Prevalências de ideação, plano e tentativa de suicídio: um inquérito de base populacional em Campinas, São Paulo, Brasil

The effect of common mental disorders on suicidal attempts by women, during pregnancy and six to nine years after birth

There is scarcity of global data on suicide attempts (SA). The higher frequency of mental disorders places women at a higher risk for SA. Mental disorders (MD) are ranked first in the Global Burden of Diseases (GBD) in terms of years lived with disability (YLD) and common mental disorders (CMD) affect women the most. IN this light, the present study aimed to investigate the impact of CMD during pregnancy, as well as 6 to 9 years after birth, on SA in women who were registered in the Family Health Strategy from the town of Recife, Pernambuco, Brazil. This study consisted of two stages of a prospective cohort. 643 adult women were included. The prevalence of CMD in stage I (pregnancy) and in stage III (six to nine years after birth) were, respectively, 19.3% and 12.6%. The incidence of SA was 10.9%. The multivariate analysis demonstrated a cumulative effect of CMD for SA: only during pregnancy (OR 5.4; 95%CI 2.2-13.3); only in the third stage (OR 5.8; 95%CI 2.3-14.9); and in both stages (OR 6.0; 95%CI 2.5-14.4). The increase of CMD in women increases the chances of SA, hence the importance of implementing public policies for women's health, especially for those with a history of mental disorders and unhealthy habits, and those who suffer violence.

Development and validation of a questionnaire to measure association factors with suicide

Background and Aims

Our goal was to develop an online questionnaire to survey the prevalence of suicidal behavior.

Methods

We developed a questionnaire with 51 variables and proceeded with validations. Validations were performed using face validity, content validity, and construct validity. Reliability was performed by test-rest.

Results

The face validity was 1.0 and the content validity was 0.91. The exploratory factor analysis got Kaiser-Meyer-Olkin = 0.86 and extracted one principal factor. The confirmatory factor analysis demonstrates root mean square error of approximation = 0.000 and comparative fit index = 1.000. The test-retest had an intraclass correlated coefficient of 0.98.

Conclusion

The adequate development questionnaire was validated, and we have an instrument to survey suicide behaviors during the pandemic time.

Patient or Public Contribution

The general population of Marília voluntarily responded to the questionnaire, as well as patients from the principal investigator's office.

Parental report of dental pain and discomfort in preschool children is associated with sleep disorders: a cross-sectional study in Brazilian families

PURPOSE

To evaluate the prevalence of sleep disorders in Brazilian preschool children and its associations with parental report of dental pain and discomfort.

METHODS

This cross-sectional study involved 604 Brazilian preschoolers (4-5 years old). Sleep disorders (SD) and the parental report of dental pain and discomfort (DPD) were evaluated using the Brazilian versions of the Sleep Disturbance Scale for Children (SDSC) and the Dental Discomfort Questionnaire (DDQ-B), respectively. Bivariate and multivariate Poisson regression analyses with robust variance were performed to analyze the association between SDSC and DP.

RESULTS

Prevalence of SD ranged from 7 to 21%. 7.9% of the children had DPD indicating the need for more invasive dental procedures (DDQ-B ≥ 5). Significant associations were found between DPD and the following SDSC domains: sleep hyperhidrosis (p = 0.024; PR_a = 1.38; 95% CI: 1.04-1.83), disorders of initiating and maintaining sleep (p < 0.001; PR_a = 1.41; 95% CI: 1.15-1.73), parasomnias (p < 0.001; PR_a = 1.82; 95% CI: 1.39-2.37), and sleep-wake transition disorders (p = 0.018; PR_a = 1.28; 95% CI: 1.04-1.58). Children with higher prevalence of DPD presented 20% higher prevalence of SD than children lower prevalence of DPD (p = 0.039; PR_a = 1.20; 95% CI: 1.01-1.44).

CONCLUSION

Preschool children with higher prevalence of DPD are more likely to have SD, such as hyperhidrosis, disorders of initiating and maintaining sleep, parasomnias, and sleep-wake transition.

Avaliação do comportamento suicida em estudantes de Medicina

RESUMO Objetivo O objetivo deste estudo foi avaliar a prevalência de comportamento suicida (ideação, plano e tentativa) nos últimos 12 meses e ao longo da vida e fatores associados entre alunos de Medicina da Universidade Federal do Rio de Janeiro (UFRJ). Métodos Um estudo seccional foi desenvolvido em uma amostra representativa e aleatória (n = 324) de 1.217 estudantes de Medicina da UFRJ entre abril e novembro de 2019. Os dados foram coletados por cinco pesquisadores em uma entrevista presencial com 296 alunos (taxa de participação de 91,4%), usando um questionário do Estudo Multicêntrico de Intervenção no Comportamento Suicida para avaliar o comportamento suicida, o PHQ-9 (Questionário de Saúde do Paciente-9) para avaliar o episódio depressivo maior e o ASSIST (Teste de Triagem do Envolvimento com Substâncias) para aferir o uso e abuso de substâncias. Para a avaliação das associações, utilizou-se o modelo de regressão logística. Resultados As prevalências nos últimos 12 meses foram de 18,9% (IC de 95%: 14,9-23,8) para ideação, 6,1% (IC de 95%: 3,9-9,4) para plano e 1,7% (IC de 95%: 0,7-4,1) para tentativa de suicídio. As prevalências ao longo da vida foram de 27,7% (IC de 95%: 22,9-33,0) para ideação, 12,5% (IC de 95%: 9,2-16,7) para plano e 5,7% (IC de 95%: 3,6-9,0) para tentativa de suicídio. Os resultados encontrados foram maiores que os achados dos estudos nacionais. O episódio depressivo maior e o tratamento psicológico atual foram associados ao comportamento suicida na análise final. Conclusões A associação com tratamento em saúde mental e episódio depressivo maior sugere que as universidades deveriam implementar programas para a prevenção do comportamento suicida.

Sensitivity is the dimension of temperament most associated with the progression from ideation to suicide attempts

BACKGROUND

To analyze the association between temperament (emotional and affective) and scrutinize the progression from suicide ideation to attempt, by using data from a large internet-based sample.

METHODS

It is a cross-sectional study, based on the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Temperament was assessed by the Affective and Emotional Composite Temperament Scale (AFECTS), and life-long suicidal behavior was determined by the adapted Suicidal Behaviors Questionnaire (SBQ-17). Odds ratios were obtained through multivariate logistic regression and a multiple linear regression were used in the analysis. According to the "ideation-to-action framework", we performed analyzes using two different reference groups: no suicidal ideation and suicidal ideation.

RESULTS

The affective temperaments that showed the greatest association with suicide attempts were depressive, cyclothymic, and volatile. The temperaments that reflected higher associations for progression from ideation to suicide attempt were cyclothymic, depressive, and euphoric. Sensitivity was manifested as the emotional temperament with the strongest positive association with the severity of suicidal behavior, followed by desire and control. Stability was estimated as the emotional trait with the strongest negative association with the severity of suicidal behavior.

LIMITATIONS

It is not a population based sample. BRAINSTEP is a self-selected sample whose participants are mostly women, who are highly educated and young.

CONCLUSIONS

Our results suggest that temperament assessment using AFECT model may be relevant to assess the risk for the progression from ideation to suicide attempts. These results strengthen the "ideation-to-action" framework that risk factors to suicide ideators can differ from suicide attempters.

Suicidality among South Brazilian tobacco growers

OBJECTIVE

To assess prevalence of suicidal ideation and suicide attempt among South Brazilian tobacco growers and to analyze the associated factors related to the suicidal ideation.

METHODS

A cross-sectional study was conducted in 2011 with a random sample of 2469 tobacco growers in São Lourenço do Sul/RS. Suicidal ideation was characterized by the question "Has the thought of ending your life been on your mind?". Suicide attempt was assessed by the question "Have you ever tried to kill yourself?". Investigation of factors associated with suicidal ideation was done by means of Poisson regression.

RESULTS

Prevalence of suicidal ideation and suicide attempt was 2.5 % and 1.2 % respectively. In the adjusted analysis, suicidal ideation was associated with being female, older age, moderate participation in religious activities and difficulty in paying debts. Those who worked in activities that required inadequate postures (hunched over or other forced positions), as well as farmers who performed 6-9 pesticide-related tasks demonstrated greater risk of suicidal ideation. Regarding health conditions, medical diagnosis of asthma, chronic low back pain, number of lifetime green tobacco sickness episodes and lifetime pesticide poisoning were positively associated with suicidal ideation.

CONCLUSION

Suicidal thoughts and attempts are relevant mental health problems among tobacco growers. Reducing pesticide use, as well as exposure to nicotine and improving socio-economic conditions, can reduce suicidal ideation and improve the mental health of exposed workers.

Major depressive episode externalizing symptoms among university students

INTRODUCTION

Depression affects 32% of university students and Major Depressive Episode (MDE) externalizing symptoms indicate the severity of the case. This study assessed MDE externalizing symptom prevalence and associated factors among university students, with emphasis on aspects related to the academic environment, including interpersonal relationships and study area chosen by students.

METHODS

A census was performed on new students in the first semester of 2017 at a university in Southern Brazil. Depressive symptom prevalence was assessed by the Patient Health Questionnaire-9. The multivariate analysis of the associated factors followed a hierarchical model, using Poisson regression with backward selection.

RESULTS

MDE externalizing symptoms were present in 20% of the university students and were more frequent among females, those with brown, black or other skin color in comparison to those with white skin color. Individuals with a family history of depression, minority sexual orientation, negative self-reported academic performance, students taking courses in the area of Linguistics, Modern Languages and Arts and students who reported strong conflicts with university teachers or colleagues also had higher prevalence of externalizing symptoms.

CONCLUSION

It is important for education institutions to train teachers to identify and deal adequately with students who have externalizing symptoms of MDE. In addition, education institutions need to pay attention to conflicts, both between students and also between students and teachers in order to take preventive measures in these circumstances.

Prevalence of anxiety, depression and suicidal behaviors among Brazilian undergraduate students: A systematic review and meta-analysis

BACKGROUND

The university context can be an overwhelming background, being especially harmful to undergraduates' mental health. Considering that several studies have reported on the prevalence of psychological distress among Brazilian undergraduate students, this study aimed to conduct a systematic review and meta-analysis of the prevalence and associated factors of anxiety, depression and suicidal behavior in this population.

METHODS

Studies reporting on the prevalence of anxiety, depression and suicidal behavior and its associated factors among Brazilian undergraduate students were systematically searched in scientific electronic databases. Pooled prevalence was calculated using a random-effects meta-analysis. Individual associated factors were summarized, and study characteristics associated with outcome prevalence were tested through meta-regression analysis.

RESULTS

Forty-seven articles were included, of which 44 were meta-analyzed (37,486 undergraduates). The pooled prevalence estimates of anxiety, depression and suicidal behavior were 37.75%, 28.51%, and 9.10%, respectively. Meta-regression analysis showed that investigations with probabilistic samples presented a higher prevalence of anxiety and that studies conducted within public institutions and with samples of exclusively medical students presented higher frequencies of depression.

LIMITATIONS

Cross-sectional data do not allow the establishment of temporality and causal inference. Furthermore, the high heterogeneity of the included studies may also constitute a weakness of this review.

CONCLUSIONS

The prevalence of anxiety, depression and suicidal behavior among Brazilian undergraduates was high. These results have scientific and practical implications, the former regarding the need for the standardization of the methodology of studies and the latter regarding the need for comprehensive mental health care for Brazilian undergraduates.

Suicidal thinking, depression, and religiosity in a freedom-deprived population

Objective:

to analyze the influence of sociodemographic variables, prison context, religiosity, and symptoms of depression on the presence of suicidal thinking in a population deprived of liberty.

Method:

a cross-sectional study with a quantitative approach, conducted with 228 participants, based on a sociodemographic questionnaire, on the prison context, and on the presence of suicidal thinking, from the Duke Religiosity Scale and the Depression, Anxiety and Stress Scale (DASS-21).

Results:

the variables that showed a statistically significant correlation were the following: female gender, not having a partner, working inside the penitentiary, being a primary defendant and using controlled medication, and females are 7.2 times more likely to present suicidal thinking, for each point more in the depression score, increases by 21% in the chances and not having a partner increases the chances of thinking about suicide by three times. Although the scores of religiosity were high, they did not present a statistically significant correlation with the presence of suicidal thinking.

Conclusion:

the prison context is complex and contains peculiarities that cause the involvement of mental health problems, as well as self-harming thoughts. Considering the relevance of the subject at issue, this work stands out in view of the scarce scientific production on the subject.

Tentativa de suicídio, transtorno de estresse pós-traumático e fatores associados em mulheres do Recife

RESUMO: Objetivo: Investigar a associação da tentativa de suicídio (TS) com o transtorno de estresse pós-traumático (TEPT), a violência por parceiro íntimo (VPI) e variáveis relacionadas aos aspectos socioeconômicos e demográficos em uma coorte de mulheres cadastradas na Estratégia Saúde da Família do Recife. Métodos: Foi realizado um estudo transversal, aninhado em um estudo de coorte prospectivo, com 644 mulheres de 18 a 49 anos, cadastradas na Estratégia Saúde da Família do Distrito Sanitário II da cidade do Recife (PE), entre julho de 2013 e dezembro de 2014. A TS foi avaliada pela pergunta “Já tentou pôr fim à sua vida?”, e o TEPT, diagnosticado por meio do Post-traumatic Stress Disorder Checklist - Civilian Version (PCL-C). Foram realizadas uma modelagem hierarquizada, a aplicação do teste χ2 e a análise de resíduos padronizados. A associação das variáveis independentes com a TS foi estimada por meio de regressão logística simples e ajustada. Resultados: A prevalência da TS foi de 10,9%, e a frequência de TEPT, de 16%. As mulheres que tinham TEPT e também as que não possuíam religião tiveram maior chance de tentar o suicídio (odds ratio - OR = 5,11, intervalo de confiança de 95% - IC95% 2,9 - 8,7; OR = 1,76, IC95% 1,0 - 2,9, respectivamente). Conclusões: Houve maior risco de TS nas mulheres que tiveram TEPT e baixa adesão a uma religião. Sendo assim, compreendeu-se que o enfrentamento do TEPT se dá prevenindo esse transtorno, tratando dele e promovendo mais conhecimentos sobre ele, além do efeito agregador e protetor social que a religiosidade promove, que também podem ser estratégias de redução e prevenção da TS.

Mental disorders and suicide risk in emerging adulthood: the 1993 Pelotas birth cohort

OBJECTIVE

To assess the prevalence of some mental disorders and suicide risk, and the association between them in youths.

METHODS

Data from the 1993 Pelotas Birth Cohort (Brazil) was used. The prevalence of mental disorders at 22 years [major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), attention-deficit/ hyperactivity disorder (ADHD), bipolar disorders type 1 and 2 (BD1; BD2), post-traumatic stress disorder (PTSD), and antisocial personality disorder (APD)] and of suicide risk were assessed using the Mini International Neuropsychiatric Interview (n = 3,781). Comorbidity between disorders was also assessed. Association of each mental disorder and the number of disorders with suicide risk was assessed using Poisson regression.

RESULTS

The prevalence of any mental disorder was 19.1% (95%CI 17.8-20.3), and GAD was the most prevalent (10.4%; 95%CI 9.5-11.4). The prevalence of current suicide risk was 8.8% (95%CI 5.9-9.7). All disorders (except APD) and the suicide risk were higher among women. Mental disorders were associated with a higher suicide risk, with the highest risks being observed for MDD (RR = 5.6; 95%CI 4.1-7.8) and PTSD (RR = 5.0; 95%CI 3.9-6.3). The higher the number of co-occurring mental disorders, the higher the risk of suicide.

CONCLUSIONS

Our findings showed that about 20% of the youths had at least one mental disorder. However, this prevalence is underestimated since other relevant mental disorders were not assessed. Mental disorders were associated with higher suicide risk, especially the comorbidity between them.

Prevalence and factors associated with suicidal ideation among family caregivers of people with mental disorders

AIMS AND OBJECTIVES

This study aimed to analyse the prevalence and factors associated with suicidal ideation among family caregivers of people with mental disorders.

BACKGROUND

Studies conducted with family caregivers of people with dementia and cancer point out a high prevalence of suicidal ideation among these subjects; however, this aspect has not yet been investigated among family caregivers of people with mental disorders.

DESIGN

This is a cross-sectional study, conducted with 537 family caregivers of patients from 16 Psychosocial Care Centers (CAPS) of the 21st Health Region of the state of Rio Grande do Sul, Brazil.

METHODS

Question 17 of the Self-Reporting Questionnaire (SRQ-20) was used for suicidal ideation screening. The prevalence of suicidal ideation was calculated according to sociodemographic and care variables, with confidence interval estimate (95% CI). Crude and adjusted odds ratios were calculated by logistic regression. The Guidelines to Reporting of Observational Studies in Epidemiology (STROBE Statement) was adhered in this study (See File S1).

RESULTS

The prevalence of suicidal ideation found in this study for the 30 days preceding the interview was 12.5% (95% CI: 10-15). The factors associated with the outcome were lower age, lower schooling, feeling of burden, self-report of stress problem and dissatisfaction with family relationships.

CONCLUSION

The prevalence of suicidal ideation among the studied family caregivers was high and strongly associated with issues regarding care, showing the need for interventions that provide support.

RELEVANCE FOR CLINICAL PRACTICE

Nurses are a large part of the workforce of the community mental health services. The careful characterisation of the subjects who show suicidal ideation, as performed in this study, may reveal specificities capable of refining the diagnostic potential for establishment of action plans in a timely manner, avoiding possible attempts or even the consummation of suicide.

Assistance related to suicidal behavior at a mobile emergency service: Sociodemographic and clinical associated factors

It is important to investigate the care given to people with suicidal behavior, as it is an important predictor of future death by suicide and there is a lack of studies on this issue in Brazil. This study had the objective of investigating assistance related to suicidal behavior at a mobile emergency service and sociodemographic and clinical associated factors. This was a quantitative, cross-sectional study based on documental information. The data were collected through manual consultation of nursing records in which call-outs for suicidal behavior in the year 2014 were documented. The data were analyzed using descriptive statistics, Chi-squared test, Fisher's exact test, correlation tests, and comparison of means tests. In the 313 records analyzed there was a predominance of adult women with self-inflicted drug poisoning, attended to in their own residence and referred to pre-hospital emergency medical services. There was a lack of documentation on signs, symptoms, and grievances in most cases. The interventions most carried out by the nurses were related to monitoring of clinical parameters. There were differences related to the victim's sex and lethality, suicide attempt method, referral to emergency services, and semester of occurrence (January-June, July-December). Suicide attempts through self-poisoning or self-inflicted injuries differed in relation to time of call-out, waiting time, lethality, documentation on clinical assessment and interventions, and referral to emergency services. This study enabled the charting of factors linked with suicidal behavior and associated factors; it offers reflections on limitations and nursing care potential in the prevention of reoccurrence of suicidal behavior.

Depressive symptoms and factors associated with depression and suicidal behavior in substances user in treatment: Focus on suicidal behavior and psychological problems

AIM

To investigate the prevalence of depressive symptoms, psychological problems, suicidal behaviour and their associations in substance users in treatment.

METHODS

A cross-sectional study, with 307 substance users in an out-patient treatment facility, was undertaken. Socio-demographic data, psychoactive substances used, depressive symptoms, and suicide information were obtained.

RESULTS

70% of participants were depressed; of those, 8.1% were either under the influence of drugs or in withdrawal. Suicidal ideation was found to be present in those who had anxiety, were nervous, had depressive symptoms, or were under drug influence or in withdrawal.

CONCLUSION

It is important to identify potential suicidal risk factors and implement the management of these conditions in substance users.

Suicidal patients in a psychiatric emergency unit: clinical characteristics and aggression profile

OBJECTIVE

To explore and describe a profile of patients admitted to a psychiatric emergency facility, comparing patients with and without a recent suicide attempt in terms of their clinical characteristics and aggression.

METHODS

This was an exploratory comparative study where patients were assessed using the Brief Psychiatric Rating Scale (BPRS) and the Overt Aggression Scale (OAS). Participants with a suicide attempt in the last 24 hours (SA) were compared to participants with a prior history of suicide attempt but no recent attempt (PHSA).

RESULTS

63 individuals (SA: 26; PHSA: 37) were selected. Both groups had similar demographic and clinical characteristics. The most prevalent diagnoses were mood (57.1%) and personality (50.8%) disorders. The majority of patients in both groups had a history of aggression episodes. Physical aggression in the week prior to admission was more prevalent in the PHSA group (51.4 vs. 19.2%, p = 0.017). The PHSA group also presented higher activation scores (p = 0.025), while the SA group presented higher affect scores on BPRS dimensions (p = 0.002).

CONCLUSION

The majority of individuals with a history of suicide attempt also presented a history of aggression. Inpatients with recent suicide attempt were hospitalized mainly due to the risk of suicide, while those with no recent suicide attempt were hospitalized mainly due to the risk of hetero-aggression. These findings support the hypothesis of an aggressive profile in suicidal patients and may open up a path for future research.

Mental health of public health workers in Bento Gonçalves, Rio Grande do Sul, Brazil

Background

Work-related mental disorders are an acknowledged global health problem.

Objective

The aim of the present study was to investigate the prevalence of and factors associated with common mental disorders and suicidal ideation among public health workers.

Methods

We conducted a cross-sectional study with municipal healthcare workers. We collected sociodemographic and occupational data including employment relationship, job area, professional category, length of work in current job and interpersonal conflict in the workplace (ICW). The analyzed mental health indicators were common mental disorders (CMD) and suicidal ideation by means of the Self Reporting Questionnaire (SRQ-20). Statistical analysis included the χ² test and Poisson regression.

Results

The prevalence of CMD and suicidal ideation was 20.3% and 11.6%, respectively, among the 597 participants. Permanent and younger employees exhibited higher CMD rates, while suicidal ideation predominated among the participants with higher educational level and the widowed/separated/divorced. Physicians, administrative employees, cleaning personnel and community health agents exhibited the highest rates of CMD. In turn, there was no association between professional category and suicidal ideation on multivariate analysis. ICW was associated with poorer mental health indicators, the association being stronger when conflict involved supervisors and coworkers.

Conclusion

Both analyzed indicators (CMD and suicidal ideation) point to a worrisome situation as concerns the mental health of professionals charged of collective health care. The possible limitations of the questionnaire applied notwithstanding, ICW was the main factor associated with poorer mental health indicators. These findings point to the need to develop specific approaches to improve the psychosocial work environment.

Suicidal ideation and attempt of older women in Northeastern Brazil

OBJECTIVE

to associate the life experiences of older women from the Northeast of Brazil with their suicidal ideation and attempts.

METHOD

Qualitative study with fourteen older adults from Piripiri (PI), Teresina (PI), Fortaleza (CE) and Recife (PE) who were interviewed between November 2013 and July 2014. The organization of data originated the themes: experiences of abuse throughout their lives; marital fractures and social isolation; weakened motherhood.

RESULTS

The women were born and lived most of their life in the countryside, amid poverty and social exclusion. They had a history of abuse, physical and sexual violence, perpetrated by intimate partners and/or family members. They experienced social isolation, weakened emotional bonds and several suicide attempts. Final considerations: The life of these older women was affected by traumatic events that enhanced feelings of hopelessness, depressive symptoms and the absence of a plan for the future, making them consider suicide as a way to anticipate death.

Suicides by hanging and its association with meteorological conditions in São Paulo

The main goal of this study was to evaluate the association between daily cases of hanging suicides and meteorological conditions in São Paulo, Brazil. We considered a retrospective observational study based on the analysis of all necroscopic medical-expert reports available in digital form from the central unit of the Instituto Médico Legal (Medical Legal Institute) of São Paulo between July 1, 2006 and June 31, 2007. The meteorological variables were combined via Principal Components Analysis. In order to explain their association with the frequency of suicides, Poisson regression models were employed. The analysis suggests that hotter and brighter days are associated with higher incidence of hanging suicides.

Lesão autoprovocada em todos os ciclos da vida: perfil das vítimas em serviços de urgência e emergência de capitais do Brasil

Resumo Caracteriza-se o perfil das vítimas de lesão autoprovocada que procuraram atendimento em serviços de urgência e emergência nas capitais brasileiras, utilizando-se a base de dados do Viva Inquérito 2014. Foi realizada estatística descritiva das lesões autoprovocadas por sexo e análise por regressão logística. As características avaliadas foram: faixa etária, sexo, raça/cor de pele, escolaridade, zona de residência, características do evento, uso de álcool e evolução do atendimento. Os resultados mostram que quase 10% dos atendimentos por violências nos serviços de urgência e emergência pesquisados decorrem de lesões autoprovocadas, com destaque para casos que envolvem mulheres e adultos. Há diferenças entre gêneros, inclusive as relacionadas à escolha do método para cometer suicídio. Alguns fatores geralmente associados às tentativas de suicídio não puderam ser avaliados, porque as informações não estavam contidas no escopo do instrumento de coleta. Conclui-se que o serviço de emergência é muito importante para os estudos de suicídio porque constituem a porta de entrada dos casos que chegam aos serviços. No entanto, dado seu caráter pontual, as informações que emite são muito restritas. Assim, os pacientes necessitam de acompanhamento posterior para prevenção das reincidências.

Mortalidade por suicídio no Estado do Paraná segundo meios utilizados: uma análise epidemiológica

RESUMO Objetivo Analisar a distribuição epidemiológica da mortalidade por suicídio, segundo os meios utilizados no Estado do Paraná. Métodos Trata-se de um estudo descritivo sobre os dados de mortalidade por suicídio e meios utilizados nas Macrorregionais de Saúde de residência, constantes no Sistema de Informações sobre Mortalidade, de 1996 a 2000 e de 2009 a 2012 e analisados por meio de estatística descritiva e inferencial, teste de qui-quadrado/c2 e medida de associação/odds ratio. Resultados Houve aumento na variação percentual da taxa de mortalidade por suicídio pelo enforcamento na maioria das Macrorregionais de Saúde do Estado, para ambos os sexos. Entretanto, o suicídio por arma de fogo, autointoxicação por pesticidas e outros meios apresentou declínio no período de 1996 a 2000 para 2009 a 2012. O enforcamento esteve associado ao sexo masculino e à idade superior a 45 anos, no período de 1996 a 2000, e à escolaridade acima de 12 anos, não ter companheiro e óbito no domicílio, para o período de 2009 a 2012. Notou-se maior variação percentual na taxa de mortalidade por suicídio na Macrorregional Oeste. Conclusão O levantamento das características específicas dos meios utilizados para o suicídio no Estado é um componente necessário para a implementação de intervenções preventivas para sua redução.

Suicide attempts by elderly women - from a gender perspective

This article analyzes the presence of gender inequality and violence in the lives of elderly women who have attempted suicide. This survey is part of a qualitative research study developed in twelve municipal regions in Brazil with high levels of suicide, and is coordinated by Claves-Fiocruz. Information was obtained by means of semi-structured interviews with thirty-two women from a sampling of fifty-nine elderly women with a history of attempted suicide. It was decided not to identify the interviewees, and to construct a narrative based on events that have occurred in the lives of all these women. The study was based on the women's life cycle (infancy, youth, adult life and old age) to see if gender inequality had been an issue in each of these phases. The inequalities began in infancy with differentiated gender upbringing; these continued during their youth and with their sexual initiation, marriage and maturity these continued during their adult life through acts of violence committed by their partners and/ or other family members which culminates in old age, when they are deprived of their independence and have lost ties, possessions and points of reference. These lives permeated with violence result in a feeling of emptiness and unworthiness, and lead many elderly women to view death as their only solution.

Tentativas de suicídio e suicídios na atenção pré-hospitalar

RESUMO Objetivo Caracterizar as tentativas de suicídio e suicídios ocorridos em um município do noroeste do Estado do Paraná, atendidos em serviço pré-hospitalar. Métodos Estudo descritivo, transversal, dos registros de atendimentos pré-hospitalares de 257 vítimas de tentativa de suicídio e suicídio, no período de 2005 a 2012, por meio de análise bidimensional por qui-quadrado. Resultados Ocorreram 180 tentativas de suicídio e 76 suicídios. A idade variou de 13 a 93 anos, com média de 33,5 ± 15,1 anos e maior prevalência na população jovem do sexo masculino. As ocorrências se concentraram nos meses da primavera e verão, na zona urbana. O uso de objeto cortante foi o método mais empregado, seguido por intoxicação e precipitação de locais elevados. Conclusão Conhecer características, métodos e fatores agravantes fornecem subsídios para implementação de medidas de prevenção.

Prevalência e fatores associados à ideação suicida na adolescência: revisão de literatura

Resumo: Para a elaboração deste artigo foi realizada uma revisão da literatura sobre a prevalência e os principais fatores associados à ideação suicida em adolescentes da população não clínica. A revisão foi baseada nos estudos de corte transversal encontrados em bases de dados eletrônicas (Medline, SciELO e Lilacs), referentes ao período de 2002 a 2013. As palavras-chave utilizadas foram: "ideação suicida", "ideação suicida e adolescentes", "ideação suicida e estudantes", "comportamento suicida e adolescentes". A prevalência de ideação suicida é alta e está significativamente relacionada a fatores como: depressão, uso de álcool e drogas, violência física, problemas de relacionamento com os pais, tristeza e solidão. A ideação suicida associada à depressão em adolescentes é prevenível desde que o adolescente seja devidamente tratado. Há necessidade de investimentos em pesquisas no Brasil, dado o crescimento das taxas de suicídio entre adolescentes, sobretudo do sexo masculino.

Estudo descritivo das tentativas de suicídio na população idosa brasileira, 2000 – 2014

Este artigo descreve as taxas de internação por tentativas de suicídio entre idosos brasileiros e discute as fragilidades dos dados dos sistemas de informação. Empregaram-se dados do Sistema de Informações Hospitalares (SIH) e do Sistema de Vigilância de Violências e Acidentes (VIVA). Analisou-se: (1) a evolução temporal das taxas segundo faixa etária (1-9; 10-19; 20-39; 40-59 e 60 ou mais anos), entre 2000 e 2014, por região; (2) as taxas trienais de internação segundo o sexo e faixas etárias 60-69, 70-79 e 80 ou mais anos, por região e unidade da federação; (3) as taxas de internação para idosos dos dois sistemas de informação. Quanto à evolução temporal, observou-se taxas mais elevadas na região Norte, e mais baixas no Nordeste. A análise segundo faixa etária e sexo mostrou taxas mais elevadas para os homens idosos das três faixas etárias investigadas. A comparação das taxas obtidas a partir dos dois sistemas mostrou um aumento gradativo daquelas oriundas do VIVA. A partir de 2012, observou-se que as taxas obtidas a partir do VIVA foram mais elevadas para as regiões Sudeste, Sul e Centro-Oeste. Destaca-se a necessidade de aprimoramento da informação sobre morbidade hospitalar e dos dados provenientes da notificação compulsória da violência.

Depressive symptoms and suicidal ideation in adolescents accompanying a parent in recyclable trash collection

The relationship between mental health and poverty has been well documented in adults. However, few studies have addressed how low socioeconomic status and psychosocial vulnerabilities may influence depressive symptoms in adolescents. The current study was carried out in a non-randomly selected sample of 239 adolescents whose parents work as ragpickers (waste collectors for recycling) in Brazil. In-person interviews were conducted, and the presence of depressive symptoms and suicidal ideation were assessed using the Children's Depression Inventory (CDI). We observed that 23% (CI ± 5.34) of the adolescents presented with depressive symptoms and 35% (CI ± 6.05) had suicidal ideation. Fatigue or loss of energy (p = .012) and irritable mood (p = .013) were significantly higher among boys than girls according to DSM-IV criteria. However, we found no gender differences in DSM-IV criteria for Major Depressive Disorders (MDD) or Dysthymic Disorder (DD) in diminished interest or pleasure, weight loss or weight gain, decreased appetite, sleep problems, feelings of worthlessness, diminished concentration or ability to think, recurrent thoughts of death, suicidal ideation, or low self-esteem. There were no significant gender differences in total CDI score, however a greater percentage of girls presented with depressed mood than boys (29.9% vs. 17.1%, p < .05).

Comportamento suicida: epidemiologia

O Brasil encontra-se entre os dez países que registram os maiores números absolutos de suicídios, com 9.852 mortes em 2011. O coeficiente médio para o período 2004-2010 foi de 5,7%. Esse índice aumentou 29,5% nas duas últimas décadas e é mais elevado em homens, idosos, indígenas e em cidades de pequeno e de médio porte populacional. Transtornos mentais encontram-se presentes na maioria dos casos de suicídio, principalmente depressão, transtorno do humor bipolar e dependência de álcool e de outras drogas psicoativas. Um estudo populacional revelou que, ao longo da vida, 17,1% das pessoas tiveram ideação suicida, 4,8% chegaram a elaborar um plano para tanto, e 2,8% efetivamente tentaram o suicídio. Dar especial atenção à pessoa que tentou se suicidar é uma das principais estratégias de prevenção do suicídio.

Women with HIV: gender violence and suicidal ideation

OBJECTIVE

To analyze the relationship between gender violence and suicidal ideation in women with HIV.

METHODS

A cross-sectional study with 161 users of specialized HIV/AIDS care services. The study investigated the presence of gender violence through the Brazilian version of the World Health Organization Violence against Women instrument, and suicidal ideation through the Suicidal Ideation Questionnaire. Statistical analyses were performed with the SPSS software, using the Chi-square test and Poisson multiple regression model.

RESULTS

Eighty-two women with HIV reported suicidal ideation (50.0%), 78 (95.0%) of who had suffered gender violence. Age at first sexual intercourse < 15 years old, high number of children, poverty, living with HIV for long, and presence of violence were statistically associated with suicidal ideation. Women who suffered gender violence showed 5.7 times more risk of manifesting suicidal ideation.

CONCLUSIONS

Women with HIV showed a high prevalence to gender violence and suicidal ideation. Understanding the relationship between these two grievances may contribute to the comprehensive care of these women and implementation of actions to prevent violence and suicide.

Atendimento a tentativas de suicídio por serviço de atenção pré-hospitalar

Objetivo: Investigar as características das vítimas de tentativa de suicídio atendidas em serviço pré-hospitalar e os intervalos de tempo consumidos nessa fase de atendimento. Métodos: Estudo transversal utilizando dados da fase pré-hospitalar de atendimento às vítimas de tentativa de suicídio no município de Arapiraca, no ano de 2011. Para análise dos dados, foram realizados teste exato de Fisher, teste t de Student e regressão logística múltipla. Resultados: Foram atendidas 80 vítimas de tentativa de suicídio pelo serviço de atenção pré-hospitalar. As mulheres, com idade superior a dos homens, foram as que mais tentaram suicídio (n = 44, 55%), e a intoxicação por medicamentos foi o método mais utilizado (n = 44, 55%). As tentativas de suicídio ocorreram com maior frequência no outono (n = 29, 36,25%), no dia de domingo (n = 18, 22,5%), principalmente no período vespertino (n = 33, 41,25%). O tempo gasto para o atendimento pré-hospitalar variou entre 34,4 e 40,5 minutos. As variáveis que estiveram associadas às tentativas de suicídio por sexo foram idade (p = 0,03) e tempo de transporte (p = 0,01). Conclusão: Foram encontradas diferenças entre os sexos das vítimas de tentativa de suicídio atendidas pelo serviço de atenção pré-hospitalar. As mulheres apresentaram maior idade que os homens e o tempo de transporte foi maior em vítimas do sexo masculino, sugerindo maior gravidade nas tentativas de suicídio cometidas por esse grupo.

Suicide attempts: a contingency analysis

The aim of this study was to understand, from the perspective of behavioral analysis, the possible antecedents and consequences of a suicide attempt for the individual responsible, using reports from patients that were hospitalized in a psychiatric hospital located in Curitiba, Paraná, Brazil, due to their suicide attempts. Three patients that attempted suicide in 2010 took part in this study. Semi-structured interviews were performed, which included questions about the attempt, its antecedents and consequences, and the life history of the patient. Functional analysis showed the presence of risk factors for suicide, as well as reinforcing consequences for the individuals, such as social care only being available after the attempts.

[Suicide Prevention Program: case study in a municipality in the south of Brazil]

This article focuses on the theme of suicide prevention based on analysis of a work in progress. A case study of the Program for Promotion of Life and Suicide Prevention of Candelária in the State of Rio Grande do Sul was conducted. It is a Brazilian municipality that has high suicide mortality rates in the general population and among the elderly. The scope of this paper is to present a experience that has proved successful and is based on a local initiative. The data presented here result from participant observation, interviews with the team carrying out the work, discussion groups and document analysis. The following categories were used: line of care, management and evaluation process. The results of intervention show that suicide rates declined from 5 deaths per year (21/100,000 inhabitants) between 1996 and 2000 to 3.6 deaths per year (12/100,000 inhabitants) between 2007 and 2009. The study establishes a dialogue with the experiences of others locations and provides contributions to prevention programs that can be set up in Brazil.

Tentativas de suicídio e mortalidade por suicídio em um município no interior da Bahia

Objetivo: Descrever o perfil das tentativas de suicídio e mortalidade por suicídio no município de Jequié/BA, no período entre 2006 e 2010. Método: Estudo epidemiológico descritivo. Os dados das tentativas de suicídio foram obtidos no Corpo de Bombeiros e DATASUS, enquanto aqueles referentes à mortalidade por suicídio foram coletados por meio das declarações de óbito (DOs) da 13ª Diretoria Regional de Saúde da Bahia (13ª DIRES) e complementados pelos registros do Instituto Médico Legal (IML). A análise foi feita por meio de estatística descritiva. Resultados: Nas tentativas de suicídio, a maior frequência foi na faixa etária de 20 a 39 anos (57,69%), entre indivíduos do sexo feminino (53,4%) e utilizando-se como meio a queda de altura (69,2%). Em relação ao suicídio, a taxa média de mortalidade foi de 3,19/100.000 habitantes, com maior frequência em indivíduos acima dos 40 anos (54,16%), do sexo masculino (87,5%), por meio de enforcamento (58,3%) e tendo como local de ocorrência o domicílio (83,33%). Conclusão: O município mostrou-se dentro das estatísticas da região Nordeste e abaixo das taxas nacionais de suicídio. Houve diferenciação entre as características do perfil das tentativas de suicídio e mortalidade por suicídio, especialmente segundo o sexo, faixa etária e meios utilizados.

Ideação suicida na adolescência: prevalência e fatores associados

OBJETIVO: Avaliar a prevalência de ideação suicida, assim como de seus fatores associados, em adolescentes entre 15 e 18 anos da cidade de Pelotas (RS). MÉTODOS: 960 adolescentes responderam a um questionário autoaplicado e sigiloso em estudo transversal de base populacional. A ideação suicida foi aferida por meio do item 17 do SRQ-20, que avalia transtornos psiquiátricos menores. Para a análise estatística, utilizou-se a regressão logística. RESULTADOS: A prevalência de ideação suicida foi de 7,7%. A baixa escolaridade da mãe, a baixa escolaridade do adolescente, o sedentarismo, o uso de álcool e de outras substâncias e o comportamento agressivo mantiveram associação estatisticamente significativa com ideação suicida. CONCLUSÃO: Programas preventivos devem preferencialmente atingir adolescentes de baixa escolaridade que apresentem comportamento agressivo e relatem uso de substâncias.