativamente a passabilidade e o apoio à identidade trans. Percebe-se a vulnerabilidade das pessoas trans para os desfechos negativos de saúde mental e a importância de enfrentar o preconceito em nível individual e social, assim como promover o apoio social e à identidade trans.

Abstract Minority stress comprehends the relationship between prejudice (perceived, anticipated and internalized) and mental health in people belonging to minority groups, as well as protective factors for stressors. This study evaluated the prevalence of depressive symptoms, suicidal ideation and attempted suicide in Brazilian trans people, and it`s relationship with minority stress, passability, social support and trans identity support. 378 people participated through a questionnaire answered online and in the hospital services they attended. Of these, 67.20% had depressive symptoms, 67.72% suicidal ideation and 43.12% attempted suicide. Three Poisson regression analyzes were performed in two steps, according to the outcomes. In the three outcomes there was a positive association with internalized prejudice and a negative association with social support, which were the only associations in the suicide attempt. Depressive symptoms and suicidal ideation were also positively associated with anticipated prejudice and negatively passability and support for trans identity. The vulnerability of transgender people to negative mental health outcomes and the importance of addressing prejudice on an individual and social level, as well as promoting social support and transgender identity support are perceived.

Intentos de suicidio y trastornos mentales / Suicide attempts and mental disorders

Introducción: el suicidio es un grave problema de salud pública mundial, más de 800,000 personas se suicidan cada año y entre 10 y 20 millones lo intentan cada año. Ha sido considerado como una conducta prevenible y el intento es un predictor clínicamente relevante que está presente en un tercio de los suicidios consumados, así como padecer un trastorno mental es otro factor de riesgo para el suicido. Objetivo: determinar la relación entre los intentos de suicidio y los trastornos mentales. Material y Métodos: se realizó una búsqueda en las bases de datos; Dialnet, Redalyc, Scielo, Biblioteca Virtual en Salud (BVS), PubMed, Science Direct y Google Académico, en español e inglés y limitada a las publicaciones entre 01 de enero 2010 y 31 de diciembre de 2020. Desarrollo: la prevalencia de vida del intento de suicidio en pacientes con Trastorno Bipolar es del 33,9 por ciento, en pacientes con Trastorno Depresivo Mayor es del 31 por ciento, y en pacientes con Esquizofrenia es del 26,8 por ciento. Conclusiones: los pacientes con trastorno bipolar y trastorno depresivo mayor, presentan mayor porcentaje de intentos de suicidio. Aunado a una comorbilidad psiquiátrica (consumo de alcohol, consumo de tabaco y trastorno de la personalidad límite), más intentos de suicidio previos, aumenta el riesgo del comportamiento suicida(AU)

Introduction: Suicide is a serious global public health problem. More than 800,000 people commit suicide every year and between 10 and 20 million people attempt suicide annually. Suicide has been considered a preventable behavior and suicide attempt is a clinically relevant predictor which is present in one-third of consummated suicides. Besides, having a mental disorder is another risk factor for suicide. Objective: To determine the relationship between suicide attempts and mental disorders such as depressive and anxiety disorders, bipolar disorder, substance-related disorders, schizophrenia and other psychotic disorders, personality disorders, and eating disorders. Material and Methods: A search was performed in Dialnet, Redalyc, Scielo, Virtual Health Library (VHL), PubMed, Science Direct, and Google Scholar databases in Spanish and English. It was limited to publications between January 1, 2010 and December 31, 2020. Development: The lifetime prevalence of suicide attempt is 31 percent in patients with Bipolar Disorder; 33,9 percent in patients with Major Depressive Disorder and 26.8 percent in patients with Schizophrenia. Conclusions: Patients with bipolar disorder and major depressive disorder have higher rates of suicide attempts. Coupled with psychiatric comorbidity (alcohol consumption, smoking, borderline personality disorder), more previous suicide attempts increase the risk of suicidal behavior(AU)

Perfil epidemiológico das emergências psiquiátricas atendidas em um hospital do Extremo Sul Catarinense entre janeiro de 2015 e dezembro de 2017 / Epidemiological profile of psychiatric emergencies in a hospital of the Southern Santa Catarina/Brazil between january 2015 and december 2017

Foi realizado um estudo observacional retrospectivo, com coleta de dados secundários e abordagem quantitativa, objetivando conhecer o perfil epidemiológico de pacientes atendidos por emergência psiquiátrica no serviço de Pronto Atendimento de um hospital geral do extremo sul catarinense. Foram selecionados prontuários do sistema TASY, de pacientes de ambos os sexos, a partir de 16 anos, com registros médicos utilizando a CID-10 (Classificação Internacional de Doenças, OMS, 1993) no Capítulo V (F00 a F99), Capítulo XIX (T36 a T50) e Capítulo XX (X60 a X84), e atendimentos realizados entre janeiro de 2015 a dezembro de 2017. Os resultados obtidos evidenciaram maior prevalência de atendimentos devido à crise ansiosa, crise depressiva e tentativa de suicídio e perfil de pacientes composto pelo sexo feminino, brancas, média de idade de 39,19 anos com desvio padrão de 17,36, sem filhos, solteiras, sem comorbidade psiquiátrica prévia diagnosticada, com ensino médio completo, católica, e maioria dos casos procedente da própria cidade onde se realizou o estudo. O método mais utilizado nas tentativas de suicídio foi a intoxicação medicamentosa. Abuso de drogas e álcool foram a quarta e a sexta causas, respectivamente, mais prevalentes de busca do setor de emergência e a maioria dos atendimentos ocorreu em março, às quartas-feiras, entre 12:00 e 18 horas. A maior parte dos desfechos resumiu-se a alta sem registro em prontuário de orientação a seguimento posterior. Nossos achados podem contribuir para medidas preventivas e terapêuticas aos pacientes psiquiátricos, na atenção primária, visando estabilizá-los e evitar agudizações que necessitem de um serviço emergencial.

A retrospective observational study has been conducted, gathering secondary data and quantitative approach and aiming at knowing the epidemiologic profile of patients attended by psychiatric emergency service of a general hospital at the extreme south of Santa Catarina. Patient profiles have been selected out of TASY system, patients from both genders, aged above 15 with medical records using ICD ­ 10 (International Classification of Diseases, WHO 1993) chapter V (F00 to F99), chapter XIX (T36 to T50) and chapter XX (X60 to X84), attendences made between January, 2015 and December, 2017. The obtained results showed higher prevalence of attendences due to anxiety crisis, depression crisis, suicide attempts and patient profiles composed mainly of catholic, single white females, middle ages 39,19 ± 17,36 , no children, no previous diagnosed psychiatrical comorbidity, high school graduated and most cases proceeding from the same city where the study was carried out. The most used method in the suicide attempts was medicinal poisoning. Alcohol and drug abuse was the fourth and sixth cause, respectively, more prevailing of search at the emergency sector, the majority of those taking place in March on a Wednesday between 12:00 pm and 6 pm. A great amount of outcomes was summed up in discharge, with no registries on orientational records for follow-up procedures. Our findings may contribute to preventive and therapeutical measures of psychiatrical patients, primarly aiming at stabilizing them and avoiding exacerbation which may lead to an emercy service

Videolaringoscopía para intubación pediátrica, en comparación con la intubación orotraqueal clásica / Video laryngoscopy for pediatric intubation, compared to classic orotracheal intubation

Introducción: Un aspecto relevante en anestesia pediátrica es el manejo de la vía aérea. Diferencias anatómicas de esta población, hace que sean más susceptibles a dispositivos diseñados para su manejo. La videolaringoscopía mejora la visión panorámica de la glotis. El objetivo del presente estudio fue comparar el uso de la videolaringoscopía con la laringoscopía directa para intubación orotraqueal, en pacientes pediátricos. Métodos: Con un diseño descriptivo observacional, se estudiaron 276 casos, pacientes de 5 a 17 años, sometidos a cirugía planificada, con anestesia general más intubación orotraqueal. El especialista decidió el dispositivo para manejo. Los datos se transcribieron de los formularios y analizados con el programa SPSS 22.0. El análisis descriptivo se basó en mediana, moda, promedio, valor mínimo, valor máximo. Medidas de dispersión desvío estándar y rango. Se condideró un valor de p < 0.05 como estadísticamente significativo. Resultados: La edad promedio del estudio fue 9.83 años. Con laringoscopía directa 97.4% se realizó la intubación al primer intento y con videolaringoscopía el 88,4% (P=0.003). En el 94.2% de casos de laringoscopía directa se realizó una intubación exitosa en menos de 10 segundos, con videolaringoscopía fue del 75.2% (P<0.001). Complicaciones se presentaron en el 6.6% de intubaciones con videolaringoscopía versus el 2.6% con laringoscopía convencional (P=0.103). El 56.2% de especialistas prefieren laringoscopía directa para manejar una vía aérea pediátrica sin predictores de dificultad. Conclusiones: La videolaringoscopía brinda un apoyo adicional en el manejo de la vía aérea de rutina, amerita siempre conocimientos y destrezas previas. La evidencia para avalar una técnica por sobre otra es insuficiente

Introduction:A relevant aspect in pediatric anesthesia is the management of the airway. Anatomical differences in this population makes them more susceptible to devices designed for their management. Video laryngoscopy improves panoramic vision of the glottis. Objective: To compare the use of video laryngoscopy with direct laryngoscopy for orotracheal intubation in pediatric patients. Methods: With an observational descriptive design, 276 cases were studied, patients from 5 to 17 years old, undergoing planned surgery, with general anesthesia plus orotracheal intubation. The specialist decided on the handling device. The data was transcribed from the forms and analyzed with the SPSS 22.0 program. The descriptive analysis was based on median, mode, average, minimum value,maximum value. Standard deviation and range dispersion measurements. A value pf p < 0.05 was considered statistically significant. Results: The average age of the study was 9.83 years. With direct laryngoscopy 97.4% intubation was performed at the first attempt and with video laryngoscopy 88.4% (p = 0.003). In 94.2% of cases of direct laryngoscopy, a successful intubation was performed in less than 10 seconds, with video laryngoscopy it was 75.2% (p = 0.000). Complications occurred in 6.6% of intubations with video laryngoscopy versus 2.6% with conventional laryngoscopy (p = 0.103). 56.2% of specialists prefer direct laryngoscopy to manage a pediatric airway without predictors of difficulty. Conclusions: Video laryngoscopy provides additional support in routine airway management, always requiring prior knowledge and skills. The evidence to support one technique over another is insufficient

Suicide and suicide attempts in adults: exploring suicide risk 24 months after a psychiatric emergency room visit

Objective: Suicide risk (including attempted and completed suicide) should be measured over short periods of time after contacting health services. The objective of this study was to identify the patterns of attempted and completed suicides within 24-months of a psychiatric emergency department visit, as well as to investigate predictive risk factors, including sociodemographic and clinical variables, previous suicidal behavior, and service utilization. Method: A convenience sample (n=147), recruited at a general hospital's psychiatric emergency room, included patients with suicidal ideation, suicidal plans or previous suicide attempts. These patients were followed for 24 months, focusing on two main outcomes: attempted and completed suicides. Results: After six months there were no completed suicides and 36 suicide attempts, while after 24 months there were seven completed suicides and 69 suicide attempts. A final logistic regression model for suicide attempts at 24 months identified somatic pathology and the number of previous psychiatric hospitalizations as predictive factors, with a good area under the receiver operating characteristic curve. Conclusions: The findings showed distinct patterns of attempted and completed suicides over time, indicating the importance of a systematic multidisciplinary suicide risk evaluation in psychiatric emergency rooms.

Tentativa de suicídio e fatores associados ao padrão uso e abuso do álcool / Suicide attempt and factors associated with standard alcohol use and abuse / Intento de suicidio y factores asociados al patrón uso y abuso del alcohol

OBJETIVO: este estudo teve como objetivo relacionar o padrão de uso, abuso e problemas relacionados ao álcool entre os pacientes que tentaram suicídio em Recife no ano de 2015. MÉTODO: trata-se de um estudo transversal, prospectivo, do tipo descritivo, epidemiológico, de abordagem quantitativa, no município do Recife-PE, realizado nas residências dos pacientes que tentaram suicídio e cujo nome consta em notificações compulsórias enviadas para a Vigilância de Atenção a Doenças não Transmissíveis da Secretaria Municipal do Recife. Para a coleta dos dados, aplicou-se o teste AUDIT, por meio de entrevistas, sendo esses dados organizados com o programa EPI-7 e analisados no programa SPSS®, versão 21.0. RESULTADOS: apresentou-se uma prevalência maior em mulheres jovens, com idade média de 38 anos, com 1º grau de escolaridade, cor parda, solteiras, desempregadas e pertencentes à classe social C. No teste AUDIT, 41,4% dos entrevistados encontram-se na zona I, necessitando de aconselhamento aos riscos do consumo de álcool, e 24,1% dos pacientes bebem. CONCLUSÃO: os comportamentos suicidas acentuam-se com o uso abusivo do álcool e, por isso, devem ser encarados pelas equipes de saúde com seriedade, respeito e compromisso, pois os agravos e as consequências dessas complicações se tornam ainda mais difíceis quando negligenciados.

OBJECTIVE: the present study aimed to relate the pattern of abuse and alcohol-related problems among patients who attempted suicide in Recife in the year 2015. METHOD: this is a cross-sectional, prospective, descriptive, epidemiological type of quantitative approach in the municipality of Recife-PE, carried out in the residences of patients who attempted suicide and whose name appears in compulsory notifications, sent to noncommunicable surveillance of the Municipal Secretariat of Recife. For the data collection, the AUDIT test was applied through interviews, having these data organized with the EPI-7 program and analyzed in the SPSS® program, version 21.0. RESULTS: a higher prevalence was found in young women, with a mean age of 38 years, with a first degree of education, brown, single, unemployed and social class C. In the AUDIT test 41.4% of the interviewees are in the area I, requiring advice on the risks of alcohol consumption and 24.1% of patients who drink. CONCLUSION: suicidal behaviors are accentuated by the abusive and continuous use of alcohol and therefore should be viewed seriously by the health teams as serious, respectful and committed, as the aggravations and consequences of these complications become even more difficult when neglected.

OBJETIVO: el presente estudio tuvo como objetivo relacionar el patrón de uso abusivo y problemas relacionados con el alcohol entre pacientes que intentaron suicidarse en Recife en 2015. MÉTODO: este es un estudio transversal, prospectivo, del tipo descriptivo, epidemiológico de abordaje cuantitativo en el municipio de Recife-PE, realizado en las residencias de los pacientes que intentaron suicidio, con nombres em notificaciones obligatorias, enviadas para Vigilancia de Atención a Enfermedad no Transmisibles de la Secretaría Municipal de Recife. Para coletar los datos, se aplicó la prueba AUDIT, por entrevistas, organizando los datos en el programa EPI-7 y analizando en el programa SPSS®, versión 21.0. RESULTADOS: se presentó una prevalencia mayor en mujeres jóvenes, con edad media de 38 años, con 1 grado de escolaridad, pardas, solteras, desempleadas y pertecentes a la clase social C. En la prueba AUDIT 41,4% de los entrevistados se encuentran en la zona I, necesitando asesoramiento a los riesgos del consumo de alcohol y 24,1% de los pacientes que beben. CONCLUSION: los comportamientos suicidas se acentuan con el uso abusivo del alcohol y deben ser encarados por los equipos de salud con seriedad y compromiso, pues las consecuencias de esas complicaciones se vuelven más difíciles cuando descuidadas.

Study of patients with suicidal ideation with sleep disorders and depression in Karnataka population

Background: 85, adult patients aged between 17 to 65 years of both sexes were studied with to know the etiology of suicidal ideation.Methods: Applying methodical instruments like sleep habits questionnaires and Black scale for suicidal ideation to rule out etiology and types of suicidal ideation.Results: Total 13(15.2%) had active suicidal ideation, 23(27%) specific plans for suicide 20(23.5%) had passive suicidal ideation, 29(34%) patients had previous history of suicidal attempts. Majority of the patients were under treatment of hypnotics and antidepressants�, 11(12.9%) were on clonozepine 12(14.1%) were on lorazepam 9(10.5%) were on chlordiazepoxide, Antidepressants, 8(9.41%) were on sertalin, 14(16.4%) desvenlafaxine, 15(17.6%) Amitriptyline, 16(18.8%) were on duloxetine.Conclusions: This pragmatic study highlights the suicidal ideation with sleep disorders and depression, will be quite helpful to psychiatrist, psycho-social worker to treat the patients efficiently

Relationship between social norms and smoking cessation among male smokers in three cities of China / 上海预防医学

Objective To explore the relationship between social norms and smoking intention, among male smokers in China. Methods A total 3 621 (with 95.8% of effective response rate) male smokers were selected and investigated with questionnaires from August to November in 2013.Univariate logistic regressions and multivariate logistic regressions were conducted to find the associations between social norms, smoking intention and quitting attempts. Results Smokers perceived low pro-quitting social norms from their family members, friends and other people around.With a 1 point increase in pro-quitting social norms score, smokers′ willingness to quit in the next 6 months increased by 69% (OR=1.69, 95%CI:1.48-1.94), and smokers were 86% more likely to quit(OR=1.86, 95%CI:1.66-2.08). Conclusion Pro-quitting social norms is proved to be an independent predictor for smoking intention, quitting attempts among male smokers in China.Therefore, future intervention should aim to establish pro-quitting social norms for smoking cessation.

Relationship between social norms and smoking cessation among male smokers in three cities of China / 上海预防医学

Objective To explore the relationship between social norms and smoking intention, among male smokers in China. Methods A total 3 621 (with 95.8% of effective response rate) male smokers were selected and investigated with questionnaires from August to November in 2013.Univariate logistic regressions and multivariate logistic regressions were conducted to find the associations between social norms, smoking intention and quitting attempts. Results Smokers perceived low pro-quitting social norms from their family members, friends and other people around.With a 1 point increase in pro-quitting social norms score, smokers′ willingness to quit in the next 6 months increased by 69% (OR=1.69, 95%CI:1.48-1.94), and smokers were 86% more likely to quit(OR=1.86, 95%CI:1.66-2.08). Conclusion Pro-quitting social norms is proved to be an independent predictor for smoking intention, quitting attempts among male smokers in China.Therefore, future intervention should aim to establish pro-quitting social norms for smoking cessation.

Associação entre precocidade do trauma psíquico e tentativas de suicídio: uma experiência de pesquisa / Association between precocity of psychic trauma and suicide attempts: a research experience

Experiências traumáticas na infância podem gerar sofrimento psicológico e aumento das vulnerabilidades e predisposições para posterior desenvolvimento de psicopatologias na vida adulta. Sintomas de comportamentos autodestrutivos e tentativas de suicídio estão entre algumas das fortes possibilidades de manifestações. O presente estudo foi realizado em um hospital de emergência, em Porto Alegre/RS, e teve como objetivo principal estudar a correlação entre traumas na infância perpetrados por figuras parentais e a TS na adultez, em uma amostra de pessoas que internaram como sobreviventes de TS. Os resultados apontaram associação entre eventos traumáticos na infância e posterior tentativa de suicídio na vida adulta. Essa correlação realça o papel do trauma psíquico precoce no desejo de interromper a própria vida posteriormente. Fica visível a necessidade de compreensão das consequências dos traumas infantis, bem como a necessidade de serem pensadas intervenções precoces na infância e nos adultos vítimas de trauma. Novos estudos são sugeridos.(AU)

Traumatic childhood experiences can generate psychological distress and the increase vulnerabilities and predispositions for later development of psychopathologies in adulthood. Symptoms of self-defeating behaviors as well as suicide attempts are among some of the strong possibilities for manifestations. The present study was conducted in an emergency hospital in Porto Alegre/RS and its main objective was to study the correlation between childhood trauma perpetrated by parental figures and TS in adulthood, in a sample of people who were hospitalized as TS survivors. The results of the investigation pointed to the association between the presence of trauma in childhood and suicide attempts in adulthood. The results showed an association between traumatic events in childhood and subsequent suicide attempt in adulthood. This correlation highlights the role of early psychic trauma in the desire to interrupt their own lives later. The need to understand the consequences of childhood trauma and the need to think about early interventions in childhood and in trauma victims adults is visible. New studies are suggested.

Las experiencias traumáticas de la infancia pueden generar angustia psicológica y el aumento de las vulnerabilidades y predisposiciones para el desarrollo posterior de psicopatologías en la edad adulta. Los síntomas del comportamiento autodestructivo y los intentos de suicidio se encuentran entre las mayores posibilidades de manifestaciones. El presente estudio se llevó a cabo en un hospital de emergencia, en Porto Alegre/RS, y su objetivo principal fue estudiar la correlación entre el trauma infantil perpetrado por figuras parentales y TS en la edad adulta, en una muestra de personas que fueron hospitalizadas como sobrevivientes de TS. Los resultados mostraron una asociación entre eventos traumáticos en la infancia y el posterior intento de suicidio en la edad adulta. Esta correlación destaca el papel del trauma psíquico temprano en el deseo de interrumpir su propia vida más tarde. La necesidad de comprender las consecuencias del trauma infantil, así como la necesidad de pensar en las intervenciones tempranas en la infancia y en los adultos víctimas de trauma es visible. Se sugieren nuevos estudios.(AU)

Suicidal behavior among substance users: data from the Second Brazilian National Alcohol and Drug Survey (II BNADS)

Objective: To investigate the prevalence rates of suicidal ideation (SI) and suicide attempts (SA) and their association with substance use in a nationally representative sample of Brazilians. Methods: The Second Brazilian National Alcohol and Drug Survey (II BNADS) is a household cross-sectional survey that investigated the consumption of psychotropic drugs and associated risk factors. This national probability sample survey used a multistage cluster design to select 4,607 participants aged 14 or older and had a total response rate of 77%. Illegal drug use, SI and SA were obtained by confidential self-report assessment. Results: SI and SA were reported by 9.9 and 5.4% of the sample, respectively. This prevalence was 20.8 and 12.4% among individuals with alcohol use disorders (AUD), 31.5 and 16.5% among cannabis users and 40.0 and 20.8% among cocaine users. After adjusting for demographic characteristics, tobacco use, family history of suicide and depression, both SI and SA were positively associated with AUD, cannabis and cocaine use. Conclusion: AUD, cannabis and cocaine use were significantly associated with SI and SA, even after the adjustments. Public health initiatives targeting suicide prevention should consider including assessment and management of substance misuse, and therapeutic approaches to substance misuse should include assessment of suicidality.

Happiness level among medical students of a medical college

Background: In psychology, happiness is recognized as “emotion”. Emotion is divided into “negative emotion” and “positive emotion”. Psychologists believe that three main components of happiness are as follows: The relative existence of positive emotion, the lack of negative emotions and life satisfaction. Medical field is one of the fields that due to the clinical period and the pressures of hospitals and stressful environment have considerable effects on happiness and their job performance. Medical students are the future healers of the society. Happiness level of the students has effects on their performance. Hence the present study is an attempt to assess the happiness level of medical students.Methods: A cross-sectional study was carried out among medical students of a private medical college in Maharashtra. The participants in the study were medical students of all academic years enrolled in a private medical college. Happiness was measured by using Oxford Happiness Questionnaire.Results: It can be observed that happiness level of medical students is 70%. Female students are slightly more happy than male students. It was found that 49% study participants are unhappy as they are having insufficient pocket money.Conclusions: The level of happiness among students does not depend on their number of attempts in previous examinations. It was evident that percentage of happiness is much more in students living with their family. It was also observed Percentage of happiness is much more in students having some hobby. The study also revealed that level of happiness decreases marginally as the academic year progresses.

Epidemiología del intento suicida en el Hospital Central de Nampula, Mozambique

Intento suicida constituye la mayoría de pacientes con lesiones autoinfligidas que acuden al servicio de urgencias. Su costo económico y social es elevado en términos de utilización de servicios de salud y el impacto que tiene en el individuo y la familia. Objetivo: Identificar algunas características epidemiológicas de casos de intento suicida vistos en el Hospital Central de Nampula, Mozambique. Material y Métodos: Estudio descriptivo, transversal y porcentual de 93 pacientes con historia de intento suicida atendidos entre mayo de 2014 y diciembre de 2016. Se identificaron algunas variables sociodemográficas, metodología y motivos, intentos previos, persistencia de la idea suicida, características del intento (impulsivo o no) y diagnóstico psiquiátrico. Resultados: Más de la mitad de los pacientes tenían entre 15 y 24 años de edad, hubo una proporción de 1.3 a 1 de mujeres vs. varones, la mayoría eran estudiantes y soltero(a)s. Conflictos interpersonales motivaron tres de cada cuatro intentos. La ideación suicida persistía en 35,5 % de los pacientes al momento de la entrevista. La mayoría efectuó el intento suicida de manera impulsiva contando con fácil acceso a un raticida de elevada letalidad, y 14,6 % tenía historia de intentos previos. Los diagnósticos psiquiátricos más frecuentes fueron trastornos de la personalidad y trastornos depresivos. Conclusiones: Conflictos interpersonales como factor desencadenante, fácil disponibilidad de un agente letal, conducta impulsiva y diagnósticos de trastornos de la personalidad y depresión son hallazgos descriptivos fundamentales de este estudio en Mozambique.

Suicidal attempt constitutes the majority of patients with self-inflicted injuries seen at hospital emergency departments. The economic and social costs are high in terms of utilization of health services and the behavior’s impact on the individual and his/her family. Objective: To identify some epidemiological characteristics of suicide attempts at Nampula Central Hospital in Mozambique. Material and Method: Descriptive, cross-sectional study on 93 patients who attempted suicide between May 2014 and December 2016. Sociodemographic variables, suicidal method, reasons for the attempt, previous attempts, persistence of suicidal ideation, psychiatric diagnosis and whether the attempt was impulsive or not were identified, data, quantified through percent figures. Results: Over half of the patients were in the 15-24, not-married, and students with a female/male ratio of 1.3. Interpersonal conflicts were the reason in ¾ parts of the attempts. Suicidal ideation persisted in 35.5 % of the patients. Most of the suicide attempts were impulsive acts, facilitated by the availability and easy access to a rodenticide called ratex, and 14.6 % of the patients had had previous attempts. The most frequent psychiatric diagnoses were personality and depressive disorders. Conclusions: Interpersonal conflicts, availability of a lethal agent, impulsive behaviour and diagnoses of personality disorders and depression were the main descripotive findings of this study in Mozambique.

Tentativa suicida y uso del tiempo libre en adolescentes escolarizados mexicanos / Suicide attempt and leisure in Mexican adolescents

Resumen El propósito del estudio fue identificar el uso del tiempo libre y su relación con la tentativa suicida en una muestra mexicana adolescente. Participaron 1290 estudiantes de nivel secundaria, entre 12 a 18 años (36 % varones, 64 % mujeres); el instrumento incluyó reactivos cerrados y formato libre. De las 11 categorías del tiempo libre obtenidas, la de relaciones fuera del ámbito familiar obtuvo el mayor puntaje (96 %) y el menor las actividades escolares (1,8 %). Se encontraron asociaciones estadísticamente significativas de riesgo suicida en las actividades pasivas, del hogar, relaciones familiares y cuidar el propio cuerpo; se encontraron actividades con efecto protector las relaciones sociales fuera del ámbito familiar y recreativas (artísticas, deportivas). Se presentan reflexiones sobre la producción y utilización creativa del tiempo libre en jóvenes y familias contemporáneas.

Abstract The aim of the present study was to identify leisure time and its association to suicide attempts in a sample of 1290 Mexican adolescents aged 12-18 (36 % male, 64 % female). The instrument included both, closed and open items. Out of 11 leisure categories, relationships outside their families were the most prevalent at 96 % while school-related activities were the least prevalent (at 1.8 %). Statistically significant differences were found for suicidal behavior and passive activities, home activities, family relationships, and body self-care. Recreation activities such as sports and arts, and relationships outside their families were found to be protective factors. Concluding considerations about the creative use of leisure for contemporary adolescents and families are included.

Resumo O objetivo deste estudo foi identificar a relação entre o uso do tempo livre e a tentativa de suicídio em uma amostra de adolescentes mexicanos. Participaram 1290 estudantes de ensino médio, entre 12 e 18 anos (36 % homens, 64 % mulheres). O instrumento de avaliação incluiu perguntas fechadas e abertas. Das 11 categorias estabelecidas para tempo livre, a que obteve maior pontuação (96 %) foi a de relações fora do âmbito familiar e a de menor pontuação (1.8 %) foi de atividades escolares. Foram encontradas associações estatísticas significativas entre o risco de suicídio e atividades passivas, tais como, atividades de casa, relações familiares e cuidados com o corpo próprio; atividades protetoras foram encontradas em relações sociais fora do âmbito familiar e de recreação (artísticas e esportivas). Apresenta-se reflexões sobre a produção e utilização criativa do tempo livre em jovens e famílias contemporâneas.