A brief research report of suicide rates in the Brazilian elderly over a 12-year period: the lack of association of the "Setembro Amarelo" campaign for suicide prevention.

Objectives: Aiming to disseminate information related to suicide prevention in Brazil, the "Setembro Amarelo" campaign has been conducted since 2015. The objective of this study is to assess the association between this campaign and elderly suicide rates over a 12-year period. Methods: Data were gathered from the Mortality Information System and the Notifiable Diseases Information System, established by public institutions in Brazil. An interrupted time-series framework was applied to assess the association between the "Setembro Amarelo" campaign and suicide mortality rates in the elderly population (60 et plus) in the southeastern region of Brazil. We consider three monthly outcomes: all suicides, suicides in males and suicide in females. We operationalize the campaign assuming three effects: short-term, declining and sustained. The period of analysis was from 2011-2022. Results: The suicide-mortality rate over time has remained stable; the average rate in the pre-campaign period was 0.028 and increased slightly to 0.035. Regardless of the campaign's operationalization and the outcome used, results show no significant associations between the campaign and elderly suicide rates. The campaign was associated with non-significant decreased effects of 15% (P=0.532) in the short term, and 16% (P=0.446) assuming the campaign was sustained. Conclusions: There is a lack of association between the campaign and suicide rates, among the elderly in Brazil's southeastern region. As suicide is complex and multifactorial, more research is needed. The campaign, while raising awareness and reducing stigma, may not reduce suicides. To reduce the suicide rate in the elderly requires addressing social, economic and cultural factors, multisectoral interventions, and upholding basic human rights.

The relationship between online searches and suicide.

AIMS: In this study, we examined the relationship between 131 suicide related Google search terms, grouped into nine categories, and the number of suicide cases per month in Ecuador from January 2011 to December 2021. METHODS: First, we applied time-series analysis to eliminate autocorrelation and seasonal patterns to prevent spurious correlations. Second, we used Pearson's correlation to assess the relationship between Google search terms and suicide rates. Third, cross-correlation analysis was used to explore the potential delayed effects between these variables. Fourth, we extended the correlation and cross-correlation analyses by three demographic characteristics - gender, age, and region. RESULTS: Significant correlations were found in all categories between Google search trends and suicide rates in Ecuador, with predominantly positive and moderate correlations. The terms 'stress' (.548), 'prevention' (.438), and 'disorders' (.435) showed the strongest associations. While global trends indicated moderate correlations, sensitivity analysis revealed higher coefficients in men, young adults, and the Highlands region. Specific patterns emerged in subgroups, such as 'digital violence' showing significant correlations in certain demographics, and 'trauma' presenting a unique temporal pattern in women. In general, cross correlation analysis showed an average negative correlation of -.191 at lag 3. CONCLUSION: Google search data do not provide further information about users, such as demographics or mental health records. Hence, our results are simply correlations and should not be interpreted as causal effects. Our findings highlight a need for tailored suicide prevention strategies that recognize the complex dynamics of suicide risk across demographics and time periods.

¿Por qué el suicidio es un problema social?

El suicidio es un problema social y de salud pública persistente; cada año representa una crisis global que afecta a las sociedades contemporáneas. Una perspectiva psicopatológica dominante resume la comprensión actual. Sin embargo, la evidencia empírica sugiere que el suicidio es un fenómeno complejo, ambivalente y multidimensional, que implica aspectos sociales, económicos, culturales y educativos. Cada muerte por suicidio es un fracaso de la sociedad y políticas públicas. El propósito de este trabajo es ofrecer algunas razones para conceptualizar el suicidio como un problema social.

Suicide is a persistent social and public health problem; every year represents a global crisis that affects contemporary societies. A dominant psychopathological perspective summarizes current understanding. However, empirical evidence suggests that suicide is a complex, ambivalent and multidimensional phenomenon, involving social, economic, cultural and educational aspects. Every death by suicide is a failure of society and public policies. The purpose of this work is to offer some reasons to conceptualize suicide as a social problem.

Evaluación de BIZI, nuevo programa en línea en español para prevenir el suicidio desde la comunidad / Evaluation of BIZI, a new Spanish-language online program for community-based suicide prevention / Avaliação do BIZI, um novo programa on-line em espanhol para prevenção de suicídio com base na comunidade

RESUMEN Objetivo. Evaluar el Programa BIZI, un programa de formación de guardianes o gatekeepers (GTK, por su sigla en inglés) en español y con un formato novedoso en línea, autocompletado, breve y de acceso libre desarrollado como parte de la estrategia de prevención de suicidio en Euskadi (España) para mejorar la prevención del suicidio desde entornos comunitarios. Métodos. Un grupo multicomponente de expertos creó el programa y probó su usabilidad en una fase preliminar. Para la evaluación se utilizó un diseño de grupo único y medidas repetidas (antes, posinmediato y a los tres meses). Se evaluó su impacto en las competencias GTK básicas con cuestionarios en línea, así como la adherencia a los contenidos y satisfacción. Se incluyeron en el estudio agentes comunitarios (educadores y trabajadores sociales, ente otros) que respondieron a una invitación enviada por los coordinadores comarcales de salud pública. Resultados. En total, 728 personas accedieron a la formación, y 86% la finalizó. Completaron la evaluación 569 personas (81,2% eran mujeres, la edad media fue de 41,4 años). Las competencias GTK básicas de actitud, autoeficacia y conocimiento mejoraron de manera significativa, y la mejora se mantuvo ≥ 3 meses en una submuestra (P = 0,0001). Conclusiones. Los resultados son prometedores y sugieren la utilidad de BIZI para mejorar la capacidad y la disposición de agentes comunitarios para identificar a personas en riesgo y derivarlos a recursos especializados. Su formato novedoso le confiere ventajas importantes respecto de otros formatos GTK más habituales, y facilita su difusión en entornos de escasos recursos. Es el primer programa de este tipo cuya eficacia ha sido demostrada y también el primero disponible en español.

ABSTRACT Objective. To evaluate the BIZI program, a Spanish-language gatekeeper training program with a novel online self-learning format that is brief and open-access. It was developed as part of the suicide prevention strategy in Euskadi (Spain) to improve community-based suicide prevention. Methods. A group of experts from different fields created the program and tested its usability in a preliminary phase. A single-group design was used for the evaluation, with repeated measurements (before, immediately after, and after three months). Online questionnaires were used to evaluate the program's impact on core competencies for gatekeepers, as well as adherence to content and user satisfaction. Community agents (educators and social workers, among others) who responded to an invitation sent by regional public health coordinators were included in the study. Results. In total, 728 people accessed the training, and 86% completed it; 569 people completed the assessment (81.2% women, mean age 41.4 years). The core gatekeeper competencies of attitude, self-efficacy, and knowledge improved significantly, and improvement was sustained ≥3 months in a subsample (P = 0.0001). Conclusions. The results are promising and suggest that BIZI is useful in improving the capacity and willingness of community agents to identify people at risk and refer them to specialized resources. Its novel format gives it important advantages over other more common gatekeeper training programs, facilitating its dissemination in low-resource environments. It is the first program of its kind whose effectiveness has been demonstrated and also the first available in Spanish.

RESUMO Objetivo. Avaliar o Programa BIZI, um programa de capacitação de gatekeepers em espanhol com um formato inovador on-line autoinstrucional, breve e de livre acesso, desenvolvido como parte da estratégia de prevenção de suicídio em Euskadi (Espanha) para melhorar a prevenção de suicídio em ambientes comunitários. Métodos. O programa foi desenvolvido por um grupo multidisciplinar de especialistas, e sua usabilidade testada em uma fase preliminar. Para a avaliação, foi utilizado um delineamento de grupo único e medidas repetidas (antes, imediatamente após e aos três meses). Foram utilizados questionários on-line para avaliar o impacto sobre as competências básicas do gatekeeper, a adesão ao conteúdo e a satisfação. Fizeram parte do estudo os agentes comunitários (educadores e assistentes sociais, entre outros) que responderam a um convite enviado pelos coordenadores de saúde pública da comarca. Resultados. O programa de capacitação foi acessado por 728 pessoas e concluído por 86% delas. Um total de 569 pessoas concluiu a avaliação (81,2% do sexo feminino, idade média de 41,4 anos). As competências básicas do gatekeeper relativas a atitude, autoeficácia e conhecimento melhoraram significativamente, e essa melhoria se manteve em uma subamostra por um período de 3 meses ou mais (P = 0,0001). Conclusões. Os resultados são promissores e indicam a utilidade do BIZI para melhorar a capacidade e a disposição dos agentes comunitários para identificar pessoas em situação de risco e encaminhá-las para recursos especializados. Seu formato inovador confere vantagens importantes em relação a outros programas de gatekeeper mais comuns e facilita sua disseminação em ambientes com poucos recursos. Esse é o primeiro programa desse tipo com eficácia comprovada, além de ser o primeiro disponível em espanhol.

Suicide prevention in a virtual environment: a roadmap for simulation-based education / Prevención del suicidio en un entorno virtual: guion para la enseñanza basada en una simulación / Prevenção do suicídio em ambiente virtual: roteiro para ensino baseado em simulação

Objective: to build and validate a simulation-based education roadmap on suicide prevention in the virtual environment. Method: methodological research subdivided into a development and validation stage. The roadmap was built using a previously drafted template based on international guidelines on good clinical simulation practices and scientific literature on suicide prevention in the virtual environment. For validation, the roadmap was validated by experts through self-application of an assessment form with answers based on "adequate, fair, and inadequate", with a field for suggestions. Descriptive statistics and the Content Validity Index (CVI≥0.8) were used. Results: nine experts took part in the study, the majority of whom were nurses (66.7%), female (55.6%), with an average age of 42.22 years. All the items in the roadmap met the acceptance criteria (CVI≥0.8). Conclusion: this study provides a useful roadmap for teaching suicide prevention in the virtual environment.

Objetivo: elaborar y validar un guion de enseñanza basada en la simulación sobre la prevención del suicidio en el entorno virtual. Método: investigación metodológica subdividida en etapa de elaboración y validación. La elaboración se realizó a partir de un template creado previamente y basado en lineamientos internacionales sobre buenas prácticas de simulación clínica y literatura científica sobre prevención del suicidio en el entorno virtual. Para la validación los especialistas validaron el guion mediante la autoaplicación de un formulario de evaluación cuyas respuestas son: "adecuado, regular e inadecuado", con un campo para sugerencias. Se utilizó estadística descriptiva e Índice de Validez de Contenido (IVC≥0,8). Resultados: participaron nueve especialistas, la mayoría enfermeros (66,7%), mujeres (55,6%), con una edad promedio de 42,22 años. Todos los elementos del guion cumplieron con el criterio de aceptación (IVC≥0,8). Conclusión: este estudio proporciona un guion útil para la enseñanza sobre la prevención del suicidio en el entorno virtual.

Objetivo: construir e validar um roteiro de ensino baseado em simulação sobre a prevenção do suicídio no ambiente virtual. Método: pesquisa metodológica subdividida em etapa de construção e validação. A construção foi realizada a partir de um template previamente elaborado e embasado por diretrizes internacionais em boas práticas de simulação clínica e literatura científica sobre a prevenção do suicídio no ambiente virtual. Para a validação, o roteiro foi validado por especialistas por meio de autoaplicação de formulário de avaliação com respostas baseadas em: "adequado, regular e inadequado", com campo para as sugestões. Foi utilizada a estatística descritiva e o Índice de Validade de Conteúdo (IVC≥0,8). Resultados: participaram nove especialistas, sendo a maioria enfermeiras (66,7%), gênero feminino (55,6%), com média de idade de 42,22 anos. Todos os itens do roteiro alcançaram o critério de aceitação (IVC≥0,8). Conclusão: este estudo disponibiliza um roteiro útil para ser empregado no ensino sobre a prevenção do suicídio no ambiente virtual.

Scoping review on socioemotional skills in the prevention of suicidal behavior among adolescents / Revisión de alcance de las habilidades socioemocionales en la prevención de la conducta suicida en adolescentes / Revisão de escopo sobre habilidades socioemocionais na prevenção do comportamento suicida em adolescentes

Abstract: Promoting socioemotional skills has been highlighted among the evidence to prevent suicidal behavior in childhood and adolescence. This review aimed to map and analyze national and international scientific papers on initiatives and programs for the prevention of suicidal behavior in adolescence based on the theoretical framework of socioemotional skills. It is a scoping review using the methodology proposed by the Joanna Briggs Institute. Eleven academic bibliographic databases were analyzed, and searches were conducted on institutional websites related to suicide prevention and Google. Papers in Portuguese, Spanish, French, and English from 2010 to July 2022 were included in the review, which consisted of 97 studies, analyzed through data matrix and thematic grouping. The results show that most are international and focused on suicide, not on self-harm alone. In general, they have an informational and instructional bias for professionals, institutions, and governments, proposed laws, programs and action plans, studies on the role of socioemotional skills and intervention research. Few strategies have been clearly tested and validated. The key elements are the ability to perceive, recognize, understand, express, and regulate one's own emotions, get motivated, and build empathy in relationships. Schools are key players in this process and the health system should act as a collaborative network. National and local prevention plans are required, emphasizing the role of schools, the health sector, and intersectoral coordination to promote health and quality of life.

Resumen: El fomento de las habilidades socioemocionales se viene destacando entre las evidencias de prevención de la conducta suicida en la infancia y la adolescencia. Este artículo tiene como objetivo identificar y analizar la producción científica nacional e internacional sobre iniciativas y programas de prevención de la conducta suicida en la adolescencia a partir del marco teórico de las habilidades socioemocionales. Se trata de una revisión de alcance que utiliza la metodología propuesta por el Instituto Joanna Briggs. Se realizaron búsquedas en 11 bases de datos académicas, en sitios web institucionales relacionados con la prevención del suicidio y en Google. Los textos incluidos estaban publicados en portugués, español, francés o inglés, en el período entre 2010 y julio de 2022. La muestra consistió en 97 publicaciones, y se utilizaron la matriz de datos y agrupación temática para analizarlas. Los resultados muestran que la mayoría de las iniciativas son internacionales y dirigidas al suicidio, sin privilegiar la autolesión. En general, tienen un sesgo informativo e instruccional dirigido a profesionales, instituciones y gobiernos, proyecto de ley, programas y planes de acción, estudios sobre el papel de las habilidades socioemocionales e investigación de intervención. Pocas estrategias habían sido probadas y validadas claramente. Los elementos clave fueron la capacidad de percibir, reconocer, comprender, expresarse y regular las propias emociones, motivarse y establecer relaciones de empatía. Las escuelas son las protagonistas, y el sector salud necesita actuar en una red de colaboración. Se necesitan planes de prevención nacionales y locales, que pongan énfasis en el papel de la escuela, del sector salud y de la articulación intersectorial para la promoción de la salud y la calidad de vida.

Resumo: Promover habilidades socioemocionais tem sido destacado, entre as evidências, como prevenção do comportamento suicida na infância e na adolescência. Este artigo visa mapear e analisar a produção científica nacional e internacional sobre iniciativas e programas de prevenção do comportamento suicida na adolescência baseados no referencial teórico das habilidades socioemocionais. Caracteriza-se por uma revisão de escopo utilizando a metodologia proposta pelo Instituto Joanna Briggs. Foram consultadas 11 bases bibliográficas acadêmicas, além de busca em sites institucionais relacionados à prevenção de suicídio e no Google. Foram incluídas publicações em português, espanhol, francês e inglês entre os anos de 2010 a julho de 2022. O acervo foi composto por 97 publicações, analisadas por meio da matriz de dados e agrupamento temático. Os resultados mostram que a maioria das iniciativas é internacional e voltada para o suicídio, sem privilegiar a autolesão. De forma geral, apresentam viés informativo e instrucional voltado para profissionais, instituições e governos, projetos de lei, programas e planos de ação, estudos sobre o papel das competências socioemocionais e pesquisas de intervenção. Poucas estratégias são claramente testadas e validadas. Os elementos-chave são a capacidade para perceber, reconhecer, compreender, expressar e regular as próprias emoções, motivar-se e estabelecer relações de empatia. As escolas são protagonistas e a saúde precisa atuar em rede colaborativa. São necessários planos nacionais e locais de prevenção, enfatizando o papel da escola, do setor saúde e da articulação intersetorial para a promoção de saúde e qualidade de vida.

Mortalidade por suicídio no Brasil: análise temporal (2010-2021) e comparação com os primeiros dois anos da pandemia de COVID-19 / Suicide mortality in Brazil: temporal analysis (2010-2021) and comparison with the first two years of the COVID-19 pandemic

Objetivo: Analisar casos de suicídio no Brasil de 2010 a 2021 e as características sociodemográficas deste fenômeno, incluindo os primeiros dois anos da pandemia de COVID-19, para avaliar a existência de relação dos aumentos de casos de suicídio no Brasil com esta doença. Métodos: Estudo ecológico de linhas temporais, com 140.339 casos analisados a partir das bases de dados do Sistema de Informações sobre Mortalidade (SIM). Taxas e regressões estatísticas foram aplicadas no software STATA®. Resultados: Observou-se maiores taxas de suicídio em homens, solteiros, e residentes nas regiões Sul e Centro-Oeste. A faixa etária de 10 a 19 anos teve crescimento de 1,7 casos x 100 mil habitantes/ano. A análise por região revelou variações significativas nas taxas, sugerindo influência de fatores contextuais. Embora a pandemia tenha gerado impactos na saúde mental, não foi possível estabelecer relação direta entre a COVID-19 e o aumento das taxas de suicídio. Conclusão: Esses resultados reforçam a necessidade de políticas públicas e intervenções preventivas, especialmente para grupos vulneráveis, como os jovens. Abordagem multifatorial é sugerida, considerando fatores socioeconômicos, acesso a serviços de saúde mental e redução do estigma associado com doenças mentais. Em suma, este estudo contribui para a compreensão das tendências temporais e características demográficas dos suicídios no Brasil, ressaltando a importância de investigações longitudinais adicionais para melhor compreensão desse fenômeno complexo. Espera-se que essas evidências fortaleçam as políticas de saúde mental e promovam estratégias mais eficazes de prevenção do suicídio.

Objective: To analyze suicide cases in Brazil from 2010 to 2021 and the sociodemographic characteristics of this phenomenon, including the first two years of the COVID-19 pandemic, to assess whether there was a relationship between the increase in suicide cases in Brazil and this illness. Methods: Ecological timeline study, with 140,339 cases analyzed from the Mortality Information System (SIM) databases. Rates and statistical regressions were performed using STATA® software. Results: Higher suicide rates in men, singles, and residents of the South and Midwest regions were observed. The age group of 10­19 years had an increase of 1.7 cases x 100 thousand inhabitants/year. Analysis by region revealed significant variations in rates, suggesting the influence of contextual factors. Although the pandemic affected mental health, it was not possible to establish a direct relationship between COVID-19 and increased suicide rates. Conclusion: These results reinforce the need for public policies and preventive interventions, especially for vulnerable groups such as young people. A multifactorial approach is suggested that considers socioeconomic factors, access to mental health services, and reduced stigma associated with mental illness. In short, this study contributes to understanding the temporal trends and demographic characteristics of suicides in Brazil, highlighting the importance of further longitudinal investigations to better understand this complex phenomenon. Hopefully, this evidence will strengthen mental health policies and promote more effective suicide prevention strategies.

A randomized 3-month, parallel-group, controlled trial of CALMA m-health app as an adjunct to therapy to reduce suicidal and non-suicidal self-injurious behaviors in adolescents: study protocol.

Background: Suicidal and non-suicidal self-injurious behaviors are among the leading causes of death and injury in adolescents and youth worldwide. Mobile app development could help people at risk and provide resources to deliver evidence-based interventions. There is no specific application for adolescents and young people available in Spanish. Our group developed CALMA, the first interactive mobile application with the user in Spanish, which provides tools based on Dialectical Behavioral Therapy to manage a crisis of suicidal or non-suicidal self-directed violence with the aim of preventing suicide in adolescents and youth. Methods: To test the effectiveness, safety and level of engagement of the CALMA app in people aged 10 to 19 who are treated in mental health services of two public hospitals, we will conduct a parallel-group, two-arm randomized controlled trial. Participants will be assessed face-to-face and via video call at four timepoints: day-0 (baseline), day-30, day-60, and day-90. A total of 29 participants per group will be included. Change in the frequency of suicidal and non-suicidal self-injurious behaviors will be compared between groups, as well as the level of emotional dysregulation, level of app engagement and time of psychiatric admission during the follow-up period. Discussion: This study is particularly relevant to young people given their widespread use of mobile technology, while there are currently no available smartphone app-based self-guided psychological strategies in Spanish that attempt to reduce suicidal behavior in adolescents who are assisted in the public health sector from low and middle-income countries in Latin America. Clinical trial registration: https://clinicaltrials.gov/, NCT05453370.

Factors associated with suicide in physicians: a silent stigma and public health problem that has not been studied in depth.

Suicide is a complex and multifaceted public health issue that affects individuals from all walks of life, including healthcare professionals such as physicians. According to research, physicians have a higher risk of suicide compared to the general population, with an estimated suicide rate that is two to three times greater than that of the general population. Suicide in physicians can have devastating consequences, not only for the individual but also for their patients and colleagues. The factors contributing to suicide in physicians are numerous and often interrelated. Physicians are exposed to numerous stressors in their daily lives, including long work hours, high workload, burnout, and exposure to traumatic events. These stressors can lead to mental health problems such as depression, anxiety, and substance use disorders, which in turn can increase the risk of suicide. In addition to work-related stressors, personal factors such as relationship problems, financial stress, and a history of mental health problems can also contribute to suicide risk in physicians. Stigma and shame around seeking help for mental health issues may also prevent physicians from seeking treatment, exacerbating the problem. Understanding the complex factors that contribute to suicide in physicians is crucial for developing effective prevention strategies. For this reason, it is necessary to know the behavior of this phenomenon and the factors associated with a higher risk of suicide in this population. However, taking into account that different regions of the world vary in socioeconomic, cultural, professional, occupational, and health attributes, it is to be expected that the behavior of these risk factors will also be heterogeneous. At present, it is presumed that there is a significant gap in the evidence, due to a predominance of evidence on this topic from high-income countries. Considering the importance of having a comprehensive understanding of the risk factors for suicide in the medical population and possible strategies to mitigate this condition, the aim of this review is to analyze the most recent evidence on these factors, and to assess the quality of the evidence and gaps that need to be studied further.

DBT-PAHSE Intervention for Reduce Emotion Dysregulation and Suicide Behavior in Mexican Early Adolescents: A Longitudinal Study.

This study aimed to evaluate the effect of time on suicidal behavior, associated risk factors, and protective factors in early Mexican adolescents. Method: With a two-year longitudinal design, which included 18 of 34 adolescents who had previously participated in a DBT skills training program (DBT-PAHSE). The study evaluated ideation, suicide attempt, depression, emotional dysregulation, and psychological resources. Results: We observed differentiating significant differences over time in emotional dysregulation (F = 2.36 p = 0.04, η2= 0.12, ß = 0.72), affective resources (F = 3.94, p = 0.01, η2 = 0.18, ß = 0.82), and suicidal ideation. (F = 2.55, p = 0.03, η2= 0.13, ß = 0.77). In conclusion, the DBT-PAHSE program prevented deaths by suicide. It showed a reduction in emotional dysregulation up to two years after the end of treatment and maintained an increase in emotional and social resources. However, improvements are required to reduce depression over time and strengthen psychological resources.

Parental Perceptions of Their Children's Access to Household Firearms.

OBJECTIVES: To provide a nationally representative estimate of the proportion of gun owners who report a child has independent access to one of their guns, and to describe characteristics of these gun owners relative to other gun-owning parents. STUDY DESIGN: We conducted a cross-sectional analysis of online survey data collected in 2019 from a nationally representative sample of US adults in households with firearms (n = 4030, response 65%). The sample comprised gun-owning respondents living in homes with children (n = 689) who were asked questions about their firearms, including how they were stored, and about who other than themselves had access to their guns: "If you were not there, who in your household could get one of your guns (and load it if it is not loaded already) if they needed to?" RESULTS: Twelve percent of US gun owners in homes with children report that a child has independent access to one of their guns (about one-fifth of those having children under age 12 years only). Gun owners who reported child access were more likely than those who reported no child access to store guns unlocked and loaded, but still one-fifth of those reporting access stored all guns locked and unloaded. CONCLUSIONS: We find that more than 10% of gun owners with children report that a child can independently access one of their guns, including parents who store all guns locked and unloaded suggesting that guidance to parents should focus on access in addition to firearm storage.

Profesores delante del comportamiento suicida de alumnos adolescentes: percepciones e intervenciones / Professores diante do comportamento suicida de alunos adolescentes: percepções e intervenções / Teachers facing the suicidal behavior among adolescent students: perceptions and interventions

Esta pesquisa buscou analisar intervenções de professores do Ensino Médio integrado ao perceberem o comportamento suicida em alunos. Para tanto, desenvolveu-se uma pesquisa de campo, de abordagem qualitativa e natureza aplicada com 12 professores efetivos de uma instituição federal de ensino. Os dados foram coletados por formulário eletrônico (Google Forms) e analisados por meio da análise de conteúdo. Os achados revelaram que os docentes têm uma visão superficial acerca do suicídio e dificuldades em manejar o comportamento suicida de seus alunos e, quando o fazem, tomam como base valores e experiências pessoais; hesitação e insegurança marcam as condutas dos docentes. O estudo realça a necessidade de a escola se tornar um espaço de diálogo e formação docente acerca do comportamento suicida.

En esta investigación se buscó analizar intervenciones de profesores de la enseñanza secundaria integrada al percibir el comportamiento suicida en alumnus. Para tanto, se desarrolló una investigación de cmapo, de abordaje cualitativa y naturaleza aplicada con 12 profesores efectivos de una institución federal de enseñanza. Los datos se recompilaron por formulario electrónico (Google Forms) y analizados através del análisis de contenido. Los hallazgos apuntaron que los docents tienen una visión superficial acerca del suicidio y dificultades en manejar el comportamiento suicida de sus almnos; cuando lo hacen, toman como base valores y experiencias personales; hesitación e inseguridad marcan las condutas de los docents. El studio pone de relieve la necesidad de la escuela volverse espacio de diálogo y formación docente acerca del comportamiento suicida.

This research sought to analyze the interventions of integrated high school teachers when they perceived suicidal behavior in students. Therefore, a field research was developed, with a qualitative approach and applied nature, with 12 permanent professors from a federal educational institution. Data were collected using an electronic form (Google Forms) and analyzed through content analysis. The findings revealed that teachers have a superficial view of suicide and difficulties in managing their students' suicidal behavior; when they do so, they are based on personal values and experiences; hesitation and insecurity mark the conduct of professors. The study highlights the need for the school to become a space for dialogue and teacher training on suicidal behavior.

El suicidio asistido como estrategia de prevención del suicidio traumático / Assisted suicide as prevention against traumatic suicide

En este artículo, el autor reflexiona sobre la importancia de reconocer el suicidio como un problema de salud pública,sus causas y las recomendaciones generales para prevenirlo. Finalmente, propone considerar la muerte médicamente asistida o el suicidio asistido como una estrategia de prevención del suicidio traumático. (AU)

In this article, the author reflects on the importance of recognizing suicide as a public health problem, its causes, and general recommendations to prevent it. Finally, he proposes considering medical assistance in dying or assisted suicide as a prevention strategy against traumatic suicide. (AU)

Moral distress experienced by online suicide prevention volunteers: qualitative research / La angustia moral experimentada por los voluntarios de la prevención del suicidio en línea: investigación cualitativa / Stress moral experimentado por voluntários de prevenção de suicídio online

Abstract: Background: With the increasing number of internet users, it becomes feasible to identify individuals at high risk of suicide and then carry out online suicide prevention. At the same time, online suicide prevention volunteers may encounter moral distress, which requires more attention. Purpose: This study aimed to explore the experience of moral distress in online suicide prevention. Method: The study was carried out as a qualitative study following the method of phenomenology. 11 interviewers were recruited through the purposive sampling method. Data were collected through semi-structured, in-depth face-to-face interviews. Colaizzi's phenomenological framework was used for data analysis. Results: All participants reported they encountered moral distress during online suicide prevention. Four themes were condensed, including: "constraints from the surrounding," "be cruel to be kind," "baby spoiled by free milk," and "when face death and depression" Participants also described their emotional experiences and response when they encountered moral distress. Conclusion: Moral distress in the process of online suicide prevention exists. More attention should be paid to the moral distress and ethical issues in online suicide prevention as the internet gradually becomes a brand-new way to prevent suicide.

Resumen: Antecedentes: Con el creciente número de usuarios de Internet, es posible identificar a las personas con alto riesgo de suicidio y llevar a cabo la prevención del suicidio en línea. Al mismo tiempo, los voluntarios de esta prevención pueden encontrarse con angustia moral, lo que requiere más atención. Objetivo: Este estudio tiene como objetivo explorar la experiencia de la angustia moral en la prevención del suicidio en línea. Método: El estudio se llevó a cabo como un estudio cualitativo siguiendo el método de la fenomenología. Se reclutó a 11 entrevistadores mediante el método de muestreo intencional. Los datos se recogieron mediante entrevistas semiestructuradas y en profundidad, cara a cara. Se utilizó el marco fenomenológico de Colaizzi para el análisis de los datos. Resultados: Todos los participantes informaron que habían encontrado angustia moral durante la prevención del suicidio en línea. Se condensaron cuatro temas, a saber: "limitaciones del entorno", "ser cruel para ser amable", "bebé mimado por la leche gratis" y "cuando se enfrenta a la muerte y la depresión". Los participantes también describieron sus experiencias emocionales y su respuesta cuando se encontraron con la angustia moral. Conclusión: La angustia moral en este proceso existe. Hay que prestar más atención a la angustia moral y a las cuestiones éticas en la prevención del suicidio en línea, ya que Internet se convierte gradualmente en una nueva forma de prevenir el suicidio.

Resumo: Antecedentes: Com o crescente número de usuário de internet, torna-se viável identificar indivíduos com alto risco de suicídio e então conduzir prevenção de suicídio online. Ao mesmo tempo, voluntários de prevenção de suicídio online podem enfrentar stress moral, o qual requer mais atenção. Proposta: Esse estudo objetiva explorar a experiência de stress moral em prevenção de suicídio online. Método: O estudo foi conduzido como um estudo qualitativo seguindo o método da fenomenologia. Foram recrutados 11 entrevistados do método de amostragem intencional. Foram coletados dados através de entrevistas face a face, semiestruturadas e em profundidade. O referencial fenomenológico de Colaizzi foi utilizado para análise dos dados. Resultados: Todos os participantes relataram terem experimentado stress moral durante a prevenção de suicídio online. Quatro temas foram condensados: "limitações do ambiente", "ser cruel para ser gentil", "bebê mimado com leite gratuito" e "quando encarando a morte e a depressão". Os participantes também descreveram suas experiências emocionais e respostas quando enfrentaram stress moral. Conclusão: Stress moral no processo de prevenção de suicídio online existe. Mais atenção deve ser dada ao stress moral e aspectos éticos em prevenção de suicídio online na medida em que a internet se torna gradualmente uma maneira totalmente nova de prevenção de suicídio.

Psychoactive substances use before suicide: detailed analysis of all cases that occurred in the Brazilian Federal District in a 10-years period.

BACKGROUND: Psychoactive substances (PASs) are an important risk factor for suicide. This study investigated the sociodemographic characteristics, data related to the suicidal behavior, the methods employed, the circumstances of the events, and the use of PASs before dying in all suicides that occurred between 2005-2014 in the Brazilian Federal District, comparing cases with positive and negative detection for PASs in the post-mortem analysis to identify groups at greatest risk. METHODS: A population-based, observational, cross-sectional study with an analytical aspect was conducted with suicides cases collected from local police, which toxicological examination was performed (headspace gas chromatographic-mass spectrometry-HS-GC/MS) for detection of ethanol and methanol in blood samples; immunoassay for other substances (cocaine, marijuana, benzodiazepine). RESULTS: The results showed that the increase in the suicide rate was 10 × greater than the population growth, and 44% of the individuals used PASs before suicide. Individuals are more likely to die by suicide at home, be male, have tried before, and change their behavior days before death; they choose to hang as the method and are influenced by alcohol. CONCLUSION: Identifying what sociodemographic characteristics are associated with a fatal suicide attempt among individuals who use PASs and those who do not use and those who have/do not have mental disorders and what methods are employed could be employed as a path to better interventions. Thus, prevention actions could be planned and directed to individuals with greater risk.

Scoping review of 30 years of suicide prevention in university students around the world: efficacy, effectiveness, and cost-effectiveness.

A scoping review of systematic reviews was carried out to identify evidence of efficacy, effectiveness, and cost-effectiveness of universal and selective suicide prevention programs among university students worldwide. Five databases were reviewed using terms in English, Spanish, and Portuguese. The following were the inclusion criteria: systematic review or meta-analysis or meta-synthesis, suicide prevention in college students, evaluation of the efficacy, effectiveness and/or cost-effectiveness of interventions, and peer-reviewed studies. The quality of reviews was assessed. The field of study features three decades of publication in high-income countries. The strategy used, the components of the program, and the target audience to which they are delivered interfere with efficacy. In the psychoeducation strategy, the experiential and didactic components are more efficacious in the knowledge about suicide. And the motivational enhancement component promotes greater self-efficacy in suicide prevention. Programs that take a multimodal approach are effective in increasing short-term attitudes related to suicide and reducing rates of completed suicide. The gatekeeper strategy delivered to peer counselors is the most effective one in the outcomes, including short-term and long-term knowledge about suicide and its prevention and self-efficacy in suicide prevention. A greater number of evaluated studies of gatekeeper interventions were identified, indicating a trend in this research field. No review addressed the effects on subgroups that were classified based on sex, racial or sexual minorities, and special (indigenous) populations. Only one study addressed cost-effectiveness, pointing out that the psychoeducation and gatekeeper strategies have relevant net benefit rates, but the gatekeeper strategy has a higher cost-benefit ratio compared to the psychoeducation strategy. The findings indicate that psychoeducation and gatekeeper interventions tend to be more efficacious when they combine education and skills training to intervene in suicidal behavior. The components of the intervention and the target audience to which it is delivered influence efficacy. Multimodal interventions evaluate completed suicide outcomes, but require greater implementation efforts, in terms of human and financial resources and more time for the evaluation.

Mental health interventions for suicide prevention among indigenous adolescents: a systematic review

ABSTRACT BACKGROUND: The legacies of colonization and of policies of forced assimilation continue to be a cause of intergenerational trauma, manifested through feelings of marginality, depression, anxiety and confusion, which place indigenous peoples at increased risk of suicide. OBJECTIVES: To assess the quality, content, delivery and effectiveness of interventions for preventing suicides among indigenous adolescents. DESIGN AND SETTING: Systematic review conducted with Cochrane methodology, Campo Grande, Mato Grosso do Sul, Brazil. METHODS: The Cochrane library, MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO databases were searched for studies published up to February 2021. The following inclusion criteria were used: published in any language; interventions that aimed to prevent suicides among indigenous adolescents; randomized or non-randomized study with a control or comparative group; and validated measurements of mental health problems. RESULTS: Two studies were identified: one on adolescents in the remote Yup'ik community in south-western Alaska, and the other on Zuni adolescents in New Mexico. Both studies showed evidence of effectiveness in interventions for reducing some of the risk factors and increasing some of the protective factors associated with suicide. High levels of community engagement and culture-centeredness were key anchors of both studies, which ensured that the intervention content, delivery and outcome measurements aligned with the beliefs and practices of the communities. Both studies were judged to have a moderate risk of bias, with biases in sample selection, attrition and inadequate reporting of results. CONCLUSIONS: The current evidence base is small but signaled the value of culturally appropriate interventions for prevention of suicide among indigenous adolescents. REGISTRATION DETAILS: The study protocol is registered in the international prospective register of systematic reviews (PROSPERO); no. CRD42019141754.

Bootstrapping semi-supervised annotation method for potential suicidal messages.

The suicide of a person is a tragedy that deeply affects families, communities, and countries. According to the standardized rate of suicides per number of inhabitants worldwide, in 2022 there will be approximately about 903,450 suicides and 18,069,000 unconsummated suicides, affecting people of all ages, countries, races, beliefs, social status, economic status, sex, etc. The publication of suicidal intentions by users of social networks has led to the initiation of research processes in this field, to detect them and encourage them not to commit suicide. This study focused on determining a semi-supervised method to populate the Life Corpus, using a bootstrapping technique, to automatically detect and classify texts extracted from social networks and forums related to suicide and depression based on initial supervised samples. To carry out the experiments we used two different classifiers: Support Vector Machine (SVM) (with Bag of Words (BoW) features with and without Term-Frequency/Inverse Document Frequency (Tf/Idf), as a weighted term, and with or without stopwords) and Rasa (with the default feature extraction system). In addition, we performed the experiments using five data collections: Life, Reddit, Life+Reddit, Life_en, and Life_en + Reddit. Using the semi-supervised method, we managed to increase the size of the Life Corpus from 102 to 273 samples with texts from the social network Reddit, in a combination Life+Reddit+BoW_Embeddings, with the SVM classifier, with which a macro f1 value of 0.80 was achieved. These texts were in turn evaluated by annotators manually with a Cohen's Kappa level of agreement of 0.86.

Assessment and associations between quality of life and risk of suicide / Avaliações e associações entre qualidade de vida e risco de suicídio / Evaluaciones y asociaciones entre calidad de vida y riesgo de suicidio

This study aimed to verify the extent to which the levels of quality of life are related to and influence suicide risk indices. A descriptive, correlational, quantitative research was performed. A non-probabilistic sample was used which was composed of 11,863 Brazilian participants all over 18 years old, who responded to the Risk Assessment Suicide Scale (RASS) and the World Health Organization Quality of Life BREF Instrument (WHOQOL-BREF), and whose data were analyzed by using descriptive statistics, the Spearman correlation and multiple linear regression using the Statistical Package for Social Sciences (SPSS). The results identify negative, moderate and significant correlations between the constructs, and that the domains of quality of life influence 47.8% of the variations in the suicide risk indices, confirming that the psychological domain is the most relevant within the explanatory model created. The conclusion is that there is a the need for public policies to improve the quality of life and prevent suicide (AU).

Este estudo objetivou verificar em que medida os níveis de qualidade de vida se relacionam e influenciam os índices de risco de suicídio. Realizou-se uma pesquisa descritiva, correlacional, de abordagem quantitativa. Contou-se com uma amostra não probabilística composta por 11.863 participantes - brasileiros e maiores de 18 anos, que responderam à Risk Assessment Suicide Scale (RASS) e ao Word Health Organization Quality of Life Instrument Bref(WHOQOL-bref), cujos dados foram analisados por meio de estatística descritiva, correlação de Spearman e regressão linear multivariada pormeio do Statistical Package for Social Science (SPSS). Os resultados identificam correlações negativas, moderadas e significativas entre os construtos; e que os domínios de qualidade de vida influenciam em 47,8% as variações nos índices de risco de suicídio, constatando que o domínio psicológico é o mais relevante dentro do modelo explicativo criado. Conclui-se a necessidade de políticas públicas para melhoria da qualidade de vida e prevenção de suicídio (AU).

Este estudio objetivó comprobar hasta qué medida los niveles de calidad de vida se relacionan e influyen en las tasas de riesgo de suicidio. Se realizó una investigación descriptiva, correlacional y cuantitativa. Hubo una muestra no probabilística compuesta por 11.863 participantes brasileños mayores de 18 años, que respondieron a la Risk Assessment Suicide Scale (RASS) y al Word Health Organization Quality of Life Instrument Bref(WHOQOL-bref), cuyos datos fueron analizados mediante estadística descriptiva, correlación de Spearman y regresión lineal multivariante en Statistical Package for Social Science (SPSS). Los resultados identifican correlaciones negativas, moderadas y significativas entre los constructos; y que los dominios de calidad de vida influyen en un 47,8% en las variaciones de los índices de riesgo de suicidio, encontrando que el dominio psicológico es el más relevante dentro del modelo explicativo creado. Estos hallazgos revelan la necesidad de políticas públicas para mejorar la calidad de vida y prevenir el suicidio (AU).

Raising Capacity to Address Mental Health Concerns in Costa Rica.

Background A family medicine team based out of Mayo Clinic, Rochester assembled in 2019 to provide home visits and direct care to underserved populations of patients in La Cruz, Costa Rica. In addition to the provision of direct patient care, our team was interested in conducting a community needs-based assessment to identify an area for provider education efforts and the local providers on a chronic health issue using local feedback and physician data. Suicide awareness and prevention were identified as a priority based on rising suicide rates as well as limited psychiatry services in the area, with some major providences having ~0.60 psychiatrists available per 100,000 people. Our group provided a half-day educational course on mental health topics related to suicide awareness for local health workers. The primary objective of this study was to evaluate any lasting changes in practice, confidence, and knowledge among local health workers attributable to our training and add to the limited research on this topic. Methods Two groups of participants (81) from local hospitals were recruited via local providers and divided into two morning and afternoon groups on a single day. Each group comprised primary care providers, nurses, social workers, and finance officers. Both were given the same educational presentation that could be broadly applied to each various role. Our team provided lectures on mental health, as well as how to improve personal resilience. Locally medically trained translators were used. Pre and post-lecture surveys gathered demographic data, experience with these mental health issues, and confidence in addressing mental health concerns. Pre and post-lecture surveys, including open-ended as well as Likert scale and multiple-choice questions, were handed out at the beginning and end of each lecture to all participants. A four to six months follow-up survey was delivered by email using SurveyMonkey to evaluate retention and impact of educational materials. Results The initial two groups of participants (n = 81) were aged 23-60 years (mean: 43), and 67% (39) were female. Work experience ranged from 0 to 37 years (mean: 14) with 64% (37) doing direct patient care. Preliminary lecture content data from participants (n = 44) demonstrated an overall increase in correct responses by +15.4% from the pre-test (percent correct, 38.1%) to post-test (53.5%, p < 0.01). Individuals (n = 55) with past exposure to suicide were much more likely to report asking patients about suicide than those with no prior exposure (56.3% vs. 8.3%; p < 0.01). At the six-month follow-up with participants (n = 11), when asked about their confidence in learning objectives from the lecture given prior, the rates of low confidence decreased as well as the level of high confidence improved but was not statistically significant. The rate of low confidence of respondents' confidence in asking about mental health concerns decreased from 35.2% to 0% (p < 0.01). Conclusions Our group was able to successfully deliver lectures to a mixed audience of health workers in a region self-identified as struggling with mental health issues in Costa Rica. The surveys suggested learning occurred. A trend suggestive that the educational content improved the participants' confidence and knowledge components over time was noted. Future service trips may be able to build on this initial experience to improve on ways to raise capacity while delivering direct care to regions in need.