Dificuldade de comunicar a morte do paciente aos familiares / Difficulty communicating the patient's death to family members / Dificultad para comunicar la muerte del paciente a los familiares

Resumo Considerando que comunicar a morte de paciente a familiares é tarefa difícil para profissionais de saúde, o objetivo desta pesquisa foi identificar na literatura recomendações para reduzir os malefícios dessa situação. Trata-se de estudo qualitativo realizado por meio de revisão bibliográfica nas bases de dados do Portal Capes com a utilização dos termos "morte" e "comunicação". Os resultados, obtidos em 18 artigos selecionados, foram divididos em três categorias: formação profissional, preparo familiar e prática profissional. Quanto à formação profissional, indicou-se, sobretudo, treinamento por role playing precedido de fundamentação teórica; para o preparo dos familiares, recomendou-se promover diálogo enquanto o paciente vive; em relação à prática profissional, aconselhou-se compartilhar informações entre colegas e adotar medidas para controle emocional. Constatou-se que práticas simuladas, troca de informações entre profissionais, controle emocional dos profissionais e diálogo com e entre familiares contribuem para reduzir o malefício da comunicação de morte.

Abstract Considering that informing family members of a patient's death is an arduous task for health professionals, the objective of this research was to identify in the literature recommendations to reduce the distress caused by this situation. This is a qualitative study carried out by means of a literature review on the Capes Portal database using the terms "death" and "communication." The results, obtained from 18 selected articles, were divided into three categories: professional training, family preparation, and professional practice. Regarding professional training, it was indicated, above all, training by role playing preceded by theoretical foundations; for family members' preparation, the recommendation was to engage in dialogue while the patient is alive; in relation to professional practice, the advice given was information sharing between colleagues and adoption of measures for emotional control. It was found that simulated practices, information sharing between professionals, emotional control of professionals and dialogue with and between family members contribute to reducing the distress when communicating death.

Resumen Teniendo en cuenta que comunicar la muerte de un paciente a familiares es tarea difícil para los profesionales de la salud, el objetivo de esta investigación fue identificar en la literatura recomendaciones para reducir los daños de esa situación. Se trata de un estudio cualitativo realizado por medio de revisión bibliográfica en las bases de datos del portal Capes con la utilización de los Términos "muerte" y "comunicación". Los resultados, obtenidos a partir de 18 artículos seleccionados, fueron divididos en tres categorías: formación profesional, preparación familiar y práctica profesional. En cuanto a la formación profesional, se indicó, sobre todo, entrenamiento por role playing precedido de fundamentación teórica; para la preparación de los familiares, se recomendó promover el diálogo mientras el paciente vive; en relación con la práctica profesional, se aconsejó compartir informaciones entre compañeros y adoptar medidas de control emocional. Se comprobó que prácticas simuladas, intercambio de informaciones entre profesionales, control emocional de los profesionales y diálogo con y entre familiares contribuyen a reducir el daño de la comunicación de muerte.

The death of parents by homicide and child grief: systematic review / A morte de pais por homicídio e o luto infantil: revisão sistemática / La muerte de padres por homicidio y el luto infantil: revisión sistemática

Parental death associated with violent circumstances has important repercussions for child grief, representing a risk factor for development. In this sense, this article aimed to identify, in national and international literature, the biopsychosocial characteristics involved in the grief of children from zero to 12 years of age due to the death of parents by homicide and the psychotherapeutic approaches applied in this context. Searches were performed in the databases: PsycINFO, PubMed, BVS-Psi, and Portal de Periódicos Capes using the keywords: grief, child, and homicide. The review was registered in PROSPERO (CRD42019120703). Around 158 articles were found, following the PRISMA recommendations for systematic evaluation. After analysis, seven articles constituted the final sample. There is a lack of studies on the subject. However, the sample indicated specificities of grief resulting from homicide and the psychotherapeutic interventions applied to this demand. Further studies on child grief due to parental death by homicide are suggested.

A morte parental associada a circunstâncias violentas traz importantes repercussões para o luto infantil, representando um fator de risco para o desenvolvimento. Nesse sentido, este artigo visou identificar, nas literaturas nacional e internacional, as características biopsicossociais envolvidas no luto de crianças entre 0 e 12 anos decorrente da morte de pais vítimas de homicídio, e as abordagens psicoterapêuticas aplicadas nesse contexto. Foram realizadas buscas nas bases de dados PsycInfo, PubMed, BVS-Psi e Portal de Periódicos Capes utilizando os descritores: luto, criança e homicídio. Esta revisão foi registrada no PROSPERO (CRD42019120703). Foram encontrados 158 artigos, e foram seguidas as recomendações PRISMA para avaliação sistemática. Após análise, sete artigos constituíram a amostra final. Constatou-se carência de estudos sobre o tema. Todavia, a amostra assinalou as especificidades do luto decorrente de homicídio e as intervenções psicoterapêuticas aplicadas a essa demanda. Sugerem-se novos estudos sobre luto infantil decorrente de morte parental por homicídio.

Muerte parental asociada con circunstancias violentas tiene importantes repercusiones para luto infantil, lo que representa un factor de riesgo para el desarrollo. Así, esto artículo apunta identificar, en la literatura nacional e internacional, características biopsicosociales involucradas de luto de niños entre cero y 12 años debido la muerte de padres de homicidios y abordajes psicoterapéuticas aplicadas en este contexto. Búsqueda de artículos en bases de datos PsycInfo, PubMed, BVS-Psi y Portal de Periódicos Capes utilizando los descriptores luto, niño y homicidio. Esta revisión se registró en PROSPERO (CRD42019120703). Fueron encontrados 158 artículos. Siguiéndose las recomendaciones PRISMA para evaluación sistemática. Después del análisis, siete artículos constituyeron la muestra final. Constátese carencia de estudios sobre el tema. Mas, la muestra indicó especificidades de luto como resultado de homicidio y las intervenciones psicoterapéuticas aplicadas esta demanda. Se sugieren estudios adicionales sobre luto infantil debido la muerte parental por homicidio.

Recent statistics and risk factors of suicide in children and adolescents

Youth suicide is like the tip of an iceberg; while many adolescents have died from suicide, many more adolescents have been harmed by suicide attempts and self-injury. Suicide influences not only the victims, but also their family members, friends, teachers, and neighbors. Witnesses can suffer from posttraumatic stress disorder. Suicide is the second leading cause of death among adolescents worldwide and the first cause of death among Korean adolescents. The number of suicides in Korea, especially among high school students and female students, is rapidly increasing when compared with Western countries. Suicide accounted for 28.2% of deaths among Korean adolescents in 2010. There were 4.44% and 18.97% of adolescents who had attempted suicide and had experienced suicidal ideation in their lifetime, which shows that many adolescents have a potential risk for suicide. Previous studies in Western countries have revealed that risk factors for adolescent suicide consist of three categories: sociodemographic factors (male and low socioeconomic and educational status), mental health factors (depression and drug abuse), and individual negative life events and family diversity (family history of suicidal behavior, parental death, and child abuse). In conclusion, suicide is common and rapidly increasing in Korean adolescents. However, the risk factors of suicide and suicide behaviors in Korean adolescents are yet to be determined. A well-designed nationwide survey is needed to investigate the prevalence and risk factors of suicide behaviors and mental disorders among Korean adolescents.

Especificidade no processo de elaboração do luto na adolescência / Especificidad em el proceso de elaboración del luto em la adolescencia / The specific characteristics of working through mourning during adolescence

Propomos neste trabalho, a partir da nossa experiência clínica, a hipótese da existência de certas particularidades na elaboração das perdas na adolescência; especificamente abordamos o penoso processo de luto pela morte do pai. Os processos identificatórios, as questões inerentes à sexualidade e identidade de gênero, assim como os conflitos inerentes à constelação edípica adquirem singular intensidade nesse período da vida. Consideramos importante abordar essas questões pelo esclarecimento que podem trazer para a tarefa clínica com esses analisandos e pelo enriquecimento da nossa compreensão metapsicológica da constituição do psiquismo do adolescente. Ampliamos a compreensão do lugar psíquico dos processos temporais, identificatórios e de simbolização, assim como o impacto dos mesmos na vida adulta.

Proponemos en este trabajo la hipótesis de la presencia de ciertas particularidades en la elaboración del luto en la adolescencia, especificamente en lo referente al penoso luto por la muerte del padre. En la adolescencia el proceso de identificación, y los temas relacionados con la sexualidad e identidad de género, así como el conflicto edípico, adquieren una intensidad singular. Estas cuestiones esclarecen sobre la tarea clínica con estos analisantes y amplian nuestra comprensión metapsicológica de la constitución del psiquismo adolescente. Ampliamos la comprensión del lugar psíquico de los procesos temporales, la identificación y la simbolización, asi como su impacto en la vida adulta.

We suggest based on our clinical experience the hypothesis that the processes of working through mourning during adolescence has particular characteristics, specially the painful grief of the father’s death. Identification, gender identity, sexuality and Oedipus conflict’s anxiety attain an overwhelming intensity during this period of life. This issue is both important for clinical purposes as for the methapsicological understanding of the youngster’s mind. We expand the mind space given to temporal, indemnificatory and symbolization processes and we explore its impacts on their upcoming adult life.

Epidemiology of Depressive Disorder

In Korea, the prevalence of major depression is 4 per 100 and the world prevalence is 10 per 100. Risk factors are women, younger cohort, separated and divorced, persons with family history, early parental death and disruptive childhood environment, negative stressful events and chronic stress, absence of confidant in women, and urban areas. The mean age of onset ranges from late twenties to early thirties, but the age of onset becomes earlier and the prevalence of major depression is increasing. The recurrence rate is 85% and patients experience four episodes of depression on average and major depression is ranked as the fourth disabling disease. It was proven that major depression is one of most chronic and disabling diseases. The prognosis is poorer with comorbid dysthymia. Anxiety disorder, substance dependence, and hypothyroidism are frequent comorbid conditions with depression. And coronary arterial disease and stroke are also frequent comorbidities and their mortality rates increase with depression. The diathesis-stress model of depression is supported by the genetic study of depression. In conclusion, the rate of depression is rising and depression is one of the most chronic and disabling diseases. Therefore, I hope the disease be prevented through future studies.