Association between suicidal behavior and symptoms of other mental health problems in Mexican adolescents.

BACKGROUND: Suicidal behavior in adolescents is a growing public health problem. Knowing its risk factors is key for reducing it. OBJECTIVE: To identify the relationship between two suicidal behaviors (ideation and attempt) and eight mental health problems (MHPs) in Mexican adolescents. MATERIAL AND METHODS: Through an online survey of adolescent students from 20 states, the following information was screened: symptomatology of six MHPs (affective problems/depression, behavioral problems, somatic problems, inattention and hyperactivity problems, oppositional defiant problems and anxiety problems) and suicidal behavior (suicidal ideation and suicide attempts). MHP and suicidal behavior frequencies and percentages were analyzed, and associations were sought using binary logistic regression. RESULTS: Six-thousand seven hundred sixty-six adolescents completed the survey, out of whom 61.02% were females, with ages ranging between 11 and 19 years (16.38 ± 1.33); 10% reported suicidal behavior, and between 3 and 5%, MHPs. The predictors (χ2(8) = 387.13, p < 0.001) of suicidal behavior were affective problems/depression, behavioral problems, somatic problems, oppositional defiant problems and anxiety problems. CONCLUSION: Five mental health problems increased the risk of reporting suicidal behaviors.

ANTECEDENTES: Las conductas suicidas en adolescentes son un problema de salud pública que va en aumento. Conocer sus factores de riesgo es clave para reducirlas. OBJETIVO: Identificar la relación entre dos conductas suicidas (ideación e intento) y ocho problemas de salud mental (PSM) en adolescentes mexicanos. MATERIAL Y MÉTODOS: Mediante una encuesta en línea a adolescentes escolarizados de 20 estados, se tamizó la siguiente información: sintomatología de seis PSM (problemas afectivos/depresión, problemas conductuales, problemas somáticos, problemas de inatención e hiperactividad, problemas oposicionistas desafianes y problemas de ansiedad) y conducta suicida (ideación e intentos de suicidio). Se analizaron frecuencias y porcentajes y se indagó asociación mediante regresión logística binaria. RESULTADOS: Completaron la encuesta 6766 adolescentes entre 11 y 19 años (16.38 ± 1.33), 61.02 % del sexo femenino. El 10 % reportó conducta suicida y entre 3 y 5 %, PSM. Los factores predictivos (χ2(8) = 387.13, p < 0.001) de la conducta suicida fueron problemas afectivos/depresión, problemas conductuales, problemas somáticos, problemas oposicionistas desafiantes y problemas de ansiedad. CONCLUSIÓN: Cinco problemas de salud mental incrementaron el riesgo de reportar conductas suicidas.

Impact of accidental and intentional injuries in Mexico. Findings of the Global Burden of Disease study for 1990 and 2021.

BACKGROUND: Previous analyses on the burden of disease in Mexico identified that injuries differentially affect young people, males and working-age people. OBJECTIVE: To analyze the burden of disease due to intentional and unintentional injuries in Mexico during 1990 and 2021, at the national and state levels. MATERIAL AND METHODS: The results of the Global Burden of Disease study for the 1990-2021 period were used to describe the burden of disease attributed to injuries in Mexico. The life years lost (YLL) due to premature mortality, years lived with disability (YLD) and disability-adjusted life years (DALY) were analyzed. RESULTS: The burden of disease related to intentional injuries has increased, as also have YLDs and DALYs associated with unintentional injuries. Men continue to have higher mortality and DALY rates compared to women. Interpersonal violence and suicide have steadily increased. The analysis by state showed patterns with important variations. CONCLUSIONS: Injuries generate catastrophic consequences in terms of mortality and disability in Mexico. It is necessary to promote and strengthen programs and policies in order to improve the data system and injury prevention.

ANTECEDENTES: Análisis previos sobre la carga de la enfermedad en México identificaron que las lesiones afectan de manera diferenciada a hombres, personas jóvenes y en edad productiva. OBJETIVO: Analizar la carga de la enfermedad por lesiones intencionales y no intencionales en México durante 1990 y 2021 en los ámbitos nacional y estatal. MATERIAL Y MÉTODOS: Se utilizaron los resultados del Global Burden of Disease respecto al período 1990-2021 para describir la carga de la enfermedad por las principales causas de lesiones en México; se analizaron los años perdidos por muerte prematura (APMP), los años vividos con discapacidad (AVD) y los años de vida saludable perdidos (AVISA). RESULTADOS: La carga de la enfermedad relacionada con lesiones intencionales se ha incrementado, al igual que los AVD y AVISA por lesiones no intencionales. Los hombres continúan presentando tasas de mortalidad y AVISA más altas comparados con las mujeres. La violencia interpersonal y el suicidio se han incrementado de manera sostenida El análisis por estados mostró patrones con variaciones importantes. CONCLUSIONES: Las lesiones generan consecuencias catastróficas en términos de mortalidad y discapacidad en México. Es indispensable impulsar y reforzar los programas y políticas para mejorar el sistema de datos y la prevención de lesiones.

Male sex and hazardous alcohol use following military sexual assault increase suicide risk among US service members and veterans.

Background: Higher alcohol use and military sexual assault (MSA) are associated with increased risk of death by suicide. Risk for death by suicide is rapidly increasing among females, who report higher rates of MSA, yet actual death by suicide and alcohol use are higher among males. It is not well understood whether higher alcohol use confers greater suicide risk in male or female service members and veterans who have experienced MSA.Objective: To determine whether the association between alcohol misuse and suicide risk was moderated by biological sex in a sample of male and female service members (N = 400, 50% female) who reported MSA.Method: Participants completed surveys of alcohol use and suicide risk as well as a demographic inventory. Linear regression with an interaction term was used to determine if suicide risk differed by sex and alcohol use severity after accounting for discharge status, sexual orientation, and age.Results: Average scores on the suicide risk measure were consistent with an inpatient psychiatric sample and scores on the AUDIT-C were indicative of a probable positive screen for alcohol misuse. Suicide risk was most pronounced among males who reported higher levels of hazardous alcohol use. A sensitivity analysis examining suicide risk by sex and screening results for alcohol misuse (positive/negative) showed that men with a probable positive screen had higher suicide risk.Discussion: The current study provides novel findings on suicide risk among survivors of military sexual violence by including both male and female survivors. Interventions to decrease suicide risk following MSA may consider alcohol reduction strategies, and optimizing these interventions in males. Engaging military culture at both the US Departments of Defense and Veterans Affairs to encourage more healthy alcohol consumption may mitigate this public health concern. Future research may consider how country of origin relates to these associations.

Average scores for the suicide risk measure and alcohol use were high among a sample of male and female survivors of military sexual assault.Suicide risk was most pronounced among males who reported higher levels of hazardous alcohol use.A sensitivity analysis examining suicide risk by sex and screening results for alcohol misuse (positive/negative) showed that men with a probable positive screen had higher suicide risk.

Euthanasia and assisted suicide in neurological diseases: a systematic review.

OBJECTIVE: To identify the neurological diseases for which euthanasia and assisted suicide are most frequently requested in the countries where these medical procedures are legal and the specific characteristics of euthanasia in some of these diseases, and to show the evolution of euthanasia figures. METHODS: We conducted a systematic literature review. RESULTS: Dementia, motor neuron disease, multiple sclerosis, and Parkinson's disease are the neurological diseases that most frequently motivate requests for euthanasia or assisted suicide. Requests related to dementia constitute the largest group, are growing, and raise additional ethical and legal issues due to these patients' diminished decision-making capacity. In some countries, the ratios of euthanasia requests to all cases of multiple sclerosis, motor neuron disease, or Huntington disease are higher than for any other disease. CONCLUSIONS: After cancer, neurological diseases are the most frequent reason for requesting euthanasia or assisted suicide.

Proximal characteristics of suicide attempts: a study in a public hospital in Spain.

INTRODUCTION: Different parameters of suicide attempts treated since the implementation of the Attention to Suicide Risk Program (ARSUIC) in 2012 at the Hospital Ramón y Cajal in Madrid Region are described in this paper. METHOD: The sample was composed of 107 patients and the information was collected through a questionnaire created ad hoc with the following variables: type of suicidal ideation; drug use immediately prior to the attempt; method (in case of drug overdosing: drug/s used); location; accessibility to rescue; planning; intentionality; criticism; and brakes. RESULTS: Descriptive statistics were obtained and a comparison by gender was made through the χ2 and contingency coefficients tests. The data from the retrospective longitudinal study showed that the most common profile was of patients with unstructured ideas of death and no previous drug use who took an unplanned drug overdose in the family home, with the intention of self-harm or avoidance of discomfort, especially with benzodiazepines. Patients tend to ask for help afterwards and criticise the attempt, but potential restraints are often not recorded in the clinical report. Regarding the dissimilarities based on gender, statistically significant differences were found in prior alcohol consumption, in favour of men and in the overdose method, specifically with benzodiazepines, in favour of women. CONCLUSIONS: Knowing the types of attempts at self-harm is essential for improving prevention, understanding and patient management.

Effects of different indications on electroconvulsive therapy.

OBJECTIVE: The objective of the study is to evaluate how electroconvulsive therapy (ECT) affects treatment-resistant depression, bipolar and schizophrenic patient groups, and suicide attempt histories and to evaluate the relationship between treatment variables and patient outcomes. METHOD: In a retrospective cohort study at the inpatient psychiatry clinic of Çam and Sakura City Hospital between January, 2021, and February, 2023, 103 patients receiving ECT were analyzed. They were categorized into two groups according to indications that suicide risk (n = 76) and resistance to pharmacotherapy (n = 27). RESULTS: The analysis revealed no significant age (p = 0.374) or gender (p = 0.304) differences between groups. However, significant differences emerged in diagnostic distribution (p = 0.027), with the suicide risk group receiving more ECT sessions (13.6 ± 11.2, p = 0.025) and experiencing longer total seizure times (427 ± 325 s, p = 0.023) compared to the treatment-resistant group (8.5 ± 4.7 sessions and 279 ± 115 s, respectively). CONCLUSIONS: ECT's therapeutic application does not differ from demographic variables but is influenced by clinical diagnosis, with suicide risk patients receiving more intensive treatment. These findings highlight the necessity of individualized ECT protocols and suggest that diagnostic considerations are critical in optimizing ECT treatment strategies. Despite its retrospective design, the study underscores the importance of personalized ECT regimens and calls for further prospective research to validate these findings.

OBJETIVO: Evaluar cómo la terapia electroconvulsiva afecta a grupos de pacientes con depresión resistente al tratamiento, trastorno bipolar, esquizofrenia y antecedentes de intentos suicidio, y evaluar la relación entre variables de tratamiento y resultados. MÉTODO: En una cohorte retrospectiva en la clínica de psiquiatría para pacientes internados del Çam and Sakura City Hospital, entre el 01/2021 y el 03/2023, se analizaron 103 pacientes que recibieron terapia electroconvulsiva. Estos se clasificaron en dos grupos según los indicios de riesgo de suicidio (n = 76) y de resistencia a la farmacoterapia (n = 27). RESULTADOS: El análisis no mostró diferencias significativas en cuanto a edad (p = 0.374) y sexo (p = 0.304) entre los grupos. Sin embargo, hubo diferencias significativas en la distribución diagnóstica (p = 0.027), con el grupo de riesgo de suicidio recibiendo más sesiones de terapia electroconvulsiva (13.6 ± 11.2; p = 0.025) y experimentando tiempos totales de convulsión más largos (427 ± 325 segundos; p = 0.023) en comparación con el grupo resistente al tratamiento (8.5 ± 4.7 sesiones y 279 ± 115 segundos, respectivamente). CONCLUSIONES: La aplicación terapéutica de la terapia electroconvulsiva no difiere según las variables demográficas, pero sí se ve influenciada por el diagnóstico clínico, recibiendo los pacientes de riesgo de suicidio un tratamiento más intensivo.

[The euthanasia law and professional experiences: tensions in clinical practice]. / La ley de eutanasia y experiencias profesionales: tensiones en la práctica clínica.

OBJECTIVE: To analyze the process of assisted death provision in Catalonia and identify the main tensions, difficulties, and/or sources of discomfort related to professional practice. METHOD: A qualitative study was conducted based on interviews (n=29) and focus groups (n=19) with professionals who participated in the euthanasia process. The selection of participants combined the snowball and maximization of variability procedures, taking into account the variables of professional profile, setting, gender, age and territoriality. Intentional and theoretical sampling process. RESULTS: The assisted death process is divided into four main moments: 1) reception of the request, 2) medical-bureaucratic procedure, 3) the actual procedure, and 4) closure. At each of these moments, difficulties arise that can be a source of discomfort and have to do with the limits and tensions between the legal and moral, the conception of one's own professional role, the lack of recognition of some professional roles, stress and overload, the lack of formal and informal support, and the relationship with the patient and his/her family. The bureaucratic-administrative stress derived from a protective law, with both prior and subsequent verifying control, stands out, given that it stresses the professionals immersed in a healthcare system already under high pressure after budget cuts and the COVID-19 epidemic. CONCLUSIONS: Throughout the assisted death process, the sources of distress are diverse and of a psychological, psychosocial, and structural nature. These results may lead to interventions for psychological and peer support, information, training, institutional involvement, and burden reduction.

Critical appraisal of the Colombian clinical practice guide for the prevention, diagnosis and treatment of suicidal ideation and/or behaviour (adoption).

INTRODUCTION: Suicide is a complex, global public health problem. The Colombian clinical practice guideline provides relevant input for its prevention, diagnosis and treatment. The objective was to evaluate the methodological quality, credibility and applicability of the Colombian clinical practice guideline for suicidal behaviour. METHODS: An academic group of 12 evaluators was established to assess the guide and its recommendations in a standardised way, using the AGREE-II and AGREE-REX instruments. The evaluations were given in the range of 0.0-1.0 with 0.7 as a cut-off point for appropriate quality. RESULTS: The global assessment of the AGREE-II was greater than 0.7 in the dimensions: "scope and objective" (0.86), "clarity of presentation" (0.89), "applicability" (0.73) and "editorial independence" (0.89). The lowest scores were for "participation of those involved" (0.67) and "rigour in preparation" (0.69). With the AGREE-REX, the results in all dimensions were below 0.70, which indicates lower quality and suitability for use. CONCLUSIONS: The adoption process of the Colombian guideline for suicidal behaviour was a rigorous methodological process, while the practice recommendations were valued as of low applicability due to low support in local evidence. It is necessary to strengthen the generation and synthesis of evidence at the national level to give greater support and applicability to the practice recommendations.

Moral injury and mental health among health-care workers during the COVID-19 pandemic: meta-analysis.

Background: During the COVID-19 pandemic, health-care workers (HCWs) may have been confronted with situations that may culminate in moral injury (MI). MI is the psychological distress that may result from perpetrating or witnessing actions that violate one's moral codes. Literature suggests that MI can be associated with mental health problems.Objective: We aimed to meta-analytically review the literature to investigate whether MI is associated with symptoms of posttraumatic stress disorder (PTSD), anxiety, depression, burnout, and suicidal ideation among active HCWs during the COVID-19 pandemic.Method: We searched eight databases for studies conducted after the onset of the COVID-19 pandemic up to 18 July 2023, and performed random-effects meta-analyses to examine the relationship between MI and various mental health outcomes.Results: We retrieved 33 studies from 13 countries, representing 31,849 individuals, and pooled 79 effect sizes. We found a positive association between MI and all investigated mental health problems (rs = .30-.41, all ps < .0001). Between-studies heterogeneity was significant. A higher percentage of nurses in the samples was associated with a stronger relationship between MI and depressive and anxiety symptoms. Samples with a higher percentage of HCWs providing direct care to patients with COVID-19 exhibited a smaller effect between MI and depressive and anxiety symptoms. We observed a stronger effect between MI and PTSD symptoms in US samples compared to non-US samples.Conclusion: We found that higher MI is moderately associated with symptoms of PTSD, anxiety, depression, burnout, and suicidal ideation among HCWs during the COVID-19 pandemic. Our findings carry limitations due to the array of MI scales employed, several of which were not specifically designed for HCWs, but underscore the need to mitigate the effect of potentially morally injurious events on the mental health of HCWs.

We conducted the first meta-analysis of moral injury and mental health among healthcare workers.Moral injury is moderately associated with symptoms of PTSD, depression, anxiety, burnout, and suicidal ideation.There was a stronger association between MI and anxiety and depressive symptoms for samples with more nurses.

Unravelling psychiatric heterogeneity and predicting suicide attempts in women with trauma-related dissociation using artificial intelligence.

Background: Suicide is a leading cause of death, and rates of attempted suicide have increased during the COVID-19 pandemic. The under-diagnosed psychiatric phenotype of dissociation is associated with elevated suicidal self-injury; however, it has largely been left out of attempts to predict and prevent suicide.Objective: We designed an artificial intelligence approach to identify dissociative patients and predict prior suicide attempts in an unbiased, data-driven manner.Method: Participants were 30 controls and 93 treatment-seeking female patients with posttraumatic stress disorder (PTSD) and various levels of dissociation, including some with the PTSD dissociative subtype and some with dissociative identity disorder (DID).Results: Unsupervised learning models identified patients along a spectrum of dissociation. Moreover, supervised learning models accurately predicted prior suicide attempts with an F1 score up to 0.83. DID had the highest risk of prior suicide attempts, and distinct subtypes of dissociation predicted suicide attempts in PTSD and DID.Conclusions: These findings expand our understanding of the dissociative phenotype and underscore the urgent need to assess for dissociation to identify individuals at high-risk of suicidal self-injury.

Dissociation, feelings of detachment and disruption in one's sense of self and surroundings, is associated with an elevated risk of suicidal self-injury; however, it has largely been left out of attempts to predict and prevent suicide.Using machine learning techniques, we found dissociative identity disorder had the highest risk of prior suicide attempts, and distinct subtypes of dissociation predicted suicide attempts in posttraumatic stress disorder and dissociative identity disorder.These findings underscore the urgent need to assess for dissociation to identify individuals at high-risk of suicidal self-injury.

Falando sobre o suicídio: prevenção e promoção de vida entre adolescentes / Talking about suicide: prevention and promotion of life among adolescents / Hablando del suicidio: prevención y promoción de la vida entre los adolescentes

Resumo O fenômeno do suicídio é um importante problema de saúde pública mundial, tanto em termos econômicos como em termos de sofrimento humano. O artigo refere-se a uma pesquisa na área de prevenção e promoção de saúde realizada com um grupo de estudantes, com idades entre 16 e 18 anos, de uma escola estadual do município de Carmo do Cajuru, MG. A pesquisa de caráter exploratório e qualitativo se viabilizou por meio da realização de grupos focais para a produção de dados, sob a perspectiva da Psicologia Social. O material coletado foi analisado a partir da Análise de Conteúdo. A pesquisa permitiu conhecer as representações sociais dos adolescentes acerca da adolescência e do suicídio e constatar que são convergentes com a literatura existente. Avançou-se na promoção de vida na medida em foi proporcionado um espaço para escuta e discussão sobre sentimentos e tabus acerca dessas temáticas.

Abstract Suicide phenomenon is an important public health problem worldwide in economic terms, as well as in terms of human suffering. The article refers to a research in the area of prevention and health promotion carried out with a group of students, aged between 16 and 18 years, of a public high school from the town of Carmo do Cajuru, MG. The exploratory and qualitative research was made feasible through the realization of focus groups for the production of data, from the perspective of Social Psychology. The collected material was analyzed from the Content Analysis. Through the research it was possible to know the social representations of adolescents about adolescence and suicide and to verify that they are convergent with the existing literature. Progress was obtained in life promotion as a space had been provided for listening and discussion about feelings and taboos about the themes.

Resumen El fenómeno del suicidio es un importante problema de salud pública mundial, tanto en términos económicos como de sufrimiento humano. El artículo se refiere a una investigación en el área de prevención y promoción de la salud realizada con un grupo de estudiantes, con edades entre 16 y 18 años, de una escuela pública del municipio de Carmo do Cajuru, MG. La investigación exploratoria y cualitativa fue posible gracias a la realización de grupos focales para la producción de datos, desde la perspectiva de la Psicología Social. El material recopilado se analizó mediante el análisis de contenido. La investigación posibilitó conocer las representaciones sociales de los adolescentes sobre la adolescencia y el suicidio y verificar que son convergentes con la literatura existente. Se avanzó en la promoción de la vida en la medida en que se brindó un espacio de escucha y discusión sobre sentimientos y tabúes sobre estos temas.

Inconstitucionalidade da criminalização do médico pela prática de eutanásia / Unconstitutionality of criminalizing physicians for the practice of euthanasia / Inconstitucionalidad de la criminalización del médico por la práctica de la eutanasia

Resumo Este estudo objetivou evidenciar a inconstitucionalidade da aplicação dos arts. 121 e 122 do Código Penal brasileiro à prática de eutanásia. Para isso, realizou-se análise crítica desses artigos, considerando os fundamentos constitucionais e casos de paciente com doença grave e incurável acometido por sofrimento insuportável. Serviram de base a Constituição Federal brasileira, a doutrina do direito constitucional e a Ação Direta de Inconstitucionalidade 3.510-DF/2008. Após a análise, verificou-se a incompatibilidade dos referidos artigos com a moldura constitucional, concluindo-se que a aplicação desses dispositivos legais à prática de eutanásia usurpa a autonomia do cidadão para proteger apenas uma dimensão da vida, às custas da violação de direitos fundamentais: dignidade da pessoa humana, liberdade, inviolabilidade da vida privada e não ser submetido a tortura nem a tratamento desumano ou degradante.

Abstract This study aimed to show the unconstitutionality of applying arts. 121 and 122 of the Brazilian Penal Code to the practice of euthanasia. To this end, we carried out a critical analysis of these articles, considering the constitutional foundations and cases of patients with severe and incurable diseases affected by unbearable suffering. It was based on the Brazilian Federal Constitution, the doctrine of constitutional law, and the Direct Action for the Declaration of Unconstitutionality 3,510-DF/2008. After the analysis, we found incompatibility of these articles with the constitutional framework, concluding that the application of these legal provisions to the practice of euthanasia usurps citizen autonomy to protect only one dimension of life, at the expense of violating fundamental rights: dignity of the human person, freedom, inviolability of private life, and not being subjected to torture or inhuman or degrading treatment.

Resumen Este estudio tuvo como objetivo poner de manifiesto la inconstitucionalidad de la aplicación de los artículos 121 y 122 del Código Penal brasileño a la práctica de eutanasia. Para ello, se llevó a cabo un análisis crítico de estos artículos, teniendo en cuenta los fundamentos constitucionales y casos de paciente con enfermedad grave e incurable que padecen un sufrimiento insoportable. Se utilizaron como base la Constitución Federal brasileña, la doctrina del derecho constitucional y la Acción Directa de Inconstitucionalidad 3.510-DF/2008. Tras el análisis, se comprobó la incompatibilidad de dichos artículos con el marco constitucional y se llegó a la conclusión de que la aplicación de estas disposiciones legales a la práctica de eutanasia usurpa la autonomía del ciudadano para proteger una sola dimensión de la vida, a expensas de la violación de derechos fundamentales: la dignidad de la persona humana, la libertad, la inviolabilidad de la vida privada y el derecho a no ser sometido a tortura ni a trato inhumano o degradante.

Tentativa de suicídio em mulheres privadas de liberdade em unidade prisional / Suicide attempts amomg women deprived of their freedom in a prison unit / Intento de suicidio en mujeres privadas de la libertad en una unidad penitenciaria

RESUMO Objetivo: descrever as ocorrências e os fatores associados à tentativa de suicídio em mulheres privadas de liberdade em uma unidade prisional. Método: estudo transversal, em unidade prisional do Paraná - Brasil, com 30 mulheres, com dados coletados em 2022, através dos instrumentos Columbia-Suicide Severity Rating Scale e outro elaborado pelas autoras e analisados descritivamente e inferencialmente. Resultados: durante a vida, 16 (53,3%) mulheres apresentaram comportamentos suicidas; 14 (46,7%) fizeram tentativas efetivas de suicídio; 14 (46,7%) tiveram danos físicos; e 10 (33,3%) atos preparatórios. A tentativa efetiva de suicídio teve associação com pensamentos suicidas antes da prisão (p <0,01) e pensamentos durante a prisão (p< 0,02). Conclusão: histórico anterior de ideação influenciaram na tentativa de suicídio. Assim, importa avaliar comportamentos suicidas na admissão e permanência de mulheres privadas de liberdade. Este estudo contribui para diminuir a lacuna na produção científica brasileira dessa temática com essa população.

ABSTRACT Objective: to describe the occurrences and factors associated with attempted suicide among women deprived of their freedom in a prison unit. Method: a cross-sectional study conducted at a detention facility in Paraná - Brazil, with 30 women, with data collected in 2022 using the Columbia-Suicide Severity Rating Scale instrument and another one prepared by the authors and analyzed descriptively and inferentially. Results: during their lifetime, 16 (53.3%) women presented suicidal behavior; 14 (46.7%) made actual suicide attempts; 14 (46.7%) had physical damage; and 10 (33.3%) preparatory acts. An actual suicide attempt was associated with suicidal thoughts before arrest (p<0.01) and with thoughts during arrest (p<0.02). Conclusion: previous history of ideation influenced the suicide attempt. Therefore, it is important to evaluate suicidal behavior in the admission and permanence of women deprived of their freedom. This study contributes to reducing the gap in the Brazilian scientific production on this topic with this population segment.

RESUMEN Objetivo: describir los sucesos y factores asociados al intento de suicidio en mujeres privadas de la libertad en una unidad penitenciaria. Método: estudio transversal, en una unidad penitenciaria de Paraná, Brasil, con 30 mujeres, con datos recolectados en 2022, mediante dos instrumentos, el Columbia-Suicide Severity Rating Scale y otro elaborado por las autoras, y analizados de forma descriptiva e inferencial. Resultados: a lo largo de su vida, 16 (53,3%) mujeres presentaron conductas suicidas; 14 (46,7%) intentaron suicidarse realmente; 14 (46,7%) sufrieron daños físicos; y 10 (33,3%) realizaron actos preparatorios. El intento de suicidio se asoció con pensamientos suicidas antes de ir a prisión (p <0,01) y con pensamientos durante la permanencia en prisión (p<0,02). Conclusión: el antecedente previo de ideación influyó en el intento de suicidio. Por lo tanto, es importante evaluar la conducta suicida al ingreso y durante la permanencia de mujeres privadas de la libertad. Este estudio contribuye a reducir las lagunas de la producción científica brasileña sobre este tema con esta población.

Avaliação funcional em famílias de pessoas com comportamento suicida: aplicação do modelo calgary / Functional assessment in families of people with suicidal behavior: application of the calgary model / Evaluación funcional de familias de personas con conducta suicida: aplicación del modelo de calgary

RESUMO: Objetivo: desvelar as ações que mantém a funcionalidade da família de pessoas com comportamento suicida. Método: trata-se de estudo qualitativo, descritivo-exploratório, baseado no referencial teórico e metodológico do Modelo Calgary de avaliação familiar. Participaram do encontro online, no ano de 2022, para construção do genograma familiar 11 usuários do Núcleo de Estudo e Prevenção do Suicídio, localizado em Salvador, Bahia, Brasil. Da segunda etapa, a entrevista contou com nove famílias de usuários. Resultados: emergiram as categorias: vigilância por familiares; uso de tecnologias pelo familiar para contato diário; manejo da crise suicida por familiares e atenção dos familiares às necessidades básicas, todas as categorias relacionadas a pessoa com comportamento suicida. Conclusão: percebe-se caminhos para implementação de políticas de saúde e manuais que orientem família e amigos no manejo da crise suicida, evitando assim consequências não desejáveis, como a tentativa de suicídio e o ato concretizado.

Objective: unveil the actions that maintain the functionality of the family of people with suicidal behavior. Method: this is a qualitative, descriptive-exploratory study, based on the theoretical and methodological framework of the Calgary Family Assessment Model. 11 users of the Suicide Study and Prevention Center, located in Salvador, Bahia, Brazil, participated in the online meeting in 2022 to construct the family genogram. In the second stage, the interview included nine user families. Results: the following categories emerged: surveillance by family members; family member's use of technology for daily contact; management of the suicidal crisis by family members and family attention to basic needs, all categories related to a person with suicidal behavior. Conclusion: there are ways to implement health policies and manuals that guide family and friends in managing the suicidal crisis, thus avoiding undesirable consequences, such as the suicide attempt and the completed act.

RESUMEN: Objetivo: revelar las acciones que mantienen la funcionalidad de la familia de personas con conducta suicida. Método: se trata de un estudio cualitativo, descriptivo-exploratorio, basado en el marco teórico y metodológico del Modelo de Evaluación Familiar de Calgary. Once usuarios del Centro de Estudio y Prevención del Suicidio, ubicado en Salvador, Bahía, Brasil, participaron del encuentro online en 2022 para elaborar el genograma familiar. En la segunda etapa, la entrevista incluyó a nueve familias de usuarios. Resultados: surgieron las categorías: control por parte de los familiares; uso de la tecnología por parte de los familiares para mantener contacto diario; manejo de la crisis suicida por parte de los familiares y atención de los familiares a las necesidades básicas, todas las categorías se relacionan con la persona con conducta suicida. Conclusión: existen formas de implementar políticas y manuales de salud que orienten a los familiares y amigos para manejar la crisis suicida, y evitar consecuencias no deseadas, como el intento de suicidio y el acto consumado.

¿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.

Suicide attempts in the adult Mexican population: an analysis of sociodemographic characteristics and associated factors / Tentativas de suicídio na população adulta mexicana: uma análise de fatores sociodemográficos e associados

ABSTRACT Objective: Suicide is the culmination of a process or continuum known as suicidal behavior that proceeds from ideation and planning to attempt. The objective was to estimate the prevalence of suicide attempts in the adult Mexican population and to analyze their main associated factors. Methods: We conducted an observational, cross-sectional, and descriptive study with information from the National Health and Nutrition Survey (2018). Self-reported lifetime suicide attempt was used in the analysis. We analyzed depression, obesity, tobacco smoking, and alcohol consumption as suicide attempt-associated factors using a multivariate logistic regression model. Results: The prevalence of adult suicide attempt was 2.0% (95%CI 1.8-2.2) and it was higher among women (2.4%; 95%CI 2.2-2.8) and young people (2.9%; 95%CI 2.4-3.4). Low education (OR=1.6; 95%CI 1.2-2.2), being single (OR=1.3; 95%CI 1.0-1.6), having obesity (OR=1.4; 95%CI 1.1-1.8), consumption of alcohol (OR=2.4; 95%CI 1.7-3.4) or tobacco smoking (OR=1.8; 95%CI 1.4-2.4), and having strong symptoms of depression (OR=10.1; 95%CI 6.2-16.3) were associated with a higher prevalence of suicide attempts. Conclusion: These results help better understand suicidal behavior in Mexico and identify the factors that increase the likelihood of suicide attempts, which is essential to help reduce suicide mortality. This research is crucial for developing early interventions and prevention programs aimed at reducing suicide's public health burden.

RESUMO Objetivo: O suicídio é o resultado de um processo ou continuidade conhecido como comportamento suicida, que parte da ideação e planejamento até a tentativa. O objetivo foi estimar a prevalência de tentativa de suicídio na população adulta mexicana e analisar seus principais fatores associados. Métodos: Realizamos um estudo observacional, transversal e descritivo com informações da Pesquisa Nacional de Saúde e Nutrição (2018). Na análise, foi utilizado o relato de tentativa de suicídio ao longo da vida. Analisamos a depressão, a obesidade, o tabagismo e o consumo de álcool como fatores associados à tentativa de suicídio, usando um modelo de regressão logística multivariada. Resultados: A prevalência de tentativas de suicídio em adultos foi de 2,0% (intervalo de confiança de 95% — IC95% 1,8-2,2); foi mais alta entre as mulheres (2,4%; IC95% 2,2-2,8) e entre os jovens (2,9%; IC95% 2,4-3,4). Baixa educação (odds ratio — OR=1.6; IC95% 1.2-2.2), estado civil solteiro (OR=1.3; IC95% 1.0-1.6), obesidade (OR=1.4; IC95% 1.1-1.8), consumo de álcool (OR=2.4; IC95% 1.7-3.4) ou tabaco (OR=1.8; IC95% 1.4-2.4) e sintomas fortes de depressão (OR=10.1; IC95% 6.2-16.3) estão associados a uma maior prevalência de tentativas de suicídio. Conclusão: Esses resultados ajudam a entender melhor o comportamento suicida no México e a identificar os fatores que aumentam a probabilidade de tentativas de suicídio, o que é essencial para ajudar a reduzir a mortalidade por essa causa. Esta pesquisa é crucial para o desenvolvimento de intervenções precoces e programas de prevenção com o objetivo de reduzir o ônus de saúde pública do suicídio.

Prevalência e fatores de riscos relacionados a comportamentos suicidas em profissionais do sexo / Prevalencia y factores de riesgo relacionados con la conducta suicidal en trabajadores sexuales / Prevalence and risk factors related to suicidal behavior in sex workers

Introdução: O trabalho sexual consentido é, historicamente, permeado por estigmas, proporcionando a marginalização social de profissionais do sexo e sua maior exposição a fatores de riscos que tendenciam a condutas suicidas. Objetivo: Identificar a prevalência e dos fatores de riscos relacionados a comportamentos suicidas em profissionais do sexo, tendo em vista a vulnerabilidade social desse grupo. Metodologia: Este estudo é uma revisão integrativa de literatura, determinada a partir da seguinte questão de pesquisa: "Qual a prevalência e os fatores de riscos relacionados a comportamentos suicidas entre profissionais do sexo?". Em seguida, aplicou os subsequentes Descritores em Ciências da Saúde: "Suicide" e "Sex workers", que foram combinados com o operador booleano "AND", nas plataformas National Library of Medicine, Science Direct, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Literatura Latino-americana e do Caribe, Scientific Eletronic Library Online, BioMed Central, Business Source Completee WorldWideScience. Foram selecionados 19 artigos relacionados ao objeto de estudo. Resultados: A prevalência de suicídio em profissionais do sexo foi classificada em três subcategorias: tentativas de suicídio, com predominância de 31,57% (n=6), ideação suicida com 15,78% (n=3) e o risco de suicídio com 5,26% (n=1). Os riscos de comportamentos suicidas foram associados a diversos fatores, sobretudo a violência (47,36%; n=9), depressão (26,31%; n=5) e a pobreza (15,78%; n=3). Conclusões: Há uma alta prevalência de comportamentos suicidas em profissionais do sexo que está associada a diversos fatores de riscos, verificando a carência de abordagens comunitárias direcionadas à vulnerabilidade social desse grupo (AU).

Introduction: Consensual sex work has historically been permeated by stigma, leading to the social marginalization of sex workers and their increased exposure to risk factors that tend to correlate with suicidal behaviors. Objective:To explore the prevalence and risk factors related to suicidal behavior in sex workers, considering the social vulnerability of this group. Methodology: This study is an integrative literature review, guided by the research question: "What is the prevalence and risk factors related to suicidal behaviors among sex workers?" The following Health Science Descriptors were applied: "Suicide" and "Sex workers," combined with the boolean operator "AND," on platforms such as the National Library of Medicine, Science Direct, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Literatura Latino-americana e do Caribe, Scientific Eletronic Library Online, BioMed Central, Business Source Complete, and WorldWideScience. Nineteen articles related to the study's objectivewere selected. Results:The prevalence of suicide among sex workers were classified into three subcategories: suicide attempts, with a predominance of 31.57% (n=6), suicidal ideation with 15.78% (n=3) and the risk of suicide with a prevalence of 5.26% (n=1). The risks of suicidal behavior were associated with several factors, especially violence (47,36%; n=9), depression (26.31%; n=5) and poverty (15.78% /n=3). Conclusions: There is a high prevalence of suicidal behaviors among sex workers, associated with various risk factors, highlighting the need for community-based approaches addressing the social vulnerability of this group (AU).

Introducción: El trabajo sexual consensuado ha estado históricamente impregnado de estigmas, llevando a la marginación social de los profesionales del sexo y a una mayor exposición a factores de riesgo que tienden a asociarse con conductas suicidas. Objetivo: Identificar la prevalencia y los factores de riesgo relacionados con comportamientos suicidas en profesionales del sexo, considerando la vulnerabilidad social de este grupo. Metodología: Este estudio es una revisión integradora de la literatura, derivada de la siguiente pregunta de investigación: "¿Cuál es laprevalencia y los factores de riesgo relacionados con comportamientos suicidas entre los profesionales del sexo?". Posteriormente, se aplicaron los siguientes Descriptores en Ciencias de la Salud: "Suicide" y "Sex workers", combinados con el operador booleano "AND", en plataformas como la Biblioteca Nacional de Medicina, Science Direct, Portal de Periódicos de la Coordinación de Perfeccionamiento de Personal de Nivel Superior, Literatura Latinoamericana y del Caribe, Scientific Electronic Library Online, BioMed Central, Business Source Complete y WorldWideScience. Se seleccionaron 19 artículos relacionados con el objeto de estudio. Resultados: La prevalencia de suicidio en profesionales del sexo se clasificó en tres subcategorías: intentos de suicidio, con una predominancia del 31,57% (n=6), ideación suicida con el 15,78% (n=3) y el riesgo de suicidio con el 5,26% (n=1). Los riesgos de comportamientos suicidas se asociaron con varios factores, especialmente la violencia (47,36%; n=9), la depresión (26,31%; n=5) y la pobreza (15,78%; n=3). Conclusiones: Existe una alta prevalencia de comportamientos suicidas en profesionales del sexo asociada con diversos factores de riesgo, destacando la necesidad de enfoques comunitarios dirigidos a la vulnerabilidad social de este grupo (AU).

Tasas de suicidio y concentración de litio en agua corriente en Rocha y Montevideo: primer estudio en Uruguay, período 2019-2020 / Suicide rates and lithium concentration in tap water in Rocha and Montevideo: first study in Uruguay, period 2019-2020 / Taxas de suicídio e concentração de lítio na água encanada em Rocha e Montevidéu: primeiro estudo no Uruguai, período 2019-2020

El suicidio es un fenómeno que además de las pérdidas humanas que involucra, repercute negativamente en familiares y allegados, produciendo a su vez enormes gastos en el sistema sanitario. En Uruguay, la tasa de suicidio no solo ha experimentado un aumento sostenido, representando una preocupación constante para las autoridades, sino que suele ser una de la más altas de Latinoamérica, en 2022 fue de 23,08 cada 100.000 habitantes. Reconociendo que el suicidio es un fenómeno multifactorial grave, diversos estudios han indagado sobre la posible correlación entre la presencia de litio en agua corriente y tasas de suicidio, habiéndose observado una relación inversa, lo que permitiría considerar el litio como eventualmente protector de la conducta suicida. El presente estudio pretende abordar dicha correlación en los departamentos de Rocha y Montevideo, de Uruguay. Los resultados obtenidos no son concluyentes. En cuanto a las concentraciones de litio presentes en agua corriente, en general son menores a las señaladas en otros estudios como protectoras (30 µ/L). Es necesario profundizar en este eje de discusión, como en otros, para obtener un diagnóstico más detallado de este complejo y sentido fenómeno.

Suicide is a phenomenon that, in addition to the human losses it involves, has a negative impact on family members and acquaintances, leading to enormous costs in the healthcare system. In Uruguay, the suicide rate has not only experienced a sustained increase, representing a constant concern for authorities, but it also tends to be one of the highest in Latin America, reaching 23.08 per 100,000 inhabitants in 2022. Recognizing that suicide is a serious multifactorial phenomenon, several studies have investigated the possible correlation between the presence of lithium in tap water and suicide rates, noting an inverse relationship. This suggests that lithium could potentially be considered protective against suicidal behavior. This study aims to address this correlation in the departments of Rocha and Montevideo, Uruguay. The results obtained are inconclusive. Regarding the concentrations of lithium present in tap water, they are generally lower than those indicated in other studies as protective (30 µg/L). It is necessary to delve deeper into this axis of discussion, as in others, to obtain a more detailed diagnosis of this complex and profound phenomenon.

O suicídio é um fenómeno que, além das perdas humanas que envolve, tem um impacto negativo nos familiares e amigos, produzindo enormes gastos no sistema de saúde. No Uruguai, a taxa de suicídio não só tem registado um aumento sustentado, representando uma preocupação constante para as autoridades, mas geralmente é uma das mais altas da América Latina, sendo de 23,08 por 100.000 habitantes em 2022. Reconhecendo que o suicídio é um fenómeno multifatorial grave, vários estudos têm investigado a possível correlação entre a presença de lítio na água encanada e as taxas de suicídio; observa-se uma relação inversa, o que permitiria considerá-lo como um possível protetor do comportamento suicida. O presente estudo visa abordar esta correlação nos departamentos de Rocha e Montevidéu no Uruguai. Os resultados obtidos não são conclusivos. Quanto às concentrações de litio presentes na água corrente, são geralmente inferiores às indicadas em outros estudos como protetoras (30 µ/L). É necessário aprofundar esta área de discussão como em outras linhas de pesquisa, e obter um diagnóstico mais detalhado deste fenômeno complexo e significativo.

Suicidio con agroquímicos en contextos rurales. Revisión bibliográfica de la producción científica latinoamericana

La complejidad, dinámica y multidimensionalidad de los eventos suicidas hace que sean considerados un problema de salud pública, tanto a nivel nacional como internacional. Entre los métodos de suicidio, la ingestión de agroquímicos es uno de los más empleados en el mundo. Esta revisión bibliográfica tuvo como objetivo relevar artículos científicos latinoamericanos que estudian o analizan el suicidio en contextos rurales. En particular, aquellos que utilizan como medio la ingesta de agroquímicos. Para ello, se realizó una revisión exploratoria en las siguientes bases de datos bibliográficas: BVS, SciELO y DOAJ. Tras la combinación de descriptores y términos libres se halló un total de 343 artículos. A partir de distintos criterios de inclusión y exclusión, el cuerpo documental quedó conformado por cinco artículos, cuatro de Brasil y uno de Colombia. Entre los resultados obtenidos se destaca que el suicidio con agroquímicos es considerado una problemática en los contextos rurales analizados. Las investigaciones asocian este tipo de eventos con la manipulación o utilización intensiva de agroquímicos, en particular, en adultos jóvenes. Entre las sustancias más utilizadas se encuentran los insecticidas. Asimismo, se señala que existe un subregistro de casos, lo cual dificulta el desarrollo de estrategias preventivas. El interés incipiente en el tema demanda multiplicar los estudios y disciplinas que lo aborden. Además de esto, se requiere una articulación mayor entre ciencia, tecnología y políticas de monitoreo en salud mental que generen visibilidad sobre este tipo de problemas y fomenten el desarrollo de estrategias participativas y promocionales en contextos rurales.

The complexity, dynamics, and multidimensionality of suicidal events make them a public health problem, both nationally and internationally. Among the methods of suicide, the ingestion of agrochemicals is one of the most commonly used worldwide. This bibliographic review aimed to survey Latin American scientific articles that study and/or analyze suicide in rural contexts, particularly those using agrochemical ingestion as a method. An exploratory review was conducted in the following bibliographic databases: BVS, Scielo, and DOAJ. After combining descriptors and free terms, a total of 343 articles were found. Based on various inclusion and exclusion criteria, the document body consisted of five articles, four from Brazil and one from Colombia. One of the key findings is that suicide involving agrochemicals is seen as a significant issue in the rural areas under study. Research associates this type of event with the manipulation and/or intensive use of agrochemicals, particularly in young adults. Insecticides are among the most commonly used substances. It is also noted that there is underreporting of cases, which hinders the development of preventive strategies. The emerging interest in the topic demands an increase in studies and disciplines addressing it. In addition, greater articulation is required between science, technology, and mental health monitoring policies to raise awareness about these issues and promote the development of participatory and promotional strategies in rural contexts.

A complexidade, a dinâmica e a multidimensionalidade dos eventos suicidas fazem com que eles sejam considerados um problema de saúde pública, tanto em nível nacional quanto internacional. Entre os métodos de suicídio, a ingestão de agrotóxicos é um dos mais utilizados no mundo. Esta revisão da literatura teve como objetivo fazer um levantamento dos artigos científicos latino-americanos que estudam e/ou analisam o suicídio em contextos rurais. Em particular, aqueles que utilizam a ingestão de agrotóxicos como meio de suicídio. Para tanto, foi realizada uma revisão exploratória nas seguintes bases de dados bibliográficas: BVS, Scielo e DOAJ. Após a combinação de descritores e termos livres, foi encontrado um total de 343 artigos. Com base em diferentes critérios de inclusão e exclusão, o corpo documental foi composto por cinco artigos, quatro do Brasil e um da Colômbia. Entre os resultados obtidos, destaca-se que o suicídio com agrotóxicos é considerado um problema nos contextos rurais analisados. As pesquisas associam esse tipo de evento ao manuseio e/ou uso intensivo de agrotóxicos, principalmente em adultos jovens. Os inseticidas estão entre as substâncias mais comumente usadas. Observa-se também que há uma subnotificação dos casos, o que dificulta o desenvolvimento de estratégias preventivas. O incipiente interesse pelo assunto exige a multiplicação de estudos e disciplinas que o abordem. Além disso, há necessidade de maior coordenação entre ciência, tecnologia e políticas de monitoramento de saúde mental que gerem visibilidade desse tipo de problema e incentivem o desenvolvimento de estratégias participativas e promocionais em contextos rurais.

Mortalidad por suicidio y sus características de comportamiento en la ciudad de Lima durante los años 2017-2022 / Suicide mortality and its behavioral characteristics in the city of Lima during the years 2017-2022

RESUMEN Describir la mortalidad por suicidio y sus principales características en Lima, Perú, durante el período 2017-2022. Materiales y métodos: Estudio descriptivo observacional que reporta características sociodemográficas y métodos de suicidio durante el período 2017-2022. Se estimaron también las tasas estandarizadas de mortalidad por año y por edad en Lima y sus distritos para cada año del período 2017-2021. Se registró un total de 559 muertes por suicidio durante el período 2017-2022 en Lima Metropolitana, con una razón hombre/mujer de 2,6 y edad mediana de 37. El 68,78% correspondía a personas solteras, el 44,54 % tenía educación secundaria, el 60,82 % de los suicidios ocurrieron en el hogar, y el ahorcamiento fue el método más frecuente (70,98 %). La mortalidad por suicidio alcanzó una proporción de 5,52 por cada 100 000 habitantes para Lima Metropolitana durante el período 2017-2021. Este indicador aumentó hasta un máximo en 2019 y ha disminuido desde entonces. Los distritos con mayor mortalidad fueron Pucusana, Barranco y San Bartolo. Conclusiones: La mortalidad por suicidio en Lima Metropolitana ha mostrado una tendencia decreciente desde el año 2019. Por otro lado, es imperativo mantener una vigilancia exhaustiva a largo plazo e implementar estrategias de prevención y atención en salud mental, particularmente en los distritos y grupos demográficos más afectados.

ABSTRACT To describe suicide mortality and its main characteristics in Lima, Peru during the period 2017-2022. Methods: A descriptive observational study that reports the main sociodemographic characteristics and methods of suicide, during the period 2017-2022 in Metropolitan Lima and its districts. Age-standardized mortality rates were also estimated annually and throughout the period 2017-2021. There were 559 deaths by suicide during 2017-2022 in Lima, with a male/female ratio of 2.6, and a median age of 37; 68,78% were single, 44,54% had secondary education, 60,82% occurred at home, and hanging was the main method (70,98%). Suicide-related mortality was 5.52 per 100 000 habitants for Lima during the period 2017-2021. It increased to a peak in 2019 and then decreased. The districts with the highest mortality were Pucusana, Barranco and San Bartolo. Suicide mortality has shown a decreasing trend since 2019 in Lima; it is imperative to maintain comprehensive long-term surveillance, and to implement prevention and mental health care strategies, particularly in the most affected districts and demographic groups.