Situación de la conducta suicida en estudiantes de colegios y universidades de San Juan de Pasto, Colombia / Suicidal behaivor in high school and college students in San Juan de Pasto, Colombia

ABSTRACT

Suicidal behavior, in its different manifestations, represents an international public health problem, being one of the ten main causes of general mortality and one of the three top main causes of death in adolescence and young adulthood. The statistics of suicidal attempts are also very worrying, even more if it is considered that for each case of suicide attempt attended in a health-care center, it is estimated that there are four non-reported and non-attended cases. Several studies report the importance of considering the role of some risk factors such as a family loss, a family history of suicidal behaviors, severe mental health problems in the family, economic problems, personality disorders, non-stable mood state, aggressiveness, impulsiveness and social alienation. When those problems are combined with alcohol or drug abuse, the suicide risk is higher. The presence of suicidal behaviors in Latin-Americans high school and university students has been reported by different papers in which the suicidal ideation indicators range from 8% to 25% and the suicide attempts vary from 8% to 12%. In these papers the difference between women and men is highlighted, given that the first group has a higher propensity of suicidal attempts and men group is in full risk of comitted suicide. There are no statistics that confirm the differences between high school and university students. Some studies have confirmed the importance of stressful life events in the suicide phenomenon during adolescents, especially of interpersonal and emotional stressors. Few studies have inquired about the characteristics of suicidal behaviors in student population in Colombia. For this reason, health promotion and suicide prevention actions have not reached the expected effects. The purpose of this study is to know the prevalence and the characteristics of suicidal behavior in high school and college students in the city of San Juan de Pasto. A descriptive study was developed with 463 students belonging to six high schools and two universities, which ensures equal proportions regarding level (high school or university), gender and type of education (public or private). Their ages range from 9 to 30 years old. The Parasuicide Indicators Schedule (CIP- Cédula de Indicadores Parasuicidas) was applied; it was part of a battery of tests of the <students of San Juan de Pasto>> project, which was approved by the ethical committee of the University of Nariño. The stressful life events questionnaire for adolescents (Cuestionario de Eventos Estresantes Vitales para Adolescentes -EEVA-Udenar) was applied to a randomly selected sub-sample. The prevalence of suicidal behavior was of 30%, 18% of the sample analyzed had suicidal thoughts, 4% had suicidal plans and 8% reported previous suicide attempts. The suicidal behavior was more frequent in women than in men and it is unsettling that the proportion of suicide attempts between women and men is 31. Suicide behaviors were more frequent in students whose ages ranged from 17 to 20 years old. Suicide attempts are more common in students with ages between 25 and 30 years old and from 13 to 20 years old. Moreover, the suicidal ideation was highly reported in students with ages ranging from 17 to 24 years old. In addition the highest prevalence of suicidal behavior took place during university years, but 9th graders are the group with the highest risk of suicide attempts. However, suicidal behavior is reported to be more common in university students than in high school students. This tendency was equal as for ideations and plans, but the proportions were the same for suicide attempts. The students of public institutions reported a higher presence of suicidal behaviors, specifically in ideations and plans, but the situation is the opposite for suicide attempts. Using the ANOVA procedure, it was found that the presence of stressful life events was different for each kind of suicidal behavior. In this way, the highest frequencies were found in suicide attempters, followed by the <> and the <>. Finally, the lowest frequencies were found in the non-suicidal students. However, these differences were not found in the intensity of stressful life events. The main events related to suicide attempts were sexual violence, physical family abuse, living far away from one's family and suicidal behaviors in a member of the family. On the other hand, the events mainly related to suicide ideation were parents divorce, terminal illness, losing a job and suicidal behaviors in a member of the family. Most of the attempters have presented a self-harming behavior at least once, but the main average was 2.25 times during their life. The first attempt was carried out at an age ranging from 7 to 22 years, the average was 14 years old, but the type is in the rank between 13 and 15 years old (47%). Near 40% of attempters had a real intention of ending their lives and 42% of them were not worried about living or dying. The purpose of the suicidal behavior was mainly dying, ending their problems, getting attention and ending suffering. The most highly reported self injury method was cutting themselves with sharp objects, followed by the ingestion of pills. Sixty six percent of the suicide attempts were not reported to somebody and only 22% of the cases were taken to some health center; in other words, only one of five suicide attempts could be registered in government statistics. When these persons carried out a suicide attempt, they doubted about the effectiveness of the method and only one third expected death to be a sure event. More than half of the suicide attempters did not ask for help. However when they did, women turned to friends and spiritual counselors, while men looked for the family and friend support. The high rate of suicidal behaviors in high school and college students in the city of San Juan de Pasto was evidenced. The prevalence of suicidal ideation was higher than the prevalence found in other studies, and the suicide attempts were fewer. The age in which people turned into a full risk group ranged from 17 to 24 years old, although the suicidal behaviors first showed up around 11 years old, which is the tendency showed in other countries. It was identified that stressful life events associated with suicidal ideation had the characteristic of threat, and those related with suicide attempt had the characteristic of harm or loss, proposed by Folkman and Lazarus. The crucial role of some stressful life events in the origin of the suicidal behavior was demonstrated. Specifically, being a victim of sexual abuse is a key event for the beginning of the suicidal process. The presence of repeated suicide attempts is a risk factor to commit suicide, because the predictor value of that event has been demonstrated. Moreover, the presence of suicide ideation makes more probable the presence of a more hazardous behavior in the future. When the students look for ending their problems or stop being a problem for other people, at the moment of the suicide attempt, the serious conflict that the adolescents live in this age is shown. Since the suicide attempt is a very private event, the under-report of the suicide attempts is a matter of concern. That suggests why the governmental statistics are actually so high. This situation demands early preventive actions to identify cases in high risk of suicidal behavior. A new issue studied in this work is the difference between public and private institutions, students belonging to the former have a higher propensity to suicidal ideations while the latter have more risk to attempt suicide. The overview offered by this paper urges coordinated actions to identify and intervene in high risk cases to prevent suicide behavior and to promote life.

RESUMEN

La conducta suicida en sus distintas formas representa un problema de salud pública internacional, ya que se encuentra dentro de las diez principales causas de mortalidad general y entre las tres primeras causas de muerte en el grupo de adolescentes y adultos jóvenes. Las estadísticas acerca de los intentos de suicidio también son preocupantes y más aún si se considera que por cada caso de intento de suicidio que recibe ayuda en un centro de salud, se estima que existen cuatro intentos no reportados, ni atendidos. Diversas investigaciones han señalado la importancia de considerar el papel de algunos factores de riesgo, tales como la pérdida de algún familiar, la presencia previa de una historia de suicidio en la familia, problemas graves de salud mental en la familia, los factores económicos, alteraciones de la personalidad, estado de ánimo inestable, agresividad, impulsividad y alienación social. Cuando éstas se combinan con abuso de alcohol y drogas aumenta el riesgo de suicidio. La presencia de conductas suicidas en estudiantes de educación secundaria y universitaria de Latinoamérica ha sido reportada por diferentes investigaciones, en las cuales se han hallado indicadores de ideación suicida que oscilan entre el ocho y el 25% de los casos, mientras que los intentos de suicidio varían entre el ocho y el 12%. El objetivo de este estudio se centró en conocer la presencia y las características de las conductas suicidas en estudiantes de colegios y universidades de la ciudad de San Juan de Pasto. Se llevó a cabo un estudio de tipo descriptivo, con 463 estudiantes, pertenecientes a seis colegios y dos universidades, de edades comprendidas entre nueve y 30 años, garantizando participaciones similares por nivel (secundaria o superior), género y sector (público o privado). Se aplicó una versión adaptada de la Cédula de Indicadores Parasuicidas (CIP), la cual fue parte de una batería de pruebas del proyecto <estudiantes de la ciudad de San Juan de Pasto>>, proyecto avalado por el Comité de ética de la Universidad de Nariño. Los resultados mostraron que cerca de un 30% de los estudiantes encuestados ha tenido alguna conducta suicida durante su vida. De esta manera, se encontró que 18% presentaron ideas suicidas y el 8% llevaron a cabo intentos de suicidio. Los análisis de contingencia demostraron que la conducta suicida se presenta de manera distinta dependiendo del género y del nivel educativo (secundaria o superior). Además, se halló mayor presencia de conductas suicidas en mujeres, en jóvenes entre los 17 y 20 años, en universitarios y en estudiantes del sector público. Igualmente, se halló que el número de episodios de autolesión varía entre 1 y 10, los cuales se presentan por primera vez entre los 13 y 15 años de edad. Además, la mayoría de personas recuerda que no le interesaba si vivía o moría y pensaban que la muerte era posible. Los métodos de suicidio más utilizados fueron el corte con objetos filosos, el consumo de pastillas o medicamentos y la ingesta de otras sustancias. El objetivo de la conducta fue principalmente morirse, terminar con los problemas y dejar de ser carga para otros. De todas las personas que reportaron un intento de suicidio, tan sólo un 20% acudió a un servicio de salud y otro 48% lo comentó con alguien. Al revisar la presencia de eventos vitales estresantes se halló que quienes habían tenido un intento de suicidio presentaron un mayor número de eventos estresantes. Los eventos asociados con intento de suicidio fueron violación sexual, maltrato físico, vivir alejado de la familia y conductas suicidas de un ser querido. Por otro lado, para la ideación suicida los eventos más relevantes fueron una enfermedad mortal, la pérdida del empleo en familiares, la separación o divorcio de los padres y la presencia de conductas suicidas en seres queridos. En conclusión, en este estudio se evidenció la alta tasa de conductas suicidas en estudiantes de colegios y universidades de la ciudad de San Juan de Pasto, lo que demanda acciones prontas y coordinadas de detección oportuna y prevención integral de este tipo de comportamientos.