Association Between Suicidal Behaviour and Cannabis and Tranquilizer use, Depression, Aggression and Other Borderline Personality Traits Among Students in Sincelejo, Colombia

Objective: This objective of this study is to examine the association between suicidal behaviour and substance use, depression, aggressiveness and borderline personality traits among adolescents from Sincelejo, a rural city in the north of Colombia. Methods: This cross sectional study included 352 participants selected by purposive sampling, from a public and a private school located in Sincelejo, Sucre district, in the north of Colombia. Students ages ranged from 12 to 18 years old (mean, 15.09 ± 1.82). The participants completed three screening tools: a socio-demographic questionnaire, a screening instrument to collect information related to the frequency of use of some substances, such as tobacco and cannabis, and a self-report inventory to assess various personality and psychopathology domains. A series of t-tests, ANOVA and linear regression analyses were conducted. Results: Physical aggression (t = 7.74; p < 0.01), cognitive depression (t = 5.03; p < 0.01), affective depression (t = 8.24; p <0.01), affective instability (t = 3.46; p <0.01), few social relationships (t = 3.36; p < 0.01), self-harm (t = 3.45; p< .01), cannabis and tranquilizer use (t = 2.83; p < 0.05; and t = 2.37; p <0.05) had a significant independent relationship with suicidal behaviour. Aggression (t = 2.59; p <0.05), components of depression (t = 9.03; p <0.01) and borderline personality traits (t = 4.12; p <0.01) also predicted suicidal behaviour. Conclusions: More longitudinal studies are needed in this area to identify the causal relations between the factors studied and the suicidal behaviour of young people in Sincelejo.

Objetivo: El objetivo de este estudio es examinar la asociación del comportamiento suicida con el consumo de sustancias, síntomas depresivos, agresividad y rasgos de personalidad límite en adolescentes de Sincelejo (Sucre), una ciudad rural del norte de Colombia. Métodos: Este estudio transversal incluyó a 352 participantes seleccionados por muestreo intencional de una escuela pública y privada ubicada en Sincelejo, distrito de Sucre, en el norte de Colombia. Las edades de los estudiantes oscilaron entre los 12 y los 18 anos (media, 15,09 ± 1,82). Los participantes completaron 3 instrumentos de cribado: uno de datos sociodemográficos, uno sobre consumo de algunas sustancias, tales como tabaco y cannabis, y su frecuencia y un instrumento de autoinforme para evaluar varios dominios de la personalidad y algunas psicopatologías. Se realizaron una serie de pruebas de la t, ANOVA y análisis de regresión lineal. Resultados: La agresión física (t = 7,74; p <0,01), el componente cognitivo de la depresión (t = 5,03; p <0,01), el componente afectivo de la depresión (t = 8,24; p <0,01), la inestabilidad afectiva (t = 3,46, p < 0,01), las pocas relaciones sociales (t = 3,36, p < 0,01), las autolesiones (p <0,01; t = 3,45, p <0,01), el cannabis (t = 2,83; p <0,05) y la toma de tranquilizantes (t = 2,37; p <0,05), se asociaron con el comportamiento suicida. La agresión (t = 2,59; p <0,05), los componentes de la depresión (t = 9,03; p <0,01) y los rasgos de personalidad límite (t = 4,12, p <0,01) predijeron el comportamiento suicida. Conclusiones: Se requieren más estudios longitudinales en esta área con el fin de identificar las relaciones causales entre los factores estudiados y el comportamiento suicida de los jóvenes en Sincelejo.

Valoración de algunos indicadores del programa de atención a la conducta suicida en adolescentes / Evaluation of Some Indicators of the Program of Attention to Suicidal Behavior in Adolescents

Introducción: El suicidio está entre las tres primeras causas de muerte en el grupo de adolescentes y adultos jóvenes, su incidencia no ha descendido en el presente siglo. Objetivo: Valorar algunos indicadores relevantes del programa de atención a la conducta suicida en adolescentes. Métodos: Investigación en sistema y servicios de salud con diseño de estudio observacional descriptivo en tres áreas de salud del municipio Cienfuegos: áreas V, VII y VIII, de enero a septiembre del 2019. El universo fue de 46 profesionales de los Equipos de Salud Mental y Equipo Básicos de Salud. Se utilizaron como instrumentos dos encuestas, diseñadas y validadas por criterio de experto. Fueron seleccionados 6 indicadores en las dimensiones estructura y proceso y 4 en resultado. Se utilizó una media ponderada para procesar los datos. Resultados: Los indicadores valorados de regular fueron: en la estructura: capacitación de los recursos humanos y capacidad técnica del personal; en el proceso: confección de las historias clínicas, diseminación del programa en las unidades de salud y su verificación y las modalidades terapéuticas; y en resultado: la participación del equipo de salud mental en las investigaciones relacionadas con la conducta suicida. Conclusiones: Existe un grupo de deficiencias que conlleva a que el cumplimiento del programa de atención a la conducta suicida en adolescentes sea valorado como regular, en las tres áreas de salud del municipio Cienfuegos estudiadas(AU)

Introduction: Suicide is among the first three causes of death in the group of adolescents and young adults; its incidence has not decreased in the present century. Objective: To assess some relevant indicators of the adolescent suicidal behavior care program. Methods: Research in health system and services with descriptive observational study design in health areas V, VII and VIII of Cienfuegos municipality from January to September 2019. The universe was 46 professionals of the Mental Health Teams and Basic Health Team. Two surveys were used as instruments, designed and validated by expert criteria. Six indicators were selected in the structure and process dimensions and four in outcome. A weighted average was used to process the data. Results: The indicators rated as fair were: in the structure: training of human resources and technical aptitude of personnel; in the process: preparation of clinical histories, dissemination of the program in health units and its verification and therapeutic modalities; and in the outcome: participation of the mental health team in research related to suicidal behavior. Conclusions: There is a group of deficiencies that leads to the fact that compliance with the program of attention to suicidal behavior in adolescents is valued as regular in the three health areas of the Cienfuegos municipality studied(AU)

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.

Interacciones sociales, bullying y conducta suicida en niños y adolescentes con trastorno del espectro autista / Social Interactions, Bullying, and Suicidal Behavior in Children and Adolescents with Autism Spectrum Disorder

Introducción: La evidencia plantea que el trastorno del espectro autista puede asociarse con un aumento, en el pensamiento, del deseo de querer morir; ante esta situación se hace necesario investigar los factores de riesgo que afectan a menores con esta condición. Objetivo: Explorar en la literatura de qué forma las interacciones sociales y el bullying son factores de riesgo en la conducta suicida en niños y adolescentes con trastorno del espectro autista. Métodos: Se realizó una búsqueda que incluyó las principales bases de datos y de gestores de la información (PubMed, SciELO, WoS, Google académico, Scopus, Dialnet), entre marzo y agosto de 2021. Se utilizaron términos como suicidal behavior; trastorno del espectro autista; intimidación; nteracción social. Análisis y síntesis de la información: Se entregan argumentos de cómo el bullying representa un factor de riesgo para la conducta suicida, también de cómo los intercambios comunicativos se encuentran afectados en los menores con trastornos del espectro autista y esto puede aumentar el riesgo suicida. Se describe la escasa literatura vinculada a la evaluación de la conducta suicida en los menores con estos trastornos y de la necesidad de continuar investigando en esta temática. Conclusión: Los niños y adolescentes con necesidades educativas especiales, entre los que se encuentran los niños con trastornos del espectro autista, están expuestos a un mayor número de factores de riesgo para la aparición de conducta suicida. Estos elementos deben considerarse a la hora de programar y planificar protocolos de prevención del suicidio en el contexto sanitario y educativo(AU)

Introduction: Evidence suggests that autism spectrum disorder may be associated with an increase, in thinking of the wish to die; given this situation, it is necessary to investigate the risk factors that affect children with this condition. Objective: To explore in the literature how social interactions and bullying are risk factors for suicidal behavior in children and adolescents with autism spectrum disorder. Methods: A search including the main databases and information managers (PubMed, SciELO, WoS, Google Scholar, Scopus, Dialnet) was carried out between March and August 2021. Terms such as suicidal behavior; autism spectrum disorder; bullying; social interaction were used. Analysis and synthesis of information: Arguments are given on how bullying represents a risk factor for suicidal behavior, also on how communicative exchanges are affected in children with autism spectrum disorders and this may increase suicidal risk. It is described the scarce literature related to the evaluation of suicidal behavior in children with these disorders and the need for further research on this topic. Conclusion: Children and adolescents with special educational needs, including children with autism spectrum disorders, are exposed to a greater number of risk factors for the development of suicidal behavior. These elements should be considered when programming and planning suicide prevention protocols in the health and educational context(AU)

A cross-sectional study on the prevalence and severity of suicidal ideations and behaviors of senior high school students using the Columbia-Suicide Severity Rating Scale (C-SSRS)

Objectives@#In the light of increased suicide risk among adolescents, this research aimed at determining the prevalence and severity of suicidal ideations and behaviors of senior high school students in a public secondary school in Metro Manila using the Columbia-Suicide Severity Rating Scale (C-SSRS).@*Methodology@#This is a descriptive cross-sectional school-based study, conducted on 236 senior high school students, 18 years old and above, in San Juan National High School (SJNHS) in San Juan, Metro Manila. The study employed convenience sampling. Upon selection, the C-SSRS was administered. Data on four constructs of suicide were gathered: 1) suicidal ideation severity; 2) intensity, which was quantified in terms of frequency, duration, control, deterrents and reasons for suicidal ideation; 3) suicidal behavior rated on a nominal subscale as actual, aborted, interrupted, preparatory behavior and non-suicidal injurious behavior; and lastly 4) lethality of actual suicide attempts on a 6-point ordinal scale, and if actual lethality was zero, potential lethality was further rated on a 3-point ordinal scale.@*Results@#The majority (67.8%) had mild suicidal ideations; 37.71% had active suicidal ideations with intent but not necessarily a specific plan and only 13.98% had active suicidal ideation with intent to act and a specific plan. The intensity of suicidal ideation was not that frequent in 35.59% of the respondents i.e.18.64% 1x/ week and 16.95% less than 1x/ week. About a third (30.07%) had very short duration of suicidal ideations i.e. fleetingly (19.92%) or less than an hour/ day (11.02%). A third (32.62%) were able to easily control (18.64%) or control with minimal difficulty (13.98%). Reason for suicidal ideation were either to get attention (10.59%) or to end the emotional pain (11.02%). A third (30.93%) had actual attempts (15.25%) and Non -Suicidal Self Injury (NSSI) (15.68%); while another 35.06 % had interrupted (16.53%) or aborted (19.07%) attempts. Those who had actual attempts, 41.67% had no physical injury while 50 % incurred minor injuries. Thirty- two (88.89%) had suicidal attempt that was likely to result in injury but not likely to cause death.@*Conclusion@#In light of these relatively high prevalence rates for suicidal ideation and behaviors, schoolwide intervention on education or awareness programs, gatekeeper training, peer leadership, skills training and screening or assessment may have to be instituted to curb the increased suicide risk of the senior high school students and further prevent suicide attempts.

Factores de riesgo psicosociales que influyen en el comportamiento suicida en las personas privadas de la libertad en Colombia / Psychosocial risk factors that influence suicidal behavior in people deprived of liberty in Colombia

Resumen Objetivo: Identificar los factores de riesgo psicosocial y las características que los componen; que a su vez repercuten en el comportamiento suicida, en los privados de la libertad de Colombia, para mejorar la atención psicológica que se lleva a cabo en los centros penitenciarios. Método: Articulo de revisión documental, de tipo cualitativo, realizado a través de una recolección, revisión y análisis de 55 documentos; de los cuales se seleccionaron 13 artículos que cumplían con los criterios de inclusión y exclusión previamente establecidos. Durante la investigación se tiene en cuenta la elaboración y distinción del documento, de acuerdo a la recolección y organización de la información obtenida a través de bases de datos como Scielo, Scopus, Oxford, Science Direct, Redalyc, Pubmed, entre otros, por lo tanto, se discriminaron las categorías y subcategorías desarrolladas durante la indagación correspondientes al tema a trabajar. Resultados: Se identificaron los factores de riesgo psicosociales fundamentales como: prisionización, vínculo familiar o afectivo, consumo de sustancias psicoactivas, proyecto de vida, problemas psicológicos y tiempo de condena; que presenta la población penitenciaria a nivel mundial, los cuales se tienen en cuenta para reducir las tasas de comportamiento suicida en el ámbito carcelario. Conclusiones: En la revisión documental se logró identificar cuáles son los factores de riesgo que permitan detectar a tiempo el comportamiento suicida en las personas privadas de la libertad, teniendo en cuenta que la población carcelaria a nivel mundial va en aumento y el comportamiento suicida es catalogado como un problema grave de salud pública; se evidenció la falta de existencia de información para la investigación con base a la atención psicosocial que se le brinda a las personas privadas de la libertad alrededor de los factores de riesgos psicosociales que influyen en el comportamiento suicida; por tal razón es importante investigar a profundidad acerca de los factores protectores que pueden prevenir el suicidio en la población.

Abstract Objective: To identify the characteristics that make up the psychosocial risk factors that have an impact on suicidal behavior in Colombian prisoners, in order to improve the psychological care provided in penitentiaries. Method: Documentary review article, of qualitative type, carried out through a collection, review and analysis of 50 documents; of which 13 articles were selected for the elaboration of the results. During the research, the elaboration and distinction of the document is taken into account, according to the collection and organization of information collected through databases such as Scielo, Scopus, Oxford, Science Direct, Redalyc, Pubmed, among others, Therefore, the categories and subcategories developed during the investigation corresponding to the topic to work are discriminated. Results: Key psychosocial risk factors were identified, such as: prison ionization, family or affective bond, use of psychoactive substances, life plan, psychological problems and time of sentence; presented by the prison population worldwide, which are taken into account to reduce suicide rates in prison settings. Conclusions: The documentary review identifies the risk factors and protective factors that allow the timely detection of suicidal behaviour in persons deprived of their liberty, taking into account that some of the risk factors may also be protective factors, such as family ties, the life plan, the process of imprisonment and the time of sentence, and other factors if they are highly relevant because of their risk in suicidal behavior; such as substance use and psychological problems.

Sintomas depressivos e comportamento suicida em população geral de cidade mineira / Síntomas depresivos y comportamiento suicida en población general de una ciudad de minas gerias / Depressive symptoms and suicide behavior in a general population of a city in minas gerais

Objetivo:analisarapresença/intensidade sintomatologia depressivaerelacionar com comportamento suicida em população geral adulta. Método:estudo exploratório, quantitativo, entrevistas com questionário semiestruturado,questões norteadorasparadepressão/comportamento suicida, escalas psicométricasdedepressão,sorteio de locais;amostra não probabilística, estratificada,por conveniência;50 participantes por área geográfica.Resultados:Dos 200 participantes, 73 (36,5%) apresentaram sintomatologia depressiva(maior queamédia nacional),e62 (84,92%),depressão prévia. Notou-se:prevalênciadeintensidadesintomatologiamoderada(37,0%)egrave (15,1%)e otempo de diagnóstico de depressão,de 0 a 5 anos (41,1%).Participantes sem sintomatologia prévia apresentaram maior severidade dos sintomas depressivos, em suamaioria,mulheres, adultos jovens, brancos, casados,empregados, pessoas que viviam com familiares, pessoas que possuíam comorbidades clínicasem tratamento,pessoas que moravam em área de vulnerabilidade social(31,50%). Relataram comportamento suicida26 participantes (13%), 13 (50,0%) em5 anos;15 (57,7%) trataram, 06 (40%)há 3 meses; 03 (11,5%) em hospitais psiquiátricos;11(42,3%) com ideação suicida semtratamento.Relação entre depressão e comportamento suicida. Conclusão:resultados embasamimplantação políticas públicas de prevenção/tratamento

Objective:to analyze the presence/intensity of depressive symptomsand relate it to suicidal behavior in the general adult population. Method:exploratory, quantitative study, interviews with a semi-structuredquestionnaire, guiding questions for depression/suicidal behavior, depression psychometric scales, drawing of locations; non-probabilistic sample, stratified by convenience, 50 participants by geographicarea. Results:200 participants, 71 (36,5%) had depressive symptoms(greater than national average), 62 (84,92%) prior depression, prevalence moderate symptomatology (37,08%)-severe (15,1%), time since diagnostic of depression 0 to 5 years (41,1%),participants without previous symptoms had greater severity of depressive symptoms; mostly women, young adults, white, married, employed, living with family members, clinical comorbidities, undergoing treatment; lived in an area of social vulnerability (31.50%). 26 (13%) reported suicidal behavior, 13 (50.0%) in 5 years; 15 (57.7%) treated, 06 (40%) for 3 months; 03 (11.5%) in psychiatric hospitals; 11 (42.3%) with suicidal ideation without treatment. Relationship between depression and suicidal behavior. Conclusion:results support the implementation of public prevention/treatment policies

Objetivo:analizar la presencia/intensidad de síntomas depresivos, relacionarlos con la conducta suicida en la población adulta general. Método:estudio exploratorio cuantitativo, entrevistas con cuestionario semiestructurado, preguntas orientadoras para depresión/conducta suicida, escalas psicométricas de depresión, dibujo de localizaciones; muestra no probabilística, estratificada por conveniencia, 50 participantes por área geográfica. Resultados:200 participantes, 73 (36,5%) tenían síntomas depresivos (mayores que el promedio nacional), 62 (84,92%) depresión previa, prevalencia de sintomatología moderada (37,0%) -grave (15,1%), tiempo desde el diagnóstico de depresión 0 a 5 años (41,1%), los participantes sin síntomas previos tenían una mayor gravedad de los síntomas depresivos; en su mayoría mujeres, adultos jóvenes, blancos, casados, empleados, que viven con miembros de la familia, comorbilidades clínicas, en tratamiento; vivía en una zona de vulnerabilidad social (31,50%). 26 (13%) informaron comportamiento suicida, 13 (50,0%) en 5 años; 15 (57,7%) tratados, 6 (40%) durante 3 meses; 3 (11,5%) en hospitales psiquiátricos; 11 (42,3%) con ideación suicida sin tratamiento. Relación entre depresión y conducta suicida. Conclusión:los resultados apoyan la implementación de políticas públicas de prevención / tratamiento

Avaliação do comportamento suicida em estudantes de Medicina / Assessment of suicidal behavior in medical students

OBJETIVO: O objetivo deste estudo foi avaliar a prevalência de comportamento suicida (ideação, plano e tentativa) nos últimos 12 meses e ao longo da vida e fatores associados entre alunos de Medicina da Universidade Federal do Rio de Janeiro (UFRJ). MÉTODOS: Um estudo seccional foi desenvolvido em uma amostra representativa e aleatória (n = 324) de 1.217 estudantes de Medicina da UFRJ entre abril e novembro de 2019. Os dados foram coletados por cinco pesquisadores em uma entrevista presencial com 296 alunos (taxa de participação de 91,4%), usando um questionário do Estudo Multicêntrico de Intervenção no Comportamento Suicida para avaliar o comportamento suicida, o PHQ-9 (Questionário de Saúde do Paciente-9) para avaliar o episódio depressivo maior e o ASSIST (Teste de Triagem do Envolvimento com Substâncias) para aferir o uso e abuso de substâncias. Para a avaliação das associações, utilizou-se o modelo de regressão logística. RESULTADOS: As prevalências nos últimos 12 meses foram de 18,9% (IC de 95%: 14,9-23,8) para ideação, 6,1% (IC de 95%: 3,9-9,4) para plano e 1,7% (IC de 95%: 0,7- 4,1) para tentativa de suicídio. As prevalências ao longo da vida foram de 27,7% (IC de 95%: 22,9-33,0) para ideação, 12,5% (IC de 95%: 9,2-16,7) para plano e 5,7% (IC de 95%: 3,6-9,0) para tentativa de suicídio. Os resultados encontrados foram maiores que os achados dos estudos nacionais. O episódio depressivo maior e o tratamento psicológico atual foram associados ao comportamento suicida na análise final. CONCLUSÕES: A associação com tratamento em saúde mental e episódio depressivo maior sugere que as universidades deveriam implementar programas para a prevenção do comportamento suicida.

OBJECTIVE: The aim of this paper is to analyze the lifetime and past 12-month prevalence rates of suicidal behavior (suicidal ideation, suicide plans and suicidal attempt) and associated factors among medical students at the Federal University of Rio de Janeiro. METHODS: Sectional study was applied to a representative and random set (n = 324) of 1,217 medical students between April and November of 2019. The data were collected by five researchers through in-person interviews with 296 of 324 volunteers (participation rate of 91.4%), using the Multisite Intervention Study on Suicidal Behavior interview to assess suicidal behavior, the PHQ-9 (Patient Health Questionnaire-9) to assess major depressive episode, and ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) to assess substance use and abuse. A logistic regression model was used to calculate associations. RESULTS: The rates of past-12 month were found to be 18.9% (CI 95%: 14.9-23.8) for ideation, 6.1% (CI 95%: 3.9-9.4) for suicide plans and 1.7% (CI 95%: 0.7-4.1) for suicidal attempts. The lifetime prevalence rates were 27.7% (CI 95%: 22,9-33,0) for suicidal ideation, 12.5% (CI 95%: 9.2-16.7) for plans and 5.7% (CI 95%: 3.6-9.0) for suicidal attempts. These rates are higher than the measured results among medical students in Brazil. The factors associated in the final analysis were the major depressive episode and current psychological treatment. CONCLUSIONS: The association between mental health treatment and major depressive episode suggest that the universities should implement suicidal behavior prevention programs.

Programas de prevenção ao suicídio: revisão integrativa da literatura / Programas de prevención del suicidio: una revisión integradora de la literatura / Suicide prevention programs: an integrative literature review

International scientific productions about suicide prevention programs were analyzed in the PsycInfo, PubMed, and ScienceDirect databases. Eighty-nine studies were obtained and, after analyzing the in-clusion and exclusion criteria, 26 publications remained, which were included in the review. The pub-lications were evaluated according to the year of publication, authorship, name, format, duration, target public, and country of application of the prevention program. Subsequently, a detailed descrip-tion of the stages of each program, target audience, materials used, and constructs covered was carried out. In general, the results indicated 18 types of programs, most of them applied in the United States, and all interventions were directed to the school context. Considering that suicide is a public health problem, knowing prevention programs can help health professionals to improve initiatives in relation to the phenomenon of suicide

Analisaram-se produções científicas internacionais acerca de programas de prevenção ao suicídio nas bases de dados PsycInfo, PubMed e ScienceDirect. Obtiveram-se 89 estudos, e, após a análise dos critérios de inclusão e exclusão, restaram 26 publicações que foram incluídas na revisão. As publicações foram avaliadas quanto a ano de publicação, autoria, nome do programa de prevenção, formato, dura-ção, público e país de aplicação. Posteriormente, realizou-se uma descrição detalhada das etapas de cada programa, do público-alvo, dos materiais utilizados e dos construtos abordados. De forma geral, os resultados indicaram 18 tipos de programa, com a maior parte deles aplicados nos Estados Unidos, além de todas as intervenções terem sido direcionadas para o contexto escolar. Considerando que o suicídio é um problema de saúde pública, conhecer os programas de prevenção pode auxiliar os profis-sionais de saúde no aprimoramento das iniciativas em relação ao fenômeno do suicídio

Las producciones científicas internacionales sobre programas de prevención del suicidio se analizaron en las bases de datos PsycInfo, PubMed y ScienceDirect. Se obtuvieron 89 estudios y, tras analizar los criterios de inclusión y exclusión, quedaron 26 publicaciones que fueron incluidas en la revisión. Las publicaciones se evaluaron según año de publicación, autoría, nombre del programa de prevención, formato, duración, público y país de aplicación. Posteriormente, se realizó una descripción de las etapas de cada programa, público objetivo, materiales utilizados y constructos cubiertos. En general, los resultados indicaron 18 tipos de programas, la mayoría de ellos aplicados en Estados Unidos, además de que todas las intervenciones fueron dirigidas al contexto escolar. Considerando que el suicidio es un problema de salud pública, conocer los programas de prevención puede ayudar a los profesionales de la salud a mejorar las iniciativas relacionadas con el fenómeno del suicidio.

Fatores associados à recorrência de tentativas de suicídio: uma revisão integrativa da literatura de 2000 a 2020 / Factors associated with recurrence of suicide attempts: an integrative literature review from 2000 to 2020

Os fatores associados ao suicídio são múltiplos e multifacetados e o tornam a consequência final de todo um processo. Neste trabalho, foi conduzida, a partir de duas bases de dados - Biblioteca Virtual da Saúde e PubMed -, uma revisão de estudos para identificar fatores associados à repetição de tentativas de suicídio entre os anos 2000 e 2020. Foram extraídas informações referentes à data de publicação, população, local, meios de coleta utilizados e fatores associados. Os dados foram posteriormente organizados em categorias de análise. No total, 23 estudos foram selecionados e revisados. Houve maior correspondência para repetição em pessoas que já haviam tentado suicídio. Transtorno mental e o uso abusivo de substâncias apareceram como segundo fator mais associado. Os resultados apontam a tentativa de suicídio como a variável mais associada a novas tentativas e a suicídios. Conclui-se, com base nos achados, que ações preventivas podem ter maior impacto se iniciadas antes da apresentação da primeira tentativa de suicídio.(AU)

The factors associated with suicide are multiple, multifaceted, and make it the ultimate consequence of an entire process. In this paper, a systematic review of studies was conducted on two data basis -Virtual Health Library and PubMed - with a view to identify factors associated with the repetition of suicide attempts between the years 2000 and 2020. Information regarding date of publication, population, place and means of collection used and associated factors were extracted. The data were later organized into categories of analysis. In total, 23 studies were selected and reviewed. There was greater correspondence for repetition in people who had already attempted suicide. Mental disorder and substance abuse appeared as the second most associated factor. The results indicate the suicide attempt as the variable most associated with new attempts and suicides. It is concluded, based on the findings, that preventive actions can have a greater impact if initiated before the presentation of the first suicide attempt.(AU)

Los factores asociados al suicidio son múltiples, multifacéticos y lo convierte en la consecuencia última de todo un proceso. En este articulo se realizó, en las bases de datos de la Biblioteca Virtual en Salud y PubMed, una revisión de estudios para identificar factores asociados a la repetición de intentos de suicidio entre los años 2000 y 2020. Se extrajo información sobre fecha de publicación, población, lugar, medio de recolección utilizado y factores asociados. Posteriormente, los datos se organizaron en categorías de análisis. En total, se seleccionaron y revisaron 23 estudios. Hubo mayor correspondencia por repetición en personas que ya habían intentado suicidarse. El trastorno mental y el abuso de sustancias aparecieron como el segundo factor más asociado. Los resultados indican el intento de suicidio como la variable más asociada a nuevos intentos y suicidios. Se concluye, con base en los hallazgos, que las acciones preventivas pueden tener un mayor impacto si se inician antes de la presentación del primer intento de suicidio.(AU)

The perceived stress from interpersonal relations and suicidal behavior in freshmen: moderating roles of meaning in life and intolerance of uncertainty / 中华行为医学与脑科学杂志

Objective:To examine the roles of the threat to self-moderator (intolerance of uncertainty) and the motivational moderator (meaning in life) in the relationship between triggering variables (thwarted belongingness and fear of negative evaluation) and outcome variables (suicidal ideation and suicidal behavior) based on the integrated motivational-volitional model of suicidal behavior.Methods:A total of 1 325 university freshmen were investigated with the thwarted belongingness questionnaire, the brief fear of negative evaluation scale, the intolerance of uncertainty scale, the meaning in life questionnaire, the positive and negative suicide ideation inventory and the suicidal behaviors questionnaire-revised.SPSS 24.0 software was used for descriptive statistics, independent sample t-test, Pearson correlation analysis, and moderating effect analysis. AMOS 20.0 software was used for mediating effect analysis. Results:(1) Female students had more fear of negative evaluation than males ((41.89±9.96), (40.31±10.68), t=2.03, P<0.05). Students from rural areas experienced more thwarted belongingness than students from urban areas ((23.83±8.87), (22.49±9.17), t=2.51, P<0.05). (2) Thwarted belongingness, fear of negative evaluation, and intolerance of uncertainty were positively related to suicidal ideation and suicidal behavior ( r=0.24-0.59, all P<0.001), while meaning in life was negatively related to suicidal ideation and suicidal behavior ( r=-0.43, r=-0.22, both P<0.001). (3) Suicidal ideation mediated the relationship between thwarted belongingness and suicidal behavior ( β=0.34, P<0.001) and mediated the relationship between fear of negative evaluation and suicidal behavior ( β=0.11, P<0.001). (4) Compared to the students with lower levels of intolerance of uncertainty, for those who had higher levels of intolerance of uncertainty, thwarted belongingness had a stronger predictive power on suicidal ideation ( β=0.27, P<0.001; β=0.41, P<0.001) and fear of negative evaluation also had a stronger predictive power on suicidal ideation ( β=0.08, P<0.001; β=0.14, P<0.001). Compared to the students with lower levels of meaning in life, for those who had higher levels of meaning in life, fear of negative evaluation had a weaker predictive power on suicidal ideation ( β=0.20, P<0.001; β=0.12, P<0.001). Conclusion:This study provides empirical evidence to the integrated motivational-volitional model of suicidal behavior. Results indicate that effects of perceived stress from interpersonal relations on suicidal ideation are moderated by meaning in life and intolerance of uncertainty. Reducing the perceived stress from interpersonal relations, lessening the level of intolerable of uncertainty, and carrying out intervention programs aiming at meaning in life are potential intervention ways to reduce the suicide risks of university freshmen.

Percepções de profissionais da saúde sobre o comportamento suicida na adolescência / Health professionals' perceptions of suicidal behavior in adolescence

Trata-se de uma pesquisa qualitativa que teve como objetivo identificar como os profissionais atuantes em Centro de Referência de Assistência Social (CRAS) e Centro de Atenção Psicossocial Infantil (CAPSi) de uma cidade da região metropolitana de Porto Alegre, no Rio Grande do Sul, percebem o comportamento suicida na adolescência e como atuam nesses casos. Participaram do estudo seis profissionais, sendo a coleta de dados realizada por meio de entrevistas semiestruturadas, as quais foram gravadas e transcritas na íntegra. A análise dos dados ocorreu através da análise de conteúdo. Conclui-se que, na visão dos profissionais, a qualidade do vínculo afetivo entre os cuidadores e o adolescente é um significativo fator de proteção, assim como a relação com outros pares. Além disso, os profissionais destacaram a importância do trabalho interdisciplinar para atuação com esta demanda. Propõe-se o desenvolvimento de novos estudos sobre a temática, aumentando a conscientização sobre o suicídio na adolescência.

This is a qualitative survey that aimed to identify how professionals working at the Social Assistance Reference Center (CRAS) and Child Psychosocial Attention Center (CAPSi) in a city in the metropolitan area of Porto Alegre, Rio Grande do Sul, perceive the suicidal behavior during adolescence and how they act in these cases. Six professionals participated in the study, and data were collected through semi-structured interviews, which were recorded and transcribed in their entirety. The data analysis came from the content analysis. It is concluded that the quality of the affectional bond between the caregivers and the adolescent is a significant protective factor, as well as the relationship with other peers. In addition, the importance of interdisciplinary work to act with this demand stands out. It is proposed the development of new studies on the subject, increasing the awareness of youth suicide.

Intervenções para comportamentos suicidas e autolesivos em adolescentes: revisão integrativa de literatura / Interventions for adolescents suicidal and self-injurious behaviors: integrative literature review

Os comportamentos suicidas e autolesivos representam uma preocupação crescente com a saúde dos adolescentes, dado o crescimento significativo do suicídio nessa faixa etária nas últimas décadas. Diante disso, realizou-se uma revisão integrativa de literatura, com o objetivo de investigar a estrutura de intervenções voltadas para comportamentos suicidas e autolesivos na adolescência. A busca rastreou artigos publicados entre 2015 e 2020, nas bases de dados PsycInfo, Cochrane Library e PubMed. Foram selecionados 30 artigos. Os resultados indicam que as estratégias de intervenção voltadas a comportamentos suicidas e autolesivos em adolescentes demandam o uso de uma diversidade de componentes, com a importância da inclusão de pais e/ ou familiares no tratamento. A Terapia Comportamental Dialética (DBT) e a Terapia Cognitivo-Comportamental (TCC) destacam-se como modelos de tratamento com eficácia potencial no tratamento de adolescentes. Identifica-se ampla área de pesquisa a ser desenvolvida, e o campo se beneficiaria do avanço na identificação de mediadores e moderadores de mudança.(AU)

Suicidal and self-injurious behaviors represent a growing concern for the health of adolescents, given the significant increase in suicide in this age group in recent decades. Therefore, an integrative literature review was carried out, with the objective of investigating the structure of interventions aimed at suicidal and self-injurious behaviors in adolescence. The search tracked articles published between 2015 and 2020, in the PsycInfo, Cochrane Library and PubMed databases. 30 articles were selected. The results indicate that intervention strategies aimed at suicidal and self-injurious behaviors in adolescents require the use of a variety of componentes, with the importance of including parents and/or family members in the treatment. Dialectical Behavioral Therapy (DBT) and Cognitive-Behavioral Therapy (CBT) stand out as treatment models with potential efficacy in the treatment of adolescents. A broad area of research to be developed is identified, and the field would benefit from advances in the identification of mediators and moderators of change.(AU)

Las conductas suicidas y autolesivas representan una preocupación creciente para la salud de los adolescentes, dado el aumento significativo de suicidios en este grupo de edad en las últimas décadas. Por lo tanto, se realizó una revisión integrativa de la literatura, con el objetivo de investigar la estructura de las intervenciones dirigidas a las conductas suicidas y autolesivas en la adolescencia. La búsqueda rastreó artículos publicados entre 2015 y 2020 en las bases de datos PsycInfo, Cochrane Library y PubMed. Se seleccionaron 30 artículos. Los resultados indican que las estrategias de intervención dirigidas a las conductas suicidas y autolesivas en adolescentes exigen el uso de una variedad de componentes, siendo importante la inclusión de los padres y/o familiares en el tratamiento. La Terapia Conductual Dialéctica (DBT) y la Terapia Cognitivo-Conductual (TCC) se destacan como modelos de tratamiento con potencial eficacia en el tratamiento de adolescentes. Se identifica un área amplia de investigación a desarrollar, y el campo se beneficiaría de los avances en la identificación de mediadores y moderadores del cambio.(AU)

Efectividad de una intervención educativa dirigida a adultos mayores con riesgo suicida / Effectiveness of an Educational Intervention in Aged Adults at Suicidal Risk

Introducción: El suicidio ha constituido desde siempre uno de los grandes enigmas de la humanidad, plantea cuestiones filosóficas, sociales, psicológicas, religiosas y morales. La conducta suicida constituye en Cuba un problema de salud en aumento. Objetivo: Valorar la efectividad de una intervención educativa sobre conducta suicida en el adulto mayor en riesgo. Métodos: Se realizó un estudio preexperimental, prospectivo, durante el período comprendido desde noviembre 2017 a marzo 2019 en el consultorio 1 del policlínico "Mario A. Pérezˮ de Sagua la Grande. La población de estudio estuvo constituida por todos los adultos mayores dispensarizados como riesgo suicida. La muestra quedó integrada por 42 pacientes seleccionados por criterios de inclusión, exclusión y salida. Resultados: Predominó en la muestra el grupo de edad de 60-64 (40,5 por ciento), y las mujeres (59,5 por ciento), el indicador de riesgo desesperanza (61 por ciento) y depresión menor (30,9 por ciento). Al diagnóstico, la información global del tema no era aceptable y posteriormente se constató 97,6 por ciento de información global adquirida. Se aplicó una intervención educativa, validada por los especialistas como factible y pertinente, la cual abarcó 8 encuentros. Conclusiones: La intervención educativa aplicada resultó efectiva al elevar el nivel de información de los adultos mayores con riesgo suicida. El equipo básico de salud es un pilar fundamental para evitar esta conducta, aplicando el enfoque de riesgo en la población(AU)

Introduction: Suicide has always been one of the great enigmas of humanity: it raises philosophical, social, psychological, religious and moral questions. Suicidal behavior is a growing health concern in Cuba. Objective: To assess the effectiveness of an educational intervention on suicidal behavior in the elderly at risk. Methods: A prospective and pre-experimental study was carried out, during the period from November 2017 to March 2019, in the family medical office # 1 of Mario A. Pérez Polyclinic of Sagua la Grande Municipality. The study population consisted of all the older adults classified as being at suicidal risk. The sample was made up of 42 patients selected by inclusion, exclusion and exit criteria. Results: The age group 60-64 (40.5 percent) predominated in the sample, together with women (59.5 percent), the indicator of hopelessness risk (61 percent) and minor depression (30.9 percent). At diagnosis, the global information on the subject was not acceptable and, subsequently, 97.6 percent of the global information acquired was obtained. An educational intervention was applied, validated by the specialists as feasible and pertinent, which included eight meetings. Conclusions: The educational intervention applied was effective in raising the level of information of older adults at suicide risk. The basic health team is a significant tool for avoiding this behavior, applying the risk approach to the population(AU)

Treatment compliance and risk and protective factors for suicide ideation to completed suicide in adolescents: a systematic review

Objective: To review the literature regarding adolescent suicide risk and explore the associations between treatment compliance (expressed as a concept including measured adherence to treatment and/or mental health service utilization) and risk and protective factors for suicidal behavior (SB), as well as the association between treatment compliance and reattempts. Methods: PubMed, LILACS, and Google Scholar were searched using the following terms: (adolescent*) AND (suicide*) AND (risk factor OR protective factors) AND (treatment compliance OR treatment attrition OR treatment adherence OR treatment drop out OR treatment retention OR mental health utilization). We retrieved studies that focused on the relation of treatment compliance to risk and protective factors for SB and that had only adolescent samples. Results: Of 4,841 articles, 30 original articles were selected for review. Most studies indicated high mental health service (MHS) utilization and poor treatment adherence by SB patients. Social minority status and conduct disorder were associated with less treatment adherence, while female sex, parental perceived need for treatment, and major depression were associated with greater treatment adherence. Inpatient and intensive emergency care after SA and family interventions improved MHS utilization and treatment compliance. However, we found no substantial protective effect of treatment compliance against reattempts. Conclusion: Effective treatment planning for compliance requires considering psychopathology, treatment planning, and social, familial, and individual factors.

Notificações, internações e mortes por lesões autoprovocadas em crianças nos sistemas nacionais de saúde do Brasil / Notifications, hospitalizations and deaths from self-harm in children in Brazil's national health systems

Resumo Praticamente não há estatísticas sobre o comportamento suicida na infância no mundo. Em parte, este cenário pode ser explicado pela representação social de alegria desta fase da vida. Este artigo tem como objetivo analisar informações sobre notificações, internações e mortes por lesões autoprovocadas entre crianças de cinco a nove anos no Brasil, visando conhecer sua magnitude e distribuição no período de 2006 a 2017, a partir dos dados dos sistemas nacionais de informação de saúde. Foram identificados 58 óbitos de crianças brasileiras decorrentes dessa causa, com a maioria sendo do sexo masculino, de cor da pele branca e com nove anos de idade. O enforcamento foi o meio mais utilizado pelas crianças para se matar. As internações por tentativas de suicídio no período de 2006-2017 somaram 1.994 casos, com predominância entre os meninos em todas as regiões. No que diz respeito às notificações, a maioria se refere a crianças entre oito e nove anos de idade, com cor da pele parda e do sexo feminino, com destaque à autointoxicação. A evidência de que qualquer comportamento suicida na infância está fortemente associado às tentativas ou ao suicídio consumado na adolescência e na vida adulta é uma das principais indicações da necessidade de prevenção desse comportamento na primeira década da vida.

Abstract There are virtually no statistics on childhood suicidal behavior globally. This setting can be partly explained by the social representation of joy in this early phase of life. This paper aims to analyze information on self-harm reports, hospitalizations, and deaths among children aged 5-9 years in Brazil to know its magnitude and distribution from 2006 to 2017, based on data from national health information systems. The results show 58 deaths of Brazilian children with intentional self-harm, primarily male, white, and nine years old. Hanging was the most commonly used mechanism for children to kill themselves. A total of 1,994 hospitalizations were recorded for suicide attempts in children in the period 2006-2017, with a predominance of males in all regions. Regarding notifications, most refer to children between 8 and 9 years of age, black and female, emphasizing self-poisoning. Evidence that any suicidal behavior in childhood is strongly associated with attempted or completed suicide in adolescence and adulthood is one of the main indications of the need to prevent this behavior in the first decade of life.

Comportamento suicida: o paradoxo vida e morte em meio à pandemia de COVID-19 / Suicide behavior: life and death paradox in the midst of the COVID-19 pandemic / La conducta suicida: la paradoja de la vida y la muerte en el contexto de la pandemia de COVID-19

A pandemia da COVID-19 provoca inúmeros impactos na saúde mental, que variam desde reações esperadas de estresse agudo até agravos que podem descompensar condições psicopatológicas preexistentes ou deflagrar novas. O objetivo deste estudo é identificar e analisar fatores de risco para o suicídio que podem ser exacerbados pela situação de emergência sanitária global. A revisão narrativa permitiu mapear os seguintes fatores de risco: luto complicado, insegurança econômica, isolamento social, violência doméstica, abuso de álcool e drogas, barreiras no acesso ao sistema de saúde e às redes de suporte comunitário, psicossocial e espiritual, riscos inerentes às situações de hospitalização e vulnerabilidade dos profissionais da linha de frente. Também foram abordados aspectos que podem funcionar como proteção e métodos de prevenção/posvenção ao suicídio. A situação pandêmica eleva a vulnerabilidade ao comportamento suicida, porém os efeitos deletérios podem ser mitigados com estratégias de proteção à saúde mental, que devem ter prioridade na agenda de saúde pública (AU).

The COVID-19 pandemic causes numerous impacts on the mental health, ranging from expected reactions of acute stress to more pronounced complications, which can decompensate pre-existing psychopathological conditions or trigger new ones. The purpose of this study is to identify and analyze risk factors for suicide that may be exacerbated by the global health emergency situation. The narrative review allowed mapping the following risk factors: complicated grief, economic insecurity, social isolation, domestic violence, alcohol and drug abuse, barriers in accessing the health system and community, psychosocial and spiritual support networks, risks inherent to hospitalization situations, and vulnerability of frontline professionals. Aspects that can act as protection and methods of suicide prevention and postvention were also addressed. The pandemic situation raises the vulnerability of people to suicidal behavior, but the deleterious effects can be mitigated with mental health protection strategies, which should have priority on the public health agenda (AU).

La pandemia de COVID-19 causa numerosos efectos en la salud mental de las personas, desde las esperadas reacciones de estrés agudo hasta complicaciones que pueden descompensar condiciones psiquiátricas preexistentes o desencadenar otras nuevas. El objetivo de este estudio es identificar y analizar los factores de riesgo de suicidio que pueden verse exacerbados por la situación de emergencia sanitaria mundial. La revisión narrativa permitió mapear los siguientes factores de riesgo: duelo complicado, inseguridad económica, aislamiento social, violencia doméstica, abuso de alcohol y drogas, barreras de acceso al sistema de salud y a las redes de apoyo comunitario, psicosocial y espiritual, riesgos inherentes a las situaciones de hospitalización y vulnerabilidad de los profesionales de primera línea. También se abordaron los factores que pueden funcionar como protección y los métodos de prevención y postvención del suicidio. La situación de pandemia aumenta la vulnerabilidad al comportamiento suicida, pero los efectos nocivos pueden mitigarse con estrategias de protección de la salud mental, a las que debería darse prioridad en la agenda de salud pública(AU).

Análisis comparativo del marco legal en salud mental y suicidio en México / Comparative analysis of the legal framework on mental health and suicide in Mexico

Resumen: Objetivo: Analizar el marco legislativo y normativo en salud mental y suicidio en México. Material y métodos: Se realizó un análisis secundario de los principales ordenamientos jurídicos en materia de salud mental y suicidio, vigentes hasta septiembre de 2020, de las 32 entidades de México y del nivel federal. Resultados: Se analizaron 51 documentos. Sólo 14 entidades cuentan con una Ley de Salud Mental y dos estados tienen una Ley de Suicidio. A nivel federal, se definen los lineamientos de atención de la conducta suicida en las normas técnicas de la Secretaría de Salud. Sin embargo, en las leyes de salud, nacional o estatales, han existido omisiones al respecto. La prevención no se define a profundidad en la mayoría de los documentos analizados. Conclusiones: Es prioritario impulsar leyes integrales de salud mental y conducta suicida armonizadas en el ámbito nacional.

Abstract: Objective: Analyze the legislative and normative framework on mental health and suicide in Mexico. Materials and methods: A secondary analysis of the main legal systems on mental health and suicide, in force until September 2020, of the 32 entities in Mexico and at the federal level was carried out. Results: 51 documents were analyzed. Only 14 states have a mental health law and two states have a law on suicide. At the federal level, the guidelines for the care of suicidal behavior are defined in the technical standards issued by the health ministry. However, in both state and national health laws, there has been omissions in this regard. Prevention is not defined in depth in most of the documents analyzed. Conclusions: It is a priority to promote comprehensive laws on mental health and suicidal behavior harmonized at the national level.

Estado del arte de los estudios sobre conducta suicida en población privada de la libertad / State of the art of studies on suicidal behavior in the population deprived of freedom

Resumen El suicidio en población privada de la libertad (PPL) en centros de reclusión de la ciudad de Bogotá, por la comisión de diferentes delitos, trae consigo una serie de preguntas y cuestionamientos que generan inquietud, duda y en ocasiones temor. El objetivo del estudio fue establecer el estado del arte de los estudios realizados y las tendencias halladas sobre conducta suicida en esta población. En esta investigación se encontrarán los principales estudios, investigaciones y documentos tecnicos realizados por funcionarios y académicos, recopilados en trece documentos. Se pudo establecer que son pocos los documentos encontrados (13), pocas las investigaciones y en su mayoría de tipo descriptivo.

Abstract The suicide in the population deprived of freedom (PPL, for its initials in Spanish) in prisons in the city of Bogotá, for the commission of different crimes, brings with it a series of questions and issues that generate concern, doubt and sometimes fear. The purpose of the study was to establish the state of the art of studies carried out and trends found on suicidal behavior in this population. In this research we will find the main studies, research and technical documents made by officials and academics, compiled in thirteen documents. It could be established that there are few documents found (13), few investigations and most of them are descriptive.

Factors associated with suicide attempt among youth: A retrospective review of psychiatric inpatients 15-24 years old admitted for suicidalIdeation and behavior at The Medical City (TMC) from 2013-2017

OBJECTIVES@#This study aimed to determine the factors associated with suicide attempt among psychiatry inpatients aged 15 to 24 years old, admitted for suicidal ideations or behavior at The Medical City during a five-year study period, January 2013 to December 2017; to describe the demographic and clinical profile of these patients; and to determine if there was an association between demographic and clinical factors as well as suicidal attempt in this population.@*METHODOLOGY@# This retrospective chart review, investigated the association between demographic and clinical variables, and suicide attempt in a sample of suicidal psychiatry inpatients aged 15-24 years old, during a 5-year study period. The sample was subdivided into two subsets according to the presence or absence of suicide attempts in their lifetime. The demographic and clinical variables were then collected, analyzed, and compared between the two groups.@*RESULTS@#The present study reviewed 199 charts of suicidal psychiatry inpatients aged 15-24 years old hospitalized from 2013 to 2017 at The Medical City. The present study found an increasing trend in the number of psychiatric inpatients aged 15 to 24 who were confined for suicidal ideation and/or behavior over the course of the study period. Of the 199 subjects included in the study, 119 (59.8%) had attempted suicide, while 80 (40.2%) had not.@*CONCLUSION@#On comparison of the demographic and clinical factors among patients with a suicide attempt versus without an attempt, sex was found to be significantly associated with an attempt (p-value = 0.01). Specifically, the odds of a suicide attempt was twice higher among females (odds ratio = 2.27). Among the other demographic and clinical variables studied, no sufficient statistical evidence was found to declare significant statistical association with suicide attempt. This suggests that etiological factors related to suicide attempts for male and females may differ, hence such nuances need to be taken into account in the clinical assessment and design of interventions to prevent suicide.