ABSTRACT
BACKGROUND: Worldwide, depression is one of the leading causes of disability, contributing significantly to the global burden of disease. The aim of this study was to evaluate in Brazil the effect of living in rural or urban areas on the prevalence of major depressive episode (MDE), as well as the differences among associated factors in both contexts. METHODS: Data from 60,202 adult residents from a household-based cross-sectional survey conducted in Brazil were analyzed. The prevalence of MDE, evaluated using PHQ-9, as well as the prevalence ratios between the categories of the independent variables were estimated. Multiple hierarchical Poisson regression analyses based on a theoretical model were reproduced for both rural and urban areas. RESULTS: Residents of rural areas showed lower MDE prevalence (3.3% [95% CI: 2.9-3.9] vs. 4.2% [95% CI: 3.9-4.6], p < .05) and the effect of rurality remained even adjusted by potential confounders (PR = 0.8 [95% CI: 0.7-0.9]). Better education, social network, and access to health services were protective factors for both rural and urban areas, while previous diagnosis of depression, chronic diseases, and obesity were risk factors. Living in the northern region, being indigenous, presenting higher income and number of goods were protective factors only in rural areas. In urban areas, being younger and having an occupation were protective factors, whereas female sex and having some disability were risk factors. CONCLUSIONS: Rural and urban areas differ not only in the prevalence of depression, but also in the way in which different factors influence its occurrence.
Subject(s)
Depressive Disorder, Major , Adult , Brazil/epidemiology , Cross-Sectional Studies , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/epidemiology , Female , Humans , Prevalence , Rural Population , Urban PopulationABSTRACT
ABSTRACT Objetivo: Assess the impact of the lockdown measures on hospitalizations and emergency psychiatric care in a capital of a Brazilian state. Methods: Psychiatric hospitalizations and emergency psychiatric attendances carried out between January 7th and May 28th, 2020, were evaluated, covering the periods before and after lockdown due to COVID-19 pandemic in the city of Fortaleza, capital of the state of Ceará, Brazil. The data in the two periods were described and presented in time series graphs. Attendances were also described according to the severity categories. Comparisons were performed using Mann-Whitney U test and test for proportions. Results: The daily average of hospitalizations and of attendances decreased in the evaluated periods from 16.0 to 10.8 (p < 0.001) and 67.9 to 35.0 (p < 0.001), respectively. This absolute reduction was observed in all categories of severity. No difference was observed in the proportion of severe attendances (2.3% vs. 2.8%; p = 0.207). The proportion of mild cases decreased from 18.6% to 10.7% (p < 0.001) and of intermediate severity cases increased from 79.1% to 86.5% (p < 0.001). Conclusion: The findings showed both a decrease in emergency psychiatric attendances and hospitalizations, which can lead to severe impacts in the absence of counterpart mitigation measures by the local mental health system.
RESUMO Objetivo: Avaliar o impacto das medidas de distanciamento social em hospitalizações e atendimentos psiquiátricos de urgência em uma capital de estado brasileiro. Métodos: Foram avaliadas as internações e atendimentos psiquiátricos de urgência realizados entre 7 de janeiro e 28 de maio de 2020, abrangendo os períodos antes e após o lockdown em razão da pandemia de COVID-19 na cidade de Fortaleza, capital do estado do Ceará, Brasil. Os dados nos dois períodos foram descritos e apresentados em gráficos de séries temporais. Os atendimentos também foram descritos de acordo com as categorias de gravidade. As comparações foram realizadas pelo teste U de Mann-Whitney e o teste de hipóteses para proporções. Resultados: A média diária de internações e de atendimentos diminuiu nos períodos avaliados, de 16,0 para 10,8 (p < 0,001) e de 67,9 para 35,0 (p < 0,001), respectivamente. Tal redução absoluta foi observada em todas as categorias de gravidade. Não foi observada diferença na proporção de atendimentos graves (2,3% vs. 2,8%; p = 0,207). A proporção de casos leves diminuiu de 18,6% para 10,7% (p < 0,001) e a de gravidade intermediária aumentou de 79,1% para 86,5% (p < 0,001). Conclusões: Os resultados mostraram uma diminuição nos atendimentos psiquiátricos de urgência e nas hospitalizações, o que pode levar a impactos severos na ausência em contrapartida de medidas de mitigação pelo sistema de saúde mental local.
ABSTRACT
Objetivo: descrever as características e taxas de mortalidade por suicídio no estado do Ceará e suas macrorregiões. Método: estudo descritivo, compreendendo o período de 2012-2016. Resultados e conclusão: a maioria dos casos ocorreu no sexo masculino, entre não casados, em domicílio, por enforcamento, na macrorregião de Fortaleza. A taxa no Ceará foi de 5,1/100.000. As macrorregiões do Sertão Central, Sobral e Cariri apresentam maiores taxas. Taxas mais elevadas ocorreram no interior do estado, onde, habitualmente, há menor acesso a serviços especializados, sendo a participação da atenção primária de grande importância no enfrentamento desse agravo.
Objective: to describe the characteristics and rates of mortality by suicide in the state of Ceará and its macro-regions. Method: a descriptive study covering the period 2012-2016. Results and conclusion: most cases occurred in males, among unmarried people, at home, by hanging, in the macro-region of Fortaleza. The rate in Ceará was 5.1/100.000 thousand. The macro-regions of Sertão Central, Sobral, and Cariri have higher rates of cases. Higher rates occurred in areas in the interior of the state, where there is usually less access to specialized services, and the participation of primary care is of great importance in dealing with this problem.
Subject(s)
Suicide , Primary Health Care , Sex , Single Person , Mortality , Minors , MenABSTRACT
OBJECTIVE: To describe the characteristics and rates of child psychiatric hospitalizations in the Brazilian public health system, as well as their variation according to the country's macro-regions. METHODS: This was a descriptive study focusing on year 2017, having as main source the Brazilian Ministry of Health's hospital information system. Child hospitalizations were considered to encompass those of individuals under 13 years of age whose main diagnosis was included in Chapter V of the International Classification of Diseases, 10th edition (ICD-10). RESULTS: The most prevalent diagnostic group was F10-F19, with 24.1% (21.8-26.3), followed by groups F30-39, F80-F89, F90-F99, F20-F29, with no statistical difference among them. Hospitalizations occurred more frequently in non-psychiatric hospitals, with 93.1% (91.7-94.4); most hospitalizations lasted for up to one week - 75.5% (73.2-77.8). The national hospitalization rate was 4.3 (4.1-4.5)/100,000, showing variations according to macro-regions. The highest rate was found in the South macro-region and the lowest in the Northeast, with values of 10.9 (9.9-12.0)/100,000 and 1.9 (1.6-2.2)/100,000, respectively. Intermediate values were found in the other macro-regions. CONCLUSION: Some specificities of the characteristics of hospitalizations for psychiatric reasons in this age group could be attested, as well as important variations in their occurrence among the different macro-regions of the country.
Subject(s)
Child, Hospitalized/statistics & numerical data , Hospitalization/statistics & numerical data , Hospitals, Psychiatric/statistics & numerical data , Length of Stay/statistics & numerical data , Mental Disorders , Brazil/epidemiology , Child , Female , Humans , Male , Mental Disorders/epidemiology , Mental Disorders/therapyABSTRACT
Abstract Objective To describe the characteristics and rates of child psychiatric hospitalizations in the Brazilian public health system, as well as their variation according to the country's macro-regions. Methods This was a descriptive study focusing on year 2017, having as main source the Brazilian Ministry of Health's hospital information system. Child hospitalizations were considered to encompass those of individuals under 13 years of age whose main diagnosis was included in Chapter V of the International Classification of Diseases, 10th edition (ICD-10). Results The most prevalent diagnostic group was F10-F19, with 24.1% (21.8-26.3), followed by groups F30-39, F80-F89, F90-F99, F20-F29, with no statistical difference among them. Hospitalizations occurred more frequently in non-psychiatric hospitals, with 93.1% (91.7-94.4); most hospitalizations lasted for up to one week - 75.5% (73.2-77.8). The national hospitalization rate was 4.3 (4.1-4.5)/100,000, showing variations according to macro-regions. The highest rate was found in the South macro-region and the lowest in the Northeast, with values of 10.9 (9.9-12.0)/100,000 and 1.9 (1.6-2.2)/100,000, respectively. Intermediate values were found in the other macro-regions. Conclusion Some specificities of the characteristics of hospitalizations for psychiatric reasons in this age group could be attested, as well as important variations in their occurrence among the different macro-regions of the country.
Subject(s)
Child , Female , Humans , Male , Child, Hospitalized/statistics & numerical data , Hospitalization/statistics & numerical data , Hospitals, Psychiatric/statistics & numerical data , Length of Stay/statistics & numerical data , Mental Disorders , Brazil/epidemiology , Mental Disorders/therapy , Mental Disorders/epidemiologyABSTRACT
Abstract Objective: To evaluate the coverage, characteristics and the risk of suicide in the indigenous people of Tabatinga in the Brazilian Amazon. Methods: An active surveillance strategy for suicide cases was used: records of the Ministry of Health, the Municipal Health Secretariat, the Special Indigenous Health District of the Upper River Solimões (Distrito Sanitario Especial Indígena Alto Río Solimões), the Military Hospital of Tabatinga, the National Indian Foundation (Fundación Nacional del Indio) and the civil registry offices were examined from 2007 to 2011 for individuals over 9 years of age. Adjusted rates were estimated using the direct method and according to age. A descriptive analysis was performed and the hypothesis tests were considered significant if p-values were <0.05. Results: The coverage of indigenous suicide was 82.8%, since 11 (17.2%) were classified as hidden suicides. For men between 15 and 29 years of age, and for women aged from 12 to 20 years, the probability of suicide was around 70.0%. In 17.2% of the sample there was a record of alcohol consumption before death and relationship between victims. The corrected adjusted mortality rate was 111.7/100,000 (95% CI, 84.6-148.6). Conclusions: The risk of suicide in the indigenous people of the Tabatinga is very high. Coping strategies should consider the complex relationship between suicide and alcohol consumption, gender differences and the existence of vulnerable groups, such as young people, especially those with close relatives who have committed suicide.
Resumen Objetivo: Evaluar el alcance, las características y el riesgo de suicidio de los indígenas de Tabatinga, en la Amazonia brasileira. Métodos: Se utilizó una estrategia de vigilancia activa del suicidio y se examinaron los registros de mayores de 9 años, de 2007-2011, del Ministerio de Salud, la Secretaría Municipal de Salud, el Distrito Sanitario Especial Indígena Alto Río Solimões, el Hospital Militar de Tabatinga, la Fundación Nacional del Indio y la notaría del Registro Civil. Las tasas ajustadas se calcularon utilizando el método directo, según la edad. Se realizó un análisis descriptivo y se consideró que las pruebas de hipótesis eran significativas si p < 0,05. Resultados: El alcance del suicidio indígena fue del 82,8%, ya que 11 (17,2%) se clasificaron como suicidios ocultos. Alrededor del 70,0% de la probabilidad de suicidio de los varones se situó a los 15-29 años y la de las mujeres, a los 12-20 años. En el 17,2% de la muestra, se registró consumo de alcohol antes de la muerte y relación parental entre las víctimas. La tasa de mortalidad ajustada corregida fue 111,7/100.000 (IC95%, 84,6-148,6). Conclusiones: El riesgo de suicidio de los indígenas de Tabatinga es muy alto. Las estrategias de afrontamiento deben considerar la compleja relación entre el suicidio y el consumo de alcohol, las diferencias de sexo y la existencia de grupos vulnerables, como los jóvenes, especialmente aquellos con parientes cercanos que ya cometieron suicidio.
Subject(s)
Humans , Male , Female , Adult , Suicide , Health of Indigenous Peoples , Indigenous Peoples , Brazil , Family , Death , Watchful Waiting , IndiumABSTRACT
This study aimed to describe the characteristics, distribution, and mortality rates from suicide in indigenous children in Brazil compared to non-indigenous children. This descriptive study covered the years from 2010 to 2014, using national databases. The study collected deaths in individuals 10 to 14 years of age whose underlying cause was "inentional self-inflicted injury". Hanging was the most frequently used means in both indigenous and non-indigenous children, although it was more frequent in the former. Among indigenous children, suicides in hospitals or other healthcare establishments were less common than in non-indigenous. Approximately three-fourths of suicides in indigenous children occurred in just 17 municipalities. The mortality rate from suicide among indigenous children was 11.0/100,000 (8.4-14.3), or 18.5 times higher (10.9-31.6) than in non-indigenous, which was 0.6/100,000 (0.5-0.6), with no differences between boys and girls. This study showed for the first time on a national scale the specific characteristics of suicide in indigenous children, with high rates, and also identified priority areas for interventions.
O objetivo deste trabalho foi descrever as características, a distribuição e as taxas de mortalidade por suicídio entre crianças indígenas no Brasil, comparativamente as não indígenas. Realizou-se um estudo descritivo, compreendendo os anos de 2010 a 2014, utilizando dados dos sistemas nacionais de informação. Foram selecionados os óbitos de pessoas com idades de 10 a 14 anos, cuja causa básica foi classificada como "lesões autoprovocadas voluntariamente". O enforcamento foi o meio utilizado com mais frequência, tanto entre indígenas como entre não indígenas, embora tenha sido mais frequente no primeiro grupo. Entre indígenas, a ocorrência de suicídio em hospital ou outros estabelecimentos de saúde foi menor do que o observado entre os não indígenas. Aproximadamente, 3/4 dos suicídios entre crianças indígenas ocorreram em 17 municípios. A taxa de mortalidade por suicídio entre crianças indígenas foi de 11,0/100 mil (8,4-14,3), 18,5 (10,9-31,6) vezes maior do que a observada entre as não indígenas, 0,6/100 mil (0,5-0,6), sem diferenças entre meninos e meninas. Este trabalho evidenciou, pela primeira vez, em escala nacional, especificidades das características do suicídio indígena, suas elevadas taxas, bem como identificou ainda áreas prioritárias para intervenções.
El objetivo de este trabajo fue describir las características, distribución y tasas de mortalidad por suicidio entre niños indígenas en Brasil, en comparación con los no indígenas. Se realizó un estudio descriptivo, desde el año 2010 hasta el 2014, utilizando datos de los sistemas nacionales de información. Se seleccionaron los fallecimientos de personas con edades comprendidas de 10 a 14 años, cuya causa básica de fallecimiento se clasificó como "lesiones auto provocadas voluntariamente". El ahorcamiento fue el medio utilizado con más frecuencia, tanto entre indígenas como entre no indígenas, aunque haya sido más frecuente en el primer grupo. Entre indígenas, la ocurrencia de suicidios en hospitales u otros establecimientos de salud fue menor de lo que se observó entre los no indígenas. Aproximadamente, 3/4 de los suicidios entre niños indígenas se produjeron en 17 municipios. La tasa de mortalidad por suicidio entre niños indígenas fue de 11,0/100 mil (8,4-14,3), 18,5 (10,9-31,6) veces mayor que la observada entre los no indígenas, 0,6/100 mil (0,5-0,6), sin diferencias entre niños y niñas. Este trabajo evidenció, por primera vez, en escala nacional, especificidades de las características del suicidio indígena, sus elevadas tasas, así como, incluso, se identificaron áreas prioritarias para intervenciones.
Subject(s)
Child Mortality/ethnology , Indians, South American/statistics & numerical data , Suicide/statistics & numerical data , Adolescent , Brazil/epidemiology , Cause of Death , Child , Cities/statistics & numerical data , Cross-Cultural Comparison , Female , Humans , Male , Residence Characteristics/statistics & numerical data , Risk Factors , Sex Factors , Suicide/ethnology , Suicide/psychologyABSTRACT
Resumo: O objetivo deste trabalho foi descrever as características, a distribuição e as taxas de mortalidade por suicídio entre crianças indígenas no Brasil, comparativamente as não indígenas. Realizou-se um estudo descritivo, compreendendo os anos de 2010 a 2014, utilizando dados dos sistemas nacionais de informação. Foram selecionados os óbitos de pessoas com idades de 10 a 14 anos, cuja causa básica foi classificada como "lesões autoprovocadas voluntariamente". O enforcamento foi o meio utilizado com mais frequência, tanto entre indígenas como entre não indígenas, embora tenha sido mais frequente no primeiro grupo. Entre indígenas, a ocorrência de suicídio em hospital ou outros estabelecimentos de saúde foi menor do que o observado entre os não indígenas. Aproximadamente, 3/4 dos suicídios entre crianças indígenas ocorreram em 17 municípios. A taxa de mortalidade por suicídio entre crianças indígenas foi de 11,0/100 mil (8,4-14,3), 18,5 (10,9-31,6) vezes maior do que a observada entre as não indígenas, 0,6/100 mil (0,5-0,6), sem diferenças entre meninos e meninas. Este trabalho evidenciou, pela primeira vez, em escala nacional, especificidades das características do suicídio indígena, suas elevadas taxas, bem como identificou ainda áreas prioritárias para intervenções.
Abstract: This study aimed to describe the characteristics, distribution, and mortality rates from suicide in indigenous children in Brazil compared to non-indigenous children. This descriptive study covered the years from 2010 to 2014, using national databases. The study collected deaths in individuals 10 to 14 years of age whose underlying cause was "inentional self-inflicted injury". Hanging was the most frequently used means in both indigenous and non-indigenous children, although it was more frequent in the former. Among indigenous children, suicides in hospitals or other healthcare establishments were less common than in non-indigenous. Approximately three-fourths of suicides in indigenous children occurred in just 17 municipalities. The mortality rate from suicide among indigenous children was 11.0/100,000 (8.4-14.3), or 18.5 times higher (10.9-31.6) than in non-indigenous, which was 0.6/100,000 (0.5-0.6), with no differences between boys and girls. This study showed for the first time on a national scale the specific characteristics of suicide in indigenous children, with high rates, and also identified priority areas for interventions.
Resumen: El objetivo de este trabajo fue describir las características, distribución y tasas de mortalidad por suicidio entre niños indígenas en Brasil, en comparación con los no indígenas. Se realizó un estudio descriptivo, desde el año 2010 hasta el 2014, utilizando datos de los sistemas nacionales de información. Se seleccionaron los fallecimientos de personas con edades comprendidas de 10 a 14 años, cuya causa básica de fallecimiento se clasificó como "lesiones auto provocadas voluntariamente". El ahorcamiento fue el medio utilizado con más frecuencia, tanto entre indígenas como entre no indígenas, aunque haya sido más frecuente en el primer grupo. Entre indígenas, la ocurrencia de suicidios en hospitales u otros establecimientos de salud fue menor de lo que se observó entre los no indígenas. Aproximadamente, 3/4 de los suicidios entre niños indígenas se produjeron en 17 municipios. La tasa de mortalidad por suicidio entre niños indígenas fue de 11,0/100 mil (8,4-14,3), 18,5 (10,9-31,6) veces mayor que la observada entre los no indígenas, 0,6/100 mil (0,5-0,6), sin diferencias entre niños y niñas. Este trabajo evidenció, por primera vez, en escala nacional, especificidades de las características del suicidio indígena, sus elevadas tasas, así como, incluso, se identificaron áreas prioritarias para intervenciones.
Subject(s)
Humans , Male , Female , Child , Adolescent , Suicide/statistics & numerical data , Indians, South American/statistics & numerical data , Child Mortality/ethnology , Suicide/ethnology , Suicide/psychology , Brazil/epidemiology , Residence Characteristics/statistics & numerical data , Sex Factors , Cross-Cultural Comparison , Risk Factors , Cause of Death , Cities/statistics & numerical dataABSTRACT
The Mato Grosso do Sul State (MS) has the second-largest indigenous population and the highest incidence rates of TB among indigenous people in Brazil. However, little is known about the risk factors associated with active TB in indigenous people in the region, especially regarding socioeconomic factors. The aim of this study is to assess the effect of the Family Allowance Program (BFP) and of other predictors of active TB in a high-risk indigenous population in Brazil. We conducted a case-control study with incident TB cases matched by age and by village of residence (1:2 proportion) between March 2011 and December 2012. We used a conditional logistic regression for data analysis. A total of 153 cases and 306 controls were enrolled. The final model included the following risk factors: alcohol consumption (low-risk use OR=2.2; 95% CI 1.1-4.3; risky use OR=2.4; 95% CI 1.0-6.0; dependent/ damaging use OR=9.1; 95% CI 2.9-29.1); recent contact with a TB patient (OR=2.0; 95% CI 1.2-3.5); and male sex (OR=1.9; 95% CI 1.1-3.2). BFP participation (OR=0.5; 95% CI 0.3-0.6) and BCG vaccination (OR=0.5; 95% CI 0.3-0.9) were found to be protective factors against TB. Although the BFP was not designed to target TB-affected households specifically, our findings reveal the importance of the BFP in preventing one of the most important infectious diseases among adults in indigenous villages in Brazil. This result is in line with the End-TB strategy, which identifies social protection, poverty alleviation and targeting other determinants of TB as key actions.
Subject(s)
Indians, South American/statistics & numerical data , Social Security/statistics & numerical data , Tuberculosis, Pulmonary/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Brazil/epidemiology , Case-Control Studies , Female , Humans , Male , Middle Aged , Risk Factors , Socioeconomic Factors , Young AdultABSTRACT
Resumo Iauaretê é uma populosa e multiétnica localidade indígena situada no Alto Rio Negro, que vem passando por um importante processo de urbanização. Suas lideranças têm expressado preocupações relacionadas à violência, em particular às brigas dos jovens, principalmente em situações nas quais há consumo de bebidas alcoólicas. O objetivo deste trabalho foi analisar esse fenômeno, utilizando referenciais teóricos que pudessem dar sentido às especificidades indígenas em geral, e rionegrinas em particular. Através da pesquisa etnográfica, demonstrou-se que as brigas dos jovens fazem parte de um complexo fenômeno no qual interagem, de maneira sinérgica e dialética, as mudanças na forma de ocupação do território (incremento populacional, quebra da regra de residência patrilocal, entre outras); a fragilidade dos mecanismos de consanguinização da alteridade; e a necessidade de demarcação de diferenças, em um ambiente no qual concepções e práticas nativas tradicionais são atualizadas em um contexto de importantes transformações do modo de vida indígena.
Abstract Iauaretê is a populous and multi-ethnic indigenous place located at the Upper course of the Rio Negro in the state of Amazonas, Brazil. This region is undergoing an important urbanization process and their leaderships have been expressing concerns regarding violence, particularly fights among the youth, mainly in situations that involve the use of alcoholic beverages. The objective of this study was to analyze this phenomenon, using a theoretical framework capable of comprising general indigenous characteristics, as well as those specific for populations living near the Rio Negro. Through the ethnographic research, the fights among the youth were shown to be part of a complex phenomenon involving synergic and dialectic interactions that affect the changes in how the territory is being occupied (increased population, breaks of the rule of patrilocal residence, among others); the frailty of the consanguinity mechanisms of alterity; and the need to define the differences in an environment in which native conceptions and traditional practices are being updated into a context of important transformations in the indigenous lifestyle.
Subject(s)
Adolescent , Young Adult , Violence , Alcohol Drinking , Adolescent , Indigenous Peoples , Anthropology, Cultural , Young AdultABSTRACT
OBJECTIVE: to describe suicide characteristics and mortality rates among indigenous and non-indigenous people in Roraima, Brazil. METHODS: descriptive study using data from the Mortality Information System (SIM) about the suicides in individuals over 10 years old, recorded in the period from 2009 to 2013; suicide mortality rates were adjusted by sex and age. RESULTS: 170 suicide cases were reported, being 17.1% among indigenous people; median ages were 24 years among indigenous and 29 among non-indigenous people; four municipalities concentrated 25/29 of the suicides among indigenous people; the 141 suicides among non-indigenous people were distributed in 13/15 municipalities in the state; suicide mortality rates were 15.0/100,000 among indigenous people and 8.6/100,000 among non-indigenous people. CONCLUSION: ethnic-racial peculiarities stood out in suicide mortality; among the indigenous people, rates were higher, younger ages prevailed and deaths were concentrated in a smaller number of municipalities, when compared to non-indigenous people.
Subject(s)
Ethnicity/statistics & numerical data , Indians, South American/statistics & numerical data , Suicide/statistics & numerical data , Adolescent , Adult , Age Factors , Brazil/epidemiology , Child , Cities , Female , Humans , Information Systems , Male , Middle Aged , Suicide/ethnology , Young AdultABSTRACT
OBJECTIVE: To analyze the narratives of family members on the suicide of older adults in Manaus, State of Amazonas, Brazil. METHODS: This is a qualitative study of the narratives of eight older adults, who committed suicide in the period of 2001-2012. In the analytic-interpretative process, we have tried to perform the hermeneutic double exercise: to interpret the interpretation of narrators. We have used as theoretical references authors who have investigated suicide from the perspective of gender and its correlations with the sociofamiliar context and with mental disorders. RESULTS: The family members would conceive the suicide of the older adults as related to losses, which would occur in a strained sociofamiliar scenario, leading to the appearance of psychopathological situations that, if not properly followed, would result in death. There would also be something inexorable in this sequence of events. The older adults, by the very time of their life, would tend to accumulate losses of different aspects in their trajectory. Their rigor and other relational limitations would simultaneously stress family relationships, favoring conflicts, and hinder adherence to treatment. This model of understanding, which has a wide support in the hegemonic medical-psychological discourse, in a sense minimizes possible self- or heteroaccusations directed at family members. CONCLUSIONS: Special attention should be given to identify the older adults who present losses, family conflicts, and signs of psychopathology and who do not follow-up psychosocial care services. Strategies to help older adults handle family conflicts and losses, empowering them, should be developed and made available by intersectoral actions. The adequate treatment of psychopathological conditions should be implanted in a context in which active search mechanisms also existed for older adults who abandoned follow-up. The implementation of these actions is a challenge to be faced in Manaus, State of Amazonas, Brazil, where there is a low availability of psychosocial care services, which are not articulated with specialized care services in tertiary medical conditions, and there is still low coverage by the basic care.
Subject(s)
Family/psychology , Mental Disorders/psychology , Narration , Suicide/psychology , Adult , Aged , Brazil , Female , Hermeneutics , Humans , Male , Middle Aged , Qualitative Research , Suicidal Ideation , Suicide, Attempted/psychology , Young AdultABSTRACT
Resumo OBJETIVO: descrever características e taxas da mortalidade por suicídio entre indígenas e não indígenas em Roraima, Brasil. MÉTODOS: estudo descritivo, com dados do Sistema de Informações sobre Mortalidade (SIM) sobre suicídios ocorridos em maiores de 10 anos de idade, registrados no período 2009-2013; as taxas de mortalidade por suicídio foram ajustadas por sexo e idade. RESULTADOS: foram registrados 170 suicídios, 17,1% em indígenas; as medianas das idades foram de 24 para indígenas e de 29 anos para não indígenas; quatro municípios concentraram 25/29 dos suicídios entre indígenas; os 141 suicídios entre não indígenas distribuíram-se em 13/15 municípios do estado; as taxas de mortalidade por suicídio foram de 15,0/100 mil indígenas e de 8,6/100 mil não indígenas. CONCLUSÃO: evidenciaram-se especificidades étnico-raciais na mortalidade por suicídio; entre os indígenas, as taxas foram mais elevadas, predominaram idades menores e as mortes concentraram-se em menor número de municípios, na comparação com os não indígenas.
Resumen OBJETIVO: describir características y tasas de mortalidad por suicidios entre indígenas y no-indígenas en Roraima. MÉTODOS: se realizó un estudio descriptivo con datos del Sistema de Información de Mortalidad, referente a suicidios en mayores de 10 años, entre 2009-2013; las tasas de mortalidad por suicidio se ajustaron por sexo y edad. RESULTADOS: se registraron 170 suicidios, 17.1% indígenas; las medias de edad fueron 24 años entre indígenas y 29 entre no-indígenas; cuatro municipios concentran 25/29 suicidios entre los indios; los 141 suicidios entre los no-indígenas se distribuyeron en 13/15 municipios en el estado; las tasas de mortalidad por suicidio fueron 15.0/100.000 entre indígena y 8.6/100.000 entre no-indígena. CONCLUSIÓN: hubo especificidades étnico-raciales en la mortalidad por suicidio; entre los indígenas, las tasas fueron más altas, predominaron las edades más jóvenes y las muertes se concentran en pocos municipios, comparado con no-indígenas.
Abstract OBJECTIVE: to describe suicide characteristics and mortality rates among indigenous and non-indigenous people in Roraima, Brazil. METHODS: descriptive study using data from the Mortality Information System (SIM) about the suicides in individuals over 10 years old, recorded in the period from 2009 to 2013; suicide mortality rates were adjusted by sex and age. RESULTS: 170 suicide cases were reported, being 17.1% among indigenous people; median ages were 24 years among indigenous and 29 among non-indigenous people; four municipalities concentrated 25/29 of the suicides among indigenous people; the 141 suicides among non-indigenous people were distributed in 13/15 municipalities in the state; suicide mortality rates were 15.0/100,000 among indigenous people and 8.6/100,000 among non-indigenous people. CONCLUSION: ethnic-racial peculiarities stood out in suicide mortality; among the indigenous people, rates were higher, younger ages prevailed and deaths were concentrated in a smaller number of municipalities, when compared to non-indigenous people.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Suicide/statistics & numerical data , Ethnicity/statistics & numerical data , Indians, South American/statistics & numerical data , Suicide/ethnology , Brazil/epidemiology , Information Systems , Age Factors , CitiesABSTRACT
ABSTRACT OBJECTIVE To analyze the narratives of family members on the suicide of older adults in Manaus, State of Amazonas, Brazil. METHODS This is a qualitative study of the narratives of eight older adults, who committed suicide in the period of 2001-2012. In the analytic-interpretative process, we have tried to perform the hermeneutic double exercise: to interpret the interpretation of narrators. We have used as theoretical references authors who have investigated suicide from the perspective of gender and its correlations with the sociofamiliar context and with mental disorders. RESULTS The family members would conceive the suicide of the older adults as related to losses, which would occur in a strained sociofamiliar scenario, leading to the appearance of psychopathological situations that, if not properly followed, would result in death. There would also be something inexorable in this sequence of events. The older adults, by the very time of their life, would tend to accumulate losses of different aspects in their trajectory. Their rigor and other relational limitations would simultaneously stress family relationships, favoring conflicts, and hinder adherence to treatment. This model of understanding, which has a wide support in the hegemonic medical-psychological discourse, in a sense minimizes possible self- or heteroaccusations directed at family members. CONCLUSIONS Special attention should be given to identify the older adults who present losses, family conflicts, and signs of psychopathology and who do not follow-up psychosocial care services. Strategies to help older adults handle family conflicts and losses, empowering them, should be developed and made available by intersectoral actions. The adequate treatment of psychopathological conditions should be implanted in a context in which active search mechanisms also existed for older adults who abandoned follow-up. The implementation of these actions is a challenge to be faced in Manaus, State of Amazonas, Brazil, where there is a low availability of psychosocial care services, which are not articulated with specialized care services in tertiary medical conditions, and there is still low coverage by the basic care.
RESUMO OBJETIVO Analisar as narrativas de familiares sobre o suicídio de idosos em Manaus, Amazonas, Brasil. MÉTODOS Estudo qualitativo de narrativas de oito idosos que morreram por suicídio no período 2001-2012. No processo analítico-interpretativo, buscou-se realizar o exercício da dupla hermenêutica: interpretar a interpretação dos narradores. Teve-se como referenciais teóricos autores que investigaram o suicídio a partir da perspectiva de gênero, de suas correlações com o contexto sociofamiliar e com transtornos mentais. RESULTADOS Os familiares conceberiam o suicídio dos idosos como relacionado a perdas, que se dariam em um cenário sociofamiliar tensionado, levando ao surgimento de quadros psicopatológicos que, se não adequadamente acompanhados, resultariam na morte. Haveria também algo de inexorável nessa sequência de eventos. O idoso, pelo próprio tempo de sua vida, tenderia a acumular em sua trajetória perdas de diferentes matizes. Sua rigidez e outras limitações relacionais tensionariam simultaneamente as relações familiares, favorecendo conflitos, e dificultariam a adesão ao tratamento. Esse modelo de compreensão, que tem amplo ancoramento no discurso médico-psicológico hegemónico, de certo modo, se presta a minimizar eventuais auto- ou heteroacusações direcionadas aos familiares. CONCLUSÕES Especial atenção deveria ser direcionada para se identificar idosos que apresentem simultaneamente perdas, conflitos familiares, indícios de psicopatologia e não seguimento em serviços de atenção psicossocial. Estratégias para auxiliar os idosos a lidar com as perdas e conflitos familiares, empoderando-os, deveriam ser desenvolvidas e disponibilizadas por meio de ações intersetoriais. O adequado tratamento de condições psicopatológicas deveria ser implantado, em um contexto no qual também houvesse mecanismos de busca ativa de idosos que abandonaram o acompanhamento. Implantar essas ações é um desafio a ser enfrentado em Manaus, onde há baixa disponibilidade de serviços de atenção psicossocial, que não se articulam com os serviços de atenção especializada em condições médicas de abordagem terciária, havendo ainda baixa cobertura pela atenção básica.
Subject(s)
Humans , Male , Female , Adult , Aged , Young Adult , Suicide/psychology , Family/psychology , Narration , Mental Disorders/psychology , Suicide, Attempted/psychology , Brazil , Qualitative Research , Suicidal Ideation , Hermeneutics , Middle AgedABSTRACT
OBJECTIVE: to describe the occurrence of the recording of mental disorders (MD) in primary health care (PHC) services in Brazilian municipalities and to analyze associated factors. METHODS: an ecological study was conducted using PHC Information System secondary data for the year 2014; the magnitude of the occurrence of MD recording was assessed through indicators developed for this purpose; bivariate analysis was used. RESULTS: 15,216 MD cases were recorded in 42 (0.8%) municipalities, corresponding to 16.9 MD cases/100,000 inhabitants for Brazil, with significant variations between the country's macro-regions; MD recording in PHC was most frequent in the Southeast and Southern macro-regions (p=0.001), in state capital cities (p<0.001), in municipalities with more than 200,000 inhabitants (p<0.001), those with PHC coverage greater than 75% (p=0.005) and those with Psychosocial Care Centers (p=0.001). CONCLUSION: recording of MD in PHC is incipient, unequally distributed and possibly dependent on local initiatives.
Subject(s)
Health Information Systems/statistics & numerical data , Mental Disorders/epidemiology , Primary Health Care/statistics & numerical data , Brazil/epidemiology , Cities/epidemiology , HumansABSTRACT
Taxas de mortalidade por suicídio mais elevadas são recorrentemente encontradas em indígenas quando comparadas a populações circunvizinhas, inclusive em São Gabriel da Cachoeira, Amazonas, município brasileiro com maior percentual de autodeclarados indígenas. Entender como o suicídio é representado em contextos indígenas específicos é uma dimensão qualitativa, pouco explorada e relevante. O objetivo deste artigo foi analisar sete narrativas sobre suicídio de um kumu (curandeiro tradicional) da mais populosa comunidade indígena de São Gabriel da Cachoeira. No processo analítico-interpretativo realizou-se uma dupla hermenêutica, ou seja, interpretar a interpretação do narrador, buscando apoio na literatura etnográfica clássica e contemporânea, nas teorias sobre o processo de construção da pessoa e do parentesco no contexto ameríndio. A análise das narrativas permitiu reconstruir o suicídio como um fenômeno associado a conflitos que se ancoram pro fundamente em aspectos socioculturais e históricos dos povos indígenas daquela região, que remetem a tensões inter geracionais, de gênero e no campo do parentesco. O gerenciamento desses conflitos parece estar comprometido, já que estratégias tradicionais parecem perder a eficácia simbólica e outras não foram adequadamente encontradas para substituí-las. O consumo de álcool, embora seja um elemento importante para compreensão do suicídio, não deveria ser tomado como elemento explicativo central, mas, sobretudo como um catalisador desses conflitos.
Higher suicide mortality rates are recurrently found among indigenous in comparison with surrounding populations, including in São Gabriel da Cachoeira, in the state of Amazonas, the Brazilian city with the highest percentage of self-declared indigenous people. To understand how suicide is represented in specific indigenous contexts is a qualitative and relevant dimension, but poorly explored. The aim of this study was to analyze seven narratives about suicide of a kumu (traditional healer) from the most populous indigenous community of São Gabriel da Cachoeira. In the analytical and interpretative process, we attempted to make the practice of double hermeneutic, interpret the interpretation of the narrator, seeking support on the classical and contemporary ethnographic literature, theories about the construction of the person and of kinship in the Amerindian context. The analysis of the narratives allowed reconstructing suicide as a phenomenon associated with conflicts deeply inserted in socio-cultural and historical aspects of the indigenous populations of that region, which refer to intergenerational tensions, gender and kinship. The management of these conflicts seems to be compromised, since traditional strategies appear to lose their symbolic effectiveness, and other appropriate alternatives were not found to replace them. Alcohol use, although an important element in the understanding of suicide, should not be taken as the central explicative element, but above all as a catalyst of these conflicts.
Subject(s)
Humans , Male , Female , Anthropology, Cultural , Narration , Indigenous Peoples , Suicide , Cultural Characteristics , Alcohol Drinking , Qualitative ResearchABSTRACT
A proposta do texto consiste em apresentar alguns apontamentos sobre o processo de supervisão acadêmica em área indígena, no âmbito do Programa Mais Médico para o Brasil (PMMB), partindo de uma experiência de pouco mais de dois anos como tutor no contexto do estado do Amazonas, visando fornecer subsídios para discussão. Após uma breve contextualização, apresento algumas das especificidades da supervisão em área indígena que podem ser reunidos em três grupos: a) transcorrer em contexto onde antes havia importante carência de médicos; b) dá-se em área de difícil acesso; c) ocorrer em um cenário político complexo. Dentre as conclusões apresentadas destaca-se a necessidade de se estabelecer interações mais efetivas entre o Ministério da Educação e a Secretaria Especial de Saúde Indígena para enfrentarmos os desafios de supervisionar os médicos em área indígena.
The purpose of the text is to present some notes about the academic supervision process on indigenous areas, under the Programa Mais Médico para o Brasil (PMMB), starting from a little more than two years experience as a tutor in the state of the context of Amazon to provide input for discussion. After a brief background, I present some of the specifics of supervision on indigenous area that can be divided into three groups: a) spend in the context where there was significant shortage of doctors; b) takes place in an area of difficult access; c) occur in a complex political landscape. Among the conclusions presented highlights the need to establish more effective interactions between the Brazilian Ministry of Education and the Special Secretariat of Indigenous Health to meet the challenges of supervising physicians in indigenous areas.
El propuesto del texto es presentar algunas notas sobre el proceso de supervisión académica en tierras indígenas, en el marco del Programa Mais Médico para o Brasil (PMMB), a partir de una pequeña experiencia de más de dos años como profesor particular en el estado de Amazonas contexto para proporcionar información para el debate. Después de una breve reseña, se presentan algunas de las características específicas de la supervisión en el área indígena que se pueden dividir en tres grupos: a) pasan en el contexto donde había gran escasez de médicos; b) se lleva a cabo en una zona de difícil acceso; c) se producen en un complejo panorama político. Entre las conclusiones presentadas destaca la necesidad de establecer una interacción más eficaces entre el Ministerio de Educación de Brasil y la Secretaría Especial de Salud Indígena para afrontar los retos de la supervisión de médicos en las zonas indígenas.
Subject(s)
Humans , Family Health , Health of Indigenous Peoples , Indigenous Peoples , National Health Programs , Physicians/supply & distribution , BrazilABSTRACT
No Brasil, há indícios de que alguns povos indígenas apresentam taxas de mortalidade por suicídio significativamente superiores às taxas nacionais e regionais. Por outro lado, evidências apontam para as dificuldades de se transpor categorias biomédicas ao contexto das sociedades indígenas, tendo em vista que estes se valem de referenciais simbólicos particulares para compreender o processo saúde-doença e a morte. O objetivo deste artigo foi refletir sobre as dificuldades para utilização do conceito de suicídio no contexto indígena, ponto crucial para abordagem deste tema através de uma perspectiva menos etnocêntrica. O caminho proposto para tal foi o de se recorrer ao chamado estranhamento antropológico do conceito biomédico de suicídio. Para tanto, nós fizemos a análise do mito do Jurupari amplamente difundido entre os povos indígenas da região do Alto Rio Negro, utilizando três perguntas norteadoras: Jurupari queria morrer?; Jurupari morreu?; Quem matou Jurupari? Para responder estas perguntas, recorreu-se a informações etnográficas sobre suicídio entre povos indígenas brasileiros. Através da análise realizada, demonstraram-se as dificuldades de transposição do conceito biomédico de suicídio para o contexto indígena. Isto foi feito na medida em que evidenciamos: 1) a amplificação das dificuldades de se falar de intencionalidade no contexto indígena; 2) as diferentes concepções indígenas sobre morte e morrer; 3) a complexa correlação entre suicídio e homicídio nos sistemas etiológicos nativos. Por fim, apresentaram-se, mesmo que de forma preliminar, algumas eventuais dificuldades como possíveis caminhos para abordagem do suicídio indígena, tanto por meio de estratégias qualitativas como quantitativas...
Several evidences shows that in Brazil, suicide mortality rates of some indigenous people are significantly higher than national and regional rates. Furthermore, evidence points to the difficulties to transport biomedical categories to the indigenous societies, because they use specific symbolic references to understand the health-disease process and the death. The aim of this paper was to reflect on the difficulties to use the concept of suicide in the indigenous context, an important principle to explore this theme from a less ethnocentric way. The proposed way for this was to resort to the so-called anthropological strangeness of the biomedical concept of suicide. To this end, we did an analysis of an indigenous myth that is widespread in the Upper Rio Negro region, the myth of Jurupari, using three guiding questions: Jurupari wanted to die?; Jurupari died?; Who killed Jurupari? To answer these questions we used the ethnographic information about suicide among Brazilian indigenous. Through the performed analysis, the difficulty to transport the biomedical concept of suicide to the indigenous context was demonstrated. This was down when we presented: i) the amplification of the difficulties to speak of intentionality in this context, ii) the different indigenous conceptions about death and dying, iii) the complex correlation between suicide and homicide in natives etiological systems. Finally, even in a preliminary way, some potential difficulties and possible ways to approach indigenous suicide by qualitative and quantitative strategies was presented...
Subject(s)
Humans , Male , Female , Anthropology, Cultural , Cultural Characteristics , Cultural Diversity , Cultural Factors , Individuality , Death , Indigenous Peoples , Suicide , Qualitative Research , Public HealthABSTRACT
Objective: To analyze mortality rates and to describe the demographic and epidemiological characteristics of suicides recorded in the state of Amazonas. Methods: A descriptive and retrospective study has been carried out with emphasis on municipalities, which have shown, simultaneously, a high mortality rates and a high proportion of self-reported indigenous population, based on 2005 - 2009 data as provided by the Informatics Department of the Unified National Health System. Results: Among the general population of the state of Amazonas, the mortality rate, by suicide, of 4.2/100.000 inhabitants has been reported, similar to that of Manaus (4.6/100.000 inhabitants). In contrast, at Tabatinga (25.2/100.000 inhabitants), at São Gabriel da Cachoeira (27.6/100.000 inhabitants) and at Santa Isabel do Rio Negro (36.4/100.000 inhabitants), municipalities, where the proportion of self-reported indigenous population is high, besides the taxes being notably higher, it was observed that most of the suicides has occurred among men; among young men aged between 15 - 24 years; at home; by hanging; during "weekend" and among the indigenous population. Discussion: Our findings have unveiled that suicide comes forth as a serious public health issue in some municipalities in the state of Amazonas, further indicating that the event occurs within very specific contexts, and that the dimension and the magnitude of the problem can be even more serious among populations or in territories exclusively inhabited by indigenous people. .
Objetivo: analisar as taxas de mortalidade e descrever as características demográficas e epidemiológicas dos suicídios registrados no Estado do Amazonas. Métodos: Realizou-se um estudo descritivo e retrospectivo com ênfase nos municípios que apresentaram, simultaneamente, elevadas taxas de mortalidade e elevadas proporções de população autodeclarada indígena, com base nos dados de 2005 - 2009 do Departamento de Informática do Sistema Único de Saúde. Resultados: Na população geral do Amazonas foi reportada taxa de mortalidade por suicídio de 4,2/100.000 habitantes, semelhante a de Manaus (4,6/100.000 habitantes). Em contraposição em Tabatinga (25,2/100.000 habitantes), em São Gabriel da Cachoeira (27,6/100.000 habitantes) e em Santa Isabel do Rio Negro (36,4/100.000 habitantes), municípios nos quais a proporção de população autodeclarada indígena é alta, além de taxas notadamente superiores, observou-se que a maioria dos suicídios ocorreu em homens; em jovens de 15 - 24 anos; no domicílio; por enforcamento; no "fim de semana" e em indígenas. Discussão: Nossos achados revelam que o suicídio desponta como um sério problema de saúde pública em alguns municípios do Amazonas, indicando ainda que o evento ocorre em um contexto particular e que a dimensão e a magnitude do problema possa ser ainda mais grave em populações ou territórios formados exclusivamente por indígenas. .
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Indians, South American , Self Report , Suicide/statistics & numerical data , Brazil/epidemiology , Cities , Mortality/trends , Retrospective StudiesABSTRACT
Quais são os critérios para identificar quando o consumo de bebidas alcoólicas se tornou problemático? Os critérios biomédicos que definem a dependência ao álcool como uma patologia se aplicam a todos os contextos culturais? O uso do álcool é uma questão de contornos complexos, em especial quando se consideram os povos indígenas, entre os quais problemas relacionados ao uso de álcool aparecem como importantes problemas de saúde pública, embora a produção acadêmica nacional sobre o assunto ainda seja relativamente escassa. Como o álcool adquire uma variedade de funções em diferentes grupos sociais, a análise não pode se restringir à ingestão da bebida em si: é preciso relacionar o consumo a processos socioculturais e político-econômicos. É o que defendem os autores desta coletânea, que descreve e analisa as características específicas dos diversos modos de uso de álcool em diferentes povos indígenas brasileiros. Os capítulos trazem relatos teóricos, etnográficos, historiográficos e de intervenções culturalmente orientadas. Buscam superar os enfoques limitados aos aspectos patológicos do consumo de álcool: demonstram que os efeitos da bebida sejam negativos, sejam positivos não podem ser dissociados de seus aspectos sociais, econômicos e psicológicos. Essa complexidade aponta para a necessária complementaridade entre as perspectivas da biomedicina e as das ciências sociais, além de ratificar a importância do protagonismo indígena no enfrentamento dos problemas relacionados ao uso de bebidas alcoólicas