Mental health, suicide risk and the important role of self-esteem in Adolescents before and during coexistence with COVID-19 in Ecuador

Introduction/Objectives: COVID-19 has had a significant emotional impact on people's lives, especially adolescents. Therefore, the aim was to assess the predictors of suicide risk during the COVID-19 pandemic in adolescents in Ecuador by means of a longitudinal study. Method: The application of a longitudinal design with two measures: before the start of the pandemic and one year afterwards. The sample consisted of 137 adolescents between 12-18 years of age. The variables analysed were mental health, the risk of suicide and self-esteem. Statistical analyses were performed using mean comparison, correlations, QCA models and mediation models. Results: The results indicated higher levels of anxiety and stress after one year of the pandemic. In addition, a higher risk of suicide following the pandemic was observed in those adolescents with higher scores in emotional symptomatology and low self-esteem. QCA models and mediation models highlighted the importance of self-esteem as a protective variable between pre-COVID-19 suicide risk and emotional symptomatology and post-COVID-19 suicide risk. Conclusions: This study highlights adolescents' level of vulnerability to the pandemic and its significant psychological impact. It is important to detect which factors function as risks and which as protection against COVID-19 in order to implement intervention programmes that target these aspects and ensure better adolescent well-being.

Introducción/Objetivos: La COVID-19 tuvo un impacto emocional en la vida de las personas, especialmente en la adolescencia. El objetivo fue evaluar los predictores de riesgo de suicidio en adolescentes en Ecuador por medio de un estudio longitudinal. Método: Se trata de un diseño longitudinal con dos medidas: antes del inicio de la pandemia y un año después. La muestra fue de 137 adolescentes entre 12 y 18 años. Las variables analizadas fueron la salud mental, el riesgo de suicidio y la autoestima. Los análisis estadísticos se realizaron mediante comparación de medias, correlaciones, modelos QCA y modelos de mediación. Resultados: Los resultados indicaron mayores niveles de ansiedad y estrés después de un año de la pandemia. Se observó un mayor riesgo de suicidio tras la pandemia en aquellos adolescentes con puntuaciones más altas en sintomatología emocional y baja autoestima. Los modelos QCA y los modelos de mediación destacaron la importancia de la autoestima como variable protectora en el riesgo postsuicidio. Conclusiones: Este estudio pone de manifiesto el nivel de vulnerabilidad de los adolescentes ante la pandemia y su importante impacto psicológico. Es importante detectar qué factores funcionan como riesgos y cuáles como protección frente al COVID-19 para implementar programas de intervención.

Assessment of Suicide Risk and Potential Protective Factors among Patients Admitted at a Tertiary Mental Health Care Institute in Assam

Suicide is a major public health concern having a number of risk factors. Psychopathology is found to be one of the many protective factors of suicide. The current study intended to appraise the risks of attempting suicide and the presence of preventive factors among the patients admitted to tertiary mental health care setting. A total of 53 patients with mental illness care hospital in- cluded in the study. The risk of suicide was assessed with modified SAD PERSONS and Nurses'#39; Global Assessment of Suicide Risk tools and protective factors were assessed with the Reasons for Living inventory. The result showed that 13.3 percent of the admitted patients with mental illness had high risk of suicide and 3.8 percent very high risk of suicide requiring hospitalisation for the same. The participants had scored considerably higher in protective factors as described by the reasons for living inventory.

Potential profile analysis of potential risk characteristics for suicide among college students / 中华行为医学与脑科学杂志

Objective:To explore the characteristics and trends of potential suicide risk among college students in China, as well as the predictive factors for the potential suicide risk subgroups, in order to provide scientific basis for early identification and precise intervention of potential suicide risks.Methods:From 2017 to 2021, a total of 14 653 undergraduate students were selected from 6 universities in Hubei Province through cluster sampling.Data were collected once a year in October after freshmen enrolled (a total of 5 times). Mplus 8.3 and SPSS 26.0 softwares were used for statistics.Latent profile analysis(LPA)was used to analyze the category characteristic of suicide risk in 5 dimensions, and multinomial logistic regression was constructed to analyze the gender and school year effects of suicide risk categories, as well as whether the differences in suicide risk would expand, decrease or maintain over time.Results:(1) According to the fitting indexes of the LPA, the potential suicide risk of college students could be divided into three heterogeneous categories, namely C1 low-risk group (75.6%), C2 helpless high-risk group (3.7%) and C3 personality high-risk group (20.7%). (2) The 2 high suicide risk groups (C2 and C3) had significant gender and grade effects.In terms of gender, female students were significantly less likely to be in the " C3 personality high-risk group" than male students.As the enrollment grade increased, the probability of entering the two high suicide risk groups showed an increasing trend.(3) Interpersonal sensitivity was a significant positive predictor of entry into the " C3 personality high-risk group" ( B=0.150, OR=1.162, 95% CI=1.140-1.185). Paranoid Ideation was a significant positive predictor of entry into the " C2 helpless high-risk group" ( B=0.103, OR=1.109, 95% CI=1.051-1.170). Phobic anxiety was a significant negative predictor of entry into both the " C2 helpless high-risk group" ( B=-0.041, OR=0.976, 95% CI=0.937-1.016)and the " C3 personality high-risk group" ( B=-0.031, OR=0.987, 95% CI=0.965-1.010). (4)Over time, the probability of entering the two high-risk suicide groups(C2 and C3) increased.The proportion of C2 and C3 showed an upward trend, and the proportion of C3 showed a more significant upward trend, with a 10% increase over the past 5 years. Conclusions:The potential suicide risk of college students can be divided into three heterogeneous categories.There are significant differences in the impact of gender, grade of enrollment, and mental health symptoms (interpersonal sensitivity, phobic anxiety, and paranoia ideation) on potential suicide risk among different subgroups.Targeted intervention measures should be taken based on the characteristics of college students in the high-risk group of suicide and should focus on college students with high neurotic personality traits in the high suicide risk group to reduce the occurrence of crisis events.

Investigation and correlation analysis of financial toxicity and risk of suicide in the patients with head and neck cancer / 中国实用护理杂志

Objective:To understand the current state of financial toxicity and suicide risk in head and neck cancer patients, to investigate the correlation between the level of financial toxicity and suicide risk in head and neck cancer patients, and to provide a basis for reducing the level of financial toxicity and the risk of suicide in head and neck cancer patients.Methods:A cross-sectional survey was conducted, from March 1 to July 31, 2022, 150 head and neck cancer patients were selected from Oncology Department of East Hospital Affiliated to Tongji Universityby by convenient sampling method. The survey was carried out by means of the general questionnaire, Comprehensive Score for Financial Toxicity based on the Patient-Reported Outcome Measures (COST-PROM), Cancer Suicide Risk Scale (CSRS), and then analysis the datum.Results:The score of COST-PROM of 150 head and neck cancer patients was (18.00 ± 6.12) points, and the score of CSRS of head and neck cancer patients was (36.31 ± 8.51) points. The total score of economic toxicity was significantly negatively correlated with the total score of suicide risk and its dimensions ( r values were -0.446 to 0.235, all P<0.05). The total score of suicide risk was negatively correlated with the total score of economic toxicity and the scores of each dimension ( r values were -0.446 to -0.251, all P<0.05). Conclusions:Patients with head and neck cancer were at higher risk of suicide, and financial toxicity was a significant contributing factor to suicide risk, with higher levels of financial toxicity associated with a higher risk of suicide. Reducing the level of financial toxicity in patients with head and neck cancer has important implications for reducing their risk of suicide.

Riesgo suicida y estrategias de afrontamiento al estrés en población campesina colombiana / Suicidal risk and strategies for coping with stress in Colombian rural population

Resumen Introducción: El comportamiento suicida hace referencia a las diversas conductas para dejar de vivir es un fenómeno multifactorial ampliamente estudiado en población urbana, sin embargo, la población campesina, especialmente agricultores y trabajadores agrícolas están entre los grupos de alto riesgo. Objetivo: Evaluar las relaciones entre el riesgo suicida y las estrategias de afrontamiento al estrés en una muestra de 76 campesinos entre los 18 y 79 años del municipio de El Santuario, Colombia, durante la emergencia sanitaria por Covid-19. Método: Para este estudio se utilizó un diseño descriptivo correlacional de corte transversal y se emplearon como instrumentos la Escala de Evaluación de Riesgo Suicida -ERS- y la Escala de Estilos y Estrategias de Afrontamiento (EEEAE). Resultados: Los resultados encontrados en la Escala ERS no indicaron niveles clínicos de riesgo suicida. Y respecto a la EEEAE casi siempre los participantes usaban las estrategias de Reevaluación positiva, Apoyo social, Desconexión cognitiva y Resolver el problema. Hubo correlaciones negativas entre todas las dimensiones de la escala ERS con EEEAE, menos entre las dimensiones Depresión/Desesperanza y Aislamiento/Soporte social (ERS) con la Desconexión cognitiva (EEEAE) y especialmente la estrategia de Reevaluación Positiva tuvo un peso significativo sobre riesgo suicida. Conclusiones: La Reevaluación Positiva es una estrategia de afrontamiento que puede proteger la salud mental ante situaciones de estrés asociados con el riesgo suicida de la población campesina, los agricultores y trabajadores agrícolas.

Abstract Introduction: Suicidal behavior refers to the various behaviors to stop living, it is a multifactorial phenomenon widely studied in the urban population, however, the rural population, especially farmers and agricultural workers, are among the high-risk groups. Objective: Evaluate the relationships between suicidal risk and stress coping strategies in a sample of 76 peasants between 18 and 79 years of age from the municipality of El Santuario, Colombia during the Covid-19 health emergency. Method: For this study, a cross-sectional correlational descriptive design was used. The Suicide Risk Assessment Scale -SRAS- and the Coping Styles and Strategies Scale were used as measurement instruments (CSSS). Results: The results found in the SRAS Scale did not indicate clinical levels of suicidal risk. And regarding the EEEAE, the participants almost always used the strategies of Positive Reappraisal, Social Support, Cognitive Disconnection and Problem-Solving skills. There were negative correlations between all the dimensions of the SRAS scale with CSSS, less between the dimensions Depression/Hopelessness and Isolation/social support (SRAS) with Cognitive Disconnection (CSSS) and especially the Positive Reappraisal had a significant weight on suicidal risk. Conclusions: Positive Reappraisal is a coping strategy that can protect mental health in situations of stress associated with suicidal risk of the rural population, farmers, and agricultural workers.

Suicide in cancer patients undergoing palliative care: A report of two cases / Suicidio en pacientes con cáncer que recibe cuidados paliativos: reporte de dos casos

Abstract Introduction Suicide represents a major public health problem worldwide, and cancer patients might have vulnerability factors which increase suicide risk. There are multiple factors associated with this tragic outcome, including those stemming from the disease itself, mental illness and social, personal and spiritual factors. Although previous reports have identified a suicide rate which ranges from .03-7% among cancer patients undergoing palliative care, this has not been studied in Mexico. Objective This study sought to report the cases of suicide in patients with cancer undergoing palliative care at a large cancer reference center. Method A retrospective review of records was performed between 2018-2019 for patients treated at the Palliative Care Service of the Instituto Nacional de Cancerología in Mexico City. Records for patients who committed suicide were reviewed to describe factors associated with this outcome. Results Among all deaths identified during the record review, two were due to suicide (.09%). The patients were one female and one male, 60 and 42 years of age, diagnosed with breast cancer and gastroesophageal junction cancer, respectively, associated with tobacco and alcohol consumption, as well as several economic, social, and familial stress factors. One of the patients was identified as likely having major depressive disorder. Discussion and conclusion Deaths might be underreported in our population. A systematic evaluation is required in order to establish and detect suicidal behavior risk factors, and a follow-up plan for all these patients.

Resumen Introducción El suicidio representa un problema de salud pública en todo el mundo. Los pacientes con cáncer pueden tener factores de vulnerabilidad para presentar conducta suicida. Hay múltiples factores asociados con este fenómeno, incluidos los derivados de la enfermedad en sí, enfermedades mentales y factores sociales, personales y espirituales. Aunque hay reportes previos que describen una tasa de suicidio que va del .03 al 7% entre los pacientes con cáncer que reciben cuidados paliativos, esto no se ha estudiado en México. Objetivo Reportar los casos de suicidio en pacientes oncológicos que reciben cuidados paliativos en un centro oncológico de referencia. Método Se trata de un estudio retrospectivo, donde se revisaron los expedientes de los pacientes atendidos en el Servicio de Cuidados Paliativos del Instituto Nacional de Cancerología entre 2018-2019. Se revisaron los expedientes de los pacientes que se suicidaron para describir los factores de riesgo que presentaban. Resultados Entre todas las muertes identificadas durante la revisión de expedientes, dos se debieron a suicidio (.09%). Los pacientes fueron una mujer y un hombre, de 60 y 42 años, diagnosticados de cáncer de mama y de una unión gastroesofágica, respectivamente. Los factores asociados fueron el consumo de tabaco y alcohol, así como varios factores de estrés económico, social y familiar. Se identificó, asimismo, que uno de los pacientes padecía trastorno depresivo mayor. Discusión y conclusión Es posible que los suicidios estén infrarreportados en nuestra población. Se requiere una evaluación sistemática para establecer y detectar factores de riesgo de conducta suicida, y un plan de seguimiento para todos estos pacientes.

Perfil epidemiológico e toxicológico dos suicídios ocorridos em uma região do sul do Brasil entre os anos de 2011 e 2017 / Epidemiological and toxicological profile of suicides in a region of southern Brazil between 2011 and 2017

Objetivo: Avaliar e definir o perfil epidemiológico e toxicológico dos suicídios que ocorreram nas cidades da Associação de Municípios da Região Carbonífera (AMREC) entre o período de janeiro de 2011 e dezembro de 2017. Métodos: Estudo observacional retrospectivo realizado no Instituto Médico Legal (IML) de Criciúma/SC, com dados obtidos através de questionários padronizados para todo óbito classificado como suicídio entre 2011 e 2017. Resultados: A taxa média de suicídios da região ficou em 10,08 óbitos a cada cem mil habitantes, sendo este tipo de morte mais prevalente entre os homens (69,4%). Entre os métodos utilizados para tal fim, os mais prevalentes foram o enforcamento (75,6%) e a intoxicação medicamentosa (6,5%), este último mais comum entre o gênero feminino. Foram positivos 28% dos exames de alcoolemia e 37% dos exames toxicológicos, apresentando os benzodiazepínicos como a droga mais encontrada. Conclusão: Os índices de suicídios encontrados na AMREC se mantiveram altos nos anos estudados, sendo superiores à média nacional e catarinense. Os resultados do estudo relatam uma maior propensão do gênero masculino em cometer uma autoagressão, além de uma alta associação entre exame toxicológico positivo e suicídio.

Objective: To determine the epidemiological and toxicological profile of suicides that occurred in the Association of Municipalities of the Coal Producing Region of Santa Catarina between January 2011 and December 2017. Methods: This retrospective observational study was conducted at the Instituto Médico-Legal of Criciúma using data obtained through standardized questionnaires for every death classified as suicide between 2011 and 2017. Results: The mean regional suicide rate was 10.08 per 100,000 inhabitants, which was more prevalent among men (69.4%). The most prevalent methods were hanging (75.6%) and drug overdose (6.5%), the latter being more common among women. A total of 28% of the blood alcohol tests and 37% of the toxicological tests were positive, with benzodiazepines being the most frequently found drug. Conclusion: The suicide rates in this region remained high during the study period, higher than the national and state averages. In this sample, men had a greater propensity to commit self-harm, and a strong association was found between positive drug tests and suicide.

Sleep characteristics and their impact on suicide risk among adolescents with depressive disorder and bipolar disorder / 四川精神卫生

ObjectiveTo compare the differences in sleep structure characteristics between adolescents with depressive disorder and adolescents with bipolar disorder， and to explore the impact of sleep indicators and other factors on the suicide risk of adolescents with affective disorder. MethodsThe medical records of adolescents with depressive disorder （n=97） and bipolar disorder （n=52） who met the International Classification of Diseases， tenth edition （ICD-10） and hospitalized in the Affiliated Brain Hospital of Guangzhou Medical University from January 1， 2019 to June 30， 2021 were retrospectively reviewed. Data including age， gender， body mass index （BMI）， psychiatric diagnosis， the Nurses' Global Assessment of Suicide Risk （NGASR） score and polysomnography （PSG） results of the patients were collected. Then patients were divided into two groups according to NGASR score， scored 0~5 were in the low risk group （n=32） and scored above 5 were in the high risk group （n=117）. Meantime， the PSG data of normal adolescents （n=80） in the previous literature were collected as the control group. Thereafter， a multiple linear regression model was established to explore the related factors affecting suicide risk in adolescents with affective disorder. ResultsThe sleep efficiency and the proportion of stage N2 sleep in high risk group were lower than those in low risk group （Z=-2.138， -2.520， P<0.05）. The total sleep time， N2 sleep duration and rapid eye movement （REM） sleep time in depression group were less than those in bipolar group （t=-2.822， -3.087， -2.277， P<0.05 or 0.01）. The proportion of REM sleep in depression group and bipolar group were lower than those in control group （t=-2.369， -2.069， P<0.05）. Linear regression analysis denoted that the factors affecting the suicide risk in adolescents with affective disorder included stage N1 sleep duration （β=0.019， P<0.05）， gender （male vs. female， β=-4.051， P<0.01） and psychiatric diagnosis （bipolar disorder vs. depressive disorder， β=-1.429， P<0.05）. ConclusionIn contrast to adolescents with bipolar disorder， the sleep structure of adolescents with depressive disorder is characterized by poor sleep continuity and less light sleep. Furthermore， the N1 sleep duration， female gender and diagnosis of depressive disorder are risk factors affecting the suicide in adolescents with affective disorder.

Mediating effect of insomnia in the relationship between childhood trauma and suicide risk in middle school students / 中华行为医学与脑科学杂志

Objective:To explore the mediating role of insomnia between childhood trauma and suicide risk in middle school students.Methods:Childhood trauma questionnaire(CTQ), insomnia severity index(ISI) and suicidal behaviors questionnaire-revised(SBQ-R) were used to investigate 3 442 middle school students.According to the total score of the SBQ-R, those who scored less than or equal to 6 were divided into low suicide risk group, and those who scored more than or equal to 7 were divided into high suicide risk group.In this study, there were 2 168 students in the low suicide risk group and 1 274 students in the high suicide risk group.SPSSAU 21.0 online statistical software was used for common method deviation test, descriptive statistics, variance analysis and correlation analysis, and structural equation model was constructed, and Bootstrap method was used for mediation effect test.Results:(1) There were statistically significant differences between the high suicide risk group and the low suicide risk group in terms of grade and gender( χ2=11.144, 83.737, both P<0.05), and there were statistically significant differences in the types of childhood trauma and the severity of insomnia( χ2=292.211, 333.998, both P<0.05). (2) The total score of childhood trauma in the high suicide risk group (43.92±10.50) was higher than that in the low suicide risk group (37.74±6.93) ( F=351.78, P<0.01), and the score of insomnia in the high suicide risk group (10.66±5.54) was higher than that in the low suicide risk group (7.04±4.76) ( F=379.25, P<0.01). (3)The total score of childhood trauma was positively correlated with the score of suicide risk ( r=0.415, P<0.01), and the total score of childhood trauma was positively correlated with the score of insomnia ( r=0.306, P<0.01), and the score of insomnia was significantly positively correlated with the score of suicide risk ( r=0.399, P<0.01). After controlling for demographic data, anxiety and depression, the correlation was still significant ( P<0.01). (4) Path analysis and mediation test showed that childhood trauma had a positive effect on insomnia ( β=0.30, P<0.01), insomnia had a positive effect on suicide risk ( β=0.29, P<0.01), and childhood trauma had a positive effect on suicide risk ( β=0.33, P<0.01). The mediating effect of insomnia accounted for 21.21% of the total effect.After controlling for demographic data, anxiety and depression, the mediating effect accounted for 10.66% of the total effect. Conclusion:Childhood trauma and insomnia have a significant impact on the suicide risk among middle school students.Insomnia plays a partial mediating role between childhood trauma and middle school students' suicide risk.Timely management of the sleep disturbances of traumatized individuals can reduce the suicide risk among middle school students.

Relato de caso: avaliação do risco de suicídio no transtorno depressivo maior grave com sintomas psicóticos / Case report: evaluation of suicide risk in severe major depressive disorder with psychotic symptoms

Para além de sua sintomatologia clássica, o Transtorno Depressivo Maior (TDM) pode cursar com episódios únicos ou recorrentes de quadros psicóticos, marcados pela presença de delírios e alucinações cujos conteúdos associam-se frequentemente a ideias negativas e depressivas de morte, ruína, culpa e punição merecida. Esta condição está fortemente conectada a alto risco suicida, motivo pelo qual deve-se diagnosticar e intervir de maneira positiva o mais precocemente possível, a fim de que a vida, o sentido e a qualidade de viver do indivíduo possam ser restaurados e preservados. O caso relatado refere-se a uma paciente com diagnóstico atual de TDM grave e recorrente com sintomas psicóticos e alta intencionalidade suicida. Apresenta o humor constantemente deprimido, choro fácil e frequente, hipobulia, distúrbios do sono e sentimentos de menos-valia. Ademais, seu quadro cursa com sonhos e sensações estranhas relacionados a entidades malignas, assim como com alucinações visuais persistentes e delírios religiosos de pecado, culpa exagerada e punição divina. Frente à resistência dos sintomas ao tratamento farmacológico inicial, foram discutidas outras possibilidades de abordagem, conduta e diagnósticos diferenciais paralelamente à avaliação constante do risco de suicídio. [au]

In addition to its classic symptomatology, Major Depressive Disorder (MDD) may go through single or recurring episodes of psychotic events marked by the presence of delusions and hallucinations, with contents which are frequently associated to negative and depressive ideas about death, ruin, guilt and deserved punishment. This condition is strongly linked to high suicide risks, constituting the main reason why it is necessary to diagnose and positively intervene as soon as possible in order to restore and preserve the person's life, meaning and quality of life. The case reported herein refers to a female patient with a current diagnosis of severe and recurrent MDD with psychotic episodes and high suicidal tendencies. This patient constantly presents depressed mood, frequent and easy crying, hypobulia, sleep disorders and devaluation of herself. Furthermore, her case occurs with strange dreams and sensations related to evil entities, along with persistent visual hallucinations and religious delusions of sin, excessive guilt and divine punishment. Due to the symptoms resistance to the initial pharmacological treatment, other possibilities of approach, conduct and differential diagnoses were discussed in parallel to a continual evaluation of the suicide risk. [au]

Sobre el suicidio en los profesionales de la salud y la importancia de la creación de estrategias desde un enfoque holístico / On suicide in health professionals and the importance of creating strategies from a holistic approach / Sobre o suicídio em profissionais de saúde e a importância da criação de estratégias a partir de uma abordagem holística

RESUMEN El presente artículo tiene como finalidad analizar y plantear posibles soluciones desde un enfoque holístico para la prevención del suicidio en la comunidad médica, puesto que, es una realidad social que debe ser atendida ya que se encuentra en crecimiento, siendo los profesionales de la salud los que presentan una mayor tasa de suicidio frente a otras profesiones. Por consiguiente, se indaga acerca de los principales factores de riesgo desde el ámbito psicosocial y se cuestiona la forma en cómo se da la formación de los ^ profesionales de la Ciencia de la Salud, ya que se considera que este responde a exigencias sociales y económicas del sector de la salud, pero deja olvidada las condiciones laborales, sociales y psicológicas de los prestadores de salud. En este orden de ideas y reconociendo el escenario globalizado en el que la sociedad está inmersa, es relevante propender por la indagación directa del origen del estrés en el ámbito laboral, analizar las condiciones laborales y los riesgos implícitos a los que se encuentra expuesto el médico dentro de la organización, para poder así brindar herramientas oportunas y preventivas en torno a la disminución de las tasas de suicidios.

ABSTRACT The purpose of this article is to analyze and propose possible solutions from a holistic approach for the prevention of suicide in the medical community, since it is a social reality that must be addressed since it is growing, with health professionals being the that present a higher suicide rate compared to other professions. Consequently the main risk factors are investigated from the psychosocial field and the way in which the training of Health Science professionals is given is questioned, since it is considered that this responds to social and economic demands of the health sector, but neglects the working, social and psychological conditions of health providers. In this order of ideas and recognizing the globalized scenario in which society is immersed, it is relevant to tend to directly investigate the origin of stress in the workplace, analyze working conditions and the implicit risks to which the doctor is exposed within the organization, in order to provide timely and preventive t°°ls around the decrease in suicide rates.

RESUMO O objetivo do artigo é analisar e propor possíveis soluções a partir de uma abordagem holística para a prevenção do suicídio na comunidade médica, visto que se trata de uma realidade social que deve ser abordada porque está em crescimento, sendo os profissionais de saúde quem têm uma taxa de suicídio mais elevada em comparação com outras profissões. Os principais fatores de risco são investigados a partir do campo psicossocial e questiona-se a forma como se dá a formação dos profissionais das Ciências da Saúde, por considerar-se que esta responde às demandas sociais e econômicas do setor saúde, mas deixa esquecidas as condições laborais, sociais e psicológicas dos prestadores deste setor Reconhecendo o cenário globalizado em que a sociedade está imersa, é relevante investigar diretamente a origem do estresse no ambiente de trabalho, analisar as condições de trabalho e os riscos implícitos a que o médico está exposto dentro da organização, a fim de assim, fornecer ferramentas oportunas e preventivas em torno da redução das taxas de suicídio.

Assessment， management and treatment recommendation for suicide risk of bipolar disorder with mixed features / 四川精神卫生

The purpose of this article is to provide references for understanding the current provision of bipolar disorder with mixed features as well as future efforts in clinical practice. The article is to review the profile of assessment， management and treatment of suicide risk in bipolar disorder with mixed features. And this review also provides a theoretical framework toward future targeted therapeutic interventions and guidance for bipolar disorder with mixed features.

Depresión y Riesgo de Suicidio en Trabajadoras Sexuales

Resumen La depresión en un problema de salud pública a nivel mundial y una de las principales causas para el suicidio. La etiología de la depresión es multifactorial, ya que se solapan factores biológicos y psicosociales; es más prevalente en personas adultas jóvenes, de sexo femenino y en quienes tienen antecedentes de vivencias adversas, condición muy frecuente en la historia de vida de las trabajadoras sexuales. Objetivo de investigación: Identificar la prevalencia de depresión y riesgo de suicidio en las trabajadoras sexuales de Cochabamba en el periodo de junio a diciembre de 2019 y relacionar con factores psicosociales. Materiales y métodos: estudio con enfoque cuantitativo, no experimental, transversal y correlacional; con la participación de 433 trabajadoras sexuales seleccionadas por muestreo no probabilístico y accidental, realizado en el centro de salud de referencia para esta población. Los instrumentos utilizados fueron: un cuestionario para datos sociodemográficos, el Inventario de depresión de Zung y la Escala de desesperanza de Beck, autoaplicados. El estudio tiene 95% de confianza, con margen de error de 4,6% y varianza de 50%. Se cumplió con los principios de la Declaración de Helsinki y se utilizó el consentimiento informado por escrito, firmado por cada participante. Resultados: el 40% de las personas que participaron en el estudio presentaron depresión clínica, con una relación positiva con los factores: sociodemográficos consumo regular de alcohol y motivos económicos para el trabajo sexual. Se identificó el riesgo de suicidio en el 30% de las encuestadas, con relación positiva con los factores sociodemográficos ausencia de religión y nivel alto de escolaridad. La depresión asociada al riesgo de suicidio fue de 1,6 veces más que en los casos de ausencia de depresión. Conclusión: las trabajadoras sexuales presentan una alta prevalencia de depresión clínica y mayor riesgo de suicidio, asociados con factores sociodemográficos que pueden ser intervenidos con programas de promoción de una vida saludable y prevención del suicidio, la implementación de servicios en salud mental que estén al alcance de esta población, además de la invitación a las autoridades, instituciones y organizaciones para un análisis más profundo de alternativas laborales para la mujer en la sociedad actual. El estudio presenta limitaciones porque no refleja la situación de toda la población femenina dedicada al trabajo sexual siendo necesario profundizarlo, pero su mayor aporte es dar relevancia a la situación de un sector invisible socialmente.

Abstract Depression is a public health problem worldwide and one of the principal causes of suicide. The etiology of depression is multifactorial since both biological and psychosocial factors overlap; it is more prevalent in young female adults and in people with a history of adverse life experiences, a very frequent condition in the lives of sex workers. Research main goal: to identify the prevalence of depression and suicide risk in sex workers in Cochabamba at the Surveillance, Information and Reference Regional Center (CDVIR, abbreviation in Spanish), from June through December 2019 and to relate such prevalence to psychosocial factors. Materials and methods: a study with a quantitative, non-experimental, transversal, and correlational approach, with the participation of 433 sex workers selected by non-probabilistic and accidental sampling, was performed at the health center referred for this population. The instruments used were a questionnaire for sociodemographic data, the Zung Depression Inventory, and the Beck Hopelessness Scale, all self-administered. The study has 95% confidence, with a margin of error of 4.6% and a variance of 50%. The principles of the Declaration of Helsinki were complied with and the written informed consent, signed by each participant, was used. Results: 40% of the people participating in the study presented clinical depression, related positively to these sociodemographic factors: regular alcohol consumption and economic reasons for sex work. Suicide risk was identified in 30% of the respondents, positively related to the sociodemographic factors: lack of religion and high level of education. Depression associated with suicide risk was 1.6 times more than cases related to lack of depression. Conclusion: sex workers present a high prevalence of clinical depression and a higher risk of suicide, which are associated to sociodemographic factors that can be treated with programs promoting a healthy life and preventing suicide, as well as implementing mental health services that should be available to this sector. Furthermore, authorities, institutions and organizations should be invited for a more in-depth analysis of employment alternatives for women in today's society. The study presents certain limitations since it does not reflect the situation of the entire female population dedicated to sex work, which makes it necessary to look into it in depth. However, its greatest contribution has been to give relevance to the particular situation of a socially invisible sector.

Caracterización psicosocial de pacientes con riesgo suicida / Psychosocial characterization of patients at suicidal risk / Caracterização psicossocial de pacientes em risco suicida

RESUMEN La depresión es una enfermedad que ha estado presente en todos los tiempos y aparejado a ella ha estado el suicidio. Se realizó esta investigación con el objetivo de caracterizar el estado biopsicosocial de los pacientes con riesgo suicida. A través de un estudio observacional descriptivo transversal en pacientes con riesgo suicida del área de salud correspondiente al policlínico "Faustino Pérez Hernández" del municipio Buey Arriba en el año 2019. El universo fue de 33 pacientes. Las variables a estudiar fueron: edad, sexo, funcionamiento familiar, antecedentes personales o familiares de intento suicida y depresión. Predominaron los pacientes del sexo femenino (54, 54 %) y el grupo de 48 a 57 años de edad (27,27 %); resultó que el 39,30 % de los pacientes provenían de una familia disfuncional; el 66,60 % tenían padres o hermanos con intentos suicidas; los niveles de depresión fueron alto como rasgo (39,3 %) y alto como estado (57,5 %). Se concluye que el riesgo suicida en la población de estudio se caracterizó por ser más frecuentes en el sexo femenino, sobre todo en pacientes con disfunción familiar, familiares con antecedentes de intentos suicidas y un estado de depresión alto como rasgo y estado.

ABSTRACT Depression is a disease that has been present for all time and suicide has been associated with it. This research was carried out with the aim of characterizing the biopsychosocial status of patients with suicide risk. A descriptive cross-sectional observational study was carried out in patients with suicide risk in the health area corresponding to the polyclinic "Faustino Pérez Hernández" in the municipality of Buey Arriba in 2019. The universe was 33 patients. The variables studied were: age, sex, family functioning, personal or family history of suicide attempt and depression. Female patients predominated (54, 54%) and the group from 48 to 57 years of age (27.27%); it turned out that 39.30% of the patients came from a dysfunctional family, 66.60% had parents or siblings with suicide attempts; depression levels were high as a trait (39.3%) and high as a state (57.5%). It is concluded that the suicide risk in the study population was characterized by being more frequent in the female sex, especially in patients with family dysfunction, relatives with a history of suicide attempts and a state of high depression as a trait and state.

RESUMO A depressão é umadoença que esteve presente em todos os momentos e tem sido associada a ela. Esta pesquisa foi realizada como objetivo de caracterizar o estado biopsicossocial de pacientes em risco suicida. Estudo observacional descritivo transversal foi realizado em pacientes com risco suicida da área de saúde correspondente à policlínica "Faustino Pérez Hernández" do município de Ox Arriba em 2019. O universo era de 33 pacientes. As variáveis a serem estudada foram: idade, sexo, funcionamento familiar, histórico pessoal ou familiar de tentativa de suicídio e depressão. Predominaram pacientes do sexo feminino (54, 54%) e o grupo de 48 a 57 anos (27,27%); verá-se que 39,30% dos pacientes vieram de uma família disfuncional; 66,60% tinham pais ou irmãos com tentativas de suicídio; os níveis de depressão eram elevados como característica (39,3%) estado (57,5%). Conclui-se que o risco suicida na população do estudo foi caracterizado por ser mais comum no sexo feminino, especialmente em pacientes com disfunção familiar, familiares com histórico de tentativas de suicídio e estado de alta depressão como traço e estado.

Factores de riesgo para conducta suicida en adolescentes escolarizados: revisión de tema / Risk factors for suicidal behavior in school adolescents: a review of the topic

Introducción: la conducta suicida es una secuencia de eventos que se da de manera progresiva y, en muchos casos, inicia con pensamientos e ideas que siguen con planes suicidas y culminan en uno o múltiples intentos, hasta el suicidio consumado que puede ser desencadenado por diversos factores de riesgo biológicos, psicológicos o socioculturales. Objetivo: identificar los diferentes factores de riesgo más frecuentes en conductas suicidas en adolescentes escolarizados. Metodología: se realizó una revisión de la literatura en las bases de datos internacionales como PubMed, Proquest, Scopus, Dialnet con los términos deCS: suicidio, factores de riesgo, adolescentes y conductas; después, se filtró la búsqueda por fecha; aquellos que fueron publicados como máximo cinco años en inglés y español. Resultados: se encontraron varios factores de riesgo para el desarrollo de la conducta suicida de adolescentes escolarizados, correspondientes a las esferas biológica, psicológica y social de cada individuo, como el género, la edad, problemas emocionales y trastornos afectivos, consumo de sustancias, relaciones interpersonales y bullying. Conclusiones: la conducta suicida es un fenómeno multifactorial que puede ser prevenido mediante intervenciones de atención primaria en salud..Au

Introduction: suicidal behavior is a sequence of events that occur progressively and, in many cases, begin with thoughts and ideas followed by suicidal plans and culminating in one or more suicide attempts, until the consummated suicide that can be triggered by several risks. Factors, both biological, psychological and sociocultural. Objective:to identify the different risk factors with greater frequency of suicidal behavior in adolescents enrolled in school. Methodology: a review of the literature was made in international databases such as PubMed, Proquest, Scopus, Dialnet with the terms of CS: suicide, risk factors, adolescents and behaviors. Subsequently, the search was filtered by date; Those that were published maximum five years ago and the language; english and spanish. Results: several risk factors were found for the development of suicidal behavior in adolescents of school age, which are part of the biological, psychological and social spheres of each individual, such as sex, age, emotional problems and affective disorders. the use of substances, interpersonal relationships and bullying. Conclusions: suicidal behavior is a multifactorial phenomenon that can be prevented through primary health care interventions..Au

Aspectos generales del riesgo suicida en la consulta del médico general / Suicidal risk on medical setting. An overview

El presente artículo revisa las características clínicas y epidemiológicas del suicidio en Chile, así como también los principales factores de riesgo involucrados en esta conducta. Se describen algunos mitos en relación al problema, variables comunicacionales y estrategias de intervención en la consulta del médico no especialista para pacientes con ideación y conducta suicida junto con las principales herramientas para limitar el suicidio.

This article reviews the clinical and epidemiological characteristics of suicide in Chile, as well as the main risk factors involved in this behavior. Some myths are described in relation to the problem, communication variables and intervention strategies in the consultation of the non-specialist doctor for patients with suicidal ideation and behavior along with the main tools to limit suicide.

Las distorsiones cognitivas y el riesgo de suicidio en una muestra de adolescentes chilenos y colombianos: un estudio descriptivo-correlacional / Cognitive distortions and risk for suicidal behaviors, considering Chilean and Colombian adolescents as sample: A descriptive-correlational study is conducted

Resumen Objetivo: Determinar la relación entre las distorsiones cognitivas y el riesgo de suicidio en una muestra de adolescentes chilenos y colombianos. Método: Este es un estudio descriptivo correlacional, de corte no experimental y transversal. El riesgo de suicidio se estableció con la Escala de Suicidalidad de Okasha y se identificaron las distorsiones cognitivas mediante el Inventario de Pensamientos Automáticos de Ruiz y Lujan. Ambas pruebas se realizaron en una muestra de adolescentes chilenos (n = 200; Colegio Alma Mater) y colombianos (n = 200; Institución Educativa Santa Librada) entre los 13 y 18 años de edad. Se seleccionó la muestra mediante un muestreo no probabilístico e intencional, y los participantes se separaron en grupo con riesgo de suicidio y grupo sin riesgo de suicidio (control). Se realizó un análisis descriptivo de la muestra, y una comparación de las distorsiones cognitivas entre los grupos. Finalmente, el análisis inferencial de los datos identificó la relación e intensidad entre distorsiones cognitivas y riesgo de suicidio. Resultados: Se encontró relación estadísticamente significativa entre las distorsiones cognitivas y riesgo de suicidio, y las siguientes distorsiones presentaron la mayor intensidad en chilenos y colombianos: Filtraje, Interpretación del Pensamiento, Pensamiento Polarizado y Sobregeneralización. La correlación entre los resultados de adolescentes chilenos y colombianos es positiva y alta. Conclusiones: Los resultados del presente estudio permitirán prevenir el riesgo de suicidio en adolescentes chilenos y colombianos mediante la evaluación de estas distorsiones cognitivas, las que también podrán guiar intervenciones psicoterapéuticas reduciendo significativamente la severidad y riesgo de cometer suicidio.

Abstract Objective: This paper aims to determine the relationship between cognitive distortions and risk for suicidal behaviors considering Chilean and Colombian adolescents as sample. Method: A descriptive-correlational, non-experimental and transversal study was conducted. The risk of suicide was assessed with screening scale of suicidality (scale of Okasha) and the cognitive distortions were determined through Automatic Thoughts Inventory by Ruiz and Lujan. Both of the tests were performed in Chilean (n = 200; from Alma Mater School) and Colombian adolescents as sample (n = 200; educational institution Santa Librada). These adolescents were between 13-18 years-old. This sample was selected through non-probabilistic intentional sample procedure, and the individuals were divided in two groups: one of them are at risk of suicide and the other without suicidal risk (control). A descriptive analysis of the sample, as well as a comparison of the cognitive distortions between groups was performed. Finally, inferential analysis of data is used to determine the relationship and the intensity between cognitive distortions and the risk for suicidal behaviors. Results: A significant relationship between the cognitive distortions and the suicide risk was found, and the following presented the highest intensity between Chilean and Colombian individuals: Filtration, Interpretation of Though, Polarized Though and Overgeneralization). Moreover, the relationship between the results in Chilean and Colombian adolescents was positive and strong. Conclusions: Results of this study will allow to prevent risk for suicidal behaviors in Chilean and Colombian adolescents, assessing these cognitive distortions, which make possible to conduct psychotherapeutic interventions significantly, reducing the risk for suicidal behaviors.

Tentativa suicida y uso del tiempo libre en adolescentes escolarizados mexicanos / Suicide attempt and leisure in Mexican adolescents

Resumen El propósito del estudio fue identificar el uso del tiempo libre y su relación con la tentativa suicida en una muestra mexicana adolescente. Participaron 1290 estudiantes de nivel secundaria, entre 12 a 18 años (36 % varones, 64 % mujeres); el instrumento incluyó reactivos cerrados y formato libre. De las 11 categorías del tiempo libre obtenidas, la de relaciones fuera del ámbito familiar obtuvo el mayor puntaje (96 %) y el menor las actividades escolares (1,8 %). Se encontraron asociaciones estadísticamente significativas de riesgo suicida en las actividades pasivas, del hogar, relaciones familiares y cuidar el propio cuerpo; se encontraron actividades con efecto protector las relaciones sociales fuera del ámbito familiar y recreativas (artísticas, deportivas). Se presentan reflexiones sobre la producción y utilización creativa del tiempo libre en jóvenes y familias contemporáneas.

Abstract The aim of the present study was to identify leisure time and its association to suicide attempts in a sample of 1290 Mexican adolescents aged 12-18 (36 % male, 64 % female). The instrument included both, closed and open items. Out of 11 leisure categories, relationships outside their families were the most prevalent at 96 % while school-related activities were the least prevalent (at 1.8 %). Statistically significant differences were found for suicidal behavior and passive activities, home activities, family relationships, and body self-care. Recreation activities such as sports and arts, and relationships outside their families were found to be protective factors. Concluding considerations about the creative use of leisure for contemporary adolescents and families are included.

Resumo O objetivo deste estudo foi identificar a relação entre o uso do tempo livre e a tentativa de suicídio em uma amostra de adolescentes mexicanos. Participaram 1290 estudantes de ensino médio, entre 12 e 18 anos (36 % homens, 64 % mulheres). O instrumento de avaliação incluiu perguntas fechadas e abertas. Das 11 categorias estabelecidas para tempo livre, a que obteve maior pontuação (96 %) foi a de relações fora do âmbito familiar e a de menor pontuação (1.8 %) foi de atividades escolares. Foram encontradas associações estatísticas significativas entre o risco de suicídio e atividades passivas, tais como, atividades de casa, relações familiares e cuidados com o corpo próprio; atividades protetoras foram encontradas em relações sociais fora do âmbito familiar e de recreação (artísticas e esportivas). Apresenta-se reflexões sobre a produção e utilização criativa do tempo livre em jovens e famílias contemporâneas.

Analysis of the Prescription Patterns of Medications that List Suicide in Use Cautions using the HIRA Claims Data

OBJECTIVE: Suicide has recently become an important social problem. Thus, we analyzed prescription drugs that cause suicidal ideation. METHODS: Of 156 drugs on the the Minister of Food and Drug Safty (MFDS) EZ-Drug site that had “suicide” listed as a side effect, 78 had “suicide” listed as a warning or contraindication; those 78 drugs were analyzed using data from the 2016 Health Insurance and Review and Assessment Services National Patient Sample (HIRA-NPS). RESULTS: 51 “suicide risk” drugs was identified. Of all patients, 5.2% had received such drugs. The prescription rate was 0.8% of all prescriptions, accounting for 1.6% of all prescription days. From logistic regression analysis, the prescription rate for the drugs was approximately 1.1 times higher for women than for men. With regard to age, the prescription rate for patients 66 years and older was 15.5 times higher than those for patients 25-years and lower. With regard to medical departments, the prescription rates in psychiatry and dermatology departments were 8.1 times higher and 0.6 times lower than those in internal medicine departments, respectively. With regard to region, the prescription rates in Daegu and Jeju were 1.3 times higher and 0.79 times lower than those in Seoul, respectively. CONCLUSION: Drug-induced suicidal behavior is possible, and therefore efforts are needed to prevent it.

Mindfulness and suicide risk in undergraduates:chain mediating effect of cognitive flexibility and de-pressive cognition / 中华行为医学与脑科学杂志

Objective To explore the chain mediating effect of cognitive flexibility and depressive cognition between mindfulness and suicide risk in undergraduates. Methods Suicidal Behaviors Question-naire-revised (SBQ-R),mindful attention awareness scale ( MAAS),cognitive flexibility inventory (CFI) and depressive cognition scale (DCS) were used to investigate 2 627 freshmen from a medical university in Guangdong Province. Results The scores of suicide risk,mindfulness,cognitive flexibility and depressive cognition were (M(QR)):4. 00(2. 00),67. 00(15. 00),78. 00(13. 00),5. 00(7. 00),respectively. The re-sults of correlation analysis showed that suicide risk was positively correlated with depressive cognition ( r=0. 280,P<0. 01), and negatively correlated with the level of mindfulness and cognitive flexibility ( r=-0. 253,r=-0. 196,P<0. 01). Mindfulness was positively correlated with cognitive flexibility (r=0. 539,P<0. 01),negatively correlated with depressive cognition (r=-0. 518,P<0. 01). Cognitive flexibility was nega-tively correlated with depressive cognition (r=-0. 584,P<0. 01). Mediation modeling analysis showed that mindfulness had a significant direct effect on suicide risk. The direct effect value was -0. 101,accounting for 34. 9% of the total effect. The total indirect effect of mindfulness on suicide risk was -0. 188,accounting for 65. 1% of the total effect. The mediating effect of cognitive flexibility as mediator between mindfulness and suicide risk was -0. 063,accounting for 21. 8% of the total effect. The mediating effect of depressive cogni- tion as mediator between mindfulness and suicide risk was -0. 054,accounting for 18. 7% of the total effect. The chain mediating effect of cognitive flexibility and depressive cognition was -0. 071, accounting for 24. 6% of the total effect. Conclusion Mindfulness can influence suicide risk,not only through the direct path,but also through the indirect path of cognitive flexibility and depressive cognition,as well as the chain mediating path between these two variables.