Formas extremas de sofrimento psíquico na infância e adolescência atuais / Extreme forms of psychic pain in current childhood and adolescence / Formas extremas del padecimiento psíquico en la infancia y la adolescencia actuales

O autor considera que o alarmante crescimento do número de suicídios de adolescentes constitui a ponta de um iceberg muito mais amplo: o sofrimento profundo, muitas vezes naturalizado, das gerações mais jovens. É um sofrimento em que o olhar sociológico costuma verificar o fracasso dos adultos na transmissão de um legado que permita a inclusão dos recém-chegados no corpo social. Nós, psicanalistas, registramos - paradoxalmente ­ um êxito nessa conjuntura inquietante: aquele que corresponde às tendências filicidas e destrutivas para com os jovens, as quais autores como Raskovsky, Winnicott e Lacan exploraram em suas análises. São examinadas algumas peculiaridades sintomáticas da adolescência atual. Examina-se a orientação fornecida por algumas observações de Freud e Lacan com o intuito de acomodá-las e processá-las no dispositivo analítico (AU)

The author considers that the alarming growth in the number of adolescent suicides is the tip of a much larger iceberg: the deep suffering, often accepted as natural, of the younger generations. It is a pain in which the sociological analysis usually finds the adults' failure in conveying a legacy that enables inclusion of the newcomers in the social body. We psychoanalysts register ­ paradoxically ­ a success in this disturbing situation: the one that corresponds to filicidal and destructive impulses towards the youngsters, which authors such as Raskovsky, Winnicott and Lacan explored in their work. Some symptomatic peculiarities of current adolescence are examined. Guidance provided by some Freudian and Lacanian observations is examined to accommodate and process them in the analytical field (AU)

El autor considera que el crecimiento alarmante de las cifras de suicidio adolescente constituye la punta de un iceberg mucho más extendido: el profundo padecimiento, muchas veces naturalizado, de las generaciones jóvenes. Es un padecimiento en el que la mirada sociológica suele verificar el fracaso de los adultos en la transmisión de un legado que permita incluir a los recién llegados en el cuerpo social. Los psicoanalistas registramos ­ paradojalmente ­ un éxito en esta coyuntura inquietante: el que corresponde a las tendencias filicidas y destructivas para con los jóvenes, que han explorado en sus desarrollos autores como Raskovsky, Winnicott El autor considera que el crecimiento alarmante de las cifras de suicidio adolescente constituye la punta de un iceberg mucho más extendido: el profundo padecimiento, muchas veces naturalizado, de las generaciones jóvenes. Es un padecimiento en el que la mirada sociológica suele verificar el fracaso de los adultos en la transmisión de un legado que permita incluir a los recién llegados en el cuerpo social. Los psicoanalistas registramos ­ paradojalmente ­ un éxito en esta coyuntura inquietante: el que corresponde a las tendencias filicidas y destructivas para con los jóvenes, que han explorado en sus desarrollos autores como Raskovsky, Winnicott (AU)

Riesgo de suicidio adolescente en localidades urbanas y rurales por género, región de Coquimbo, Chile / Risk of Adolescent Suicide in Urban and Rural Areas of the Coquimbo Region of Chile, by Gender / Risco de suicídio adolescente em áreas urbanas e rurais por gênero, região de coquimbo, Chile

RESUMEN Objetivo: comparar el riesgo de suicidio de adolescentes de enseñanza media, residentes de localidades urbanas y rurales por género en la región de Coquimbo, Chile. Material y método: la investigación es de tipo cuantitativo descriptivo no experimental, en una muestra no probabilística. En noviembre del 2016, de forma anónima, se aplicó el Cuestionario de Screening de Suicidalidad de Okasha, sobre tendencia suicida, a una muestra de 349 adolescentes de 14-19 años (48,7 % hombres-51,3 % mujeres), que asistían a establecimientos educativos urbanos y rurales, de la región de Coquimbo, en Chile. Se utilizó una ANOVA de dos vías para las variables localidad y género. Resultados: no existen diferencias en el riesgo de suicidio según localización geográfica, pero sí por género; se presentó un 15,76 % de adolescentes femeninas con riesgo suicida. Conclusiones: el suicidio es un problema de salud pública mundial, sobre el que no se ha abordado adecuadamente a nivel de prevención y promoción en salud; existe diversidad de factores que influyen en el riesgo suicida y el factor asociado al género femenino presenta un mayor riesgo; mientras que la ubicación geográfica de residencia no registra riesgo.

ABSTRACT Objective: Compare the risk of suicide, by gender, among adolescent, secondary-school students who are residents of urban and rural areas in the Coquimbo region of Chile. Materials and method: This is a non-experimental, descriptive quantitative study of a non-probabilistic sample. In November 2016, Okaska's Suicidality Scale to gauge the tendency towards suicide was applied anonymously to a sample of 349 adolescents ages 14-19 (48.7% males and 51.3% females) who were attending urban and rural educational establishments in the Coquimbo region of Chile. A two-way ANOVA was used for the locality and gender variables. Results: There are no differences in the risk of suicide according to geographic location. However, by gender; 15.76% of the female adolescents were found to be at suicidal risk. Conclusions: Suicide is a global public health problem that has not been addressed adequately in terms of prevention and health promotion. There are varieties of factors that influence the risk of suicide. The female-gender factor presents a greater risk, while the geographical location of residence appears to pose risk.

RESUMO Objetivo: comparar o risco de suicídio de adolescentes por gênero, estudantes do ensino médio, residentes em áreas urbanas e rurais da Região de Coquimbo, Chile. Materiais e método: a pesquisa é de tipo quantitativo descritivo não experimental, numa amostra não probabilística. Em novembro de 2016, de forma anônima, aplicou-se o Questionário Screening de Suicidalidade de Okasha, sobre tendência suicida, a uma amostra de 349 adolescentes entre 14 e 19 anos (48,7 % homens e 51,3 % mulheres), que se encontravam em estabelecimentos educativos urbanos e rurais da Região de Coquimbo. Utilizou-se ANOVA de duas vias para as variáveis área e gênero. Resultados: não existem diferenças no risco de suicídio segundo a localização geográfica, mas sim por gênero; apresentaram-se 15,76 % de adolescentes do sexo feminino com risco suicida. Conclusão: o suicídio é um problema de saúde pública mundial, sobre o qual não se tem abordado adequadamente, no que se refere à prevenção e promoção em saúde; há diversidade de fatores que influenciam no risco suicida, e o fator associado ao gênero feminino apresenta maior risco, enquanto a localização geográfica de residência não o registra.

La conducta suicida en la adolescencia y sus condiciones de riesgo / Suicidal behavior in adolescence and its risk conditions

Introducción: La conducta suicida es una gran preocupación para los clínicos que trabajan con adolescentes, siendo el suicidio una de las primeras 5 causas de muerte en adolescentes entre 15 y 19 años. La conducta suicida es una emergencia médica cuya evaluación debe ser acuciosa, sin embargo, la determinación precisa del riesgo suicida es difícil de realizar en la práctica clínica. En esta revisión, los autores analizan de la literatura tanto nacional como extranjera las características de la conducta suicida con énfasis en los factores de riesgo, las estrategias de evaluación de estos y los aspectos del manejo clínico del riesgo. Objetivo: Revisar los diferentes factores asociados con el riesgo de conducta suicida en adolescentes de manera de encontrar predictores precoces de suicidio. Método: La revisión de la literatura fue realizada usando la base de datos Medline con las siguientes palabras clave: suicide attempt, suicidal behavior, adolescents, children, suicide risk factors. Los estudios relevantes y con impacto en la práctica clínica con niños y adolescentes fueron seleccionados y revisados según criterio de los autores. Discusión: La conducta suicida se asocia a variados factores de riesgo; diversas condiciones epidemiológicas, psiquiátricas y médicas, además de eventos vitales estresantes actúan como precipitantes. El intento suicida previo y los trastornos del ánimo destacan como potentes factores de riesgo individual. Los servicios de urgencia constituyen un importante contexto de evaluación y manejo de conductas suicidas particularmente graves, por lo que debe potenciarse el desarrollo de intervenciones a este nivel y protocolizar la atención.(AU)

Introduction: Suicidal behavior is a great concern for clinicians who deal with mental health problems in adolescent. Worldwide, suicide is one of the top five causes of adolescent death between 15 and 19 years old, making of this a serious public health problem. It is a medical emergency and its evaluation must be accurate, however the exact determination of suicidal risk is difficult in the clinical practice. In this paper, the authors review the national and foreign literature to describe and analyze the characteristics of suicidal behavior, with emphasis on risk factors, strategies for evaluation and clinical management of suicidal risk. Objective: To review among different risk factors associated with suicidal behavior in adolescents, in order to find early predictors of suicide. Method: This review was systematically done using the Medline database with the following keywords: attempted suicide, suicide, adolescents, children, risks factors suicide. Relevant studies with potential impact on clinical practice were selected and reviewed. Conclusion: The suicide behavior is not associated with a single risk predictor, but to different epidemiological, psychiatric and known medical conditions and stressful vital events acting as precipitants. Prior suicide attempt stands out as the most powerful risk factor to retry. Emergency services are an important setting for evaluation and management of particularly serious suicidal behavior and should be enhanced the development of interventions at this level.(AU)

A Methodological Review of Psychological Autopsy for Adolescents

Recently, local governments and suicide prevention centers have been trying to implement psychological autopsy. This effort has focused on adult suicide so far ; however, there are some difficulties in its application to adolescent suicide. Therefore, in this study, psychological autopsy studies of Korea were reviewed, and a methodology for adolescents\' psychological autopsy was suggested. For the effective performance of the psychological autopsy in adolescent suicide, cooperation with each area of the government and implementation of bodies is necessary. In addition, the central system, which disseminates the standardized interview to the community and manages the data nationwide, should be prepared. Also, in order to improve the accuracy of diagnosis and to obtain various types of information, a structured interview should be adopted as the psychological autopsy, as well as considering the use of social media. Investigation of specific risk factors for adolescent suicide through psychological autopsy can enable determination of the intervention point for effective suicide prevention.

Suicide Prevention Program in Schools : Teacher's Perception of Benefits and Barriers / 신경정신의학

OBJECTIVES: The objective of this study was to identify the level of awareness regarding school-based suicide prevention programs in teachers who were in charge of the suicide prevention project, and to derive plans for future improvement. METHODS: A total of 582 teachers working in elementary, middle, and high schools across the country participated in this study. For the study, school-based suicide prevention programs were divided into four programs : curriculum-based program, staff in-service training, screening, and postvention ; the teachers' opinions regarding each program were then gathered by conduct of an online survey. RESULTS: The results indicated that participants chose the curriculum-based program as the most easily implementable program (65.6%), and postvention as the most difficult program to implement (52.9%). The curriculum-based program was implementable due to availability of procedure. Evasion of legal responsibility was significantly greater in postvention, making the program more desirable. Barriers to effective implementation include students' and parents' resistance to screening as well as time constraints in staff in-service training. CONCLUSION: These results suggest that a variety of preceding conditions must necessarily be prepared for successful implementation of each type of suicide prevention program. Policy implications and future directions are then discussed.

Current interventions, strategies, and networking of adolescent suicide

In this paper, the current status of adolescent suicide prevention and intervention are addressed, including areas related to medicine, counseling, mental health nursing, social welfare, and education. Many preventive efforts and intervention programs have been developed and implemented, but the results have been mostly minimal or unfruitful and many problems arose. First, there is a lack of epidemiological research and developmentally appropriate data on adolescent suicide. Thus evidence-based research on adolescent suicide necessary to make important decisions regarding prevention strategies and the allocation of budgets and human resources is not available. Second, there are only a handful of experts with an appropriate level of education and training. Current suicide prevention efforts are performed as a part of crisis intervention, but only a few persons know how to do so effectively. Finally, a good networking and referral system among each area of service is needed. One of the most important issues might be balancing the levels of service available to each subject and to provide a proper, systematized intervention and continuous crisis management services. In order to create an effective networking and referral system among several service providers for adolescent suicide prevention, we need robust support from the Korean government and local communities.