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.

Suicidal ideation and suicide attempt in patients with psychiatric disorders in a Mexico City hospital.

BACKGROUND: One of the population groups at higher risk of suicide is that of people who attend mental health institutions. OBJECTIVE: To know the demographic and clinical characteristics of people admitted for suicidal ideation and suicide attempt to the observation area of a psychiatric hospital in a period of 10 non-consecutive months. MATERIAL AND METHODS: Retrospective, descriptive, correlational study. A total of 439 medical records were collected, out of which 62.9% (n = 276) corresponded to women, 36.7% (n = 161) to men and 0.5% (n = 2) to transgender people; age ranged from 17 to 74 years. RESULTS: The highest incidence of cases was observed between 18 and 25 years of age; the most frequent diagnosis was depressive disorder, and 45.5% (n = 200) of the cases had a suicide attempt. The main method for committing a suicidal act was poisoning by taking various medications, followed by self-inflicted injuries with sharp objects. A positive correlation was found between suicide attempt and self-harm (c² = 1.965, p < 0.05). CONCLUSIONS: The findings highlight the importance of early identification of risk factors that may contribute to an increase in suicidal behaviors.

ANTECEDENTES: Uno de los grupos poblacionales en mayor riesgo de suicidio lo constituyen las personas que asisten a instituciones de salud mental. OBJETIVO: Conocer las características demográficas y clínicas de las personas ingresadas por ideación e intento suicida al área de observación de un hospital psiquiátrico en un periodo de 10 meses no consecutivos. MATERIAL Y MÉTODOS: Estudio retrospectivo, descriptivo y correlacional. Se recabaron 439 expedientes, de los cuales las mujeres representaron 62.9 % (n = 276), los hombres 36.7 % (n = 161) y las personas transgénero 0.5 % (n = 2); el rango de edad varió de 17 a 74 años. RESULTADOS: La mayor incidencia de casos se observó entre los 18 y 25 años, el diagnóstico más frecuente fue el trastorno depresivo y 45.5 % (n = 200) de los casos presentó una tentativa suicida. El principal método para cometer un acto suicida fue el envenenamiento por diversos medicamentos seguido por las lesiones autoinflingidas con objeto punzocortante. Se encontró correlación positiva entre intento suicida y autolesiones (c² = 1.965, p < 0.05). CONCLUSIONES: Los hallazgos resaltan la importancia de la identificación temprana de los factores de riesgo que pueden contribuir al incremento del comportamiento suicida.

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.

Father-Daughter Relationships among Latina Adolescents Who Attempted Suicide: An Exploratory Dyadic Analysis.

Among adolescents, Latinas are at an increased risk of experiencing suicidal ideation and attempts compared to non-Hispanic, White youth. Previous research indicates that family dynamics are influential as both protective and risk factors. Although significant research has been conducted over the past several decades examining the mother-daughter relationship, few studies have examined the father-daughter relationship among Latina adolescent suicide attempters. The relationship dynamics between fathers and daughters of Latina descent are both similar and unique compared to mother-daughter relationships. Given this, an in-depth analysis is warranted. To address this gap, the present study utilized dyadic thematic analysis to describe father-daughter relationships (N = 10 dyads, 20 individual interviews) and fathers' reactions to their Latina daughters' suicide attempt(s). Three themes emerged from the results (a) dynamic proximity, which describes the variation in emotional and physical closeness between fathers and daughters; (b) father as protector, which describes fathers' roles in protecting or failing to protect their daughters; (c) responses to the suicide attempt, which describes the various ways fathers responded to daughters' suicide attempts, ranging from helpful action to apathy. Themes gleaned from in-depth interviews informed a deeper understanding of these complex, multifaceted relationships, and how they may be linked to fathers' responses to daughters' suicide attempts. Implications for future research and clinical practice with youth at risk for suicidal ideations and behaviors, along with the impact of such experiences on families, are discussed.

Entre las adolescentes, las latinas corren un mayor riesgo de tener ideación e intentos suicidas en comparación con las jóvenes blancas no hispanas. Hay investigaciones previas que indican que la dinámica familiar influye tanto como factor protector como de riesgo. Aunque se ha investigado bastante durante las últimas décadas sobre la relación entre madre e hija, en pocos estudios se ha examinado la relación entre padre e hija en adolescentes latinas que han intentado suicidarse. La dinámica de la relación entre padres e hijas de ascendencia latina es tanto similar como única en comparación con la de la relación entre madres e hijas. En virtud de esto, es necesario un análisis profundo. Para subsanar esta carencia, en el presente estudio se utilizó el análisis temático diádico para describir las relaciones entre padres e hijas (N = 10 díadas, 20 entrevistas individuales) y las reacciones de los padres a los intentos de suicidio de sus hijas latinas. De los resultados surgieron tres temas: (a) la proximidad dinámica, que describe la variación en la cercanía emocional y física ente los padres y las hijas; (b) el padre como protector, que describe los roles de los padres a la hora de proteger o no proteger a sus hijas; (c) las respuestas al intento de suicidio, que describe las diversas maneras en las que los padres respondieron a los intentos de suicidio de las hijas, las cuales variaron desde medidas de ayuda hasta apatía. Los temas obtenidos de entrevistas detalladas informaron una mayor comprensión de estas relaciones complejas y multifacéticas, y de cómo pueden vincularse con las respuestas de los padres a los intentos de suicidio de las hijas. Se debaten las consecuencias para futuras investigaciones y para la práctica clínica con las jóvenes en riesgo de ideaciones y conductas suicidas, así como el efecto de dichas experiencias en las familias.

Demonstrating Attachment-Based Family Therapy for Transgender and Gender Diverse Youth with Suicidal Thoughts and Behavior: A Case Study.

Suicide is a growing public health issue among adolescents. While the majority of transgender and gender diverse (TGD) youth are healthy, many experience suicidal thoughts and behavior (STB). Due to discrimination and stigma, TGD youth attempt suicide at higher rates then heterosexual, cisgender and even cisgender, LGBQ youth. Despite this vulnerability to suicide, few treatments have been developed and tested for this population. One treatment, attachment-based family therapy (ABFT) has been adapted to work with LGBQ youth and may be promising for TGD adolescents at risk for suicide. This article provides an overview of our ABFT modifications for TGD youth with thoughts of suicide. Specifically, we illustrate how treatment outcomes, in a single case study, relate to processes within clinical treatment tasks. The case study demonstrates the application of these ABFT modifications with a self-identified, gender nonconforming adolescent (who had recently attempted suicide) and his caregivers. Treatment evaluation measures were collected over the course of 24 weeks to illustrate the youth's clinical progress. The youth's suicidal symptoms diminished markedly by the end of treatment. Further, the family reported an increased ability for problem solving and more open communication by treatment conclusion.

El suicidio es un problema de salud pública cada vez mayor entre los adolescentes. Si bien la mayoría de los jóvenes transgénero y de géneros diversos (TGD) son saludables, muchos tienen pensamientos y conductas suicidas. Debido a la discriminación y al estigma, los índices de intento de suicidio en los jóvenes TGD son más altos que en los jóvenes heterosexuales, cisgénero e incluso LGBQ cisgénero. A pesar de esta vulnerabilidad al suicidio, se han desarrollado y se han evaluado pocos tratamientos para esta población. Un tratamiento, la terapia familiar basada en el apego (TFBA), se ha adaptado para trabajar con jóvenes LGBQ y puede ser prometedor para adolescentes TGD en riesgo de suicidio. Este artículo ofrece un resumen de nuestras modificaciones a la TFBA para los jóvenes TGD con pensamientos de suicidio. Específicamente, ilustramos cómo los resultados del tratamiento, en un solo caso práctico, se relacionan con los procesos dentro de las tareas del tratamiento clínico. El caso práctico demuestra la aplicación de estas modificaciones de la TFBA con un adolescente que se identificó como de género no conforme (y que recientemente había intentado suicidarse) y sus cuidadores. Se recopilaron las valoraciones de una evaluación del tratamiento durante el transcurso de 24 semanas para ilustrar el avance clínico del joven. Los síntomas de suicidio del joven disminuyeron notablemente al final del tratamiento. Además, la familia informó una mayor capacidad para resolver problemas y una comunicación más abierta al concluir el tratamiento.

[Euthanasia laws in Spain and in the world: Medical aspects]. / Leyes de eutanasia en España y en el mundo: aspectos médicos.

OBJECTIVE: To compare the Spanish law on euthanasia and assisted suicide with those that exist in other countries. DESIGN: Systematic review of the bibliography. DATA SOURCES: Medline/PubMed, EMBASE and the Cochrane Library were searched for studies that contained in their title or abstract the descriptors «euthanasia¼ or «assisted suicide¼ and also «legislation¼ or «law¼, between 2002 and the end of 2020. STUDY SELECTION: The search found 1647 studies and after screening 663 were assessed, of which 30 were included in the review. Studies that only contained opinions or did not provide data on euthanasia/assisted suicide in the countries that have them regulated were rejected. DATA EXTRACTION: We registered the criteria that regulate the acceptance or rejection of a request for euthanasia or assisted suicide in Spain and in the other countries where they are decriminalized. RESULTS: The euthanasia regulations in the world can be grouped into three groups: laws that allow euthanasia and assisted suicide (Netherlands, Belgium, some states of Australia, New Zealand, Spain), those in which the law only allows assisted suicide (USA) and those in which only assisted suicide is admitted and based on court decisions, without specific legislation (Switzerland, Germany). CONCLUSIONS: Although there are differences, the laws that the Spanish euthanasia law most closely resembles are those of the Netherlands and Belgium, so it is foreseeable that the casuistry of euthanasia and its figures in Spain will resemble that of those countries in the future.

[Euthanasia: is this the law we need?] / Eutanasia: ¿es esta la ley que necesitamos?

The Spanish Euthanasia Law introduces a new right that is added to the portfolio of services provided by the Spanish health system and whose application is guaranteed within a period of 40 days. From the perspective of clinical experience, it is argued that without the effective right to quality palliative care and given the current shortcomings in dependant care, this law may send a threatening message to particularly fragile and dependant individuals that will lead to them feeling like a burden to their families and society. It is reasoned that basing the right to die on the dignity of the individual may have unexpected social repercussions. The text of the law presents the flaws of having been written hastily and without the support of advisory entities. There are issues that require clarification with regard to the application of euthanasia within the context of general practice. The conclusion is that this new law will pose more problems of the type it aims to resolve.

Suicide prevention and suicidal behavior.

In Mexico, suicidal behavior is a matter of concern because, although the rates of death by suicide are below global mean (11.4 vs. 4.1 x 100,000 population), between 1970 and 2007 they increased by 175 %, especially among young people, in whom it is the third leading cause of death. For this reason, several preventive actions have been developed but have not had the expected success, because they are poorly designed. They lack a uniform and clear case definition. Their approach is reductionist, it focuses only on the public health aspect and does not go beyond traditional plans of primary, secondary and tertiary prevention. This review aims to offer different options, such as adopting the case definition provided by Atlanta's Centers for Disease Control and Prevention (CDC). It aims to broaden the vision in order to include philosophical, psychosocial and psychiatric aspects, as well as to include, as a theoretical framework, the "diathesis-stress" psychological model and propose a population-based intervention preventive strategy.

En México la conducta suicida es una preocupación porque, aunque las tasas de suicidio consumado están por debajo de la media mundial (11.4 vs. 4.1 x 100,000 habitantes), entre 1970 y 2007 aumentaron un 175%, sobre todo a expensas de los jóvenes, en los cuales es la tercera causa de muerte. Por tal motivo, se han elaborado varias acciones preventivas que no han tenido el éxito esperado, porque están mal planteadas. Carecen de una definiciones de caso uniforme y clara. Su enfoque es reduccionista, se apega solo al de la salud pública y no salen del esquema tradicional de prevención primaria, secundaria y terciaria. La presente revisión pretende ofrecer una opciones diferentes. Adoptar como definición de caso la de los Centros para el Control y la Prevención de la Enfermedades (CCD) de Atlanta. Ampliar la visión incluyendo aspectos filosóficos, psicosociales y psiquiátricos. Incluir como marco teórico el modelo psicológico «diátesis-estrés¼ y proponer como estrategia preventiva «las intervenciones por poblaciones¼.

Association of Toxoplasma gondii infection with schizophrenia and its relationship with suicide attempts in these patients.

OBJECTIVES: To investigate the association between schizophrenia and Toxoplasma gondii, and to assess the association of infection with suicide attempts and age of onset of schizophrenia in these patients. METHODS: Case-control study Fars Province, southern Iran. Cases were individuals with psychiatric diagnosis of schizophrenia as per Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Controls were healthy blood donors, frequency-matched with patients according to age and sex. For the detection of IgG antibodies, enzyme-linked immunosorbent assay (ELISA) was used. Data about demographic information in all subjects and duration of illness and history of suicide attempts in patients with schizophrenia were collected using a brief questionnaire and hospital records. Chi-square test and multivariable logistic regression were used for statistical analyses. RESULTS: Among 99 cases, 42 individuals (42%) were positive for T. gondii antibody, vs. 41 (27%) among 152 controls (OR = 2, 95% CI: 1.2-3.4, P = 0.012). We compared the suicide attempts in patients with schizophrenia based on their T. gondii serologic status. There was a lower rate of suicide attempts in seropositive male patients than seronegative ones (OR = 0.3, 95% CI: 0.1-0.97, P = 0.04). Age of onset of schizophrenia did not differ between T. gondii-infected and non-infected patients. CONCLUSIONS: These findings may have implications for schizophrenia and suicide prevention programmes. However, clearly further studies are required to confirm them.

Suicide deaths in rural Andhra Pradesh--a cause for global health action.

OBJECTIVES: To determine the proportion of deaths attributable to suicides in rural Andhra Pradesh, India over a 4-year period using a verbal autopsy method. METHODS: Deaths occurring in 45 villages (population 185,629) were documented over a 4-year period from 2003 to 2007 by non-physician healthcare workers trained in the use of a verbal autopsy tool. Causes of death were assigned by physicians trained in the International Classification of Diseases, version 10. All data were entered and processed electronically using a secure study website. RESULTS: Verbal autopsies were completed for 98.2% (5786) of the deaths (5895) recorded. The crude death rate was 8.0/1000. 4.8% (95% CI 4.3-5.4) of all deaths were suicides, giving a suicide rate of 37.5/100,000 population. Forty-three percent of suicides occurred in the age group 15-29 years, and 62% were in men. In the younger age groups (10-29 years), suicides by women (56%) were more common than by men (44%). Poisoning (40%) was the most common method of self-harm followed by hanging (12%). CONCLUSION: The suicide rate in this part of rural Andhra Pradesh is three times higher than the national average of 11.2/100,000, but is in line with that reported in the Million Death Study. There is an urgent need to develop strategies targeted at young individuals to prevent deaths by suicide in India.

Helping Parents Cope with Suicide Threats: An Approach Based on Nonviolent Resistance.

Parent training in nonviolent resistance was adapted to deal with situations of suicide threat by children, adolescents, and young adults. The approach aims at reducing the risk potential and the mutual distress surrounding the threat-interaction. Parent training in nonviolent resistance has been shown to help parents move from helplessness to presence, from isolation to connectedness, from submission to resistance, from escalation to self-control, and from mutual distancing and hostility to care and support. Those emphases can be crucial for the diminution of suicide risk. Parents show good ability to implement the approach and report gains on various areas over and beyond the reduction in suicide threat. A particular advantage is that the method can be used also in cases where the young person threatening suicide is not willing to cooperate.

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.

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.

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.

[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.

Factors associated with suicidal intent in economically active patients diagnosed with major depression.

INTRODUCTION: Every 40s, one person in the world commits suicide. As such, suicide is considered a public health problem, and prior suicide attempt is one of the risk factors associated with completed suicide. Despite the strategies implemented and the studies carried out, in Colombia suicide figures are on the rise, more markedly in the economically active population. OBJECTIVE: To identify the sociodemographic, family, personal, economic and religious factors associated with suicide attempt in patients of productive age (18-62 years old) in a mental health institution in Bogota, Colombia. METHODS: An analytical prevalence study was conducted at the Nuestra Señora de la Paz mental health clinic in Bogota. To explore the relationship between the factors described and suicide attempt, a review of 350 medical records of the selected population was carried out. RESULTS: In total, 37.7% of the sample presented a suicide attempt. Associations were found between the suicide attempt and higher education than primary school (PR=0.47 [0.23-0.97]), no economic income (PR=1.72 [1.13-2.61]), no partner (PR=2.10 [1.33-3.32]), alcohol consumption (P=.045), hallucinogen use (PR=2.39 [0.97-3.43]) and the presence of personality disorder (PR=1.93 [1.11-3.34]). CONCLUSIONS: The results of the study are similar to those previously described in other studies around the world. There is a need to recognise and address various factors associated with suicide attempt in depressed patients in order to implement promotion and prevention actions, early identification and specific interventions that have an impact on the numbers of completed suicide in the country.

Risk factors associated with suicide attempt as predictors of suicide, Colombia, 2016-2017.

BACKGROUND: Suicidal behaviour is the cause of half of all violent deaths. It is considered to be a public health problem with one million victims a year. Suicide attempt is the most important risk factor. In Colombia, in 2017 the suicide attempt rate was 51.8/100,000 inhabitants, and the fatality rate reached 10.0/100,000. The objective is to identify suicide attempt factors associated with death and determine survival after the attempt for 2 years. MATERIAL AND METHODS: Retrospective cohort study and survival analysis. A total of 42,594 records of the suicide attempt surveillance system databases and 325 records of death by suicide in 2016 and 2017 were analysed. The risk factors were examined and a χ2-test and multivariate analysis and logistic regression were performed. Cumulative survival probability was calculated using the Kaplan-Meier method. A Cox regression model was applied to determine the proportional relationship of the suicide attempt variables that are related to suicide. RESULTS: Men die by suicide 4.5 times more often than women. One in four suicide victims had made at least one prior suicide attempt. The attempt factors related with death by suicide were: male gender (HR = 2.99; 95% CI, 2.27-3.92), adulthood (over 29 years, HR = 2.38; 95% CI, 1.90-2.99), living in a rural area (HR = 2.56; 95% CI, 2.04-3.20), chronic disease history (HR = 2.43; 95% CI, 1.66-3.57) and depression disorder (HR = 1.94; 95% CI, 1.55-2.41). Some 50% of suicide deaths occur up to 560 days after the suicide attempt. CONCLUSIONS: The risk of suicide is highest in male patients, with a history of depression, chronic illness and exposure to heavy workloads.

Evolution and differences of suicide rates in Peru by gender and department, 2017-2019.

INTRODUCTION: Annual suicide rates are increasingly notably worldwide due to various accompanying risk factors. The objective of this study is to know the suicide mortality rates and their distribution between the years 2017 and 2019. METHODS: The national death registries of the Ministry of Health of Peru were analysed, calculating the regional death rates from suicides adjusted for age and gender using the standardisation recommended by the World Health Organization. RESULTS: A total of 1666 cases of suicide were identified (69.3% males); the age group with the highest frequency was that of 20-29 years (27.8%); the mean age at suicide was higher in males (37.49±18.96 vs. 27.86±15.42; P<.001). Hanging was the most common suicide method among both males (58.87%) and females (48.14%). For males, hanging was followed by poisoning (22.6%) and firearms (4.59%); for females, by poisoning (38.75%) and firearms (0.59%). The suicide rate increased from 2017 (1.44/100,000 inhabitants) to 2019 (1.95). The highest rates were identified in the departments of Arequipa, Moquegua and Tacna. CONCLUSIONS: In recent years, there has been an increase in the number of suicide cases and the rates by department, with the highest number of cases reported in males. Males tend to use more violent suicide methods. The risk factors in the vulnerable populations that were identified in this study need to be known.