Caracterización de la conducta suicida en población general de la Región de Coquimbo (Chile) entre 2018 y 2020 / Characterization of suicidal behavior in Coquimbo, Chile, between 2018 and 2020

Introducción La conducta suicida es un problema de salud pública mundial. La Organización Mundial de la Salud estimó en 700 000 los fallecimientos por suicidio para el año 2021. Objetivo El propósito fue estimar la prevalencia de la conducta suicida y describir sus factores relacionados en la Región de Coquimbo, Chile, entre los años 2018 y 2020. Métodos Se analizaron 2190 notificaciones por intentos suicidas del sistema de vigilancia epidemiológica regional, que correspondieron a 1781 personas; junto con 217 informes de personas fallecidas por suicidio del Servicio Médico Legal. Resultados La tasa global de suicidio para la región en el período fue de 9,79 fallecimientos por 100 000 habitantes. Se estandarizaron las tasas del año 2018 según la información disponible, con método directo para la tasa regional (9,55 por 100 000 habitantes) e indirecto para las comunas. Las comunas rurales presentaron mayores tasas que las urbanas. Las mujeres mostraron mayor riesgo de intentos (: 1,28; intervalo de confianza 95%: de 1,23 a 1,33) y menor riesgo de suicidio (0,086; de 0,06 a 0,13) que los hombres. Las personas jóvenes presentaron mayor riesgo de intentos y menor riesgo de suicidio, comparado con personas mayores. Destaca el aumento de la tasa de suicidio en personas mayores (de 70 a 79 años) durante el año 2020. El nivel educacional básico es una variable de riesgo para suicidio (2,21; de 1,15 a 4,23), comparado con educación universitaria. Los intentos de suicidio previos y patología psiquiátrica son factores de riesgo. Conclusiones La prevalencia de suicidio y los factores relacionados son similares a lo reportado en otros estudios e informes nacionales, destacando la ruralidad y mayor riesgo en varones de edad adulta avanzada. A diferencia de los suicidios, los intentos son más frecuentes en mujeres y personas jóvenes. Antecedentes de problemas de salud mental, intentos previos y violencia en la familia son factores de riesgo para ambas conductas. Conocer el comportamiento de la conducta suicida en la población es fundamental para su prevención.

Introduction Suicidal behavior is a public health problem worldwide. The World Health Organization estimated 700 000 deaths for the year 2021. Objective This study aimed to estimate the prevalence of suicidal behavior and describe its related factors in the Coquimbo Region, Chile, between 2018 and 2020. Methods 2190 suicide attempt notifications from the regional epidemiological surveillance system were analyzed, corresponding to 1781 people, along with 217 reports from the Forensic Medical Service of people who died by suicide. Results The overall suicide rate for the region during that period was 9.79 deaths per 100 000 inhabitants. The 2018 rates were standardized according to available information, with direct methods for the regional rate (9.55 per 100 000 inhabitants) and indirect methods for the communes. Rural communes presented higher rates than urban ones. Women showed a higher risk of attempts (OR 1.28; 95% CI 1.23 to 1.33) and a lower risk of suicide compared to men (0.086; 0.06 to 0.13). Young people had a higher risk of suicide attempts and a lower risk of suicide compared to older people. The increased suicide rates in older people (70 to 79 years) during 2020 are noteworthy. Basic education level is a risk variable for suicide (2.21; from 1.15 to 4.23), compared to having higher education. Previous suicide attempts and psychiatric pathology are risk factors. Conclusions Suicide prevalence and related factors are similar to those reported in other studies and national reports, highlighting rurality and higher risk in older male adults. In contrast to suicides, attempts are more frequent in women and young people. A history of mental health problems, previous attempts, and family violence are risk factors for both outcomes. Knowing the patterns of suicidal behavior in the population is fundamental for its prevention.

Study of Deliberate Self-Poisoning Among Adult Females in A Tertiary Care Hospital

Background: Poisoning is a common medico-social problem in our country causing around 300,000 episodes and around 2000 deaths per year. Attempted suicide among adult females are a major public health problem. The number of self-poisoning in females are increasing in our country day by day. The incidence, nature, etiology, age group affected and the outcome of self-poisoning in females of our country is different from that of the western world. Objective: The objective of the study was to analysis the socio-demographic profile & pattern of deliberate self-poisoning among adult females admitted in the Medicine Department, Dhaka Medical College Hospital. Material and Methods: This was a descriptive cross sectional study conducted in the Department of Medicine, Dhaka Medical College Hospital from January 2016 to June 2016. 100 admitted female participants were enrolled in this study as study population. A purposive sampling method was applied for sampling from study population. Results: The age of the participants were from 18 to 55 years with the mean age of 28.19 (± 9.84) years. Most number of the participants were in 21-29 year’s age group (42%) followed by ?20 year’s (29%). House wife (30%) was the most common occupation followed by student (25%). Most of the participants were from lower economic class (51%), followed by middle class (41%). 48% participants were in primary level, 24% in secondary level and 22% were illiterate. Most of the participants were married (51%), followed by unmarried (35%), divorced (9%) and widow (5%). 62% participants from rural and 38% from urban area. 75% were Muslim and 25% were Hindu. 55% were from the joint family and 45% were from the nuclear family. Most of the self-poisoning occurred between 6 am to 12 pm (42%), followed by 6 pm to 12 am (30%), 12 pm to 6 pm (20%) and 12 am to 6 am (8%). Insecticide was the most common poison materials (43%), followed by drug ingestion (30%), household detergent (13%), rodenticide (6%) and others (8%). Maximum participants reported the reason for self-poisoning was family disharmony (35%) followed by romantic disappointment (27%). 17% participants reported previous suicidal attempt and 11% had previous psychiatric disorder. Nearly half of the participants (43%) sought medical care within 2 hours and one fourth participants (31%) within 4 hours. About two-thirds of the participants (66%) received primary medical care from different govt. hospitals. Most of the female participants with self-poisoning were recovered completely (71%), while 20% participants recovered with complications and 9% participants died. In the study, fatality rate was found 33.3% in rodenticide and 16.3% in insecticide poisoning. Conclusions: As evident from the study, by intervene these problems by various measures might be helpful to prevent many of deliberate self-harm. Early diagnosis and prompt institution of appropriate treatment can make a favorable outcome in deliberate self-poisoning of female participants.

Eventos de risco associados ao comportamento suicida / Risk events associated with suicide behavior

Objetivo: Analisar eventos de risco associados ao comportamento suicida em indivíduos atendidos em emergência geral. Métodos: Pesquisa exploratória, descritiva, abordagem qualitativa. Coleta de dados entre dezembro de 2017 e novembro de 2019, com pessoas que tentaram o suicídio, por meio de entrevista com questionário semiestruturado. Dados analisados com Análise de Conteúdo temático. Resultados: Entrevistados 113 participantes, 86 (76,1%) do sexo feminino, 57 (50,4%) na faixa etária entre 18 e 30 anos, 103 (91,2%) heterossexuais, 49 (43,4%) solteiros. Conforme a análise dos dados, o conteúdo foi agrupado em uma categoria com quatro unidades temáticas que deram ênfase às relações familiares traumáticas, presença de histórico de experiências traumáticas para além da família, condições socioeconômicas ecomportamento impulsivo e a percepção de inexistência de fatores de proteção. Sabe-se que no comportamento suicida há interferência das relações com familiares, com amigos e com outras pessoas com as quais haja relacionamento afetivo importante, de forma que o bom vínculo familiar assume papel de proteção ao comportamento suicida, enquanto vínculos familiares conflituosos são potenciais fatores de risco. Considerações finais: Resultados revelaram a experiência da multiplicidade de eventos que influenciaram a decisão pelo suicídio, ênfase para relações afetivas e familiares prejudicadas e experiências traumáticas (AU).

Objective: Analyze risk events associated with suicidal behavior in individuals seen in general emergency care. Methods: Exploratory, descriptive research, qualitative approach. Data were collected from December 2017 to November 2019 with people who attempted suicide through an interview with a semi-structured questionnaire. Data reviewed with thematic Content Analysis. Results: This survey interviewed 113 participants, 86 (76.1%) female, 57 (50.4%) aged between 18 and 30 years, 103 (91.2%) heterosexual, and 49 (43.4%) single. According to the data analysis, the content was grouped into one category with four thematic units that emphasized traumatic family relationships, the presence of a history of traumatic experiences beyond the family, socioeconomic conditions, impulsive behavior, and the perception of the nonexistence of protective factors. It is known that suicidal behavior is influenced by relationships with family members, friends, and other people with whom there is an important emotional relationship. Good family bonds, thus, take on a protective role against suicidal behavior, while conflicting family bonds are potential risk factors. Final remarks: Results disclosed the experience of the multiplicity of events that influenced the decision to commit suicide, emphasizing damaged affective and family relationships and traumatic experiences (AU).

Fatores associados às vítimas de tentativas de suicídio atendidas no âmbito da urgência e emergência / Factors associated with victims of suicide attempts treated in a hospital emergency service / Factores asociados a víctimas de intentos de suicidio atendidas en el ámbito de urgencia y emergencia

Objetivo: analisar os fatores associados e o desfecho das vítimas de tentativa de suicídio atendidas em um serviço hospitalar de urgência e emergência. Método: estudo observacional, longitudinal, retrospectivo e quantitativo, com dados de 191 prontuários de vítimas de tentativa de suicídio atendidas entre 2013 e 2022 em uma unidade de urgência e emergência. Aplicou-se o Acute Physiology and Chronic Health Evalution II (APACHE II) e foram realizadas análises estatísticas descritiva e inferencial. Resultados: a maioria dos pacientes era de homens, adultos, com comorbidades de cunho mental, sendo o mecanismo de autoviolencia mais prevalente o abuso de medicamentos. A grande maioria não possuía tentativas prévias, sobreviveram ao evento e foram encaminhadas após a alta hospitalar para serviços especializados. Conclusão: os fatores associados à tentativa de suicídio são representados pelo sexo masculino, sem companheiro(a) e idade entre 18 e 59 anos. Quanto ao desfecho, aqueles que apresentam elevado escore no APACHE II demonstraram maiores chances de evoluírem para óbito.

Objective: to examine associated factors and outcomes of suicide attempt victims treated at a hospital emergency service. Method: this quantitative, longitudinal, retrospective, observational study considered data from 191 medical records of victims of suicide attempts treated between 2013 and 2022 in an emergency unit. The Acute Physiology and Chronic Health Evaluation II (APACHE II) was applied, and descriptive and inferential statistical analyses were performed. Results: most of the patients were men, adults, with mental comorbidities, and medication abuse was the most prevalent self-harm mechanism. The great majority had made no previous attempts, survived the event, and were referred to specialized services after hospital discharge. Conclusion: the factors associated with attempted suicide are being male, single, and aged between 18 and 59 years. As for the outcome, those with high APACHE II scores were more likely to die.

Objetivo: analizar los factores asociados y la evolución de las víctimas de intento de suicidio atendidas en un servicio de urgencias hospitalario. Método: estudio observacional, longitudinal, retrospectivo y cuantitativo, con datos de 191 historias clínicas de víctimas de intento de suicidio atendidas entre 2013 y 2022 en una unidad de urgencia y emergencia. Se aplicó el Acute Physiology and Chronic Health Evaluation II (APACHE II) y se realizaron análisis estadísticos descriptivo e inferencial. Resultados: la mayoría de los pacientes eran hombres, adultos, con comorbilidad mental, siendo el abuso de medicamentos el mecanismo de autolesión más prevalente. La gran mayoría no tenía intentos previos, sobrevivió al evento y fue derivado tras el alta hospitalaria a servicios especializados. Conclusión: los factores asociados al intento de suicidio están representados por el sexo masculino, sin pareja y con edad entre 18 y 59 años. En cuanto al resultado, aquellos con una puntuación alta APACHE II tenían más probabilidades de morir.

Perfil epidemiológico de pacientes intoxicados con acetaminofén con intenciones suicidas / Epidemiological profile of patients intoxicated with acetaminophen for suicidal purposes / Perfil epidemiológico de pacientes intoxicados com acetaminofen (Paracetamol) com intenções suicidas

Objetivo: este estudio busca describir los individuos evaluados por sobredosis de acetaminofén entre 2019 y 2020 en un centro de referencia de trasplante hepático en Colombia. Metodología: estudio derivado del análisis secundario de historias clínicas entre el 1.º de enero de 2019 y el 31 de diciembre de 2020. Los criterios de inclusión abarcan individuos con ingestión aguda y voluntaria de dosis tóxicas de acetaminofén (>4 g/día). Resultados: sesenta y tres casos, 68% mujeres, 67% menores de 18 años y 54% estudiantes. Reportó historia personal de enfermedad psiquiátrica el 60% y el 35% al menos un intento de suicidio previo. La mediana de dosis de acetaminofén fue 15g, 46% refirieron co-ingesta de otras sustancias y 13% estaba bajo efecto de sustancias psicoactivas. El 57% tenía la intención clara de suicidarse, así como 81% vomitó antes de acudir al servicio de urgencias, 22% recibió medidas de descontaminación y 10% no recibió N - acetilcisteína. Quince individuos desarrollaron lesión hepática aguda, nueve con criterios de severidad. Conclusiones: la población era predominantemente joven, la historia de enfermedad psiquiátrica fue muy prevalente y la mayoría refirieron un evento vital que explicara el comportamiento impulsivo de consumo. Ninguno desarrolló criterios para trasplante hepático, lo cual podría explicarse por la edad de los individuos, los episodios de vómito temprano, y la ausencia de enfermedad hepática crónica o de consumo de sustancias hepatotóxicas.

Objective: this study aims to describe patients with overdose intake of acetaminophen between 2019 and 2020 at a reference center for liver transplantation in Colombia. Methodology: study derived from a secondary analysis of the clinical records between January 1st, 2019, to December 31st, 2020. Inclusion criteria were individuals with voluntary acute ingestion of toxic doses of acetaminophen (>4 g/day). Results: sixty-three cases, 68% women, 67% <18-year-old, and 54% students. 60% had personal history of psychiatric illness and 35% reported at least one previous suicide attempt. The median dose of acetaminophen was 15g, 46% referred to co-ingestion with other substances and 13% were under the effect of any psychoactive substance. 57% had a clear intention of suicide. 81% vomited before the arrival to the emergency room, 22% received decontamination intervention with gastric lavage or activated charcoal, and 10% did not receive any dose of N-Acetylcysteine. Fifteen individuals developed an acute liver injury, nine with severity criteria. Conclusions: the population was predominantly young, the personal history of psychiatric disease was highly prevalent, and most of the cases referred a vital event that explains the impulsive behavior in acetaminophen consumption. None developed criteria for liver transplantation, and this could be explained by the young age of the individuals, the episodes of early vomiting, and the absence of chronic liver disease or hepatotoxic substance consumption.

Objetivo:este estudo busca descrever os indivíduos avaliados por sobredose de acetaminofen entre 2019 e 2020 num centro de referência de transplante hepático na Colômbia. Metodologia: estudo derivado da análise secundário de histórias clínicas entre o dia 1.º de janeiro de 2019 e 31 de dezembro de 2020. Os critérios de inclusão abrangem indivíduos com ingestão aguda e voluntária de dose tóxicas de acetaminofen (>4 g/dia).Resultados:sessenta e três casos, 68% mulheres, 67% menores de 18 anos e 54% estudantes. Reportou história pessoal de doença psiquiátrica, 60% e 35% pelo menos uma tentativa de suicídio prévio. A média de dose de acetaminofen foi de 15g, 46% referiram com ingestão de outras sustâncias e 13% estava sob efeito de sustâncias psicoativas. 57% tinham a intenção clara de suicidar-se, assim como 81% vomitou antes de acudir ao serviço de urgências, 22% receberam medidas de descontaminação e 10% não recebeu N - acetilcisteína. Quinze indivíduos desenvolveram lesão hepática aguda, nove com critérios de severidade. Conclusões: a população era predominantemente jovem, a história de doençapsiquiátrica foi muito prevalente e a maioria referiram um evento vital que explicasse o comportamento impulsivo de consumo. Nenhum desenvolveu critérios para transplantehepático, o qual se poderia explicar pela idade dos indivíduos, os episódios de vómito precoce, e a ausência de doença hepática crónica ou de consumo de sustâncias hepatotóxicas.

Narrativas de jóvenes con intentos suicidas: una mirada al cuerpo y la micropolítica / Narratives of young people with suicide attempts: a look at the body and micropolitics

Este artículo es el resultado de una investigación que da cuenta de la relación entre el intento de suicidio y la micropolítica en jóvenes de una institución educativa del municipio de Chinchiná, Caldas, Colombia. El referente teórico se basa en las discusiones en torno a los conceptos de micropolítica y cuerpo. La fundamentación epistemológica y metodológica fue fenomenológica hermenéutica. Todo esto dio la posibilidad de que los jóvenes en sus narrativas autobiográficas relataran sus vidas y encontraran nuevas posibilidades de existencia. Se encontraron categorías como: el encuentro con el mundo, un mundo sin cuidado, la violencia sexual, el cuerpo como espacio de comunicación, la incertidumbre, entre otras. Se concluye la importancia de comprender los procesos de singularización de los jóvenes para interpretar los sentidos que le dan al cuerpo y su relación con la micropolítica; asimismo, cómo los jóvenes manifiestan su rechazo a la producción de subjetividad capitalista a través del intento de suicidio

This article is the result of an investigation that gives an account of the relationship between suicide attempts and micropolitics in young people of an educational institution in the municipality of Chinchiná, Caldas, Colombia. The theoretical reference is based on discussions around the concepts of micropolitics and the body. The epistemological and methodological foundation was hermeneutic phenomenological. All this gave the possibility for young people in their autobiographical narratives to relate their lives and find new possibilities of existence Categories such as the encounter with the world, a world without a care, sexual violence, the body as a space of communication, uncertainty, among others, were found. It concludes the importance of understanding the processes of singularization of young people to interpret the senses they give to the body and its relationship with micropolitics. Likewise how young people manifest their rejection of the production of capitalist subjectivity through the attempt of suicide

Epidemiological behavior of suicide attempt in Colombian adolescents years 2016-2019: An ecological study / Comportamento epidemiológico da tentativa de suicídio em adolescentes colombianos anos 2016 - 2019: um estudo ecológico / Comportamiento epidemiológico del intento suicida en adolescentes colombianos años 2016-2019: Un estudio ecológico

Abstract Objective: characterize the behavior of attempted suicide in adolescents in Colombia, and its associated epidemiological factors from 2016 to 2019. Method: quantitative, observational, descriptive, and ecological study. The sample was extracted from the database of the Integrated Social Protection Information System, by identifying cases of attempted suicide for ages in the range from 12 to 17 years old, calculated for a prevalence estimate based on a total population of 32,076. Univariate and bivariate analysis of the variables of interest was performed. Results: suicide attempts occurred more frequently in females (n: 24,619; 76.7%), of subsidized regime (n: 17,960; 56%); and being in psychiatric centers is the most frequent vulnerability condition (n: 676; 2.11%). Living in the capital city is a risk factor for attempted suicide (OR: 1.423; 95% CI: 1.385 to 1.462), while being male is a protective factor (OR: 0.290; 95% CI: 0.283 a 0.298). Conclusion: suicide attempts are a subject of interest in Public Health due to their prevalence and impact on the family and social environment. The Nursing professional is competent in the identification, treatment, and prevention of this phenomenon.

Resumo Objetivo: caracterizar o comportamento da tentativa de suicídio em adolescentes na Colômbia e seus fatores epidemiológicos relacionados no período entre 2016 e 2019. Método: estudo quantitativo, observacional, descritivo e ecológico. A amostra foi obtida a partir do banco de dados do Sistema Integrado de Informação de Proteção Social, por meio da identificação de casos de tentativa de suicídio entre 12 e 17 anos, calculado para uma estimativa de prevalência de uma população total de 32.076. Foram realizadas análises univariadas e bivariadas das variáveis de interesse. Resultados: a tentativa de suicídio ocorre com maior frequência em mulheres (n: 24.619; 76,7%), de regime subsidiado (n: 17.960; 56%); e a condição de vulnerabilidade mais frequente é estar em centros psiquiátricos (n: 676; 2,11%). Morar na sede municipal é fator de risco para tentativas de suicídio (OR: 1,423; IC95%: 1,385 a 1,462) e ser do sexo masculino é fator de proteção (OR: 0,290; IC95%: 0,283 a 0,298). Conclusão: a tentativa de suicídio é um tema de interesse da Saúde Pública devido à sua prevalência e impacto no meio familiar e social, e o profissional de Enfermagem tem competência para identificar, tratar e prevenir esse fenômeno.

Resumen Objetivo: caracterizar el comportamiento del intento de suicidio en adolescentes en Colombia y sus factores epidemiológicos asociados en el período entre 2016 y 2019. Método: estudio cuantitativo, de tipo observacional, descriptivo y ecológico. La muestra se obtuvo en la base de datos del Sistema Integrado de Información de la Protección Social, mediante la identificación de casos de intento de suicidio para edades entre los 12 y 17 años, calculado para una estimación de prevalencia a partir de una población total de 32.076. Se realizó análisis univariado y bivariado de las variables de interés. Resultados: el intento de suicidio se presenta con mayor frecuencia en mujeres (n: 24.619; 76,7%), de régimen subsidiado (n: 17.960; 56%); y la condición de vulnerabilidad más frecuente es estar en centros psiquiátricos (n: 676; 2,11%). El vivir en la cabecera municipal es un factor de riesgo para el intento de suicidio (OR: 1,423; IC95%: 1,385 a 1,462) y ser hombre es factor protector (OR: 0,290; IC 95%: 0,283 a 0,298). Conclusión: el intento suicida significa un tema de interés en Salud Pública por su prevalencia e impacto en el ámbito familiar y social, y el profesional de Enfermería posee competencia para la identificación, tratamiento y prevención de este fenómeno.

Professional attitudes towards suicidal behavior in primary health care: a quasi-experimental study / Actitudes profesionales en relación a las conductas suicidas en la atención primaria de la salu: un estudio cuasi-experimental / Atitudes profissionais em relação ao comportamento suicida na atenção primária à saúde: um estudo quase-experimental

ABSTRACT Objective: to analyze the attitudes of health professionals working in Primary Health Care before and after participating in workshops about how to approach people with suicidal behavior. Method: a before-and-after quantitative and quasi-experimental study, conducted in a municipality in the inland of the state of São Paulo from August to September 2019. The sample consisted of 34 workers who answered a Sociodemographic Questionnaire and the Questionnaire on Attitudes towards Suicidal Behavior, applied before and after three workshops on how to approach people with suicidal behavior in the Primary Health Care context. The data were analyzed by means of the Wilcoxon and McNemar tests, considering p<0.05. Results: a statistically significant difference was identified before and after the workshops regarding professional ability (p=0.011), negative feelings towards the patient (p=0.025) and without a category (p=0.006), evidencing the effectiveness of the workshops on how to approach people with suicidal behavior for management and care professionals working in Primary Health Care. Conclusion: the short-term results observed after the workshops point to a change in the professionals' conception and management in relation to people with suicidal behavior. Permanent and continuous training strategies as spaces for learning, reflection and action are fundamental to qualify the approach to people with suicidal behavior.

RESUMEN Objetivo: analizar las actitudes de los profesionales de la salud que trabajan en Atención Primaria antes y después de participar en talleres sobre el enfoque en relación a personas que presentan conductas suicidas. Método: estudio de carácter cuantitativo y cuasi-experimental del tipo antes y después, realizado en un municipio del interior del estado de San Pablo de agosto a septiembre de 2019. La muestra estuvo compuesta por 34 trabajadores que respondieron un Cuestionario Sociodemográfico y el Cuestionario sobre Actitudes en Relación a las Conductas Suicidas, aplicados tanto antes como después de asistir a tres talleres sobre cómo tratar a personas con conductas suicidas en el contexto de la Atención Primaria de la Salud. Los dados se analizaron por medio de las pruebas de Wilcoxon y McNemar, considerando p<0,05. Resultados: se identificó una diferencia estadísticamente significativa antes y después de los talleres en lo que se refiere a la capacidad profesional (p=0,011), a sentimientos negativos en relación al paciente (p=0,025) y a ninguna categoría específica (p=0,006), evidenciando así la efectividad de los talleres sobre cómo tratar a personas con conductas suicidas destinados a profesionales de gestión y atención en el contexto de la Atención Primaria de la Salud. Conclusión: los resultados a corto plazo que se observaron después de los talleres señalan un cambio en la concepción y el manejo de los profesionales frente a personas que presentan conductas suicidas. Estrategias permanentes y sostenidas en el tiempo como espacios de aprendizaje, reflexión y acción son fundamentales para cualificar debidamente la forma de atender a personas con conductas suicidas.

RESUMO Objetivo: analisar as atitudes dos profissionais de saúde da Atenção Primária à Saúde antes e após a participação de oficinas acerca da abordagem em relação à pessoa com comportamento suicida. Método: estudo de natureza quantitativa e quase-experimental do tipo antes e depois, realizado em município do interior do estado de São Paulo de agosto a setembro de 2019. A amostra foi composta por 34 trabalhadores que responderam a um Questionário Sociodemográfico e ao Questionário sobre Atitudes em Relação ao Comportamento Suicida, aplicados antes e após a realização de três oficinas sobre abordagem à pessoa com comportamento suicida no contexto da Atenção Primária à Saúde. Os dados foram analisados por meio dos testes de Wilcoxon e McNemar, considerando p<0,05. Resultados: identificou-se diferença estatisticamente significativa antes e após as oficinas no que se refere à capacidade profissional (p=0,011), sentimentos negativos em relação ao paciente (p=0,025) e sem categoria (p=0,006), evidenciando a efetividade das oficinas sobre a abordagem da pessoa com comportamento suicida para os profissionais da gestão e do cuidado na Atenção Primária à Saúde. Conclusão: os resultados a curto prazo, observados após oficinas, apontam para uma mudança na concepção e no manejo dos profissionais frente à pessoa com comportamento suicida. Estratégias permanentes e continuadas de formação como espaços de aprendizagem, reflexão e ação são fundamentais para qualificar a abordagem à pessoa com comportamento suicida.

Correlation between theory of mind and attempted suicide in adolescents with depressive disorder / 中华行为医学与脑科学杂志

Objective:To explore the difference of theory of mind between adolescent depressive disorder patients with and without suicide attempt and its correlation with depression severity.Methods:From September 2019 to April 2021, totally 56 cases of attempted suicide adolescent depression patients(suicide attempted group), and 78 non-attempted suicide adolescent depression patients (non-suicide attempted group) and 23 healthy controls (healthy control group) with matched sex, age and years of education were included.The 17-item Hamilton depression scale(HAMD-17) and mini-international neuropsychiatric interview (M. I. N. I. ) were evaluated in all the subjects for depression severity and suicide trait related clinical psychological scale, theory of mind-picture sequencing task (ToM-PST) includes primary belief, primary false belief, secondary belief, secondary false belief, third-level false belief, sense of reality, reciprocity, deception and deception detection, which were used to test the theory of mind of the three groups. SPSS 25.0 software was used to statistically analyze the data, compare the differences of ToM of the three groups, and Pearson correlation analysis was used to analyze the correlation between ToM of the attempted suicide group and the clinical behavior scale.Results:The suicide attempted group was significantly lower in understanding primary false belief ((2.46±0.63) vs (2.87±0.46)) than the healthy control group( P<0.05), and the understanding of deception((2.84±0.42) vs (2.63±0.61)) was significantly higher than the non-suicide attempted group( P<0.05), and the non-suicide attempted group was significantly lower in understanding primary false belief((2.48±0.72) vs ( 2.87±0.46)) and ToM total scores((50.86±6.60) vs (54.91±5.12)) than the healthy control group(both P<0.05). Pearson correlation analysis showed that the secondary false belief of the attempted suicide group were negatively correlated with the cognitive impairment( r=-0.267, P<0.05), and third-level false belief was negatively correlated with the cognitive impairment, retardation, and depressiontotal score( r=-0.331, r=-0.319, r=-0.269, all P<0.05). There was no significant correlation between primary belief, primary false belief, secondary belief, sense of reality, reciprocity, deception, deception detection, total score of picture ranking, total score of ToM and depression in suicide attempt group(all P>0.05). Conclusion:The ability to understand deception is different between depression adolescents with and without suicide attempt, and it is not correlated with the severity of depression.

Intento de Autoeliminación en la Niñez y Adolescencia. Presentación de un modelo de prevención del intento de autoeliminación en niños y adolescentes tempranos en un Hospital Pediátrico en Montevideo

RESUMEN Objetivo general: Descripción del trabajo realizado en la Policlínica Especializada en Conductas Autolesivas (PECA) de la Clínica de Psiquiatría Infantil. Presentación de un posible modelo de prevención del segundo o posteriores intentos de autoeliminación(IAE). Metodología: Estudio descriptivo, transversal de una muestra de niños y adolescentes de edades entre 6 y 15 años que consultaron por comportamientos suicidas en un periodo de 9 meses (n=102 pacientes), en los años 2012-2013. Se realizaron entrevistas clínicas semiestructuradas, se aplicó la CBCL (Child Behavior Check List) y Cuestionario complementario. Resultados: El 78,8 % de la muestra son del sexo femenino y el 75 % tienen entre 12-14 años. Primer IAE 68 %, segundo o más IAE 16 %. Escolarizados 63,6 %. Media de PT (Problemas Totales) 66,4. El 42,3 % de los padres refieren que sus hijos son víctima de violencia. Del total de 102, 90 continúan su tratamiento. Frecuencia de reingresos 12 %. Un suicidio. Conclusiones: El desarrollo de un modelo de prevención del segundo o posteriores intentos de autoeliminación durante un periodo de 9 meses, evidencia la importancia de un seguimiento de proximidad. Las alteraciones emocionales y conductuales objetivadas en una población joven se favorecen por los bajos niveles de escolaridad y la violencia intrafamiliar.

ABSTRACT General objectives: Explain the way in which the Specialized Polyclinic in Self-Injury Behaviors, works in the Child Psychiatry Clinic. Prevention of second or more suicide attempt. Methodology: Descriptive, cross-sectional study of a sample of children and adolescents between the ages of 6 and 15 who consulted for suicidal behaviors in a period of 9 months (n 102 patients). Semi-structured clinical interviews were conducted and the CBCL (Child Behavior Check List) and supplementary questionnaire was applied. Results: Female 78,8%. 12-14 years old 75%. First suicide attempt 68%, second or more 16%. Schooling 63,6%. Mean of PT 66,4. 42,3% of parents report that their children are victims of violence. Of 102 patients, 90 (88%) continue their treatment. Frequency of readmissions 12%. One suicide, 1%. Conclusions: These numbers warm of a serious problem that requires great efforts to identify possible risk factors and reduce their incidence.

Atendimento aos pacientes com comportamento suicida: percepção de profissionais da saúde / Care for patients with suicidal behavior: perception of health professionals

O número crescente de tentativas de suicídio no Brasil e no mundo suscita a necessidade de haver profissionais de saúde qualificados para este tipo de atendimento e para a notificação da ocorrência. Este estudo objetivou descrever a percepção e o preparo dos profissionais de uma Região de Saúde para o atendimento aos pacientes com comportamento suicida. Tratou-se de uma pesquisa descritiva, transversal, de caráter quantitativo. Os dados foram obtidos por meio da aplicação de um questionário aos profissionais de saúde que trabalham na rede pública pertencente aos 15 municípios da 7ª Regional de Saúde do Estado do Paraná. Para a análise dos dados, foi empregado o teste de Qui-quadrado de Pearson. Em termos gerais, os profissionais de saúde não se sentiam preparados para atender pacientes com comportamento suicida. A maioria não tinha formação ou capacitação suficiente, desconhecia a estratificação de risco em saúde mental em conformidade com o caderno 8 do APSUS e não sabia inserir esses pacientes na rede em saúde mental. Em conclusão, há necessidade de melhor preparo dos profissionais de saúde para o atendimento aos pacientes com comportamento suicida por meio do fortalecimento à educação continuada em saúde, na perspectiva intersetorial e interdisciplinar, medida que também contribuirá para o aprimoramento das notificações ao Ministério da Saúde.

The growing number of suicide attempts in Brazil and in the world raises the need for qualified health professionals to provide this type of care and to report occurrences. This study aimed to describe the perception and preparation of professionals in a Health Region caring for patients with suicidal behavior. This was a descriptive, cross-sectional, quantitative study. Data were obtained through the application of a questionnaire given to health professionals who work in the public network belonging to the 15 municipalities of the 7th Health Region of the State of Paraná. For data analysis, Pearson's Chi-squared test was used. In general terms, health professionals did not feel prepared to treat patients with suicidal behavior. Most did not have sufficient education or training, were unaware of the risk stratification in mental health in accordance with APSUS notebook 8, and did not know how to insert these patients into the mental health network. In conclusion, there is a need for better preparation of health professionals to care for patients with suicidal behavior by strengthening continuing health education, from an intersectoral and interdisciplinary perspective, which is a measure that will also contribute to the improvement of notifications to the Ministry of Health.

Prevalence of suicidal behavior in young university students: A systematic review with meta-analysis / Prevalencia de conductas suicidas en jóvenes universitarios: revisión sistemática con metaanálisis / Prevalência do comportamento suicida em jovens universitários: revisão sistemática com metanálise

Objective: to identify the prevalence of suicidal behavior in young university students. Method: a systematic review with meta-analysis of cross-sectional studies based on the Joanna Briggs Institute proposal, and carried out in the PubMed, Web of Science, Scopus, PsycINFO and LILACS databases and in the Brazilian Digital Library of Theses and Dissertations, with no language or year restrictions. A total of 2,942 publications were identified. Selection, data extraction and methodological evaluation of the studies were performed by two independent researchers. The meta-analysis was performed considering the random effects model. Results: eleven articles were included in this review. The prevalence variation for suicidal ideation was from 9.7% to 58.3% and, for attempted suicide, it was from 0.7% to 14.7%. The meta-analysis showed a 27.1% prevalence for suicidal ideation in life, 14.1% for ideation in the last year, and 3.1% for attempted suicide in life. Conclusion: the high prevalence of suicidal behavior, even with the considerable heterogeneity of the studies, raises the need to implement interventions aimed at preventing suicide and promoting mental health, especially in the academic environment.

Objetivo: identificar la prevalencia de conductas suicidas en jóvenes universitarios. Método: revisión sistemática con metaanálisis de estudios transversales realizados a partir de la propuesta del Joanna Briggs Institute, en las bases de datos PubMed, Web of Science, Scopus, PsycINFO, LILACS y Biblioteca Digital Brasileña de Tesis y Disertaciones, sin limitaciones de idioma ni año. Se identificaron 2.942 publicaciones. La selección, la extracción de los datos y la evaluación metodológica de los estudios fueron realizadas por dos investigadores independientes. El metaanálisis se realizó considerando el modelo de efectos aleatorios. Resultados: se incluyeron once artículos en esta revisión. La variación de la prevalencia de ideación suicida fue del 9,7% al 58,3% y la del intento de suicidio fue del 0,7% al 14,7%. El metaanálisis mostró una prevalencia del 27,1% para la ideación suicida a lo largo de la vida, del 14,1% para la ideación en el último año y del 3,1% para el intento de suicidio a lo largo de la vida. Conclusión: la alta prevalencia de conducta suicida, a pesar de la considerable heterogeneidad de los estudios, plantea la necesidad de implementar intervenciones dirigidas a prevenir el suicidio y promover la salud mental, especialmente en el ámbito académico.

Objetivo: identificar a prevalência do comportamento suicida em jovens universitários. Método: revisão sistemática com metanálise de estudos transversais realizada a partir da proposta do Joanna Briggs Institute, nas bases de dados PubMed, Web of Science, Scopus, PsycINFO, LILACS e Biblioteca Digital Brasileira de Teses e Dissertações, sem restrição de idioma e ano. Foram identificadas 2.942 publicações. Seleção, extração dos dados e avaliação metodológica dos estudos foram realizadas por dois pesquisadores independentes. A metanálise foi realizada considerando o modelo de efeitos randômicos. Resultados: onze artigos foram incluídos nesta revisão. A variação da prevalência da ideação suicida foi de 9,7% a 58,3% e da tentativa de suicídio foi de 0,7% a 14,7%. A metanálise demonstrou prevalência de 27,1% para ideação suicida na vida, 14,1% para ideação no último ano e 3,1% para tentativa de suicídio na vida. Conclusão: a alta prevalência do comportamento suicida, mesmo diante da considerável heterogeneidade dos estudos, desperta a necessidade de implementação de intervenções voltadas para prevenção do suicídio e promoção da saúde mental, sobretudo no espaço acadêmico.

Caracterização das tentativas de suicídio e automutilações por adolescentes e adultos notificadas em Santa Catarina, 2014-2018 / Caracterización de intentos de suicidio y automutilación por adolescentes y adultos notificados en Santa Catarina, Brasil, 2014-2018 / Characterization of suicide attempts and self-harm by adolescents and adults notified in Santa Catarina, Brazil, 2014-2018

Objetivo: Caracterizar as tentativas de suicídio e automutilações por adolescentes e adultos, notificadas em Santa Catarina, Brasil, de 2014 a 2018. Métodos: Estudo transversal descritivo, com dados do Sistema de Informação de Agravos de Notificação. Compararam-se características sociodemográficas, clínicas e do tipo de violência autoprovocada, entre adolescentes e adultos. Resultados: Nas 8.859 notificações analisadas, as tentativas de suicídio predominaram em relação à automutilação; as violências autoprovocadas foram mais frequentes no sexo feminino, raça/cor da pele branca e presença de transtorno mental; e sua ocorrência foi maior na residência, para ambas as idades. Nos adolescentes, destacou-se a automutilação de repetição (83,3%); e nos adultos, as tentativas de suicídio de repetição (50,6%) e a suspeita de uso de álcool no momento da violência (18,3%). Conclusão: Identificou-se altas prevalências de tentativa de suicídio entre adolescentes e adultos; as características das violências foram semelhantes entre as faixas etárias analisadas.

Objetivo: Caracterizar los intentos de suicidio y automutilaciones por adolescentes y adultos, reportados en Santa Catarina, Brasil, de 2014 a 2018. Métodos: Estudio transversal descriptivo con datos del Sistema de Información de Agravamientos de Notificación. Se compararon las características sociodemográficas, clínicas y del tipo de violencia autoinfligida entre adolescentes y adultos. Resultados: Entre las 8.859 notificaciones, predominaron los intentos de suicidio en relación a la automutilación; la autolesión fue más frecuente en mujeres, de piel blanca, con trastornos mentales y ocurrieron en domicilio, en ambas edades. En los adolescentes se destacó la automutilación repetida (83,3%) y en los adultos, los intentos de suicidio repetidos (50,6%) y la sospecha de consumo de alcohol (18,3%) en el momento de la violencia. Conclusión: Se identificó una alta prevalencia de intento de suicidio entre adolescentes y adultos, las características de la violencia fueron similares entre los grupos de edad.

Objective: To characterize adolescent and adult suicide attempts and self-harm reported in Santa Catarina, Brazil, from 2014 to 2018. Methods: This was a cross-sectional descriptive study with data from the Notifiable Health Conditions Information System. The sociodemographic, clinical and type of self-inflicted violence characteristics among adolescents and adults were compared. Results Among the 8,859 notifications analyzed, suicide attempts predominated in relation to self-mutilation; self-inflected violence was more frequent in females, those of white skin color and with mental disorders; it occurred more at home, in both age groups. Among adolescents, repeated self-mutilation (83.3%) stood out, while among adults, repeated suicide attempts (50.6%) and suspected alcohol use (18.3%) at the time of violence stood out. Conclusion: We identified high prevalence of attempted suicide among adolescents and adults; the characteristics of violence were similar between the age groups analyzed.

Perfil epidemiológico das notificações de violência autoprovocada de 2010 a 2019 em um estado do sul do Brasil / Epidemiological profile of notifications of self-inflicted violence from 2010 to 2019 in a state in Southern Brazil / Perfil epidemiológico de las notificaciones de violencia autoinfligida entre 2010 y 2019 en un estado del sur de Brasil

OBJETIVO: descrever o perfil das notificações de violência autoprovocada no estado do Rio Grande do Sul no período de 2010 a 2019. MÉTODO: estudo epidemiológico observacional descritivo transversal a partir de dados secundários. Foram realizadas análises estatísticas descritivas para estudar a distribuição dos casos segundo as variáveis sociodemográficas e aquelas relacionadas ao evento. RESULTADOS: foram notificados 43.390 casos de lesão autoprovocada, dos quais 67,9% foram do sexo feminino. Verificou-se maior proporção de notificações de indivíduos na faixa etária de 20 a 29 anos, ao passo que as maiores taxas de notificação corresponderam à faixa etária de 15 a 19 anos de idade, com aumento expressivo de 2017 a 2019. A residência foi o local predominante de ocorrência das lesões autoprovocadas, e 41% das notificações eram de pessoas que já haviam se autoagredido ou tentado suicídio previamente. CONCLUSÃO: verificou-se predomínio de notificações de indivíduos do sexo feminino, na faixa etária de 20 a 29 anos, e aumento expressivo das taxas de notificação na faixa etária de 15 a 19 anos. Aponta-se a necessidade de aprofundamento sobre a violência autoprovocada, especialmente sobre fatores associados à intencionalidade suicida no comportamento autoagressivo entre adolescentes e adultos jovens, a fim de subsidiar estratégias de prevenção.

OBJECTIVE: to describe the profile for the notifications of self-inflicted violence in the state of Rio Grande do Sul/Brazil in the period from 2010 to 2019. METHOD: a cross-sectional, observational and epidemiological study based on secondary data. Descriptive statistical analyses were carried out to study the distribution of cases according to sociodemographic variables and to those related to the event. RESULTS: 43,390 cases of self-harm were reported, of which 67.9% were women. There was a higher proportion of notifications in the population aged 20-29, while the highest notification rates corresponded to the 15-19-year-old age group, with an expressive increase from 2017 to 2019. The residence was the predominant place for the occurrence of self-inflicted injuries, and 41% of the notifications were from people who had previously self-harmed or attempted suicide. CONCLUSION: there was predominance of notifications from women in the 20-29-year-old age group, and a significant increase in notification rates in the 15-19-year-old age group. It is pointed out that there is a need for further research to deepen the knowledge about self-inflicted violence, especially on the associated factors with suicidal intent in self-aggressive behavior among adolescents and young adults, in order to support prevention strategies.

OBJETIVO: describir el perfil de las notificaciones de violencia autoinfligida en el estado de Rio Grande do Sul en el período 2010-2019. MÉTODO: estudio epidemiológico observacional de corte transversal basado en datos secundarios. Se realizaron análisis estadísticos descriptivos para estudiar la distribución de casos según las variables sociodemográficas y las relacionadas con el evento. RESULTADOS: 43.390 casos de autolesiones fueron reportados, de los cuales el 67,9% fueron mujeres. Hubo una mayor proporción de notificaciones en el grupo de edad de 20 a 29 años, mientras que las tasas de notificación más altas correspondieron al grupo de edad de 15 a 19 años, con un aumento expresivo de 2017 a 2019. La residencia era el lugar predominante para la autolesión, y el 41% de las notificaciones fueron de personas que se autolesionaron o intentaron suicidarse previamente. CONCLUSIÓN: predominaron las notificaciones de mujeres del grupo de edad de 20 a 29 años, y un aumento significativo de las tasas de notificación en el grupo de edad de 15 a 19 años. Señalamos la necesidad de profundizar la violencia autoinfligida, especialmente en los factores asociados con la intención suicida en el comportamiento auto agresivo entre adolescentes y adultos jóvenes, con el fin de apoyar estrategias de prevención.

O nexo entre religiosidade/espiritualidade e o comportamento suicida em jovens / The nexus between religiosity/spirituality and suicidal behavior in young people / El nexo entre religiosidad/espiritualidad y comportamiento suicida en los jóvenes

OBJETIVO: avaliar as evidências científicas referentes à relação entre religiosidade/espiritualidade (R/E) e o comportamento suicida. MÉTODO: estudo de revisão integrativa da literatura, nas bases de dados: LILACS, PubMed e CINAHL, de janeiro de 2011 a fevereiro de 2020. Foram identificados 1044 artigos, dos quais sete foram incluídos no estudo. RESULTADOS: Predominaram estudos quantitativos (71,4%), realizados com universitários (57,14%), que investigaram a religião (71,43%) e diferentes dimensões do comportamento suicida (85,7%). A maioria dos estudos retratara benefícios da religião e da espiritualidade, mesmo que indiretamente na vida dos jovens e apontaram para efeitos protetivos da R/E em relação ao comportamento suicida. CONCLUSÃO: A R/E pode ser um fator importante para adolescentes e adultos jovens que merece ser explorada em investigações e ações que fortaleçam os fatores protetores contra o comportamento suicida e permitam o aumento da literacia em saúde mental entre lideranças religiosas.

OBJECTIVE: to evaluate the scientific evidence regarding the relationship between religiosity/spirituality (R/S) and suicidal behavior. METHOD: an integrative literature review study, conducted in the following databases: LILACS, PubMed and CINAHL, from January 2011 to February 2020. A total of 1,044 articles were identified, of which seven were included in the study. RESULTS: quantitative studies (71.4%), carried out with university students (57.14%), which investigated religion (71.43%) and different dimensions of suicidal behavior (85.7%) predominated. Most of the studies portrayed the benefits of religion and spirituality, even if indirectly in the lives of young people and pointed to the protective effects of R/S in relation to suicidal behavior. CONCLUSION: R/S can be an important factor for adolescents and young adults that deserve to be explored in investigations and actions that strengthen the protective factors against suicidal behavior and allow for an increase in mental health literacy among religious leaderships.

OBJETIVO: evaluar la evidencia científica sobre la relación entre religiosidad/espiritualidad (R/E) y conducta suicida. MÉTODO: revisión integradora de la literatura, en las bases de datos: LILACS, PubMed y CINAHL, de enero de 2011 a febrero de 2020. Se identificaron 1044 artículos, de los cuales, siete fueron incluidos en el estudio. RESULTADOS: predominaron los estudios cuantitativos (71,4%), realizados con estudiantes universitarios (57,14%), que investigaron religión (71,43%) y diferentes dimensiones de la conducta suicida (85,7%). La mayoría de los estudios han retratado los beneficios de la religión y la espiritualidad, incluso indirectamente en la vida de los jóvenes, y han señalado los efectos protectores de la R/E en relación con la conducta suicida. CONCLUSIÓN: la R/E puede ser un factor importante para los adolescentes y adultos jóvenes que merece ser explorado en investigaciones y acciones que fortalezcan los factores protectores contra la conducta suicida y permitan un aumento de los conocimientos en salud mental entre los líderes religiosos.

Atendimento hospitalar ao sujeito em sofrimento mental, em casos de tentativa de suicídio: caminhos e descaminhos / Hospital care for the mentally ill subject in cases of suicide attempt: ways and detours / Atención hospitalaria al sujeto en sufrimiento mental en casos de intento de suicidio: caminos y descaminos

O objetivo deste trabalho foi investigar a percepção do sujeito que cometeu tentativa de suicídio diante da continuidade ou não do acompanhamento e tratamento. Estudo descritivo com abordagem qualitativa, desenvolvido com pacientes encaminhados e referenciados por um serviço de emergência para centros especializados (Centros de Atenção Psicossocial - CAPS) da Rede de Saúde, no Município de Santa Cruz do Sul, Estado do Rio Grande do Sul, Brasil. Foram entrevistados 11 sujeitos que tentaram suicídio, tendo como média a idade de 41 anos. A análise resultou na identificação e classificação de três categorias: a voz que dá significados à realidade do ato, o acompanhamento como escolha e compreensão e o não acompanhamento como decisão. Os sentimentos relatados pelos sujeitos exprimem sentidos, intensidades e dimensões da realização da tentativa de pôr fim à suas vidas. As dificuldades encontradas na continuidade dos tratamentos mostram a falta de qualificação e preparação dos profissionais em saúde, nos centros especializados, particularmente do serviço de emergência.

The objective of this study was to investigate how a subject who attempted suicide apprehends the sequence or suspension of the treatment and the follow-up procedure. It is a descriptive study with a qualitative approach, developed with patients referred and referenced by an emergency service for specialized centers (CAPS) of the Health Network, in the city of Santa Cruz do Sul, RS, Brazil. Eleven subjects who attempted suicide were interviewed, averaging the age of 41 years. From the analysis resulted the identification and classification of three categories: the voice that gives meanings to the reality of the act, the follow-up care as a choice and understanding and the suspension of the follow-up as a decision. The feelings reported by the subjects express meanings, intensities and dimensions of the act of attempting to put an end to their lives. The difficulties encountered in the continuity of the treatments pictures the health professionals’ lack of qualification and preparation, both from specialized centers, and, especially from the emergency service.

El objetivo de este estudio fue investigar la percepción del sujeto que ha cometido intentos de suicidio delante de la continuación o no del tratamiento. Estudio cualitativo descriptivo, desarrollado con pacientes derivados y referenciado por un servicio de emergencia a centros especializados (CAPS) Red de Salud, en Santa Cruz do Sul, RS, Brasil. Fueron entrevistados 11 sujetos que intentaron suicidarse, con una edad media de 41 años. El análisis dio como resultado la identificación y clasificación de tres categorías: la voz que da sentido al acto, la opción y comprensión de hacer el tratamiento, y la decisión de no hacer el tratamiento. Los sentimientos reportados por los sujetos expresan formas, intensidades y dimensiones del intento de poner fin a sus vidas. Las dificultades en la continuidad de la atención muestran la falta de cualificación y formación de profesionales de la salud en centros especializados, especialmente, del servicio de emergencia.

The Characteristics of Students Who Had Attempted Self-Injury or Suicide in Chungcheongdo ‘Professional School Visits Outreach Project’ / 신경정신의학

OBJECTIVES: This study examined the characteristics of students who participated in the ‘Professional School Visits Outreach Project’ and evaluated the factors affecting self-injury or suicidal attempts.METHODS: In a cross-sectional study, psychiatrists or mental health professionals conducted a semi-structured interview with 296 students, families, and teachers in Chungcheong province and recorded the socioeconomic status (SES), past psychiatric history, current clinical symptoms, and mental status exams. Logistic regression analysis was performed on the variables with differences between the students who had attempted self-harm or suicide and those who had not.RESULTS: The subjects of this study belonged to a relatively low SES. In addition, their provisional diagnosis was mainly attention-deficit/hyperactivity disorder (38.5%) or depression (29.1%). Approximately 18.2% of students had attempted self-injury or suicide. The variables with differences between students who had attempted self-harm or suicide and those who had not, were female [odds ratio (OR) 2.878, p=0.002], provisional diagnosis of depression (OR 3.045, p=0.001), and a history of bullying victim (OR 1.927, p=0.048). Although the risks of self-injury or suicidal attempts were not increased by child abuse alone, it was increased in girls who experienced both childhood abuse and bullying victim (OR 4.222, p=0.002).CONCLUSION: The ‘Professional School Visits Outreach Project’ provides therapeutic opportunities for low SES and high-risk adolescents with multiple difficulties, such as child abuse, bullying victim, and suicidal behaviors. In addition, the recurrent experience of trauma in girls appears to increase the risk of adolescent self-injury or suicidal attempts.

Intento de suicidio en adolescentes: factores asociados / Suicide attempt in teenagers: associated factors

INTRODUCCIÓN: El intento de suicidio es el principal factor de riesgo del suicidio consumado. OBJETIVO: Analizar la prevalencia de intento de suicidio en adolescentes estudiantes de secundaria y bachillerato de la Ciudad de México, y sus factores asociados. SUJETOS Y MÉTODO: Estudio observacional, transversal y descriptivo con la Encuesta de Consumo de Drogas en Estudiantes de la Ciudad de México en 2012. El cuestionario validado, fue anónimo, estructurado y autoaplicado, contiene siete secciones: Sociodemográfica; Consumo de tabaco, alcohol y drogas; Problemas relacionados con el consumo de drogas; Conducta antisocial; Ámbito social; Ámbito interpersonal y Ámbito personal. Se crearon índices de clima familiar, comunicación con los padres y autoestima utilizando análisis de componentes principales. Se ajustó un modelo de regresión logística binomial y se analizaron las razones de momios (OR). RESULTADOS: La prevalencia estimada de intento de suicidio fue 6,8%. Los factores que incrementan la posibilidad de intento de suicido fueron: ser mujer (OR 3,1), tener menos de 16 años (OR 1,6), vivir en un clima familiar malo (OR 1,5) o con mala comunicación con los padres (OR 1,8), tener baja autoestima (OR 1,9), problemas de conducta o aprendizaje (OR 1,4) o tener una enfermedad mental (OR 3,6); haber sido forzados a tener contacto sexual (OR 2,6); o consumir drogas, tabaco o alcohol (OR 1,7, 1,2 y 1,7). CONCLUSIONES: La prevención del intento de suicidio se debe dirigir a mujeres menores de 16 años; con un desorden psiquiátrico, problema de conducta o baja autoestima; que convivan en un ambiente familiar desfavorable; con comportamientos de riesgo como consumo de tabaco, alcohol o drogas; o que hayan sido forzados a tener contacto sexual.

INTRODUCTION: Attempted suicide is the main risk factor for completed suicides. OBJECTIVE: To analyze the prevalen ce of attempted suicide in junior high school and high school students in Mexico City, and its asso ciated factors. SUBJECTS AND METHOD: Observational, cross-sectional and descriptive study conducted with data from the Mexico National Survey on Drug Use Among Students (ENCODE) 2012. The validated survey was anonymous, structured and self-applied, and contains seven sections: Sociode mographic; Tobacco, alcohol and drug use; Problems related to drug use; Antisocial behavior; Social sphere; Interpersonal sphere and Personal sphere. Family atmosphere, communication with parents, and self-esteem indexes were created using principal component analysis. A binomial logistic regres sion model was adjusted, and the odds ratio (OR) were analyzed. RESULTS: The estimated prevalence of attempted suicide was 6.8%. The factors that increased the attempted suicide possibility were: being a woman (OR 3.1), be under 16 years old (OR 1.6), living in an unfavorable family atmosphere (OR 1.5) or having a poor communication with parents (OR 1.8), having low self-esteem (OR 1.9), behavioral or learning problems (OR 1.4) or suffering a mental illness (OR 3.6); having been forced into sexual contact (OR 2.6); or drugs use, smoking or alcohol consumption (OR 1.7, 1.2 and 1.7). CONCLUSIONS: The attempted suicide prevention should be focused on women younger than 16 years, with any psychiatric disorder, behavioral problem or low self-esteem, who live in an unfavorable family atmosphere, with risky behavior such as smoking, or alcohol or drugs consumption, or who have been forced into sexual contact.

Comportamientos de riesgo de suicidio y calidad de vida relacionada con la salud en estudiantes que ingresaron a una universidad mexicana / Suicide-related behavior and health-related quality of life among first-year university students in a Mexican university

Resumen El objetivo fue determinar si existe asociación entre comportamientos de riesgo de suicidio (CRS) y menor calidad de vida relacionada con la salud (CVRS) y si esta asociación es independiente del consumo de sustancias, violencia y variables sociodemográficas. Estudio transversal, con 1229 estudiantes universitarios mexicanos; 62.4% mujeres y 37.6% hombres, edad 18.2 ± .6 años. Se aplicaron los instrumentos YRBS y KIDSCREEN-52. Presentaron desesperanza 14.2%, ideación suicida (IS) 4.7%, planeación suicida (PS) 4.0% e intento suicida 2.3%. Modelos de regresión logística múltiple muestran que la desesperanza aumentó la posibilidad de menor puntuación en todos los dominios de CVRS excepto en recursos económicos, con odds ratio OR (IC95%) que van de 1.5 (1.0-2.3) para autonomía, hasta 4.6 (3.1-6.8) para estado de ánimo. La IS incrementó la posibilidad de menor puntuación en relación con los padres y vida familiar (3.9, 1.7-8.9) y en amigos y apoyo social (2.9, 1.3-6.4). La PS aumentó la posibilidad de menor bienestar físico (2.7, 1.2-6.1) y psicológico (3.1, 1.3-7.2). En estudiantes mexicanos la CVRS se asocia a los CRS aún después de ajustar por consumo de sustancias y violencia. Se destaca que la desesperanza se asocia negativamente a los distintos dominios de la CVRS de los estudiantes.

Abstract The objective was to determine if suicide-related behavior (SRB) and health-related quality of life (HRQL) are associated and whether this association is independent of substance use, violence, and sociodemographic variables. It involved a cross-sectional study with 1,229 Mexican university students: 62.4% women; 37.6% men; age 18.2± .6 years. The YRBS and KISDSCREEN questionnaires were applied. The results were as follows: 14.2% students reported despair; 4.7% had suicidal ideation (SI); 4% had suicidal tendencies (ST); and 2.3% had attempted suicide. Multiple logistic regression models show that despair increased the possibility of lower scores in all HRQL domains except economic resources with odds ratio OR (CI 95%) ranging from 1.5 (1.0-2.3) for autonomy to 4.6 (3.1-6.8) for state of mind. The SI increased the possibility of a lower score in relationships with parents and family life (3.9, 1.7-8.9) and in friends and social support (2.9, 1.3-6.4). The ST increased the possibility for lower physical (2.7, 1.2-6.1) and psychological well-being (3.1, 1.3-7.2). HRQL is associated with SRB among Mexican students even after adjustment for substance use and violence. It highlights the fact that despair is negatively associated with different domains of the HRQL of the students.

Why do people attempt suicide? A mixed methods research from South India

Background: Every 40 seconds a person dies by suicide. Suicide is the second leading cause of death among young people 15-29 years of age, globally. In India, there is an increasing trend of suicide from 10.4 per lakh in 2003 to 10.9 per lakh in 2009.Methods: A (QUAN – QUAL) sequential explanatory design was used. Among 200 patients admitted for attempted suicide in JIPMER and Indira Gandhi Government Hospital and Post Graduate Institute Pondicherry were assessed for the reasons for attempting suicide using a semi-structured questionnaire. For a subsample of 40 (20%) In-depth interview was done to explore and understand the reasons and the undermined situation associated with attempted suicide at their residence.Results: Among the study subjects (n=200), mean (±standard deviation) age of suicide attempt was 26±9.1 years. Commonest reason for attempting suicide was verbal abuse, most often by parents (31.9%). Other precipitating factors were physical abuse, illness, marital conflict, family related problem, etc. On IDI, it was found that there were several factors like, background factors, aggravating, and protective factor. A conceptual diagram was generated depicting the imbalance between the protective and aggravating factors acting on the background factors before the execution of a suicide attempt.Conclusions: There is lot of scope to reduce the suicidal attempts in our country. Opportunistic screening should be done to identify any psycho-social issues among patients attending OPD. Strong social support and enabling environment should be provided for counselling individuals with suicidal ideation and intentions.