Ideação e comportamentos suicidas em mulheres privadas de liberdade em uma unidade prisional do estado do Paraná / Suicidal ideation and behavior in women deprived of liberty in a prison unit in the state of Paraná

Resumo: A ideação e comportamentos suicidas são considerados um problema de saúde pública. Mulheres privadas de liberdade podem apresentar maior vulnerabilidade para esses comportamentos, considerando as condições no ambiente prisional, a perda de vínculos familiares e os históricos de comorbidades mentais e físicas. Trata-se de um estudo quantitativo transversal, com o objetivo geral de analisar a ideação e os comportamentos suicidas em mulheres privadas de liberdade em uma unidade prisional do Estado do Paraná. A amostra foi por conveniência e constituída de 30 mulheres privadas de liberdade. Os dados foram coletados de maio a agosto de 2022 com aplicação do instrumento Columbia-Suicide Severity Rating Scale e de um instrumento elaborado pelos autores. Os resultados foram apresentados de maneira descritiva e inferencial. Da amostra de 30 mulheres, 15 (50,0%) eram da faixa etária de 30 a 49 anos; 15 (50,0%) declararam-se pardas; 18 (60,0%) eram solteiras; 17 (56,7%) estavam desempregadas antes da prisão; 14 (46,7%) apresentavam condição de saúde mental; 21 (70,0%) eram tabagistas; 22 (73,3%) faziam uso de álcool; e 17 (56,7%) fizeram uso de SPA. O motivo da privação de liberdade foi homicídio para 15 (50,0%) participantes. Da amostra, 20 (66,7%) foram vítimas de violência física alguma vez na vida; 17 (56,7%) de violência psicológica; e 14 (46,7%), de violência sexual. Quanto à ideação, 16 (53,3%) mulheres já haviam desejado estar mortas; 19 (63,3%) haviam tido pensamentos suicidas ativos não específicos; 15 (50,0%) haviam tido ideação suicida ativa com algum método (sem plano) sem intenção de agir; 15 (50%) haviam tido ideação suicida ativa com alguma intenção de agir; e 14 (46,7%) havia tido ideação suicida ativa com plano específico e intenção. Durante a privação de liberdade, 12 (40%) apresentaram pensamentos suicidas. Empreenderam comportamentos suicidas durante a vida 16 (53,3%) mulheres; 14 (46,7%) tiveram tentativa efetiva; 6 (20,0%), comportamento autolesivo sem intenção suicida; 8 (26,7%) tiveram tentativa interrompida; 7 (23,3%) tiveram tentativa abortada; 10 (33,3%) realizaram atos ou comportamentos preparatórios; 4 (13,3%) empreenderam tentativas de suicídio durante a privação de liberdade, das quais 3 (10,0%) empreenderam pela primeira vez durante a privação de liberdade. Na análise inferencial, as principais variáveis associadas à ideação e aos comportamentos suicidas foram: ideação suicida antes da privação de liberdade, ideação suicida durante a privação de liberdade, tratamento para condição de saúde mental, vítima de violência sexual, tentativa de suicídio e ideação suicida ativa com algum método (sem plano) sem intenção de agir. Considerando os resultados desta pesquisa e o que é previsto pela equipe de enfermagem no sistema prisional, conclui-se pela importância de avaliar a ideação e os comportamentos suicidas em mulheres privadas de liberdade desde a admissão, na permanência da privação, bem como nos aspectos relacionados à ocorrência de tais comportamentos visando à oferta de cuidados de enfermagem na prevenção, no evento e na reabilitação.

Abstract: Suicidal ideation and behaviors are considered a public health problem. Women deprived of their liberty may be more vulnerable to these behaviors, considering the conditions in the prison environment, the loss of family ties and histories of mental and physical comorbidities. This is a cross-sectional quantitative study with the general objective of analyzing suicidal ideation and behaviors in women deprived of their liberty in a prison unit located in the State of Paraná. A convenience sample was used, and it was made up of 30 women deprived of their liberty. Data were collected from May to August 2022 using the Columbia-Suicide Severity Rating Scale instrument and another instrument developed by the authors. The results were presented in a descriptive and inferential manner. Of the sample made up of 30 women, 15 (50.0%) were aged between 30 and 49; 15 (50.0%) self-declared as mixed race; 18 (60.0%) were single; 17 (56.7%) were unemployed before the arrest; 14 (46.7%) experienced mental health disorder; 21 (70.0%) were smokers; 22 (73.3%) were alcohol users; and 17 (56.7%) had used some PAS. The deprivation of liberty was caused by homicide for 15 (50.0%) participants. Of the sample, 20 (66.7%) were victims of physical violence at some point in their lives; 17 (56.7%) were victims of psychological violence; and 14 (46.7%) of sexual violence. As for suicidal ideation, 16 (53.3%) women had already wished they were dead; 19 (63.3%) had already had non-specific active suicidal thoughts; 15 (50.0%) had already had active suicidal ideation with a method (not plan) without intent to act; 15 (50%) had already had active suicidal ideation with some intent to act; and 14 (46.7%) had already had active suicidal ideation with a specific plan and intent. During their period of deprivation of liberty, 12 (40%) had suicidal thoughts. 16 (53.3%) women engaged in suicidal behavior during their lifetime; 14 (46.7%) made an actual attempt; 6 (20.0%) had self-injurious behavior without suicidal intent; 8 (26.7%) reported an interrupted attempt; 7 (23.3%) reported an aborted attempt; 10 (33.3%) had made preparations or showed suicidal behavior; 4 (13.3%) made suicide attempts during their period of deprivation of liberty, of which 3 (10.0%) attempted suicide for the first time during their period of deprivation of liberty. In the inferential analysis, the main variables associated with suicidal ideation and behaviors were the following: suicidal ideation before being deprived of their liberty, suicidal ideation during their period of deprivation of liberty, treatment for a mental health disorder, victim of sexual violence, attempted suicide, and active suicidal ideation with a method (not plan) without intent to act. Considering the results of this research and the expectations of the nursing team in the prison system, it can be concluded that it is important to evaluate suicidal ideation and behaviors among women deprived of liberty from the moment they are admitted, during the period in which they are deprived of their liberty as well as the aspects related to the occurrence of such behaviors, aiming to offer nursing care during the prevention process, the episode itself and the rehabilitation process.

Attitudes towards suicidal behavior and related factors in adolescent patients with depressive episode / 四川精神卫生

BackgroundAttitude towards suicide among adolescents is closely linked with their suicidal behavior. Previous studies on suicidal attitudes and related factors primarily focused on school samples， with limited research on relevant clinical samples of adolescents with depressive episode. ObjectiveTo analyze the attitudes towards suicidal behavior and the influencing factors in adolescent patients with depressive episode， so as to provide references for suicide intervention in this population. MethodsA total of 100 adolescent patients who met the diagnostic criteria for depressive episode according to the International Classification of Diseases， tenth edition （ICD-10） were selected from the outpatient and inpatient departments of the Fourth People's Hospital of Wuhu from May 2021 to July 2022. A self-designed general demographic questionnaire， Hamilton Depression Scale-17 item （HAMD-17）， Suicide Attitude Questionnaire （QSA）， Egma Minnen av Bardndosnauppforstran （EMBU） and Internet Addiction Test （IAT） were used to evaluate the patients' depressive symptoms， attitudes towards suicide， parenting styles and Internet addiction， respectively. Spearman and Pearson correlation analyses were used to examine the correlation between the factor scores of attitudes towards suicidal behavior in QSA and demographic characteristics， HAMD-17 score， EMBU score and IAT score. Multiple linear regression was conducted to screen the risk factors associated with attitudes towards suicidal behavior， and ROC curves were plotted to evaluate the predictive efficacy of each factor. ResultsThe scores on attitudes towards suicidal behavior in QSA among adolescent patients with depressive episode were positively correlated with scores on attitude towards the suicidal person， attitude towards euthanasia， as well as scores on mother's emotional warmth and understanding factor （r=0.210~0.485， P<0.05 or 0.01）. Conversely， they were negatively correlated with father's education level， suicidal behavior in the past 6 months， HAMD-17 score， IAT score， father's punishment and harshness， father's overinvolved， father's rejection and denial， father's overprotection， mother's overinvolved and overprotection， mother's rejection and denial， and mother's punishment and harshness factor scores （r=-0.571~-0.290， P<0.05 or 0.01）. Multiple linear regression analysis revealed that QSA scores on attitude towards the suicidal person （β=0.198， P<0.01） and attitude towards euthanasia （β=0.302， P<0.01） positively predicted score on attitude towards suicidal behavior， and fathers' education level （β=-0.180， P=0.043）， HAMD-17 scores （β=-0.366， P<0.01） and IAT scores （β=-0.191， P=0.030） negatively predicted scores on attitude towards suicidal behavior. The differences in predictive efficacy between the factors were not statistically significant （Z=-1.289~0.092， P>0.05）. ConclusionInternet addiction， depression severity， attitudes towards suicide， attitudes towards euthanasia and father's education level may influence attitudes towards suicidal behavior in adolescent patients with depressive episode. ［Funded by Scientific Research Project of Wuhu Municipal Health Commission in 2021 （number， WHWJ2021y076）， Bengbu Medical College Postgraduate Science and Technology Innovation Project （number， Byycxz21040）］

Avaliação do risco de suicídio entre alunos no início, meio e fim do curso de medicina de uma universidade no Rio de Janeiro / Suicide risk assessment among students at the beginning, in the middle and at the end of the medicine course of a university in the city of Rio de Janeiro ­ Brazil

Objetivo: Avaliar o risco de suicídio e a existência de comportamento suicida entre acadêmicos nos estágios inicial, intermediário e final do curso de Medicina de uma universidade particular e analisar os fatores de risco possivelmente associados à ideação suicida nessa população. Materiais e métodos: Foram analisados, em estudo transversal, 376 estudantes. Todos os participantes responderam questionário autopreenchível, por meio da plataforma eletrônica Google Forms, composto por 3 seções: perguntas sobre questões pessoais, perguntas do Questionário de Comportamento Suicida Revisado (Suicide Behavior Questionnaire Revised: SBQ-R) e do Inventário de Ideação Suicida Positiva e Negativa (Positive and Negative Suicide Ideation: PANSI). Resultados: 34% dos alunos eram do 1º ano, outros 34% do 3º ano e 32%, do 6º ano. 71,8% da população do estudo é composta pelo sexo feminino e 39,6% possui idade entre 21 e 24 anos. Na classificação de risco de suicídio segundo o PANSI, 31,7% dos estudantes apresentaram médio risco e 5,3%, alto risco. Na análise por etapa do curso, o 3º ano apresentou-se com maior porcentagem em alto risco (70,0%). De acordo com o SBQ-R, 37,2% dos estudantes da população total apresentaram comportamento suicida. Dentre as variáveis analisadas, orientação sexual, história de bullying na infância, conflito com responsáveis, história familiar de transtorno mental, uso de drogas ilícitas, história de violência sexual e ansiedade autorreferida foram consideradas como fatores de risco para suicídio na população total e na subanálise feita por ano de faculdade. Conclusão: A população do estudo apresenta aumento das taxas de ideação e comportamento suicida em relação a população geral. Assim, é necessária a implantação de medidas dentro das universidades para promover a saúde mental e diminuir aspectos estressantes sobre os acadêmicos. [au]

Objective : The purpose of this study is to assess the risk of suicide and the existence of suicidal behavior among academics in the early, intermediate and final stages of a private medical school, and also to analyze risk factors possibly associated with suicidal ideation in this population. Methods: This is a cross-sectional study with 376 medical students. All the participants answered a self-fillable questionnaire through the electronic platform Google Forms composed of 3 sections: questions about personal issues; questions of the Suicide Behavior Questionnaire Revised (SBQ-R); and of the Positive and Negative Suicide Ideation (PANSI) Inventory. Results: 34% of the students were in the 1st year of graduation, 34% in the 3rd year, and 32%, in the 6thyear. 71.8% of the population is female and 39.6% are between 21 and 24 years old. In the suicide risk classification according to PANSI, 31.7% of the students were in the medium risk group and 5.3% in high risk group. In the analysis per year, the 3rd year showed a greater percentage of high risk (70.0%). According to the SBQ-R classification of suicide risk, 37.2% of students out of the total population revealed suicidal behavior. Among the analyzed variables, sexual orientation, history of childhood bullying, domestic conflict, presence of mental disorders in family, use of illicit drugs, history of sexual violence and self-reported anxiety were considered as risk factors for suicide. The highlighted results revealed the same pattern when analyzed per year of college. Conclusion: The survey population has increased rates of suicidal negative ideation and behavior compared to the general population. Therefore, it is necessary to implement programs in colleges to promote a greater state of well-being and reduce stressful aspects in academics. [au]

Interaction of smoking and being bullied on suicidal behaviors: a school-based cross-sectional survey in China

BACKGROUND@#Suicidal behaviors are seriously social issues among adolescents in the world. Exposed to smoking and being bullied are risk factors of suicidal behaviors. The present study was aimed to examine the interaction of smoking and being bullied on suicidal behaviors among Chinese adolescents.@*METHODS@#A total of 18,900 students were involved in the questionnaire study, in four cities of China from November 2017 to January 2018. Suicidal behaviors, smoking, and being bullied were measured by self-reported validated instruments. Chi-square tests and logistic regression were used to analyze the associations of suicidal ideation (SI)/suicidal plan (SP)/suicidal attempt (SA), smoking, and being bullied.@*RESULTS@#The prevalence of smoking, being bullied, SI/SP/SA, were 3.1%, 20.6%, 26.4%, 13.2%, and 5.2% respectively. Interaction analysis indicated that being bullied was associated with a greater increase in the likelihood of suicidal behaviors for adolescents with smoking than for those without smoking.@*CONCLUSIONS@#These finding suggest that smoking exacerbates the association between being bullied and suicidal behaviors. Future research should explore how and why smoking appears to more bully-victims than for those without smoking and how to mitigate it.

Relationships between various forms of childhood abuse and suicidal behaviors among middle school students / 中华流行病学杂志

Objective To study the relationship between various forms of childhood abuse and suicidal behaviors among middle school students.Methods A total of 14 221 cases were retained from an epidemiological study,involving students from junior and senior middle schools in Guangzhou,Xinxiang,Shenyang and Chongqing.Information related to the demographic characteristics,types,number,timing and perpetrators of exposure to childhood abuse and suicidal behaviors was obtained.Logistic regression was used to analyze the relationships of each form of childhood abuse and suicidal behaviors.Results Number of cases (rates) of childhood abuse,physical abuse,emotional abuse,sexual abuse,suicidal ideation,suicidal planning and suicidal attempts among middle school students appeared as 7 246 (51.0％),5 824 (41.0％),5 409 (38.0％),1 039 (7.3％),2 042 (14.4％),1 174 (8.3％) and 548 (3.9％),respectively.Boys reported more physical abuse than girls,while girls reported more emotional abuse and suicide ideation than boys (P＜0.01).However,no gender differences were found in cases as sexual abuse,suicide planning or attempted suicide (P＞0.01).After controlling for confounding variables,experiences on childhood abuse were significantly associated with suicidal ideation (OR=2.03,95％CI:1.72-2.40) and suicidal planning (OR=1.93,95％CI:1.57-2.37) among boys but significantly associated with suicidal ideation (OR=2.45,95％CI:2.12-2.82),suicidal planning (OR=2.46,95％CI:2.02-3.00) and attempted suicide (OR=2.12,95％CI:1.61-2.78) among girls.Results from multivariable logistic regression analysis showed that each type of childhood abuse,occurring at any time within the first 16 years of life,especially with continuous exposure,was significantly associated with suicidal behaviors.A significant graded-relationship was found between number of abusive childhood experiences and suicidal behaviors.Students that had been maltreated by parents or others were at high risk of engaging in suicidal behaviors.Conclusion The findings suggest that the experience of any form of childhood abuse should be considered a risk factor for suicidal behaviors among the middle school students.

Relations between problems on sleeping and suicidal behaviors in middle school students / 中华流行病学杂志

Objective To understand the epidemiological characteristics and possible associations between sleeping problems and suicidal behaviors among middle school students.Methods A total of 13 817 middle school students were selected in Shenyang,Xinxiang,Chongqing and Guangzhou cities and cluster sampling method was used.Questionnaires would include information on demographics,quality of sleep,psychopathological status and suicidal behaviors.Pittsburgh Sleep Quality index (PSQI)and Adolescent Multidimensional Sub-health Questionnaire (MSQA) were used to assess the quality of sleep and psychosomatic symptoms,respectively.Rates on sleeping problems and suicidal behaviors were compared in students with specific characteristics.Effects related to sleeping problems and suicidal behaviors were analyzed,using the multivariate logistic regression model.Results The overall prevalence of problems related to sleeping among middle school students was 26.5％.28.2％ of the girls and 35.2％ of senior students reported as having more sleeping problems.Rates on suicide related ideation,planning and attempts were 16.6％,9.6％ and 4.7％,respectively.Girls reported more suicide ideation than boys.However,no gender differences were found in suicide planning or attempted suicide.It also suggested that the incidence of the suicidal behavior among students with sleeping problems was significantly higher than students without sleeping problems.Data from Multivariable logistic regression analysis showed that sleeping problems appeared as independent risk factors on suicidal behavior.Higher PSQI scores seemed coincide with the increased risk of suicidal behaviors.Students having sleeping time less than 5 hours per day showed higher risk of suicidal behaviors.Conclusion Problems on sleeping seemed a strong risk factor for suicidal behaviors among middle school students.Improvement on the quality of sleep and reasonable arrangement of sleeping time could help prevent related suicidal behaviors among middle school students.

Association between adolescent internet addiction and suicidal behaviors / 中华流行病学杂志

Objective To examine the association between internet addiction and suicidal behaviors in adolescences and to explore whether the association could be partly or fully accounted by depression or/and behaviors related to the impulsity. Methods A total of 3507 urban adolescent students in Hefei were administered to complete the questionnaire concerning interact addiction disorder(IAD), suicidal behaviors during the 12 months preceding the survey, behaviors related to the impulsity, Center for Epidemiologic Studies Depression Scale and early childhood adversities,respectively. Hierarchical logistic regressions were used to evaluate the associations and possible roles of depression and behaviors related to the impulsity between internet addition and suicidal behaviors after adjustment for confounding factors. Results Of the 3507 participants, 5.2% were diagnosed as IAD, 27.4% reported suicidal ideation during the 12 months preceding the survey, with another 9.5% had a plan and 2.6% had an attempt. Internet addition was associated with suicidal ideation(OR=1.79, 95%CI: 1.32-2.44), plan(OR=2.32, 95%CI: 1.57-3.42), and attempt(OR=2.08, 95%CI:1.03-4.22). After adjustment for potential confounding factors, the association between internet addition and attempt was insignificant. When depression and behaviors related to the impulsity were entered into Hierarchical regression respectively, the associations between internet addition, suicidal ideation and plan were substantially reduced. While internet addition was enter into Hierarchical regression, the associations between depression, behaviors related to the impulsity, suicidal ideation and plan were not reduced. Conclusion Adolescent intemet addition seems to be associated with suicidal ideation and plan, and the association is possibly mediated by depression and behaviors related to the impulsity.