[Detecting suicide risk at psychiatric emergency services]. / Detecção do risco de suicídio nos serviços de emergência psiquiátrica.

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.

Detecção do risco de suicídio nos serviços de emergência psiquiátrica / Detecting suicide risk at psychiatric emergency services

OBJETIVO: Auxiliar o profissional de saúde na identificação dos fatores de risco e de proteção, e no manejo de pacientes com risco de suicídio, por meio de entrevista clinica, no contexto de emergência médica. MÉTODO: Revisão seletiva da literatura para identificar achados clínicos relevantes e ilustrativos. RESULTADO: A entrevista clinica é o melhor método para avaliar o risco suicida e tem dois objetivos: 1) apoio emocional e de estabelecimento de vínculo; 2) coleta de informações. Existe um número considerável de informações a serem coletadas durante a entrevista: fatores de risco e proteção (predisponentes e precipitantes), dados epidemiológicos, caracterização do ato, aspectos psicodinâmicos, antecedentes pessoais e familiares, modelos de identificação, dados sobre saúde física e rede de apoio social. Dificuldades ao longo da entrevista serão encontradas, mas com conhecimento e treinamento adequado, o profissional poderá abordar e ajudar adequadamente o paciente. Embora várias escalas tenham sido propostas, nenhuma delas demonstrou eficiência para a detecção de risco de suicídio. CONCLUSÃO: Não há como prever quem cometerá suicídio, mas é possível avaliar o risco individual que cada paciente apresenta, tendo em vista a investigação detalhada e empática da entrevista clinica. Impedir que o paciente venha a se matar é regra preliminar e fundamental.

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.

Epidemiology of suicide in Brazil (1980-2000): characterization of age and gender rates of suicide.

OBJECTIVE: To describe the suicide rates in Brazil in recent decades, drawing comparisons with the worldwide epidemiological situation. METHODS: Descriptive analyses of Brazilian suicide data, relating to the 1980-2000 period and extracted from the DATASUS database. Brazilian suicide trends were examined by age and gender. RESULTS: The overall rate of suicide in Brazil increased 21% in 20 years. Men were found to be 2.3 to 4.0 times more likely to commit suicide than were women, and the highest suicide rates were found in the over-65 age group. The greatest increase in suicide rates (1900%) was seen in the 15-24 age range. CONCLUSION: Brazilian suicide rates, although low, are consistent with the global trend toward growth. Although the highest rates are still seen among the elderly, members of the younger population have been killing themselves with ever-increasing frequency.

Epidemiology of suicide in Brazil (1980 - 2000): characterization of age and gender rates of suicide

OBJETIVOS: Descrever as taxas de suicídio do Brasil nas últimas décadas, bem como compará-las com a situação epidemiológica mundial. MÉTODOS: Análise descritiva dos dados brasileiros sobre o suicídio, extraídos a partir do banco de dados de DATASUS, cobrindo o período de 1980-2000. Foram examinadas as tendências de suicídio no Brasil quanto à distribuição etária e gênero. RESULTADOS: A taxa global de suicídio no Brasil cresceu 21% em 20 anos. Os homens se suicidaram de 2,3 a 4 vezes mais que as mulheres e os idosos acima de 65 anos apresentaram as maiores taxas de suicídio. O estrato de jovens entre 15 a 24 anos foi o grupo de maior crescimento (1.900%). CONCLUSAO: A taxa de suicídio no Brasil, embora baixa, segue a tendência mundial de crescimento. Os idosos apresentam as taxas mais altas, mas, em números absolutos, a população jovem está se matando cada vez mais.