ABSTRACT
Antecedentes: el intento de suicidio es el principal factor de riesgo de muerte por suicidio. La Organización Mundial de la Salud sugiere grupos de apoyo como intervención para esta población. Objetivo: Este estudio tuvo como objetivo determinar la eficacia de los grupos de apoyo de pares para sobrevivientes de intento de suicidio (SOSA). Método: Revisión sistemática (PROSPERO ID: CRD42022307581). Resultados: En total se identificaron 946 artículos potenciales, se revisaron 81 textos completos y se incluyó un artículo. El artículo informa sobre un estudio piloto abierto con evaluaciones pre y post intervención, sin grupo de control y con alto riesgo de sesgo. Esta es una intervención prometedora, porque los resultados mostraron una disminución de la ideación suicida (d=0,33), y del intento de suicidio (d=0,31). El pequeño número de investigaciones empíricas limita las generalizaciones. Conclusión: El nivel de certeza de la evidencia es bajo (baja certeza), por lo tanto, el grado de recomendación corresponde a evidencia insuficiente (I), para recomendar esta estrategia para las políticas públicas. En este artículo se analizan las razones de estos resultados y los posibles caminos para avanzar en este campo.
Background: Suicide attempt is the main risk factor for death by suicide. The World Health Organization (WHO) suggests support groups as an intervention for this population. Objective: This study aimed to assess the efficacy of peer-support groups for survivors of suicide attempt (SOSA). Method: Systematic review (PROSPERO ID: CRD42022307581). Results: In total, 946 potential articles were identified, 81 full texts were reviewed, and one article was included. The article reported an open-label pilot study with pre- and post-intervention evaluations, without a control group, and with a high risk of bias. This is a promising intervention because the results showed decreased suicidal ideation (d=0.33) and suicide attempt (d=0.31). The small number of empirical investigations limit generalizations. Conclusion: The level of certainty of evidence is low (low certainty); therefore, the grade of recommendation corresponds to insufficient evidence (I) to recommend this strategy for public policies. The reasons for these results and possible paths to advance the field are discussed in this article.
ABSTRACT
Introduction: Suicide is a relevant subject to public health. Its incidence has increased in Chile during the last decade. The current study aims to analyze psychological factors mediating the influence of depressive symptomatology in suicide ideation and attempt in mental health patients. Method: 96 mental health patients from public services and private practice, 67 percent female, with an average age of 30.7 years (SD = 12.2) answered Goldbergs 12 item general health questionnaire (GHQ-12), Becks hopelessness scale (BHS) and coping inventory for stressful situations (CISS-21). Logistic regression and mediation analysis were used to establish suicide ideation and lifetime suicide attempt risk. Results: 22.9 percent of patients had suicide ideation during the last six months and 41.7 percent tried to commit suicide at least once during their lives. Logistic regression results shows that, after controlling for depressive symptomatology, hopelessness influences suicide ideation, and task-oriented coping influences lifetime suicide attempt. Hopelessness mediates the association between depressive symptoms and suicide ideation, and task-oriented coping mediates between depressive symptomatology and history of suicide attempt. Conclusions: Psychological factors such as hopelessness and task-oriented coping mediate the association between depressive symptomatology and non-lethal suicidal behavior, therefore they must be specifically considered in the treatment of patients at suicide risk.
Introducción: El suicidio es un problema de salud pública. Pese a los avances en salud mental, las tasas de suicidio han aumentado en Chile en la última década. El presente estudio busca identificar factores psicológicos que medien la influencia de la sintomatología depresiva en la ideación e intento de suicidio en pacientes de salud mental. Método: 96 pacientes de salud mental, de servicios públicos y consulta particular, 67 por ciento mujeres, con edad promedio de 30,7 años (DS = 12,2) respondieron los cuestionarios de salud de Goldberg (GHQ-12), de desesperanza de Beck (BHS) y de afrontamiento a situaciones estresantes (CISS-21). Se realizaron análisis de regresión logística y de mediación para determinar la influencia de los factores psicológicos en la ideación e intento suicida de los pacientes evaluados. Resultados: Un 22,9 por ciento de los pacientes encuestados había pensado en quitarse la vida en los últimos seis meses y un 41,7 por ciento había intentado suicidarse al menos una vez durante su vida. Los resultados de las regresiones logísticas muestran que, controlando la sintomatología depresiva, la desesperanza influye sobre ideación suicida, y el afrontamiento centrado en la tarea sobre el antecedente de intento de suicidio. La desesperanza media la relación entre síntomas depresivos e ideación suicida, y el afrontamiento centrado en la tarea media entre la sintomatología depresiva y antecedente de intento de suicidio. Conclusiones: Factores psicológicos como desesperanza y afrontamiento centrado en la tarea mediarían la relación entre sintomatología depresiva, y conducta suicida no letal, por lo que deben ser considerados de forma específica en el tratamiento de pacientes con riesgo suicida.
Subject(s)
Humans , Male , Adult , Female , Young Adult , Middle Aged , Adaptation, Psychological , Depression/psychology , Motivation , Suicidal Ideation , Cross-Sectional Studies , Mental Health , Surveys and QuestionnairesABSTRACT
Gallbladder cancer is generally associated with a poor prognosis, with local recurrence being the main pattern of failure. In an attempt to improve on the present status of management, we evaluated a prospective Phase II study involving preoperative 5-fluorouracil and radiation. Among 27 eligible patients with a potentially resectable gallbladder cancer detected after cholecystectomy, 18 were treated with preoperative radiation (4500 cGy; 180 cGy/fraction, 5 days/week) concurrent with a continuous infusion of 5-fluorouracil (350 mg/m2/day, days 1-5 and 21-25). Toxicity included leukopenia (8 patients) and thrombocytopenia (7 patients). Delay in surgery due to hematological toxicity was seen in 6 patients. Of the 18 patients, 15 underwent a reoperation. Resection was performed in 13 (86%). Pathologic findings after reoperation revealed residual tumor in both liver and lymph nodes in 3 patients. At a median follow-up of 24 months, 7 patients are alive. Among the patients who died after curative resection, local recurrence was demonstrated in only 1. This is the first report concerning preoperative chemoradiation in gallbladder cancer. To assess its effect on survival, a prospective randomized trial will be necessary.
