Asthma and suicidal ideation with and without suicide attempts among adults in the United States: what is the role of cigarette smoking and mental disorders?

BACKGROUND: Evidence of a respiratory diseases and suicidal ideation and suicide attempts link exists. To improve our understanding of the mechanism underlying these links, there is a need for examination of the relationship between specific respiratory disease, such as asthma, and suicidal ideation and behavior. In addition, studies need to examine many common risk factors that may play a role in the association between asthma and suicidal ideation and suicide behavior. OBJECTIVE: To examine the association between asthma and suicidal ideation with and without attempts among adults in the United States, specifically investigating the role of cigarette smoking, nicotine dependence, depression, anxiety, and alcohol abuse. METHODS: Data on 5,692 individuals 18 years and older were drawn from the US National Comorbidity Survey Replication. Descriptive and multivariate logistic regression analyses were conducted to examine the study objectives. RESULTS: The estimates of lifetime prevalence for suicidal ideation without and with attempts and asthma were 8.7%, 4.2%, and 12.0%, respectively. Being a woman, a current smoker, depressed, anxious, an alcohol abuser, or nicotine dependent increased the likelihood of suicidal ideation with attempts and asthma. Asthma was significantly (P < .001) associated with suicidal ideation with but not without attempts. Adjustment for smoking, nicotine dependence, age, sex, and race/ethnicity decreased the association between asthma and suicidal ideation with attempts by 16%. Similarly, adjustment for depression, panic disorder, and alcohol abuse led to a 12.4% decrease in this relationship. Despite these adjustments, independently or combined, a statistically significant (P = .02) association remained between asthma and suicidal ideation with attempts. CONCLUSIONS: Cigarette smoking and concurrent mental health conditions may independently account for significant proportions of the association between asthma and suicidal ideation with attempts. More research is needed to further elucidate the mechanism of the remaining association between asthma and suicide attempts. Modification of smoking behaviors and effective treatment of depression, anxiety, alcohol abuse, and possibly asthma are important suicide prevention strategies.

Critérios adotados na decisao de internar em emergência psiqui trica / Variables related to the decision to admit in the psychiatric emergency room in Brazil

A importância de vari veis demogr ficas, clínicas e contextuais na decisäo de hospitalizar feita em emergência psiqui trica foi avaliada neste trabalho. Os prontu rios de 481 pacientes atendidos na Emergência do Hospital de Saúde Mental de Messejana, em Fortaleza, durante um período de duas semanas, foram analisados retrospectivamente. Dos 481 pacientes examinados, 60 foram internados. A importância das vari veis relacionadas com a decisäo de internar foi examinada através da regressäo logística. Os resultados demonstram que cinco vari veis estäo mais associadas com a decisäo de internar: concordância do paciente com o internamento, escore baixo na escala de avaliaçäo funcional, concordância da família com o internamento, procedência do interior do Estado, violência demonstrada na ocasiäo da consulta de emergência. Ao contr rio de outros centros, esta pesquisa demonstra que o diagnóstico näo é uma das principais vari veis na decisäo de internar. Conclui-se que a decisäo de internar nesta amostra brasileira obedece a critérios diferentes de outros países

Criterios adotados na decisao de internar em emergencia psiquiatrica

A importancia de variaveis demograficas, clinicas e contextuais na decisao de hospitalizar feita em emergencia psiquiatrica foi avaliada neste trabalho. Os prontuarios de 481 pacientes atendidos na Emergencia do Hospital de Saude Mental de Messejana, em Fortaleza, durante um periodo de duas semanas, foram analisados retrospectivamente. Dos 481 pacientes examinados, 60 foram internados. A importancia das variaveis relacionadas com a decisao de internar foi examinada atraves de regressao logistica. Os resultados demonstram que cinco variaveis estao mais associadas com a decisao de internar: concordancia do paciente com o internamento, escore baixo na escala de avaliacao funcional, concordancia da familia com o internamento, procedencia do interior do Estado, violencia demonstrada na ocasiao da consulta na emergencia. Ao contrario de outros centros, esta pesquisa demonstra que o diagnostico nao e uma das principais variaveis na decisao de internar. Conclui-se que a decisao de internar nesta amostra brasileira obedece a criterios diferentes de outros paises.