Suicidal behavior in individuals with amyotrophic lateral sclerosis: A systematic review.

BACKGROUND: Amyotrophic Lateral Sclerosis (ALS) leads to a drastic reduction in quality of life, generating intense psychological distress and predisposing those affected to mental illness and, in more severe cases, suicidal behavior. OBJECTIVE: This is a systematic review aiming to estimate the frequency of wish to die, suicide ideation and suicide in individuals with ALS using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). METHODS: The following databases were used: Pubmed/MEDLINE, PsycINFO, Embase, SciELO, Biblioteca Virtual de Saúde (BVS), and Cochrane Library. The choice of appropriate descriptors, or their equivalents, to define the search terms was based on the technical and scientific vocabulary of each database. RESULTS: 13 articles were included in the present systematic review, of which three were cross-sectional studies, nine were cohort-type and there was one case-control study. The studies show that individuals with ALS have a higher risk of suicide in relation to the general population, and there is evidence that this risk is even higher in the early stages of the disease. Major Depressive Disorder was the most prevalent mental disorder in the studies included. This mental health concern is often undertreated, leading to the increased susceptibility of this population to suicide. LIMITATIONS: In general, the study samples represent a highly heterogeneous population while many instruments used in the data collection were not uniform. CONCLUSIONS: The high degree of psychological vulnerability of this population, associated with a greater predisposition to suicidal behavior, should be minimized through public health measures.

Prevalencia y factores asociados con la conducta suicida en adolescentes de Lima Metropolitana y Callao / Prevalence and correlates of suicidal behavior in adolescents from Metropolitan Lima and Callao

Objetivo: Identificar la prevalencia y los factores asociados con la conducta suicida en adolescentes de Lima Metropolitana y Callao. Métodos: Se usó la base datos del Estudio Epidemiológico Metropolitano en Salud Mental 2002. Se aplicó una ficha demográfica y socioeconómica, el cuestionario de salud mental de Colombia y la M.I.N.I. Entrevista Neuropsiquiétrica Internacional – CIE-10. Se ajustaron modelos de regresión logística múltiple. Resultados: La prevalencia de vida, en el último año y actual del deseo de morir fue: 29.1 por ciento, 15.2 por ciento y 6.8 respectivamente, observándose según el modelo de regresión logística múltiple final, asociaciones estadísticamente significativas con: sexo femenino (OR: 2.3, IC95 por ciento: 1.6-3.3), nada o poca satisfacción con su inteligencia (OR: 2.0, IC95 por ciento: 1.2-3.4), principios y valores diferentes a los de la familia (OR: 3.0, IC95 por ciento: 2.0-4.7), tener amigo confidente (OR: 1.6, IC95 por ciento: 1.1-2.5), tener enamorado(a) (OR: 1.9, IC95 por ciento: 1.4-2.8), dificultades en las funciones como hijo (OR: 1.8, IC95 por ciento: 1.1-2.9), fobia social (OR: 4.0, IC95 por ciento: 2.1-7.4) y episodio depresivo (OR: 2.8, IC95 por ciento: 1.5-5.2). En cuanto al intento suicida, la prevalencia de vida, en el último año y actual fue: 3.6 por ciento, 2.4 por ciento y 0.4 por ciento respectivamente, observ ndose según el modelo de regresión logística múltiple final, asociaciones estadísticamente significativas con: sentir que nada o poco lo respetan en la familia (OR: 4.8, IC95 por ciento: 1.9-12.0), tener enamorado(a) (OR: 2.7, IC95 por ciento: 1.2-6.0) y episodio depresivo (OR: 8.5, IC95 por ciento: 3.7-19.4). Conclusiones: La presencia de depresión y fobia social, así como los aspectos de la dinámica familiar aparecen como factores importantes a considerar en la prevención de la conducta suicida en adolescentes.

Objetive: To identify the prevalence and correlates of suicidal behavior in adolescents from Metropolitan Lima y Callao. Methods: We used the database of the Metropolitan Epidemiological Study on Mental Health 2002. Our study population comprised residents aged 12 to 17 years. Subjects completed face-to-face interviews using a demographic and socioeconomic questionnaire; the Mental Health Questionnaire of Colombia; and the M.I.N.I International Neuropsychiatric Interview - ICD-10. Relational statistical analyses and adjusted multiple logistic regression models were conducted. Results: The lifetime prevalence, 12-month prevalence and point prevalence of the wish to die were: 29.1 percent, 15.2 percent and 6.8 percent, respectively. The final model of multivariate analysis show statistically significant associations with: female gender (OR: 2.3, 95 percentCI: 1.6-3.3), nothing or little satisfaction with his intelligence (OR: 2.0, 95 percentCI: 1.2-3.4), principles and values different from those of their family (OR: 3.0, 95 percentCI: 2.0-4.7), having a confident friend (OR: 1.6, 95 percentCI: 1.1-2.5), having a girlfriend or boyfriend (OR: 1.9, 95 percentCI: 1.4-2.8), difficulties in functioning as a son/ daughter (OR: 1.8, 95 percentCI: 1.1-2.9), social phobia (OR: 4.0, 95 percentCI: 2.1-7.4) and depressive episode (OR: 2.8, 95 percentCI: 1.5-5.2). In regard to the suicide attempt, the lifetime prevalence, 12-month prevalence and point prevalence were: 3.6 percent, 2.4 percent and 0.4 percent, respectively. The final model of multivariate analysis show statistically significant associations with: feel none or little respect from family (OR: 4.8, 95 percentCI: 1.9 -12.0), having a girl or boyfriend (OR: 2.7, 95 percentCI: 1.2-6.0) and depressive episode (OR: 8.5, 95 percentCI: 3.7-19.4). Conclusions: The presence of depression and social phobia, but also family dynamic aspects appear as important factors to consider in the prevention of suicidal behaviors in adolescents.