Decoding the inflammatory signature of the major depressive episode: insights from peripheral immunophenotyping in active and remitted condition, a case-control study.

Depression is a prevalent and incapacitating condition with a significant impact on global morbidity and mortality. Although the immune system's role in its pathogenesis is increasingly recognized, there is a lack of comprehensive understanding regarding the involvement of innate and adaptive immune cells. To address this gap, we conducted a multicenter case-control study involving 121 participants matched for sex and age. These participants had either an active (or current) major depressive episode (MDE) (39 cases) or a remitted MDE (40 cases), including individuals with major depressive disorder or bipolar disorder. We compared these 79 patients to 42 healthy controls (HC), analyzing their immunological profiles. In blood samples, we determined the complete cell count and the monocyte subtypes and lymphocyte T-cell populations using flow cytometry. Additionally, we measured a panel of cytokines, chemokines, and neurotrophic factors in the plasma. Compared with HC, people endorsing a current MDE showed monocytosis (p = 0.001), increased high-sensitivity C-reactive protein (p = 0.002), and erythrocyte sedimentation rate (p = 0.003), and an altered proportion of specific monocyte subsets. CD4 lymphocytes presented increased median percentages of activation markers CD69+ (p = 0.007) and exhaustion markers PD1+ (p = 0.013) and LAG3+ (p = 0.014), as well as a higher frequency of CD4+CD25+FOXP3+ regulatory T cells (p = 0.003). Additionally, patients showed increased plasma levels of sTREM2 (p = 0.0089). These changes are more likely state markers, indicating the presence of an ongoing inflammatory response during an active MDE. The Random Forest model achieved remarkable classification accuracies of 83.8% for MDE vs. HC and 70% for differentiating active and remitted MDE. Interestingly, the cluster analysis identified three distinct immunological profiles among MDE patients. Cluster 1 has the highest number of leukocytes, mainly given by the increment in lymphocyte count and the lowest proinflammatory cytokine levels. Cluster 3 displayed the most robust inflammatory pattern, with high levels of TNFα, CX3CL1, IL-12p70, IL-17A, IL-23, and IL-33, associated with the highest level of IL-10, as well as ß-NGF and the lowest level for BDNF. This profile is also associated with the highest absolute number and percentage of circulating monocytes and the lowest absolute number and percentage of circulating lymphocytes, denoting an active inflammatory process. Cluster 2 has some cardinal signs of more acute inflammation, such as elevated levels of CCL2 and increased levels of proinflammatory cytokines such as IL-1ß, IFNγ, and CXCL8. Similarly, the absolute number of monocytes is closer to a HC value, as well as the percentage of lymphocytes, suggesting a possible initiation of the inflammatory process. The study provides new insights into the immune system's role in MDE, paving the ground for replication prospective studies targeting the development of diagnostic and prognostic tools and new therapeutic targets.

Immunological alterations in patients with current and lifetime suicide ideation and attempts: Examining the relationship with depressive symptoms.

Background: Suicidal ideation and attempt (SI/SA) have been associated with dysregulation of the immune response and inflammation. However, few studies have explored how innate and acquired cellular immunity impact on the peripheral immune response. Our study addresses this gap by examining the composition of peripheral immune cells and humoral markers among individuals with current SI/SA, individuals with a history of SI/SA, and healthy controls (HC). Additionally, we aim to explore whether depressive symptoms settle the relationship between inflammation and SI/SA. Methods: This is a multicenter case-control study that included 105 participants. Clinical and demographic characterists together with hemogram parameters, soluble pro and anti-inflamatory factors, and specific innate and adaptive immune cell populations were compared among patients with current SI/SA (n = 21), a history of lifetime SI/SA (n = 42), and HC (n = 42). Results: Patients with both current and lifetime SI/SA had a significant increase in the absolute count of monocytes and in the monocyte/lymphocyte ratio (MLR). Additionally, patients with current and lifetime SI/SA showed a significant increase in high-sensitivity C- reactive protein (hs-CRP), and patients with lifetime SI/SA also showed higher levels of Erythrocyte Sedimentation Rate (ESR). The cellular inflammatory status of patients with SI/SA was characterized by altered proportions of monocytes with higher levels of nonclassical and intermediate monocytes. No differences were observed in the number of lymphocytes and the proportion of CD4 and CD8 between patients and HC, but we found differences in markers of exhaustion of CD4 lymphocytes, with increased levels of Programmed cell death protein 1 (PD1) in Current SI/SA and Lymphocyte activation gene 3 (LAG3) in Current SI/SA and Lifetime SI/SA compared to HC. The plasmainflammatory status was marked by higher levels of soluble Triggering receptor expressed on myeloid cells 2 (sTREM2) in patients with lifetime SI/SA compared to HC. Finally, the multinomial analysis indicates that inflammation and depressive symptoms are independently associated with SI/SA. Conclusion: This study highlights the association of immunological alterations with SI/SA. Furthremore, SI/SA is independently influenced by depressive symptoms and inflammation. This may have important therapeutic implications, as in these patients, it may be necessary to treat the inflammatory process beyond treating the depressive symptoms.

Peripheral blood cellular immunophenotype in suicidal ideation, suicide attempt, and suicide: a systematic review and meta-analysis.

Previous meta-analyses have documented the association of immune-inflammatory pathways with the pathophysiology of Major Depressive Episode (MDE), as reflected by alterations in peripheral blood immune cell counts. However, it remains unclear whether these immunological changes are distinct in individuals experiencing suicidal ideation (SI) or suicidal behavior (SB), beyond the context of an MDE. This systematic review and meta-analysis aimed to examine peripheral immune cell profiles across samples with SI/SB and compare them to healthy controls or patients with MDE. A systematic literature search was conducted in MEDLINE, Embase, and PsycINFO for articles published from inception until June 12, 2023. Two independent reviewers screened the articles for inclusion, extracted data, and assessed the risk of bias using the Newcastle-Ottawa scale. Meta-analyses were performed using a random-effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) for immune cell counts or ratios between groups with and without SI/SB. Heterogeneity across studies was assessed using the restricted maximum-likelihood estimator for tau statistic and I2-statistic and tested by the Q test. Publication bias was evaluated using the Egger´s test and funnel plots. Meta-regression analyses were conducted to explore the potential moderating effects of age, gender, current or lifetime SI/SB, and the type of self-harming behavior (SI or SB). The study was registered with PROSPERO (CRD42023433089). The systematic review included 30 studies, with data from 19 studies included in the meta-analyses comprising 139 unique comparisons. Eleven different cell populations or ratios were included, comprising 1973 individuals with SI/SB and 5537 comparison subjects. White blood cell (WBC) and neutrophil counts were higher in individuals with SI/SB than in controls (WBC: SMD = 0.458; 95% CI = 0.367-0.548; p value ≤ 0.001; I2 = 0.002% and; Neutrophils: SMD = 0.581; 95% CI = 0.408-0.753; p < 0.001), indicating an inflammatory process. The neutrophil-to-lymphocyte ratio (NLR) emerged as a potential marker, demonstrating a notable elevation in individuals with SI/SB (SMD = 0.695; 95% CI = 0.054-1.335; p value = 0.033; I2 = 94.281%; Q test p value ≤ 0.001). The elevated NLR appears to be primarily driven by the increase in neutrophil counts, as no significant differences were found in lymphocyte counts between groups. Comparisons among participants with and without SI/SB and depression revealed similar trends with increased NLR, monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) observed in depressed individuals with SI/SB compared to those without SI/SB. Broad alteration in the peripheral immune cell populations and their ratios were observed in individuals with SI/SB, indicating an immune activation or dysfunction. Notably, these immunological changes were also evident when comparing MDE individuals with and without SI/SB, suggesting that such immune dysfunction associated with suicidality cannot be solely attributed to or explained by depressive symptoms. The NLR, MLR, and PLR ratios, in combination with novel immune cellular and protein biomarkers, open new avenues in understanding the immunological underpinnings of SI/SB. These findings highlight the potential utility of immune markers as part of a multi-modal approach for risk stratification and therapeutic monitoring in SI/SB.

Food Insecurity and Mental Health among Venezuelan Migrants and Refugees Living in Peru: Secondary Data Analysis of a Cross-Sectional Survey.

The objective of this study was to analyze the association between food insecurity and mental health in Venezuelan migrants and refugees residing in Peru using data from the Survey Directed at the Venezuelan Population Residing in the Country (ENPOVE) conducted in 2022. The analysis included 7739 Venezuelan adults. The presence of mental health problems was self-reported, and household food insecurity was measured using the Food Insecurity Experience Scale. The study found that 4 out of 10 participants lived in households with moderate to severe food insecurity, and around 10% reported experiencing some mental health problem in the last month. The study identified a positive association between living in households with moderate to severe food insecurity and having some mental health problem compared to living in households without food insecurity. The findings suggest that food insecurity is a common problem among the Venezuelan migrant population residing in Peru, and measures are required to address this problem and mitigate its consequences on mental health and other health problems. The study highlights the need for international organizations to provide assistance and support to these populations and ensure adequate and sustainable follow-up of food insecurity at the national level. It is also necessary to implement early detection tests for mental health problems in the migrant population, especially in individuals exposed to food insecurity. This study provides relevant evidence for addressing public health in the Venezuelan migrant population residing in Peru.

Gender Differences in the Factors Associated with Alcohol Binge Drinking: A Population-Based Analysis in a Latin American Country.

Alcohol consumption is a public health problem in Peru, fostered by traditional practices, where promoting social interaction in celebrations, facilitating field work as a source of energy and warmth, and achieving objectives in certain labor negotiations, play an important role. However, research on the risk factors of binge drinking according to gender is limited. The study aim was to determine the factors associated with binge drinking in the Peruvian adult population by gender. An analytical study of secondary data from the 2018 Peruvian Demographic and Family Health Survey was conducted. The dependent variable was binge drinking in the last 30 days. Adjusted prevalence ratios (aPR) were estimated for the association between sociodemographic and health-related variables with binge drinking. A total of 32,020 adults were included. Binge drinking was found in 22.4%. Men (32.6%; 95% confidence interval [CI]: 31.4-33.8) presented a higher consumption pattern compared to women (12.8%; 95% CI: 12.0-13.6). For both genders, differences were found in binge drinking according to sociodemographic characteristics (age and wealth quintile was associated in both genders while the educational level was associated only for men, and ethnic self-identification and marital status for women) and health- characteristics related (health insurance, smoking in the last 30 days, overweight and obesity were associated in both genders). Several factors are associated with binge drinking according to gender in the Peruvian population, including age and education level among men, as well as marital status and ethnic self-identification among women.

Comparison of traditional model-based statistical methods with machine learning for the prediction of suicide behaviour.

BACKGROUND: Despite considerable research efforts during the last five decades, the prediction of suicidal behaviour (SB) using traditional model-based statistical has been weak. This marks the need to explore new statistical methods. OBJECTIVE: To compare the performance of Cox regression models versus Random Survival Forest (RSF) to predict SB. METHODS: Using a data set of more than 300 high-risk suicidal patients from a multicenter prospective cohort study, we compare Cox regression models with RSF to address predictors of time to suicide reattempt. Cross-validation was used to assess model prediction performance, including the area under the receiver operator curve (AUC), precision, Integrated Brier Score (IBS), sensitivity, and specificity. RESULTS: A variant of the RSF denominated the RSFElimin, in which irrelevant predictor variables were eliminated from the model, presented the best accuracy, sensitivity, AUC and IBS. At the same time, the sensitivity of this method was slightly lower than that obtained with the Cox regression model with all predictor variables (CoxComp). CONCLUSION: The RSF, a machine learning model, seems more sensitive and precise than the traditional Cox regression model in predicting suicidal behaviour.

Polyunsaturated fatty acids as predictors of future suicide attempt.

Polyunsaturated fatty acids (PUFAs) and cholesterol are lipids implicated in suicide risk. We prospectively studied plasma glycerophospholipid PUFAs and cholesterol as putative predictors of suicide attempts. In a multicenter cohort study, we enrolled 123 patients admitted to the emergency department (ED) for suicidal ideation or suicide attempt. Clinical assessments were performed, with follow-up telephone evaluations 6, 12, 18, and 24 months later. Blood samples were obtained in the ED and assayed for PUFAs. Using survival analysis, suicide events were not predicted by eicosapentaenoic acid (EPA, HR: -0.83, 95%CI: 0.39-1.76, p = 0.621) or docosahexaenoic acid (DHA, HR: -0.60, 95%CI: 0.19-1.86, p = 0.371). However, higher arachidonic acid (AA) was a trend for a protective factor (HR=0.30, 95%CI: 0.08-1.08, p = 0.065) in the entire trans-diagnostic sample. This protective effect was significant in all participants with a prior suicide attempt history (n = 85; HR=0.16, 95%CI: 0.04-0.67, p = 0.012), and in the subgroup of attempters with major depressive disorder (MDD; n = 55, HR=0.15, 95%CI:0.03-0.76, p = 0.002). Total LDL- and HDL-cholesterol did not predict subsequent suicide events. AA, but not DHA or EPA, positively correlated with baseline depression severity in MDD patients (r = 0.3, p = 0.006). Contrary to our hypothesis that low n-3 PUFA levels would create risk, we found that while higher AA was associated with greater depression severity at baseline, low AA unexpectedly predicted subsequent suicide attempts, the more so in higher-risk patients. Although surprising, this result agrees with a minority of reports concerning n-6 PUFAs and may represent complex interactions with sample characteristics.

Depression in the Peruvian population and its associated factors: analysis of a national health survey.

BACKGROUND: To date, the factors associated with the presence of depression or depressive symptoms in the Peruvian population have not been described. This study aimed to determine the prevalence of clinically relevant depressive symptoms in the Peruvian population and its associated factors. METHODS: A cross-sectional analytical study of secondary data from 2018 Demographic and Family Health Survey was conducted. The survey database includes 31,996 participants over 18 years of age. The dependent variable of the analysis was the presence of depression during the 14 days before the survey measured by the Patient Health Questionnaire (PHQ-9). Factors associated with the presence of depression were estimated with a proportional odds logistic regression model. RESULTS: The overall prevalence of clinically relevant depressive symptoms was 6.4% (moderate and severe symptomatology in 3.9% [95% CI: 3.6-4.3] and 2.5% [95% CI: 2.2-2.7], respectively). Being a woman, belonging to the age groups of 45 to 64 years or 65 or older, living in the Andean region, and having high blood pressure or diabetes mellitus or some disability increased the probability of having clinically relevant depressive symptoms. LIMITATIONS: The use of the PHQ-9 tool to assess depressive symptomatology limits the evaluation to a period of two weeks before the survey, requiring further study for diagnosis confirmation. CONCLUSION: Six out of 100 Peruvians presented moderate to severe clinically relevant depressive symptoms in 2018. Strategies for depression should contemplate population subgroups , such as women and patients with chronic diseases and disabilities.

Differential Impact of Child Sexual Abuse and Family History of Suicidal Behavior in High-Risk Suicidal Patients.

The current study aimed to compare suicide-related variables as a function of 1) family history of suicidal behavior and 2) child sexual abuse among patients hospitalized for a suicide attempt or active suicidal ideation. Family history of suicidal behavior and child sexual abuse were examined independently and in combination as a diathesis for a high-risk suicidal phenotype. A multicenter cross-sectional study was designed to compare data obtained from 292 patients hospitalized for suicidal behavior. Demographic and clinical variables were compared among Group 1 (patients who reported both family history of suicidal behavior and child sexual abuse), Group 2 (patients who reported only family history of suicidal behavior), Group 3 (patients who reported only child sexual abuse), and Group 4 (patients who did not report family history of suicidal behavior or childhood sexual abuse). A multinomial logistic regression was used to examine suicide-related variables associated with each group and to compare differences between groups. Group 1 and 3 endorsed a higher number of previous suicide attempts and were more likely to be younger at the first suicide attempt compared to Group 4. Group differences remained after adjustment in a multinomial regression model. The current findings suggest that child sexual abuse may be more strongly related to suicide risk among high risk patients than family history of suicidal behavior.

Pro-inflammatory monocyte profile in patients with major depressive disorder and suicide behaviour and how ketamine induces anti-inflammatory M2 macrophages by NMDAR and mTOR.

BACKGROUND: Depression is a highly prevalent disorder that is one of the leading causes of disability worldwide. Despite an unknown aetiology, evidence suggests that the innate and adaptive immune systems play a significant role in the development and maintenance of major depressive disorder (MDD). The non-competitive glutamatergic N-methyl-D-aspartate receptor (NMDAR) antagonist, (R,S)-ketamine (ketamine), has demonstrated rapid and robust efficacy as an antidepressant when administered at sub-anaesthetic doses. METHODS: Our goal was to characterize the pro-inflammatory profile of patients with MDD by measuring pro-inflammatory cytokines in plasma and circulating monocyte subsets and to understand how ketamine induces an anti-inflammatory program in monocyte and macrophages in vitro and vivo. FINDING: Our results show that patients with MDD without other comorbidities (N = 33) exhibited significantly higher levels of pro-inflammatory IL-12 and IL-6 in plasma and that these cytokines were associated with increased numbers of non-classical (CD11b+CD16brightCD14neg) monocytes and increased activation state (CD40+CD86+) of classical monocytes in circulation. Remarkably, we have demonstrated that sub-anaesthetic doses of ketamine programs human monocytes into M2c-like macrophages by inducing high levels of CD163 and MERTK with intermediate levels of CD64 and stimulating mTOR-associated gene expression in vitro. The NMDAR antagonist MK-801, but not the α-amino-3­hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) antagonist, NBQX, also polarizes macrophages to an M2c-like phenotype, but this phenotype disappears upon mTOR pathway inhibition. Sub-anaesthetic doses (10 mg/kg) of ketamine administration in mice both promote reduction of circulating classical pro-inflammatory monocytes and increase of alternative M2 macrophage subtypes in the spleen and CNS. INTERPRETATION: Our results suggest an anti-inflammatory property of ketamine that can skew macrophages to an M2-like phenotype, highlighting potential therapeutic implications not only for patients with MDD but also other inflammatory-based diseases. FUNDING: This study was supported by grants from the Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) and Agencia Nacional de Promoción Científica y Tecnológica (ANPCyT-FONCYT).

Interaction between prospective risk factors in the prediction of suicide risk.

BACKGROUND: To meet the goal of preventing suicide the most important thing is to know the risk factors of suicidal behavior and understand their interaction. AIMS: The current study aims to evaluate prospective predictors and the interaction between factors for suicide and suicide re-attempts in high-risk, suicidal patients during a 24 month prospective follow-up period. METHODS: A multicenter prospective cohort study was designed to compare data obtained from 324 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Participants were clinically evaluated at baseline and follow-up every 6 months to assess any unfavorable events (suicide or a suicide attempt). To estimate the rate of unfavorable events, the Kaplan-Meier method was used and Cox Proportional Hazards Regression Model was employed to examine predictors of suicide and suicide reattempt. RESULTS: The incidence of a new suicide attempt was 26,000 events/100,000 persons-years. The incidence of death by suicide was 1110 events/100,000 person-year. The most reliable predictors of unfavorable events were being women, previous suicide attempts, younger age, and childhood sexual abuse. Findings revealed an interaction between childhood sexual abuse and low psychosocial functioning that increased the risk of an unfavorable event. CONCLUSION: The risk of suicide re-attempts and suicide in the current 2-year follow-up was high. There was an interaction between low psychosocial functioning and childhood sexual abuse. This evidence should be taken into account for the evaluation and planning of preventive strategies.

Lethality of Previous Suicidal Behavior among Patients Hospitalized for Suicide Risk Predicts Lethality of Future Suicide Attempts.

OBJECTIVE: A suicide attempt is an established risk factor for subsequent suicide attempts and suicide. Nonetheless, the prediction of future suicidal behavior is poor. The lethality of previous suicidal behavior may be informative to better understand future suicide risk among patients hospitalized for suicidal thoughts and behavior. The current study examined whether the lethality of patients' index (most recent suicidal episode at hospitalization), first, and worst suicidal episode predicts the lethality of one's most lethal suicide attempt during a 2-year follow-up period. METHOD: A total of 98 patients hospitalized at an emergency department for high suicide risk (i.e., acute suicidal ideation or a suicide attempt) were included in the study. RESULTS: Results indicated that the lethality of the index suicidal episode predicted the lethality of the worst suicide attempt during a 2-year follow-up period. CONCLUSIONS: These findings extend a growing literature examining risk factors that influence the progression toward high lethality suicidal behavior.

Serotonin transporter gene polymorphism as a predictor of short-term risk of suicide reattempts.

OBJECTIVE: The serotonin-transporter-linked polymorphic region (5-HTTLPR) polymorphisms are associated with suicidal behavior; however, prospective studies are scarce. Herein we aim to determine if 5-HTTLPR polymorphisms predict risk of short-term suicide reattempt in a high-risk suicidal sample. We also explore possible mediators or moderators of this relationship. METHODS: A multicenter prospective cohort study was designed to compare data obtained form 136 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Subjects were clinically evaluated, genotyped, and monitored for a new suicide attempt for 6 months. RESULTS: At 6 months of follow up, 21% of the subjects had a new suicide attempt. The frequency of L-allele and L-carrier was higher in reattempters when compared with non-reattempters (55.8% vs. 35.4%, p =  0.01 and 76.9% vs. 54.2%, p = 0.04, respectively). Reattempters also differ from non-reattempters patients with respect to age, history of previous suicide attempts, and age of onset of suicidal behavior. The logistic regression model showed that L-carriers had an odds ratio of 2.8 (95% CI: 1.0-7.6) for reattempts when compared to SS genotype. The adjusted model indicates that this association is not mediated or moderated by impulsivity. CONCLUSION: The 5-HTTLPR polymorphisms predicted short-term risk of suicidal reattempt independently of age and sex. L-carriers have almost three times more risk of relapse when compared with SS carriers.

Determinants of mental and physical health-related quality of life among patients hospitalized for suicidal behavior.

The current study was interested in exploring the clinical factors related to mental and physical health-related quality of life among patients hospitalized for suicidal behavior. A multicenter cross-sectional study was designed to compare data obtained form 246 patients hospitalized for suicide behavior. Results suggest that mental health-related quality of life was negatively associated with hopelessness while physical health-related quality of life was negatively associated with age, medical disease and the number of previous suicide attempts and positively associated with employment. Findings are discussed in the context of theoretical evidence and clinical implications.

[Comparative analysis about hospitalization characteristics in the mental health unit of a general acute care hospital]. / Análisis comparativo sobre las características de las internaciones en una sala de Salud Mental en un hospital general de agudos.

INTRODUCTION: In Argentina, like in the rest of the world, deinstitutionalization policies have been implemented. In our country, the shortage of epidemiologic data regarding admissions in mental health is a limitation for the discussion about how this changes should be implemented and its effect. OBJECTIVES: Epidemiologic data of inpatients of the Mental Health Unit of the Teodoro Álvarez General Hospital between June 2012 and May 2013 has been analyzed in order to elaborate a comparative analysis with a previous study that took place in the same unit on the years 2004-2005. MATERIALS AND METHODS: This is naturalistic, descriptive and retrospective study about adult male inpatients admitted in the psychopathology ward of the Álvarez Hospital. Data was taken from the patient's medical history report. RESULTS: There were 51 hospitalizations during the study (versus 82 hospitalizations in the previous one). The average age was 34.4 years. The average patient hospitalization was 46.2 days (versus 45.4), 84% (vs 89.7%) of hospitalizations lasted less than 90 days, although there was an increase in hospitalization that lasted between 90 and 179 days (7.3% vs 13.7%). The most frequent reason for hospitalization was acute psychotic syndrome, 62.7% (versus 48.8%) of the patients had previous psychiatric hospitalizations. The most frequent diagnosis at discharge were: 38.4% schizophrenia and other psychotic disorders (vs 38.1%), 21.5% personality disorders (vs 25%), 17% mood disorders (vs 17.7%), 15.4% substance use related (vs 22.1%). CONCLUSION: There has been a considerable decrease (from 82 to 51) in the total number of hospitalizations and also a decrease in the BTR (bed turnover ratio) from 4.1 to 2.6 and an increase in hospitalizations with a duration superior to 90 days and inferior to 179 days.

Evolución y diferencias regionales de la mortalidad por suicidios en el Perú, 2004-2013 / Evolution and regional differences in mortality due to suicide in Peru, 2004-2013

El objetivo del estudio fue estimar y analizar la evolución de las tasas de mortalidad por suicidios en el Perú entre los años 2004 y 2013. Se analizaron los registros nacionales de defunciones del Ministerio de Salud del Perú, calculando las tasas regionales de mortalidad por suicidios estandarizadas por edad. Asimismo, se proyectaron geoespacialmente las tasas agrupadas por quinquenios. Se identificaron 3162 casos de suicidios (67,2% hombres), el grupo etario con mayor incidencia fue el de 20 a 29 años (28,7%) y el 49,2% ocurrieron por envenenamiento. La tasa de suicidios pasó de 0,46 (IC 95%: 0,38-0,55) a 1,13 (IC 95%: 1,01-1,25) por 100 000 habitantes en el 2004 y 2013, respectivamente. Las mayores tasas se identificaron en Pasco, Junín, Tacna, Moquegua y Huánuco. El problema de los suicidios en Perú requiere de un abordaje integral que implica no solo identificar zonas con mayor riesgo, sino también estudiar sus factores asociados que podrían explicar la variabilidad regional observada.

The aim of this study was to estimate and analyze the evolution of mortality rates due to suicide in Peru between 2004 and 2013. National death records from the Peruvian Ministry of Health were analyzed, calculating the regional mortality rates due to suicide standardized by age. Similarly, rates grouped in 5-year periods were geospatially projected. There were 3,162 cases of suicide (67.2% men); the age range with the highest incidence was 20 to 29 years (28.7%) and 49.2% were due to poisoning. Suicide rates increased from 0.46 (95% confidence interval [CI] = 0.38-0.55) to 1.13 (95% CI = 1.01-1.25) per 100,000 people from 2004 to 2013, respectively. The highest rates of suicide were identified in Pasco, Junín, Tacna, Moquegua, and Huánuco. The suicide issue in Peru requires a comprehensive approach that entails not just identifying the areas with the highest risk, but also studying its associated factors that may explain the regional variability observed.

[Changes in the conceptualization of suicidal behavior throughout history: from antiquity to the DSM-5.] / Cambios en la conceptualización de la conducta suicida a lo largo de la historia: desde la antigüedad hasta el DSM-5.

Suicide is a universal and specific behavior of human beings which has been present throughout the history of mankind. However, throughout the ages social considerations about it have changed: the acceptance or punishment (and even how to carry out this punishment). These changes have relied upon the influence of different cultural factors. In this article, we review how the prevailing paradigms induced changes in the conceptualization of suicide.

The independent effects of child sexual abuse and impulsivity on lifetime suicide attempts among female patients.

Child sexual abuse (CSA) is a causal agent in many negative adulthood outcomes, including the risk for life-threatening behaviors such as suicide ideation and suicide attempts. Traumatic events such as CSA may pose risk in the healthy development of cognitive and emotional functioning during childhood. In fact, high impulsivity, a risk factor for suicidal behavior, is characteristic of CSA victims. The current study aims to understand the relations among CSA, impulsivity, and frequency of lifetime suicide attempts among a female patient sample admitted for suicidal behavior. Participants included 177 female patients between the ages of 18 and 63 years admitted at two hospitals in Buenos Aires, Argentina. Number of previous suicide attempts and CSA were assessed via structured interviews, while impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). A model of structural equations was employed to evaluate the role of impulsivity in the relation between CSA and suicide attempts. CSA (ß=.18, p<.05) and impulsivity (ß=.24, p<.05) were associated with the number of previous suicide attempts. However, impulsivity was not significantly associated with CSA (ß=.09, p>.05). CSA and impulsivity are independently associated with lifetime suicide attempts among female patients with recent suicidal behavior.

[Posttraumatic stress disorder: Conceptualization and psychopharmacological treatment update]. / Trastorno por estrés postraumático: conceptualización y actualización en el tratamiento psicofarmacológico.

Posttraumatic stress disorder (PTSD) is characterized by four symptom complexes: the reexperience/intrusion of the traumatic event, a state of hyperarousal when exposed to traumatic events, emotional block and emotional/affective deregulation with negative cognitive and mood alterations. Its evolution tends to be chronic and its related with a significative morbidity, affecting the functionality of the individual in his interpresonal, social and employment areas. In 1980, the American Psychiatric Association includes PTSD in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and thereafter several research studies are developed to evaluate the effectiveness of drugs on its treatment. After reviewing its conceptualization, a critical review of published literature is made in order to provide an update on evidence-based pharmacotherapy of PTSD. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the drugs that have proven most effective, achieving the degree of recommendation for first line use.

[Evolution and regional differences in mortality due to suicide in Peru, 2004-2013]. / Evolución y diferencias regionales de la mortalidad por suicidios en el Perú, 2004-2013.

The aim of this study was to estimate and analyze the evolution of mortality rates due to suicide in Peru between 2004 and 2013. National death records from the Peruvian Ministry of Health were analyzed, calculating the regional mortality rates due to suicide standardized by age. Similarly, rates grouped in 5-year periods were geospatially projected. There were 3,162 cases of suicide (67.2% men); the age range with the highest incidence was 20 to 29 years (28.7%) and 49.2% were due to poisoning. Suicide rates increased from 0.46 (95% confidence interval [CI] = 0.38-0.55) to 1.13 (95% CI = 1.01-1.25) per 100,000 people from 2004 to 2013, respectively. The highest rates of suicide were identified in Pasco, Junín, Tacna, Moquegua, and Huánuco. The suicide issue in Peru requires a comprehensive approach that entails not just identifying the areas with the highest risk, but also studying its associated factors that may explain the regional variability observed.