ABSTRACT
Palestra "Saindo para uma nova normalidade", proferida pelo Dr. Neury José Botega (Doutor em Saúde Mental pela Universidade Estadual de Campinas – Unicamp) realizada no dia 13/09/2021
Subject(s)
Mental Health , COVID-19ABSTRACT
The objective of this study was to characterize admissions to an emergency hospital due to suicide attempts and verify outcomes in 2 years. Data were collected from medical records and were analyzed using descriptive statistics and logistic regression. The sample consisted of 412 patients (58.7% women; mean age = 32.6 years old, SD = 14.3). Self-poisoning was the most frequent method (84.0%), and they were diagnosed mainly as depressive (40.3%) and borderline personality disorders (19.1%). Previous suicide attempts and current psychiatric treatment were reported by, respectively, 32.0% and 28.4%. Fifteen patients (3.6%, 9 males) died during hospitalization. At discharge, 79.3% were referred to community-based psychiatric services. Being male (OR = 2.11; 95% CI = 1.25-3.55), using violent methods (i.e., hanging, firearms, and knives) (OR = 1.96; 95% CI = 1.02-3.75) and psychiatric treatment history (OR = 2.58; 95% CI = 1.53-4.36) were predictors for psychiatric hospitalization. Of 258 patients followed for 2 years, 10 (3.9%) died (3 suicide), and 24 (9.3%) undertook new suicide attempts. Patients with a history of psychiatric treatment had higher risks of new suicide attempts (OR = 2.46, 95% CI = 1.07-5.65). Suicide attempters admitted to emergency hospitals exhibit severe psychiatric disorders, and despite interventions, they continue to present high risks for suicide attempts and death.
Subject(s)
Borderline Personality Disorder/epidemiology , Depressive Disorder/epidemiology , Poisoning/epidemiology , Suicide, Attempted/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Brazil/epidemiology , Child , Community Mental Health Services , Emergency Service, Hospital , Female , Hospitalization , Humans , Logistic Models , Longitudinal Studies , Male , Middle Aged , Recurrence , Referral and Consultation , Retrospective Studies , Sex Factors , Suicide/statistics & numerical data , Tertiary Care Centers , Violence , Young AdultABSTRACT
CONTEXT AND OBJECTIVE: Knowledge of socioeconomic impact of attempted suicide may sensitize managers regarding prevention strategies. There are no published data on this in Brazil. The aim here was to describe the direct and indirect costs of care of hospitalized cases of attempted suicide and compare these with the costs of acute coronary syndrome cases. DESIGN AND SETTING: Cost-of-illness study at a public university hospital in Brazil. METHOD: The costs of care of 17 patients hospitalized due to attempted suicide were compared with those of 17 acute coronary syndrome cases at the same hospital, over the same period. The direct costs were the summation of the hospital and out-of-hospital costs resulting from the event, determined from the medical records. The indirect costs were estimated through the human capital lost. The Mann-Whitney test and analysis of covariance (ANCOVA) with transformation adjusted for age were used for comparisons. RESULTS: The average costs per episode of attempted suicide were: direct cost, US$ 6168.65; indirect cost, US$ 688.08; and total cost, US$ 7163.75. Comparative analysis showed a difference between the indirect costs to family members, with significantly higher costs in the attempted suicide group (P = 0.0022). CONCLUSION: The cost of care relating to attempted suicide is high and the indirect cost to family members reinforces the idea that suicidal behavior not only affects the individual but also his social environment.
Subject(s)
Cost of Illness , Suicide, Attempted/economics , Acute Coronary Syndrome/economics , Adult , Age Factors , Brazil , Female , Health Care Costs , Hospitalization/economics , Hospitals, General/economics , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Risk Factors , Sex Factors , Socioeconomic Factors , Statistics, NonparametricABSTRACT
CONTEXT AND OBJECTIVE: Knowledge of socioeconomic impact of attempted suicide may sensitize managers regarding prevention strategies. There are no published data on this in Brazil. The aim here was to describe the direct and indirect costs of care of hospitalized cases of attempted suicide and compare these with the costs of acute coronary syndrome cases. DESIGN AND SETTING: Cost-of-illness study at a public university hospital in Brazil. METHOD: The costs of care of 17 patients hospitalized due to attempted suicide were compared with those of 17 acute coronary syndrome cases at the same hospital, over the same period. The direct costs were the summation of the hospital and out-of-hospital costs resulting from the event, determined from the medical records. The indirect costs were estimated through the human capital lost. The Mann-Whitney test and analysis of covariance (ANCOVA) with transformation adjusted for age were used for comparisons. RESULTS: The average costs per episode of attempted suicide were: direct cost, US$ 6168.65; indirect cost, US$ 688.08; and total cost, US$ 7163.75. Comparative analysis showed a difference between the indirect costs to family members, with significantly higher costs in the attempted suicide group (P = 0.0022). CONCLUSION: The cost of care relating to attempted suicide is high and the indirect cost to family members reinforces the idea that suicidal behavior not only affects the individual but also his social environment. .
CONTEXTO E OBJETIVO: O conhecimento do impacto socioeconômico das tentativas de suicídio pode sensibilizar gestores para programas de prevenção. No Brasil, não há dados publicados a esse respeito. O objetivo foi descrever os custos direto e indireto dos cuidados com as tentativas de suicídio de pacientes internados no hospital de uma universidade pública, e compará-los aos custos de casos de síndrome coronariana aguda. TIPO DE ESTUDO E LOCAL: Estudo de custo de doença em hospital universitário público no Brasil. MÉTODO: Os custos dos cuidados de 17 pacientes hospitalizados por tentativas de suicídio foram comparados aos custos de 17 síndromes coronarianas agudas de pacientes internados no mesmo hospital, no mesmo período. Os custos diretos foram o somatório de custos hospitalares e extra-hospitalares decorrentes do evento, determinados por registro hospitalar. Os custos indiretos foram estimados através da perda de capital humano. Teste de Mann-Whitney e análise da covariância (ANCOVA) com transformação por idade foram utilizados para comparação. RESULTADOS: As médias de custos por episódio de tentativa de suicídio foram: custo direto individual, US$ 6168,65; custo indireto individual, US$ 688,08; e custo total, US$ 7163,75. A análise comparativa indica diferença entre os custos indiretos a familiares dos dois fenômenos, com custos significativamente mais elevados no grupo de tentativas de suicídio (P = 0,0022). CONCLUSÃO: O custo dos cuidados com tentativa de suicídio é elevado e o custo indireto a familiares reforça a ideia de que o comportamento suicida não afeta apenas o indivíduo, mas também seu ambiente social. .
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Cost of Illness , Suicide, Attempted/economics , Acute Coronary Syndrome/economics , Age Factors , Brazil , Health Care Costs , Hospitalization/economics , Hospitals, General/economics , Psychiatric Status Rating Scales , Risk Factors , Sex Factors , Socioeconomic Factors , Statistics, NonparametricABSTRACT
O Brasil encontra-se entre os dez países que registram os maiores números absolutos de suicídios, com 9.852 mortes em 2011. O coeficiente médio para o período 2004-2010 foi de 5,7%. Esse índice aumentou 29,5% nas duas últimas décadas e é mais elevado em homens, idosos, indígenas e em cidades de pequeno e de médio porte populacional. Transtornos mentais encontram-se presentes na maioria dos casos de suicídio, principalmente depressão, transtorno do humor bipolar e dependência de álcool e de outras drogas psicoativas. Um estudo populacional revelou que, ao longo da vida, 17,1% das pessoas tiveram ideação suicida, 4,8% chegaram a elaborar um plano para tanto, e 2,8% efetivamente tentaram o suicídio. Dar especial atenção à pessoa que tentou se suicidar é uma das principais estratégias de prevenção do suicídio...
Brazil is among the ten countries that record the highest absolute numbers of suicides, with 9,852 deaths in 2011. The average coefficient for the period of 2004-2010 was 5.7%. This figure increased 29.5% in the last two decades and is higher for men, elders, indigenous and small and mid-sized population towns. Mental disorders are present in most cases of suicide, especially depression, bipolar disorder, and dependence of alcohol and other psychoactive drugs. A population study revealed that, throughout life, 17.1% of people had suicidal ideation, 4.8% developed a suicide plan, and 2.8% actually attempted it. Giving particular attention to a person who has ttempted suicide is a major prevention strategy...
Le Brésil fait partie des dix pays qui enregistrent le plus grand nombre absolu de suicides, avec 9.852 décès en 2011. Le coefficient moyen pour la période 2004-2010 était de 5,7. Ce chiffre a augmenté de 29,5 % au cours des deux dernières décennies et est plus élevé chez les hommes, les personnes âgées, des autochtones et des petites et moyennes populations. Un trouble mental est présent dans la plupart des cas de suicide, en particulier la dépression, le trouble bipolaire, dépendance de lalcool et dautres drogues psychoactives. Une étude de population a révélé que 17,1 % tout au long de la vie ont eu des idées suicidaires, de 4,8 % avait un plan suicide, et 2,8 % ont effectivement tenté...
El Brasil está entre los diez países que registran las cifras absolutas más elevadas de suicidios, con 9.852 muertes en 2011. El coeficiente promedio para el período 2004-2010 fue de 5,7%. Esa cifra aumentó 29,5% en las dos últimas décadas, y es mayor en los hombres, los ancianos, los pueblos indígenas y ciudades con población de tamaños pequeño y medio. Un trastorno mental está presente en la mayoría de los casos de suicidio, especialmente la depresión, el trastorno bipolar, el alcohol y otras drogas psicoactivas. Un estudio poblacional reveló que a lo largo de la vida, el 17,1% de las personas tenían ideas suicidas, 4,8% tenían un plan para el suicidio, y 2,8% en realidad un intento de suicidio. Prestar especial atención a una persona que ha intentado suicidarse es una estrategia importante para la prevención del suicidio...
Subject(s)
Humans , Suicide, Attempted , Suicide/statistics & numerical data , Suicide/psychologyABSTRACT
O Brasil encontra-se entre os dez países que registram os maiores números absolutos de suicídios, com 9.852 mortes em 2011. O coeficiente médio para o período 2004-2010 foi de 5,7%. Esse índice aumentou 29,5% nas duas últimas décadas e é mais elevado em homens, idosos, indígenas e em cidades de pequeno e de médio porte populacional. Transtornos mentais encontram-se presentes na maioria dos casos de suicídio, principalmente depressão, transtorno do humor bipolar e dependência de álcool e de outras drogas psicoativas. Um estudo populacional revelou que, ao longo da vida, 17,1% das pessoas tiveram ideação suicida, 4,8% chegaram a elaborar um plano para tanto, e 2,8% efetivamente tentaram o suicídio. Dar especial atenção à pessoa que tentou se suicidar é uma das principais estratégias de prevenção do suicídio.(AU)
Brazil is among the ten countries that record the highest absolute numbers of suicides, with 9,852 deaths in 2011. The average coefficient for the period of 2004-2010 was 5.7%. This figure increased 29.5% in the last two decades and is higher for men, elders, indigenous and small and mid-sized population towns. Mental disorders are present in most cases of suicide, especially depression, bipolar disorder, and dependence of alcohol and other psychoactive drugs. A population study revealed that, throughout life, 17.1% of people had suicidal ideation, 4.8% developed a suicide plan, and 2.8% actually attempted it. Giving particular attention to a person who has ttempted suicide is a major prevention strategy.(AU)
Le Brésil fait partie des dix pays qui enregistrent le plus grand nombre absolu de suicides, avec 9.852 décès en 2011. Le coefficient moyen pour la période 2004-2010 était de 5,7. Ce chiffre a augmenté de 29,5 % au cours des deux dernières décennies et est plus élevé chez les hommes, les personnes âgées, des autochtones et des petites et moyennes populations. Un trouble mental est présent dans la plupart des cas de suicide, en particulier la dépression, le trouble bipolaire, dépendance de lalcool et dautres drogues psychoactives. Une étude de population a révélé que 17,1 % tout au long de la vie ont eu des idées suicidaires, de 4,8 % avait un plan suicide, et 2,8 % ont effectivement tenté...(AU)
El Brasil está entre los diez países que registran las cifras absolutas más elevadas de suicidios, con 9.852 muertes en 2011. El coeficiente promedio para el período 2004-2010 fue de 5,7%. Esa cifra aumentó 29,5% en las dos últimas décadas, y es mayor en los hombres, los ancianos, los pueblos indígenas y ciudades con población de tamaños pequeño y medio. Un trastorno mental está presente en la mayoría de los casos de suicidio, especialmente la depresión, el trastorno bipolar, el alcohol y otras drogas psicoactivas. Un estudio poblacional reveló que a lo largo de la vida, el 17,1% de las personas tenían ideas suicidas, 4,8% tenían un plan para el suicidio, y 2,8% en realidad un intento de suicidio. Prestar especial atención a una persona que ha intentado suicidarse es una estrategia importante para la prevención del suicidio.(AU)
Subject(s)
Suicide/psychology , Suicide/statistics & numerical data , Suicide, AttemptedABSTRACT
This study analyzed common mental disorders in the elderly according to demographic and socioeconomic characteristics, health-related behavior, and disease history. This was a cross-sectional, population-based study with a cluster sample using data from a health survey conducted in Campinas, São Paulo State, Brazil, in 2008. SRQ-20 was used to evaluate common mental disorders. Adjusted prevalence ratios were estimated using multiple Poisson regression. Prevalence of common mental disorders was 29.7%, and higher rates were associated with female gender, age 80 years or older, lower income, not working, sedentary lifestyle, poor self-rated health, and greater number of chronic diseases. Prevalence ratios were higher in the subscale of depressive thinking. The results provide direct backing for planning interventions focused on health of the elderly, with an emphasis on elderly that work and follow healthy lifestyles. The study highlights the need for attention by health professionals to depressive disorder in the elderly.
Subject(s)
Mental Disorders/epidemiology , Age Factors , Aged , Aged, 80 and over , Body Mass Index , Brazil/epidemiology , Epidemiologic Methods , Female , Humans , Male , Middle Aged , Self-Assessment , Sex Factors , Socioeconomic Factors , Urban PopulationABSTRACT
Analisou-se o transtorno mental comum em idosos segundo variáveis demográficas, socioeconômicas, de comportamentos relacionados à saúde e morbidades. Trata-se de estudo transversal de base populacional, com amostra por conglomerados. A pesquisa utilizou dados de inquérito de saúde realizado em Campinas, São Paulo, Brasil, em 2008. Foi usado o questionário SRQ-20 para avaliar o transtorno mental comum. Foram estimadas razões de prevalências ajustadas por meio de regressão múltipla de Poisson. A prevalência de transtorno mental comum foi 29,7% e significativamente mais elevada no sexo feminino, nos idosos com 80 anos ou mais, menor renda, que não trabalhavam, sedentários, que avaliaram sua saúde como ruim/muito ruim e com maior número de doenças crônicas. Maiores razões de prevalências foram detectadas na subescala de pensamentos depressivos. Os resultados trazem subsídios para o planejamento de intervenções voltadas à saúde dos idosos, com ênfase nos idosos que trabalham e com hábitos de vida saudáveis. Apontam a necessidade de atenção dos profissionais para o quadro depressivo na terceira idade.
This study analyzed common mental disorders in the elderly according to demographic and socioeconomic characteristics, health-related behavior, and disease history. This was a cross-sectional, population-based study with a cluster sample using data from a health survey conducted in Campinas, São Paulo State, Brazil, in 2008. SRQ-20 was used to evaluate common mental disorders. Adjusted prevalence ratios were estimated using multiple Poisson regression. Prevalence of common mental disorders was 29.7%, and higher rates were associated with female gender, age 80 years or older, lower income, not working, sedentary lifestyle, poor self-rated health, and greater number of chronic diseases. Prevalence ratios were higher in the subscale of depressive thinking. The results provide direct backing for planning interventions focused on health of the elderly, with an emphasis on elderly that work and follow healthy lifestyles. The study highlights the need for attention by health professionals to depressive disorder in the elderly.
Se analizaron los trastornos mentales comunes en ancianos, de acuerdo con los comportamientos demográficos, socioeconómicos, de salud y morbilidad. Se realizó un estudio transversal, basado en la población de muestreo por conglomerados de los datos de una encuesta de salud realizada en Campinas, São Paulo, Brasil, en 2008. Se utilizó el SRQ-20 para evaluar la trastornos mentales comunes. Calculamos razones de prevalencia ajustadas por regresión de Poisson múltiple. La prevalencia de trastornos mentales comunes fue de 29,7%, significativamente mayor en las mujeres, las personas mayores de 80 años, de bajos ingresos, que no trabajan, sedentarias, que calificaron su salud como mala/muy mala y con más enfermedades crónicas. Mayores tasas de prevalencia fueron encontradas en las subescalas de trastornos depresivos. Proporcionan información para la planificación de intervenciones centradas en la salud de las personas mayores, con énfasis en las personas y el trabajo con hábitos de vida saludables. Indican la necesidad de atención profesional para los trastornos depresivos en ancianos.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Mental Disorders/epidemiology , Age Factors , Body Mass Index , Brazil/epidemiology , Epidemiologic Methods , Health of the Elderly , Self-Assessment , Sex Factors , Socioeconomic Factors , Urban PopulationABSTRACT
OBJECTIVE: To describe the sociodemographic and clinical profile of patients who underwent electroconvulsive therapy (ECT) at a university general hospital. METHOD: In this retrospective study, records from all patients undergoing ECT between January 1988 and January 2008 at the psychiatric unit of the general hospital of Universidade Estadual de Campinas (UNICAMP) were reviewed. Telephone contact was made with patients/relatives to collect follow-up data. RESULTS: A total of 200 charts were reviewed. The majority of patients were women, with a mean age of 39 years, and history of psychiatric hospitalization. The main indications for ECT were depression and catatonia. Complications were observed in less than half of the cases, and most were temporary and not severe. There was a good psychiatric outcome for 89.7% of the patients, especially for catatonic patients (100%, p = 0.02). Thirty-four percent of the cases were later contacted by telephone calls, at a mean of 8.5 years between the procedure and the contact. Among these, three (1.5%) reported persistent memory disorders and 73% considered ECT a good treatment. CONCLUSION: ECT has been performed according to international guidelines. In the vast majority of cases, undesirable effects were temporary and not severe. Response to ECT was positive in most cases, particularly in catatonic patients.
ABSTRACT
Objective: To describe the sociodemographic and clinical profile of patients who underwent electroconvulsive therapy (ECT) at a university general hospital. Method: In this retrospective study, records from all patients undergoing ECT between January 1988 and January 2008 at the psychiatric unit of the general hospital of Universidade Estadual de Campinas (UNICAMP) were reviewed. Telephone contact was made with patients/relatives to collect follow-up data. Results: A total of 200 charts were reviewed. The majority of patients were women, with a mean age of 39 years, and history of psychiatric hospitalization. The main indications for ECT were depression and catatonia. Complications were observed in less than half of the cases, and most were temporary and not severe. There was a good psychiatric outcome for 89.7% of the patients, especially for catatonic patients (100%, p = 0.02). Thirty-four percent of the cases were later contacted by telephone calls, at a mean of 8.5 years between the procedure and the contact. Among these, three (1.5%) reported persistent memory disorders and 73% considered ECT a good treatment. Conclusion: ECT has been performed according to international guidelines. In the vast majority of cases, undesirable effects were temporary and not severe. Response to ECT was positive in most cases, particularly in catatonic patients.
Objetivo: Descrever o perfil sociodemográfico e clínico de pacientes submetidos a eletroconvulsoterapia (ECT) em um hospital geral universitário. Método: Neste estudo retrospectivo, foram revisados os prontuários de todos os pacientes submetidos a ECT entre janeiro de 1988 e janeiro de 2008 na unidade psiquiátrica do hospital geral da Universidade Estadual de Campinas (UNICAMP). Os pacientes/familiares foram contatados por telefone para a coleta de dados de seguimento. Resultados: Um total de 200 prontuários foram revisados. A maioria dos pacientes era do sexo feminino, com uma idade média de 39 anos e história de hospitalização psiquiátrica prévia. As principais indicações para ECT foram depressão e catatonia. Complicações foram observadas em menos de metade dos casos, e a maioria delas teve caráter temporário e não grave. Houve resultado psiquiátrico favorável em 89,7% dos pacientes, especialmente os catatônicos (100%, p = 0,02). Trinta e nove por cento dos casos foram contatados por telefone, a uma média de 8,5 anos decorridos entre o procedimento e o contato. Entre estes, três (1,5%) relataram transtornos amnésticos persistentes e 73% consideraram a ECT um bom tratamento. Conclusão: A ECT foi realizada de acordo com diretrizes internacionais. Na grande maioria dos casos, efeitos indesejáveis foram temporários e não graves. A resposta à ECT foi positiva na maioria dos casos, especialmente em pacientes catatônicos.
Subject(s)
Humans , Male , Female , Adult , Electroconvulsive Therapy , Health Profile , Psychiatric Department, Hospital , Electroconvulsive Therapy/methods , Retrospective Studies , Socioeconomic Factors , Treatment OutcomeABSTRACT
Objective. To describe suicide rates by county size in the five geopolitical areas of Brazil. Methods. This was an ecological, descriptive study of suicide deaths in Brazil that occurred among the population 10 years of age and older in 20042010. Data were obtained from the National Mortality Information System of Brazil. Counties were defined by size as: very large (200 000+), large (< 200 000100 000), medium (< 100 00050 000), small (< 50 000 20 000), very small (< 20 00010 000, and micro (< 10 000). Age-adjusted suicide rates were calculated for all counties and for population-size groups in each geopolitical area. Rate ratio and 95% confidence interval were used to compare suicide risk between groups and the reference. Results. The national, average suicide mortality rate was 5.7 deaths/100 000 inhabitants. Except in the North and North-East, suicide mortality rates increased from the very large (> 200 000) to the micro counties (< 10 000 population). Very high rates were scattered in the North and Mid-West among the indigenous peoples (> 30 deaths per 100 000). At highest risk were micro counties in the South (13.6 deaths per 100 000), with elderly males (60+ years, 31.4) and males 4059 years (31.3) being the sex/age group with the highest rates. Conclusions. To reduce suicide mortality in Brazil, public health authorities must support mental health training in small cities and multi-professional interventions among the indigenous peoples. In addition, the causes behind underreporting of suicide deaths must be resolved in several areas.
Objetivo. Describir las tasas de suicidio según el tamaño del municipio en las cinco áreas geopolíticas del Brasil. Métodos. Estudio ecológico y descriptivo de las defunciones por suicidio en el Brasil ocurridas en la población de 10 años de edad y mayores en el período del 2004 al 2010. Se obtuvieron datos del Sistema Nacional de Información sobre Mortalidad del Brasil. Los municipios fueron definidos según su tamaño como: muy grandes (200 000 o más habitantes), grandes (de 100 000 a menos de 200 000), medios (de 50 000 a menos de 100 000), pequeños (de 20 000 a menos de 50 000), muy pequeños (de 10 000 a menos de 20 000) y micromunicipios (menos de 10 000). Se calcularon las tasas de suicidio ajustadas por edad para todos los municipios y según el tamaño de la población en cada área geopolítica. Se utilizaron la razón de tasas y el intervalo de confianza de 95% para comparar el riesgo de suicidio entre los distintos grupos y el grupo de referencia. Resultados. La tasa nacional promedio de mortalidad por suicidio fue de 5,7 defunciones/ 100 000 habitantes. Excepto en el norte y en el noreste las tasas de mortalidad por suicidio aumentaron entre los municipios muy grandes (más de 200 000) y los micromunicipios (menos de 10 000 habitantes). Se observaron tasas muy elevadas dispersas en el norte y el centro oeste entre las personas indígenas (más de 30 defunciones por 100 000). El mayor riesgo fue observado en los micromunicipios del Sur (13,6 defunciones por 100 000), donde los varones ancianos de más de 60 años (31,4) y los de 40 a 59 años (31,3) fueron los grupos de edad y sexo que presentaron las tasas más elevadas. Conclusiones. Para reducir la mortalidad por suicidio en el Brasil, las autoridades de salud pública deben abordar la capacitación en materia de salud mental en las pequeñas ciudades y promover las intervenciones interdisciplinarias en los pueblos indígenas. Además, en varias zonas se deben resolver las causas que provocan la insuficiente notificación de las defunciones por suicidio.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Young Adult , Suicide/statistics & numerical data , Brazil/epidemiology , Time FactorsABSTRACT
OBJECTIVE: To describe suicide rates by county size in the five geopolitical areas of Brazil. METHODS: This was an ecological, descriptive study of suicide deaths in Brazil that occurred among the population 10 years of age and older in 2004-2010. Data were obtained from the National Mortality Information System of Brazil. Counties were defined by size as: very large (200,000+), large (< 200,000-100,000), medium (< 100,000-50,000), small (< 50,000-20,000), very small (< 20,000-10,000, and micro (< 10,000). Age-adjusted suicide rates were calculated for all counties and for population-size groups in each geopolitical area. Rate ratio and 95% confidence interval were used to compare suicide risk between groups and the reference. RESULTS: The national, average suicide mortality rate was 5.7 deaths/100,000 inhabitants. Except in the North and North-East, suicide mortality rates increased from the very large (> 200,000) to the micro counties (< 10,000 population). Very high rates were scattered in the North and Mid-West among the indigenous peoples (> 30 deaths per 100,000). At highest risk were micro counties in the South (13.6 deaths per 100,000), with elderly males (60+ years, 31.4) and males 40-59 years (31.3) being the sex/age group with the highest rates. CONCLUSIONS: To reduce suicide mortality in Brazil, public health authorities must support mental health training in small cities and multi-professional interventions among the indigenous peoples. In addition, the causes behind underreporting of suicide deaths must be resolved in several areas.
Subject(s)
Suicide/statistics & numerical data , Adolescent , Adult , Brazil/epidemiology , Child , Female , Humans , Male , Middle Aged , Time Factors , Young AdultABSTRACT
Dez anos após seu lançamento, Prática psiquiátrica no hospital geral: interconsulta e emergência chega à sua terceira edição ampliado e atualizado, abordando tanto elementos da psicologia médica como da psiquiatria. Nos últimos anos, o reconhecimento e o interesse pela psiquiatria como área cada vez mais integrada a outras especialidades da saúde aumentou consideravelmente, assim como o conhecimento a ser dominado pelo psiquiatra de hospital geral. Em decorrência dessa nova realidade, nesta edição, os autores, destacados profissionais brasileiros e estrangeiros da área da saúde, tiveram o cuidadoso trabalho de atualização e de inclusão de novos temas.
Subject(s)
Humans , Emergencies/psychology , Health Knowledge, Attitudes, Practice , Hospitals, Psychiatric , Psychology, Medical/methodsSubject(s)
Suicide , Mortality , External Causes , Suicide , Mortality , External Causes , Time Factors , Brazil , Brazil , SuicideABSTRACT
Manual dirigido a profissionais das equipes de saúde mental. Aborda várias questões relacionadas como depressão, esquizofrenia, abuso do álcool, atenção ao paciente, centros de atenção psicossocial etc. A publicação faz parte da Estratégia Nacional de Prevenção do Suicídio e teve a colaboração da OPAS, UNICAMP e Ministério da Saúde.
Subject(s)
Public Health , Mental Health , Suicide , Risk Factors , Alcoholism , Depression , Schizophrenia , Mental Health ServicesABSTRACT
The objective of this study was to improve health professionals' knowledge and attitudes toward suicide prevention. A suicide prevention training of 18 hours duration was conducted with 270 health professionals, mainly primary care workers, who were routinely involved with patients at high risk for suicide. Questionnaires were used to assess changes in attitudes and knowledge. The score in the knowledge questionnaire, with 21 points as maximum value, increased from 8.9 to 13 points (p < .001, significance level of 95%). Of the 25 questionnaire items representing attitudes, 18 showed significant change after the training. This training model has enhanced knowledge and attitudes toward suicide prevention in healthcare workers.
Subject(s)
Attitude of Health Personnel , Education, Continuing/methods , Health Knowledge, Attitudes, Practice , Health Personnel/education , Practice Patterns, Physicians'/statistics & numerical data , Suicide Prevention , Adult , Brazil , Female , Humans , Male , Middle Aged , National Health Programs/organization & administration , Patient Care Planning , Professional Competence , Professional-Patient Relations , Urban PopulationABSTRACT
OBJECTIVE: To estimate the frequency of depression/anxiety and to establish the social, epilepsy and psychiatric characteristics in individuals with epilepsy. METHOD: A cross-sectional study was employed to evaluate 153 subjects with epilepsy who were identified in a previous community-based survey. First, a structured interview was conducted, followed by a psychiatric evaluation. Subjects with depression were compared to those without, and subjects with anxiety were compared to those without. RESULTS: The prevalence of anxiety and depression was 39.4 and 24.4%, respectively. Both were associated with low schooling (OR 3.8, 95% CI 1.6 to 9.0 and OR 2.8, 95% CI 1.2 to 6.5 for depression and anxiety, respectively), lifetime suicidal thoughts (OR 4.4, 95% CI 1.9 to 10.3 and OR 3.6, 95% CI 1.7 to 7.7) and lifetime suicide attempts (OR 9.3, 95% CI 2.6 to 32.8 and OR 6.9, 95% CI 1.8 to 26.4). CONCLUSION: The high rates of depression and anxiety reinforced the need for recognition and treatment of mental disorders in epilepsy.
Subject(s)
Anxiety/epidemiology , Depression/epidemiology , Epilepsy/psychology , Suicide, Attempted/psychology , Adolescent , Adult , Anxiety/diagnosis , Brazil/epidemiology , Cross-Sectional Studies , Data Collection , Depression/diagnosis , Epilepsy/epidemiology , Female , Humans , Male , Psychiatric Status Rating Scales , Socioeconomic Factors , Suicide, Attempted/statistics & numerical data , Young AdultABSTRACT
O artigo descreve a história do ensino da psicoterapia na Residência Médicaem Psiquiatria da Faculdade de Ciências Medicas da Universidade Estadualde Campinas (UNICAMP). Inicialmente baseado no referencial psicanalítico, oensino da psicoterapia acabou perdendo espaço, devido à crescente demandaassistencial, ao agravamento do perfil clínico dos pacientes e a uma práticaclínica mais descritiva e pautada em tratamento farmacológico, juntamentea aposentadoria da primeira geração de professores psicanalistas na décadade 1990. Nesse contexto surgiu a proposta de um atendimento de criseque incluísse os aspectos psicoterápicos na assistência ao paciente como umaprimeira tentativa de sanar essa deficiência. A experiência está em pleno andamento. O programa atual do Atendimento de crise no Ambulatório de Psiquiatria do Hospital de Clínicas da Unicamp é apresentado, bem como seus os pontos fortes e os perigos inerentes e cuidados a serem tomados nessetipo de atendimento.
Subject(s)
Psychotherapy/education , Psychotherapy/historyABSTRACT
O artigo descreve a história do ensino da psicoterapia na Residência Médicaem Psiquiatria da Faculdade de Ciências Medicas da Universidade Estadualde Campinas (UNICAMP). Inicialmente baseado no referencial psicanalítico, oensino da psicoterapia acabou perdendo espaço, devido à crescente demandaassistencial, ao agravamento do perfil clínico dos pacientes e a uma práticaclínica mais descritiva e pautada em tratamento farmacológico, juntamentea aposentadoria da primeira geração de professores psicanalistas na décadade 1990. Nesse contexto surgiu a proposta de um atendimento de criseque incluísse os aspectos psicoterápicos na assistência ao paciente como umaprimeira tentativa de sanar essa deficiência. A experiência está em pleno andamento. O programa atual do Atendimento de crise no Ambulatório de Psiquiatria do Hospital de Clínicas da Unicamp é apresentado, bem como seus os pontos fortes e os perigos inerentes e cuidados a serem tomados nessetipo de atendimento.(AU)
Subject(s)
Psychotherapy/education , Psychotherapy/historyABSTRACT
OBJECTIVE: Guide the health professional to identify risk factors and forms of protection, together with handling such patient throughout a clinical interview within the emergency service context. METHOD: Selected literature revision so as to identify relevant and illustrative key cases. RESULTS: The clinical interview is the best method to evaluate the suicidal risk and has two different aims: 1) emotional support and creation of a bond; 2) collecting information. There is a substantial amount of information to be collected during the clinical interview, such as: risk factors and protection, epidemiologic data, act characterization, psychical dynamics aspects, personal and familial historic patterns, identification models, data on physical wealth and social net support. Difficulties are to emerge throughout the clinical interview, but a trained and informed professional will be able to approach and adequately add the patient. Although several scales have been proposed, none of them have been efficient to deter the suicidal risk. CONCLUSION: There is no method to predict who is to commit suicide, nevertheless, it is possible to evaluate the individual risk of each patient with regards to a detailed and empathic clinical interview. Prevent the patient to commit suicide is the preliminary and fundamental rule.