Occupational exposure to suicide: A review of research on the experiences of mental health professionals and first responders.

Exposure to suicide is a major factor for suicidality. Mental health professionals and first responders are often exposed to suicide while on-duty. The objective of this scoping review is to describe the state of current research on exposure to suicide among mental health professionals and first responders, focusing on the prevalence and impact of exposure to suicide, and to identify current gaps in the literature. We searched MEDLINE, Scopus, PsychNET, and Web of Science and identified 25 eligible papers. Between 31.5-95.0% of professionals had been exposed to suicide. Exposure to suicide had impacts on personal life, professional life, and mental health; and caused emotional distress. There was little research investigating exposure to suicide among police officers, firefighters, and paramedics. More research existed on mental health professionals, but none assessed exposure to suicide as a risk for suicide amongst this group. The review concludes that exposure to suicide is distressing for mental health professionals, and likely to be for first responder however, more research on these groups, especially paramedics, is required.

Mortality risks among blue- and white-collar workers: A time series study among Japanese men aged 25-64 years from 1980 to 2015.

OBJECTIVE: We aimed to analyse age-standardised mortality trends in Japan among blue- and white-collar male workers aged 25-64 years, by major causes of mortality from 1980 to 2015. METHODS: Five-yearly mortality data were extracted from occupation-specific vital statistics maintained by the Japanese Ministry of Health, Labour and Welfare. A time series study was conducted among employed men aged 25-64 years. Age-standardised mortality trends by occupational category were calculated separately for all cancers, ischaemic heart disease, cerebrovascular disease and suicide. Poisson regression analysis was performed to analyse mortality trends by occupational category for each cause. RESULTS: Mortality rates for all cancers and ischaemic heart disease were higher among white-collar workers than blue-collar workers throughout the 35-year study period. The gap in the mortality rates for all four causes of death among blue- and white-collar workers widened in 2000 after Japan's economic bubble burst in the late 1990s. Simultaneously, suicide mortality rates among white-collar workers increased sharply and have remained higher than among blue-collar workers. CONCLUSIONS: White-collar male workers in Japan have a higher risk of mortality than male blue-collar workers. However, despite substantial differences, significant progress has been made in recent years in reducing mortality across all occupations in Japan.

Suicidio en adolescentes y jóvenes en Chile: riesgos relativos, tendencias y desigualdades / Suicide in adolescents and young adults in Chile: relative risks, trends, and inequalities / Suicídio em adolescentes e jovens no Chile: riscos relativos, tendências e desigualdades

RESUMEN Objetivo. Describir cuantitativamente el riesgo relativo, la tendencia y la desigualdad geográfica del suicidio en adolescentes y jóvenes entre las regiones de Chile, en el periodo 2000 al 2017. Método. Estudio ecológico poblacional a partir de los registros de defunciones por suicidio. Se estimaron tasas de mortalidad y riesgos relativos (RR) de suicidio por sexo, edad y región. Se estudió la tendencia y desigualdad geográfica del suicidio entre las regiones de Chile; medidas absolutas y relativas de desigualdades geográficas fueron estimadas. Resultados. Entre 2000 y 2017 se registraron 6 292 suicidios en adolescentes y jóvenes en Chile. Las tasas promedio de mortalidad por suicidio en Chile fueron de 8,5; 5,4 y 14.7 por 100 000 en los grupos 10-24, 10-19 y 20-24 años, respectivamente, en el periodo 2000-2017. Las tasas más altas de mortalidad por suicidio se encontraron en las regiones de Aisén, Los Lagos, Magallanes y Los Ríos. El riesgo más alto de suicidio se estimó en los hombres (RR=3,5), los jóvenes (RR=2,7) y en la región de Aisén (RR=2,0). La tasa promedio nacional en el grupo 10-24 años se mantuvo en 8,5 por 100 000 en los periodos 2000-2008 y 2009-2017. La mayor desigualdad geográfica se encontró en hombres de 20-24 años en el periodo 2000-2008. Conclusiones. El suicidio en jóvenes y adolescentes de Chile se ha mantenido sin mayores cambios en el periodo de estudio. Los hombres tienen un mayor riesgo de suicidio que las mujeres. Existen desigualdades geográficas entre las regiones de Chile en el suicidio y son más elevadas en hombres de 20 a 24 años. Se recomienda evaluar y fortalecer los programas de prevención del suicidio en los adolescentes y jóvenes, en especial en las regiones y los grupos poblacionales específicos en situación de mayor vulnerabilidad.

ABSTRACT Objective. Quantitatively describe relative risk, trends, and geographical inequalities in suicide in adolescents and young adults in regions of Chile, from 2000 to 2017. Methodology. Ecological population study based on records of death by suicide. Suicide death rates and relative risk (RR) were estimated, by sex, age, and region. Trends and geographical inequalities in suicide in regions of Chile were studied; absolute and relative measures of geographical inequalities were estimated. Results. Between 2000 and 2017, there were 6,292 suicides in adolescents and young adults in Chile. The average rates of death by suicide in Chile were 8.5, 5.4, and 14.7 per 100,000 in the 10-24, 10-19, and 20-24-year age groups, respectively, in the period 2000-2017. The highest suicide death rates were found in the Aisén, Los Lagos, Magellan and Los Ríos regions. The highest risk of suicide was estimated in men (RR = 3.5), young adults (RR = 2.7), and the Aisén region (RR = 2.0). The national average rate in the 10-24 age group remained at 8.5 per 100,000 in the periods 2000-2008 and 2009-2017. The greatest geographical inequality was found in men 20-24 years old in the period 2000-2008. Conclusions. Suicide in young adults and adolescents in Chile remained unchanged in the study period. Men have a higher risk of suicide than women. There are geographical inequalities in suicide between Chile's regions and they are highest in men between ages 20 and 24. It is recommended to evaluate and strengthen suicide prevention programs in adolescents and young adults, especially in the most vulnerable regions and population groups.

RESUMO Objetivo. Descrever quantitativamente o risco relativo, tendência e desigualdades geográficas do suicídio em adolescentes e jovens nas diferentes regiões do Chile no período entre 2000 e 2017. Método. Estudo ecológico populacional a partir de registros de mortes por suicídio. As taxas de mortalidade e riscos relativos (RR) de suicídio foram estimados por sexo, idade e região. A tendência e desigualdades geográficas do suicídio foram analisadas por região com o cálculo das medidas absolutas e relativas das desigualdades geográficas. Resultados. No período entre 2000 e 2017, foram registrados 6.292 suicídios em adolescentes e jovens no Chile. As taxas médias de mortalidade por suicídio no país foram de 8,5, 5,4 e 14,7 por 100.000 habitantes nas faixas etárias de 10-24, 10-19 e 20-24 anos, respectivamente. As taxas de mortalidade por suicídio foram maiores nas regiões de Aisén, Los Lagos, Magallanes e Los Ríos. O risco de suicídio foi maior no sexo masculino (RR = 3,5), em jovens (RR = 2,7) e na região de Aisén (RR = 2,0). A taxa média nacional na faixa etária entre 10 e 24 anos se manteve em 8,5 por 100.000 nos períodos de 2000 a 2008 e de 2009 a 2017. A maior desigualdade geográfica foi vista em homens entre 20 e 24 anos no período de 2000 a 2008. Conclusão. As taxas de suicídio em adolescentes e jovens do Chile se manteve relativamente estável no período estudado. Indivíduos do sexo masculino têm maior risco de suicídio. Existem desigualdades geográficas entre as regiões do país e as taxas de suicídio são mais elevadas em homens jovens entre 20 e 24 anos. Recomenda-se avaliar e reforçar os programas de prevenção de suicídio em adolescentes e jovens, sobretudo nas regiões e nos grupos populacionais em situação de maior vulnerabilidade.

Revisión sistemática de literatura sobre suicidio: factores de riesgo y protectores en jóvenes latinoamericanos 1995-2017 / A Systematic Literature Review on Suicide: Risk and Protection Factors in Latin American Youth 1995-2017

Resumen.Objetivo. Conocer el estado de la investigación sobre los factores protectores y de riesgo de suicidio en jóvenes en varios países de América Latina. Método. El estudio se ha realizado mediante una revisión sistemática de literatura y con un enfoque cualitativo. Resultados. La mayor parte de los estudios analizados para este artículo se han realizado desde ciencias de la salud con predominio de enfoques cuantitativos, avocándose principalmente en factores de riesgo y en menor medida en factores protectores. No obstante, se reconoce la necesidad de estudiar más a fondo estos últimos, así como las medidas de prevención que puedan ser útiles en intervenciones e investigaciones futuras. Por otro lado, se ha encontrado que la familia como primer espacio de interacción social, representa un elemento determinante tanto en el desarrollo de factores protectores como de riesgo en jóvenes. Además, se destaca que para esta población la combinación de diferentes factores de riesgo podría agravar considerablemente la ocurrencia de un intento o consumación de suicidio.

Abstract.Objective. To determine the state of research on protective and risk factors of suicide in young people in several Latin American countries. Method. The study was conducted following a Systematic Literature Review with a qualitative approach. Results. Most studies analyzed for this article have been conducted from within the health sciences with a predominance of quantitative approaches, focusing mainly on risk factors and, to a lesser extent, on protective factors. However, there is a need to study the latter in greater depth, as well as prevention measures that may be useful in future interventions and research. In addition, it has been found that the family, as the first space of social interaction, represents a determining element in the development of both protective and risk factors in young people. Furthermore, for this population, the combination of different risk factors could considerably aggravate the occurrence of a suicide attempt or consummation.

An increase in IL-6 levels at 6-month follow-up visit is associated with SSRI-emergent suicidality in high-risk children and adolescents treated with fluoxetine.

Major depressive disorder (MDD) is associated with alterations in circulatory cytokines, in adults as well as in children and adolescents. Administration of selective serotonin reuptake inhibitors (SSRIs) to MDD pediatric patients modifies cytokine levels. However, most studies only assessed changes over a short time period. In this study, we evaluated long-term effects of the SSRI fluoxetine (FLX) in children and adolescents treated for anxiety and/or MDD, including a high-risk group with pre-treatment suicidality. The study group included ninety-two patients (35 boys and 57 girls) with MDD and/or anxiety disorders, aged 13.90 ± 2.41 years. All patients were treated with FLX and followed for 6 months. The study group included children with pretreatment suicidality (high-risk group;N = 62) and without pretreatment suicidality (N = 30) according to the Columbia Suicide Severity Rating Scale. Plasma concentrations of TNFα, IL-6, and IL-1ß were measured by enzyme linked immunosorbent assays before and after six months of treatment. IL-6 and IL-1ß significantly increased as a factor of time after 6 months of treatment. The elevation was statistically significant confined to children with pretreatment suicidality. Within the children with pretreatment suicidality, IL-6 levels increased significantly after 6 months only in the children who developed SSRI-associated suicidality. To summarize, an increase in IL-6 levels after 6 months of treatment may be associated with SSRI-emergent suicidality in children with pretreatment suicidality. Further studies are needed to clarify the role and mechanism(s) of IL-6 in the pathogenesis of this life-threatening adverse event.

Causes of death in clozapine-treated patients in a catchment area: a 10-year retrospective case-control study.

Uncertainty regarding the excess of mortality in patients treated with clozapine persists. A decrease in all-cause mortality, and perhaps also in suicide, after clozapine initiation has been reported, but there are no studies in which preventable causes were ascertained in those taking medication in the long term. Here, we aimed to assess a decade of causes of deaths in a catchment area in patients with schizophrenia chronically treated with clozapine and compared them to a clozapine-treated control cohort. Causes of deaths were classified as suicide, expected (e.g. cancer), and unexpected deaths (encompassing causes of death potentially due to clozapine side effects, and unexplained sudden death). We used descriptive statistics for comparing socio-demographic and clinical factors between the three groups. Logistic regression models were used to examine risk factors associated with unexpected death compared to the control group. We found that the overall mortality was similar to that in previous studies (at 0.8% yearly on average) with unexpected deaths accounting for 52% of total deaths. The unexpected deaths group was on average treated with higher clozapine doses (mean 460 mg/day). A small but significant peak of unexpected deaths was found during the 2018 summer heat wave, which might have exacerbated dose-dependent side effects of clozapine. We suggest increased monitoring for those on higher doses of clozapine as one potential intervention to decrease mortality in this population.

Análise espaço-temporal da mortalidade por suicídio no Rio Grande do Norte, Brasil, no período de 2000 a 2015 / Space-time analysis of mortality by suicide in the State of Rio Grande do Norte, Brazil, in the period from 2000 to 2015

Resumo O objetivo deste estudo foi analisar a distribuição espaço-temporal da mortalidade por suicídio no Rio Grande do Norte (RN) no período de 2000 a 2015. Trata-se de um estudo ecológico misto que avaliou os óbitos decorrentes de suicídio registrados no RN. A análise espacial foi realizada utilizando as taxas brutas e padronizadas. A análise univariada foi realizada através do Índice de Moran Global e Local, e a análise bivariada espacial por meio do cruzamento entre as variáveis sociodemográficas e as taxas de mortalidade. Através da Regressão Joinpoint foi possível verificar a tendência de mortalidade por suicídio. Foram registrados 2.266 óbitos por suicídio de 2000 a 2015, e a análise espacial mostrou fraca autocorrelação espacial (I < 0,3) para as Taxas de Mortalidade Padronizadas para ambos os sexos, com formação de aglomerados espaciais na Região do Seridó. A análise bivariada mostrou formação de clusters na Região do Seridó com as variáveis IDH e Envelhecimento. Além disso, foi observada uma tendência de aumento da mortalidade no sexo masculino até o ano de 2003 (APC = 15,3%; IC = 9,2-21,8), seguido de um período de estabilidade.

Abstract The objective of this study was to analyze the space-time distribution of mortality by suicide in the State of Rio Grande do Norte (RN) between 2000 and 2015. This is a mixed ecological study that evaluated the deaths due to suicide registered in RN. Spatial analysis was performed using crude and standardized rates. Univariate analysis was conducted using the Moran Global and Local Index, and spatial bivariate analysis was assessed using the cross-referencing of sociodemographic variables and mortality rates. By applying Joinpoint Regression, it was possible to verify the suicide mortality trend. There were 2,266 suicide deaths from 2000 to 2015, and spatial analysis showed poor spatial autocorrelation (I <0.3) for the Standardized Mortality Rates for both sexes, with formation of spatial clusters in the Seridó Region. The bivariate analysis showed the formation of clusters in the Seridó Region with HDI and Aging variables. In addition, there was a trend of increased male mortality up to 2003 (APC = 15.3%, CI = 9.2-21.8), followed by a period of stability.

Geografías del suicidio en Argentina: un estudio ecológico espacial durante los períodos 1999-2003 y 2008-2012 / Geographies of suicide in Argentina: a spatial ecological study during 1999-2003 and 2008-2012 periods

RESUMEN Objetivo Describir la distribución geográfica y el rol de factores sociodemográficos sobre la mortalidad por suicidios, de acuerdo con sexo y grupos de edad en Argentina durante los períodos 1999-2003 y 2008-2012. Método El rol de factores sociodemográficos sobre la mortalidad por suicidios y su distribución geográfica fueron analizados mediante regresiones múltiples espaciales. Se incluyeron tres variables independientes: un índice de fragmentación social, un índice de pobreza y la densidad poblacional como indicador del nivel de ruralidad. Resultados La fragmentación social y el suicidio estuvieron directamente relacionados en hombres de 10-59 años y mujeres de 10-29 años durante 1999-2003. Durante 2008-2012 el riesgo de suicidio fue mayor en áreas de baja densidad poblacional, salvo en mujeres de 10-29 años. Conclusiones Los resultados obtenidos en este estudio apoyan la hipótesis de fragmentación social como fenómeno asociado al riesgo de suicidio en departamentos de la Argentina, pero también dan apoyo a la hipótesis de un mayor riesgo de suicidio en áreas rurales. Las medidas de prevención del suicidio podrían enfocarse en políticas que promuevan la integración social, especialmente en población joven, así como también una mayor integración de las áreas rurales con el resto del territorio.(AU)

ABSTRACT Objective The aim of this study was to describe the geographical distribution and the role of sociodemographic factors on mortality by suicides, according to sex and age groups, in Argentina during the periods 1999-2003 and 2008-2012. Methods The role of sociodemographic factors on mortality by suicides and their geographical distribution were analyzed by means of multiple spatial regressions. Three independent variables were included: an index of social fragmentation, a poverty index and population density, as an indicator of the level of rurality. Results Social fragmentation and suicide were directly related in men 10-59 years old and women 10-29 years old during 1999-2003. During 2008-2012, the risk of suicide was higher in areas of low population density, except for women aged 10-29 years. Conclusions The results obtained in this study support the hypothesis of social fragmentation as a phenomenon associated with the risk of suicide in departments of Argentina, but also support the hypothesis of an increased risk of suicide in rural areas. Suicide prevention measures could focus on policies that promote social integration, especially in the young population, as well as greater cohesion of rural areas.(AU)

Tendência de suicídio em adolescentes brasileiros entre 1997 e 2016 / Tendencia al suicidio en adolescentes brasileños entre 1997 y 2016 / Suicide trend among Brazilian adolescents between 1997 and 2016

Objetivo: Analisar a tendência da mortalidade por suicídio em adolescentes brasileiros no período de 1997 a 2016. Métodos: Estudo ecológico de séries temporais; empregou-se regressão de Prais-Winsten. Resultados: Foram registrados 14.852 óbitos por suicídio, com taxas de mortalidade por 100 mil habitantes de 1,95 em 1997, 2,65 em 2016, e média de 2,14 no período 1997-2016; predominaram óbitos no sexo masculino (67,59%), por lesões autoprovocadas intencionalmente (84,19%), ocorridos no domicílio (52,69%); a região Centro-Oeste apresentou a maior taxa no período (3,71/100 mil hab.), com destaque para Mato Grosso do Sul (8,3/100 mil hab.); observou-se tendência de aumento de 1,35% ao ano na mortalidade por suicídio na população geral de adolescentes (IC95% 0,56;2,15), 1,63% no sexo masculino (IC95% 0,56;2,29), 3,11% na região Norte (IC95% 2,25;3,98) e 4,19% no Nordeste (IC95% 2,58;5,84). Conclusão: A mortalidade por suicídio em adolescentes brasileiros mostrou tendência ascendente no período estudado.

Objetivo: analizar la tendencia al suicidio en adolescentes brasileños de 1997 a 2016. Método: estudio ecológico de series temporales; se utilizó la regresión de Prais-Winsten. Resultados: se registraron 14.852 suicidios, con tasas de mortalidad de 1,95 por 100.000 habitantes en 1997, 2,65 en 2016 y promedio de 2,14 en el período 1997-2016; las muertes predominaron en el sexo masculino (67,59%), por autolesión intencional (84,19%) y ocurridas en casa (52,69%); la región Centro-Oeste tuvo la tasa más alta en el período (3,71/100,000 habitantes), con énfasis en Mato Grosso do Sul (8,3/100,000 habitantes); hubo una tendencia de aumento del 1,35% al año de la mortalidad por suicidio en la población adolescente general (IC95% 0,56; 2,15), 1,63% en varones (IC95% 0,56; 2,29), 3,11% en la región Norte (IC95% 2,25; 3,98) y 4.19% en el Nordeste (IC95% 2,58; 5;84). Conclusión: la mortalidad por suicidio en adolescentes brasileños mostró una tendencia al alza en el período estudiado.

Objective: To analyze the suicide mortality trend among Brazilian adolescents from 1997 to 2016. Methods: This is an ecological time series study; Prais-Winsten regression was used. Results: 14,852 suicide deaths were recorded, with mortality rates per 100,000 inhabitants of 1.95 in 1997, 2.65 in 2016 and average of 2.14 for the period 1997-2016; deaths predominated in males (67.59%), as well as deaths due to intentional self-harm (84.19%) and suicides at home (52.69%); the Midwest region had the highest rate in the period (3.71/100,000 inhabitants), in particular the state of Mato Grosso do Sul (8.3/100,000 inhabitants); the suicide trend rose 1.35% per annum in the general adolescent population (95%CI 0.56;2.15), 1.63% in males (95%CI 0.56;2.29), 3.11% in the North (95%CI 2.25;3.98) and 4.19% in the Northeast (95%CI 2.58;5.84). Conclusion: Suicide mortality in Brazilian adolescents showed an upward trend in the period studied.

Estudio de la carga de la mortalidad por suicidio en México 1990-2017 / Study of suicide burden of mortality in México 1990-2017

RESUMEN: Objetivo: El principal objetivo fue analizar el nivel y la tendencia de la carga de mortalidad del suicidio en México entre 1990 y 2017, a escala nacional y estatal. Métodos: Análisis secundario basado en el estudio de la Carga Global de la Enfermedad de 2017. Se reportan tasas de mortalidad y los años de vida perdidos por muerte prematura (APMP). Para analizar la tendencia de los APMP se realizó un análisis de regresión joinpoint basado en el modelo log-lineal. Resultados: La carga de la enfermedad por suicidio se incrementó en México, principalmente en hombres y mujeres jóvenes; aunque el aumento en los adultos mayores es un reto adicional para los servicios de salud. La carga de la enfermedad varía sustancialmente entre los estados del país. Las tasas de mortalidad masculinas fueron mayores a las femeninas durante todo el periodo de estudio, aunque con una tendencia a reducir la diferencia entre ambos sexos. Se observó un patrón bimodal de la carga de la enfermedad por suicidio en México, con mayores tasas en los 15-19 años de edad y un importante incremento a partir de los 85 años de edad. Conclusión: los resultados obtenidos ponen de manifiesto un panorama preocupante, no solo desde el punto de vista social, económico y de salud, sino también en cuanto a las necesidades en materia de políticas públicas. Esto representa una llamada de atención sobre la necesidad de implementar acciones de identificación oportuna, una estrategia integral multisectorial de prevención y el estudio detallado de los factores de riesgo asociados.

ABSTRACT: Objective: The primary goal was to analyze the level and trend of the burden of suicide mortality in Mexico between 1990 and 2017 at a national and state scale. Methods: A secondary analysis based on the 2017 global burden of disease study. Mortality rates and years of life lost due to premature death (YLL) were reported here. A joinpoint regression analysis based on a log-linear model was used to analyze the trend of YLL. Results: The burden of disease due to suicides increased in Mexico, mainly in young males and females; though the raise that happened in the elderly is an additional challenge for the health system. The burden of disease varied substantially between states. The male mortality rates were higher than those of females during the whole period under study, nonetheless with a trend to reduce the difference between the sexes. A bimodal pattern of the burden of disease due to suicide in Mexico was also observed, with the higher rates located in those aged between 15 and 19 years, and an important increase in people older than 85 years of age. Conclusion: These results show a worrisome picture, not only from a social, economic and health point of view but also from the needs of public policies. This situation represents a wake-up call about the need to implement timely identification actions, a comprehensive multisectoral prevention strategy and the detailed study of suicide associated risk factors.

Suicídio e povos indígenas brasileiros: revisão sistemática / Suicide and indigenous populations in Brazil: systematic review / El suicidio y los pueblos indígenas brasileños: revisión sistemática

RESUMO Objetivo. Descrever a frequência, as características e os fatores que contribuem para o suicídio em povos indígenas brasileiros. Método. Foi realizada uma revisão sistemática da literatura a partir das bases de dados PubMed, SciELO, PsycINFO e LILACS. Foram incluídos estudos de base populacional que enfocassem suicídio em populações indígenas no território brasileiro. Resultados. A busca identificou 111 artigos, dos quais nove preencheram os critérios de inclusão. Três estudos foram realizados na região Centro-Oeste, quatro na região Norte do Brasil e dois abordaram todas as regiões do Brasil. Três estudos citaram as etnias estudadas, totalizando sete etnias (Terena, Kadiweu, Guato, Ofaie-Xavante, Guarani, Guarani-Kaiowá e Guarani-Nandeva). Os estudos demonstraram maior taxa de mortalidade por suicídio em pessoas do sexo masculino, solteiros, com 4 a 11 anos de escolaridade, na faixa etária de 15 a 24 anos, no domicílio e nos finais de semana, tendo como principal método o enforcamento. Os principais fatores de risco para o suicídio foram pobreza, fatores históricos e culturais, baixos indicadores de bem estar, desintegração das famílias, vulnerabilidade social e falta de sentido de vida e futuro. Conclusões. Todos os estudos indicaram a necessidade de desenvolvimento de estratégias em conjunto com as comunidades, considerando sua cosmovisão e os aspectos sócio-histórico-culturais de cada etnia, para minimização dos fatores de risco e redução da taxa de suicídio.(AU)

ABSTRACT Objective. To describe the frequency, characteristics, and factors contributing to suicide in indigenous populations in Brazil. Method. A systematic review of the literature was performed in PubMed, SciELO, PsycINFO, and LILACS. All population-based studies focusing on suicide among indigenous populations in Brazil were included. Results. The search identified 111 articles, of which nine met the inclusion criteria. Three of these studies were performed in the Midwest and four in the North of Brazil, while two covered all Brazilian regions. The ethnic groups investigated were specified in three studies (Terena, Kadiweu, Guato, Ofaie-Xavante, Guarani, Guarani-Kaiowá, and Guarani-Nandeva). Suicide rates were highest among males, single individuals, those with 4 to 11 years of schooling, and those aged 15 to 24 years. Suicides occurred most often in the home and on weekends, mostly by hanging. The main risk factors for suicide identified in the articles were poverty, historical and cultural factors, poor wellbeing indicators, family disintegration, social vulnerability, and lack of life or future perspective. Conclusions. All the studies indicated the need to engage communities in developing strategies, considering their cosmovision and the social, historic, and cultural view of each ethnic group to minimize risk factors and reduce suicide rates.(AU)

RESUMEN Objetivo. Describir la frecuencia y las características del suicidio y sus factores contribuyentes en los pueblos indígenas brasileños. Método. Se realizó una revisión sistemática de la bibliografía a partir de las bases de datos PubMed, SciELO, PsycINFO y LILACS. Se incluyeron estudios de base poblacional enfocados en el suicidio en las poblaciones indígenas en el territorio brasileño. Resultados. En la búsqueda se encontraron 111 artículos, de los cuales nueve se ciñeron a los criterios de inclusión. Se realizaron tres estudios en la región centro oeste y cuatro en la región norte, además de otros dos que abarcaron todas las regiones de Brasil. En tres estudios se citaron todas las siete etnias estudiadas (Terena, Kadiweu, Guato, Ofaie-Xavante, Guaraní, Guaraní-Kaiowá y E-Nandeva). En los estudios se demostró una mayor tasa de mortalidad por suicidio en personas solteras del sexo masculino, con 4 a 11 años de escolaridad, en el grupo de 15 a 24 años de edad, en el domicilio y en los fines de semana, principalmente por el método de ahorcamiento. Los principales factores de riesgo de suicidio fueron la pobreza, factores históricos y culturales, el índice de bienestar bajo, la desintegración de las familias, la vulnerabilidad social, y la falta de sentido de la vida y del futuro. Conclusiones. Todos los estudios indicaron la necesidad de formular estrategias junto con las comunidades, dentro del marco de su cosmovisión y de los aspectos sociales, históricos y culturales de cada etnia, con el fin de reducir al mínimo los factores de riesgo y la tasa de mortalidad por suicidio.(AU)

Self-Contempt as a Predictor of Suicidality: A Longitudinal Study.

People with mental illness can internalize public prejudice and negative emotional reactions to their group, leading to self-contempt. This study examined self-contempt related to having a mental illness as predictor of suicidality among 77 people with mental illness in Southern Germany. Self-contempt, depressive symptoms, hopelessness, and suicidality were assessed at baseline; suicidality was measured again 3 months later. High self-contempt at baseline predicted increased suicidality at follow-up, adjusting for baseline suicidality, symptoms, diagnosis, age, sex, and hopelessness. These results suggest that self-contempt may be a risk factor for suicidality and call for specific interventions targeting self-stigma and its emotional consequences.

Austerity policies in Brazil may affect violence related outcomes / Políticas de austeridade no Brasil podem afetar os desfechos relacionados à violência

Abstract Economic crisis is often managed with austerity policies. These measures seem to burden the population disproportionately, with the poorer being more affected. This paper aims to investigate health outcomes performance after the recent Brazilian crisis and gauge whether that pattern also emerged. Public domain data from 2010 to 2017 was used, and it was found that suicide and homicide rates increased after 2014, while mortality by road traffic injuries decreased at the same time. Furthermore, these trends were exacerbated in the North and Northeast regions and in the municipalities with the poorest quintiles of Human Development Index (HDI). The austerity policies followed by the Brazilian economic crisis may have influenced the mortality trends due to external causes, with a possible stronger impact in the North and Northeast regions and among less developed municipalities.

Resumo Crises econômicas são comumente administradas com políticas de austeridade. Estas medidas atingem a população de modo desproporcional, sendo os mais pobres os mais afetados. Este artigo pretende investigar a performance dos desfechos de saúde após a crise econômica recente e avaliar se o padrão de desproporcionalidade também ocorreu no Brasil. Dados públicos de 2010 a 2017 foram utilizados e encontramos que suicídios e taxas de homicídios aumentaram depois de 2014, enquanto mortalidade por acidentes de trânsito diminuíram. Além disto, estas tendências foram exacerbadas no Norte e no Nordeste e em municípios no quintil mais pobre em termos de Índice de Desenvolvimento Humano (IDH). As políticas de austeridade que se seguiram à crise econômica brasileira podem ter influenciado a tendência de mortalidade por causas externas, com um possível maior impacto no Norte e no Nordeste e em municípios menos desenvolvidos.

The association between adolescent suicide rates and socioeconomic indicators in Brazil: a 10-year retrospective ecological study

Objective: To examine suicide rates among adolescents from six large cities in Brazil and to analyze the relationship between adolescent suicide rates and socioeconomic indicators between 2006 and 2015. Methods: Generalized estimating equation models were used to assess the impact of socioeconomic factors - including social inequality and unemployment rates - on adolescent suicide rates. Results: The rate of adolescent suicide increased by 24% over the course of the study period. Social inequality (assessed using the Gini index), was positively associated with overall adolescent suicide rates (β = 10.68; 95%CI = 2.32-19.05; p ≤ 0.012). After disaggregating the findings by age (10-14 and 15-19 years), social inequality was associated with suicide rate only for adolescents aged 15-19 years (β = 9.63; 95%CI = 2.31-16.96; p ≤ 0.005). Disaggregating these findings by sex, the association with economic variables became significant only among females. Males had a higher overall suicide rate than females, and the highest rate was observed in male adolescents aged 15-19 years. Higher levels of unemployment were associated with higher suicide rates. Conclusion: Our findings suggest that socioeconomic indicators, particularly unemployment and social inequality, are relevant social determinants of suicide in adolescence.

Trends in suicide rates in Brazil from 1997 to 2015

Objectives: To analyze time trends of suicide rates in Brazil overall and in Brazilian states and compare the estimated suicide rates projected for 2020 with the World Health Organization (WHO) Mental Health Action Plan target. Methods: This was an ecological time-series study from 1997 to 2015, stratified by Brazilian states, specific age groups, and sex. Data were obtained from the Mortality Information System (Sistema de Informações sobre Mortalidade [SIM]) of the Brazilian Ministry of Health. Polynomial regression models were used to analyze the trends in suicide rates and to project suicide rates for 2020. Results: Considering 224 units of analysis, 21 (9.4%) showed a decreasing trend, 108 (48.2%) were stable, and 95 (42.4%) showed an increasing trend. Thus, 67% of units of analysis will not meet the WHO target in 2020. Mean suicide rates were higher in males than in females. People aged 60 years and older presented the highest suicide rates, while 84.7% of total deaths by suicide occurred among 15-to-59-year-olds. Conclusion: Overall, 90.6% of units of analysis had a stable or increasing trend in suicide rates from 1997 to 2015. If these trends remain, most of Brazil will fail to achieve the WHO-recommended reduction in suicide rates by 2020.

Mortality in Spain in the Context of the Economic Crisis and Austerity Policies.

Objectives. To analyze the mortality trend in Spain before, during, and after the economic crisis and austerity policies. Methods. We calculated age-standardized annual mortality rates in 2001 through 2016 and estimated linear trends in mortality rates during 4 periods (2001-2007, 2008-2010, 2011-2013, and 2014-2016) using the annual percentage change (APC). Results. All-cause mortality rate decreased during the period 2001 to 2016, although we found increases over the previous year. After adjusting for increased influenza activity (P = .743) and heat waves (P = .473), we found the greatest declines during the economic crisis (2008-2010) and the smallest in the period 2014 to 2016, in which the APC in mortality rates was -2.9 and -0.6, respectively. The APC before the crisis (2001-2007) and during austerity (2011-2013) was -2.0 and -2.2, respectively. We observed similar results in mortality from cardiovascular, respiratory, and digestive diseases and motor vehicle accidents. Mortality from cancer showed the smallest decline during the crisis and the austerity period, whereas suicide increased in the period 2011 to 2013. Conclusions. Lifestyle changes could explain the decline in mortality during the economic crisis. Increased influenza activity and the 2015 heat wave may prevent identifying a possible delayed effect of austerity policies in the slowing down of mortality decline in the period 2014 to 2016.