Ideación suicida en población escolarizada infantil: factores psicológicos asociados / Suicidal ideation among school children population: psycological factors associated

ABSTRACT

Nowadays, suicide is a public health problem and a social phenomenon that affects human development. From 1995 to 2002, the state of Sonora showed a 3.8% annual average increase in the occurrence of suicide in productive age population, occupying the national third place with regard to this problem's growth. During the 1970's suicide in groups of infants and school children between 5 and 14 years old started to be noticed in the country. At present time, self-inflicted injuries are eighth cause of death for this age group. Suicidal behavior is a process comprised by several stages: passive suicidal ideation, active contemplation of suicide itself, planning and preparation, suicide attempt execution, and completed suicide. Since these stages may or not be sequential, it is important to study the steps preceding suicides, such as the ideation and the attempt, in order to know and treat this problem. The suicidal ideation is a very important stage as predictive factor to approach the completed suicide and refers to the thoughts regarding one's own death, which may or not be verbalized. There is little research about this subject matter particularly in regards to population under 14; hence, in this study, psychological factors of a sample comprised by boys and girls between 10 and 12 from public and private schools from the State of Sonora will be analyzed and compared to identify those children associated with suicidal ideation and advance in the understanding of this complex phenomenon. Material and methods The study was descriptive-comparative, observational, and transversal in nature. Sample: 631 elementary school fifth and sixth grader students, both genders, aged between 10 to 13 years, from 16 public schools and four private schools in Hermosillo, Sonora. A 631 student sample was considered through clusters connecting the entire schools within the city and the number of students enrolled in the school term. Instruments: A self applied form questionnaire, which evaluates socio-demographic data, was used with the following scales: Children's Depression Inventory CDI; Children's Manifest Anxiety Scale CMAS-R (revised); Self Esteem Inventory. Procedure: In order to carry out this research, authorization was requested to the Ministry of Education of Sonora. In a first phase during an academic hour, a self-applied form questionnaire with socio-demographic information and the depression scale was given. Subsequently, the second part of the questionnaire was given to a sub-sample of two equal groups, one of them identified with suicidal ideation and the other one without ideation. Data analysis: The statistical analyses were performed using the program SPSS version 15.0. Non-parametric test χ² (Chi Square) and prevalence ratio (odds ratio) were used. Results A total of 631 boys and girls were evaluated with the depression questionnaire during the first phase. The mean age was 1 0.9 years (range: 10-13 years), the gender variable was distributed 50.8% girls and 49.2% boys, as a result of the registration rate for fifth and sixth grades of elementary education; 72.1% of the children were in public schools and 27.9% in private schools. In accordance to answers of CDI item 9, children who marked these two possible answers: <> (18.1%) and <> (11.1%) were considered with suicidal ideation. This scale evaluated how the children felt during the two weeks previous to taking the questionnaire and 29.2% of the children somehow showed suicidal ideas. The sub-sample defined from the total population was distributed into two groups: one control group with 184 children without suicidal ideation and another group with 184 children with suicidal ideation. Depression: In regard to depression, results showed that group with suicidal ideation presented greater depressive states compared to the group without suicidal ideation (p<0.03, χ²= 65.66, gl = 2), the highest percentage is located in moderate depression (40.7% and 22.8% respectively). Gender differences were shown only in the group of children without ideation becoming more frequent in boys (p<0.03, χ² = 6.92, gl = 2). While analyzing with the prevalence rate, it was found that children who show severe depression have an 8.8 higher risk of having suicidal ideation when compared with the group of children presenting this level of depression, but not expressing suicidal ideation (CI: 3.85-20.15). Self-esteem: The group with suicidal ideation showed 52.9% low self-esteem cases a statistically significant difference (p<0.00, χ² = 32.31, gl=2) compared to the group of children with no ideation that presented a 3.1% of it. Gender differences were not found in these groups. Boys and girls who show low self-esteem level have 3.7 more risk to present suicidal ideation compared with the group of children who have better self-esteem (CI: 2.3-5.9). Anxiety: Of the children with suicidal ideation, 37.7% showed a high anxiety level compared to the 18.4% presented by the children without ideation. There were no differences between boys and girls. Showing anxiety indicates a 2.6 times higher risk to present suicide ideas (CI: 1.60-4.32). Discussion Although suicidal ideation was present in school children population in a very significant way, it is considered low risk for this type of behavior. Depression appeared like the risk factor mostly associated with suicidal ideation. Boys showed more depression compared to girls; on the other hand, most studies conducted with adolescents reported that before 12 years old it is likely not to find significant differences between genders perhaps by the gender issues, the biological, hormonal and society characteristics. It is important to point out that some cases of children without depression presenting suicidal ideation were found, this information was supported by other studies. Although depression is an important risk factor, its presence is not essential for the suicidal ideation to be evident. Low self-esteem is more evident as a higher risk factor than anxiety for the presence of suicidal ideation. No significant differences by gender were found. Entering into the subject matter with population under fourteen is difficult not only because the parents' limitations to talk about it, but because of the care it must be taken while working with minors. The access to carry out this kind of research within the private school population is difficult; hence the existing little information about it. As a result of the lack of information, it becomes necessary to put it into execution under a strict methodology and according to the professional ethics in such a way that differences between children with and without suicidal ideation could be identified. Suicide is a multi-factorial character dynamic process and not only a single and changeless event; therefore, it is necessary to study how suicidal ideas are conceived and what context surrounds them from the earliest age. It is recommended to detect at a younger age the process leading to suicidal behavior and factors related to it.

RESUMEN

El suicidio es un problema de salud pública y un fenómeno social que incide sobre el desarrollo humano. A partir de la década de 1970 se observan en nuestro país suicidios en el grupo de infantes y escolares en el rango de edad de cinco a 14 años. Las lesiones autoinfligidas se ubican en el octavo lugar de las causas de defunciones para este grupo etáreo. El comportamiento suicida es un proceso de varias etapas. La primera es la ideación suicida que se refiere a los pensamientos en torno a la propia muerte y es de vital importancia como factor predictor para llegar al suicidio consumado. Aunque existe alguna investigación sobre el tema, ésta es escasa en población menor de 14 años. De ahí que en el presente estudio el objetivo es analizar los factores psicológicos en niños y niñas de 10 a 13 años, a fin de identificar aquellos asociados con la ideación suicida. Material y métodos El estudio fue descriptivo de tipo comparativo, observacional, transversal. Participantes: 631 estudiantes de quinto y sexto de primaria, varones y mujeres con edades de 10 a 13 años, de la ciudad de Hermosillo, Sonora. Instrumentos: Cuestionario en formato autoaplicado con las siguientes escalas: Children's Depresion Inventory CDI, escala de ansiedad manifiesta en niños CMAS-R y el inventario de autoestima de Coopersmith. Procedimiento: Se aplicó la primera parte del cuestionario a 631 niños, posteriormente se trabajó con una submuestra de dos grupos iguales: Uno identificado con ideación suicida (174) y el otro sin ideación (174), a los que se les aplicó la segunda parte del cuestionario. Análisis de datos: Se utilizó la prueba no paramétrica χ² y razón de prevalencias del paquete estadístico SPSS. Resultados La media de edad fue de 10.9 años, la variable sexo quedó a su vez distribuida en 50.8% niñas y 49.2% niños, el 72.1% de ellos en escuelas públicas y 27.9% en escuelas privadas, semejante a la proporción de la matrícula de educación primaria para los grupos de quinto y sexto grados. El 29.2% de los niños y niñas manifestó ideas suicidas. Depresión: El grupo de niños con ideación suicida presentó mayores estados depresivos en comparación con el grupo sin ideación (p<0.00, χ² = 65.66, gl=2). El porcentaje más alto fue localizado en la depresión moderada. Se muestran diferencias por sexo sólo en el grupo sin ideación, siendo más frecuente en los niños (p<0.03, χ² = 6.92, gl = 2). Los niños que presentan depresión grave tienen un riesgo 8.8 veces mayor de tener ideación suicida (IC: 3.85-20.15). Autoestima: El grupo con ideación presenta más casos de autoestima baja en comparación con el grupo sin ideación (52.9% y 23.1 % respectivamente), diferencia que es estadísticamente significativa (p<0.00, χ² = 32.31, gl=2). No se encontraron diferencias por sexo. Los niños y niñas que presentan un nivel de autoestima bajo tienen 3.7 veces mayor riesgo de presentar ideación suicida (IC: 2.3-5.9). Ansiedad: Treinta y siete punto siete por ciento de niños con ideación presentan un nivel de ansiedad alto en contraste con 18.4% de niños sin ideación. Tampoco aquí se presentaron diferencias por sexo. Manifestar ansiedad indica un riesgo 2.6 veces mayor para presentar ideas suicidas (IC: 1.60-4.32). Discusión La ideación suicida está presente en la población infantil escolarizada de Hermosillo, Sonora. La depresión aparece como un factor de riesgo asociado con las ideas suicidas aunque se encontraron casos de niños sin depresión pero con ideación suicida, lo que se observa también en otros estudios. La autoestima baja tiene más probabilidades de ser un factor de riesgo para la ideación suicida que la ansiedad, sin diferencias significativas por sexo. El abordaje del tema en la población menor de catorce años se dificulta no sólo por las limitaciones de los padres/madres para hablar del mismo, sino también por los cuidados que deben tenerse cuando se trabaja con menores. El suicidio es un proceso dinámico de carácter multifactorial y no sólo un hecho estático e individual. Por lo mismo es necesario estudiar cómo se gestan las ideas suicidas desde la más temprana edad. Se recomienda detectar en la edad escolar el proceso que lleva a las conductas suicidas y los factores que se le relacionan. De esta manera se pueden crear programas de prevención orientadas a los niños y prevenir que en la adolescencia se conviertan en parte de la cifra de suicidios.