Prevención de la conducta suicida en contextos escolares. Una revisión de los tipos de intervención / Prevention of suicidal behavior in school contexts. A review of types of intervention

El suicidio es un problema de salud pública que se presenta en edades cada vez más tempranas, por esta razón es importante desarrollar estrategias y programas de promoción y prevención en diferentes contextos, como el educativo. La presente revisión sistemática presenta información básica de programas o estrategias de prevención de las conductas suicidas en contextos escolares publicadas en la literatura científica (años 2008 a 2020). La búsqueda se realizó en las bases de datos EBSCO, BVS, Dialnet, Lilacs, Google Académico, Redalyc y Scielo. Se encontró que se han desarrollado programas y estrategias de prevención orientadas a sensibilización, información, entrenamiento (de gatekeeper –“guardián”- y psicoeducación), desarrollo, screening o intervención terapéutica, así como algunas intervenciones multimodales que articulan las estrategias anteriores. Se concluye que existe una amplia gama de propuestas de intervención que pueden ser consideradas por los profesionales educativos o en salud mental para la prevención efectiva de la conducta suicida en instituciones educativas. (AU)

Suicide is a public health problem that occurs at increasingly younger ages, for this reason it is important to develop promotion and prevention's strategies and programs in different contexts such as education. This systematic review presents basic information about programs or strategies for the prevention of suicidal behavior in school contexts, published in the scientific literature (years 2008 to 2020). The search was carried out in the following databases: EBSCO, BVS, Dialnet, Lilacs, Google Académico, Redalyc and Scielo. It was found that prevention programs and strategies aimed at raising awareness, information, training (of gatekeeper and psychoeducation), development, screening or therapeutic intervention, as well as some multimodal interventions that articulate the previous strategies, have been developed. It is concluded that there is a wide range of intervention proposals that can be considered by educational or mental health professionals for the effective prevention of suicidal behavior in schools. (AU)

Validation of a Standardized Procedure for Measuring Implicit Attitudes to Suicide / Validación de un procedimiento estandarizado de medición de actitudes implícitas frente al suicidio

Resumen El objetivo del estudio fue validar un procedimiento estandarizado de medición de actitudes implícitas frente al suicidio en estudiantes universitarios. Como criterios de validación concurrente para el Procedimiento de Evaluación Relacional Implícita (IRAP, abreviatura en inglés de Implicit Relational Assessment Procedure) hacia el suicidio (IRAP-HS), se utilizó el Inventario de Ideas Suicidas Positivas y Negativas (PANSI, abreviatura en inglés de Positive and Negative Suicidal Ideation) y la Escala de Desesperanza de Beck, aplicados a una muestra de 102 estudiantes de una universidad del Departamento de Nariño. Si bien los resultados encontrados en este trabajo carecen de la contundencia necesaria para plantearse la aplicabilidad clínica del IRAP-HS en el corto plazo, el comportamiento de las puntuaciones DIRAP (obtenidas mediante un proceso que busca contrarrestar los efectos de la variabilidad de los participantes relacionada con factores como la edad, la habilidad motriz y la inteligencia) en los diferentes grupos de comparación, definitivamente no permite descartar que la latencia de respuesta a los ensayos esté siendo afectada por el grado de coherencia entre la red verbal de los participantes y las relaciones especificadas en los arreglos contingenciales del procedimiento. Finalmente, se analizan algunas implicaciones de los resultados para la aplicabilidad del IRAP en la práctica clínica.

Abstract The purpose of the present study was to validate a standardized procedure for measuring attitudes towards suicide in university students. As the concurrent validation criteria for the Implicit Relational Assessment Procedure (IRAP) to suicide (IRAP-HS), the Positive and Negative Suicidal Ideas Inventory (PANSI) and the Beck Hopelessness Scale were administered to a sample of 102 students of the University of Nariño. Although the results found lack of a strong response to consider the clinical applicability of the IRAP-HS in the short term, the behavior of the DIRAP scores (obtained through a process that seeks to counteract the effects of participant variability related to factors such as age, motor skills and intelligence) in the different comparison groups does not definitively allow dismissing that the response latency to the trials is being affected by the degree of consistency between the verbal network of the participants and the relationships specified in the contingency arrangements of the procedure. Finally, some implications of the results for the applicability of IRAP-HS in clinical practice are analyzed.

Factores del estudiante que dificultan la enseñanza-aprendizaje de competencias de investigación / Student factors that difficult teaching-learning of research skills

El propósito de este trabajo fue describir la perspectiva que tienen los docentes y estudiantes de un centro de ciencias de la educación perteneciente a una universidad pública de México, acerca de los factores asociados a los estudiantes, que dificultan el proceso de enseñanza-aprendizaje de las competencias de investigación. El tipo de estudio es descriptivo, los participantes fueron ocho docentes del área curricular de investigación y siete estudiantes de licenciatura pertenecientes al centro de estudios en mención. La técnica de recolección de datos fue el registro de reportes verbales; con los docentes se desarrollaron sesiones individuales y con los estudiantes una sesión grupal. De manera adicional, se realizó una revisión documental centrada en los programas de estudio del área curricular de investigación. Los resultados indican que los principales factores que limitan la enseñanza-aprendizaje de la ciencia en este contexto, son las dificultades en las competencias lectoras y escritoras, el desinterés y las creencias desfavorables hacia la ciencia. Los resultados se discuten a la luz de la teoría interconductual y constituyen un aporte para la comprensión de las circunstancias en que se enseña y se aprende la práctica científica en un contexto en el que se forman futuros docentes.

The aim of this study was to describe the teachers and students perspective of an educational science center belonging to a public university in Mexico, about factors associated with students, which hinder the teaching-learning process of research skills. The type of study is descriptive. Eight teachers from curricular area of research and seven undergraduate students participated. The technique of data collection was the record of verbal reports; with the teachers were developed individual sessions and with the students were developed a group session. In addition, a documentary review was conducted focusing on the study programs of the research area. The results indicate that the main factors limiting the teaching-learning of science in this context are difficulties in reading and writing skills, disinterest and unfavorable beliefs towards science. The results are analyzed in light of the interbehavioral theory and constitute a contribution to the understanding of the circumstances in which scientific practice is taught and learned in a context in which future teachers are formed.

[Adapting the Suicide Resilience Inventory (SRI-25) for adolescents and young adults in Colombia]. / Adaptación del Inventario de Resiliencia ante el Suicidio (SRI-25) en adolescentes y jóvenes de Colombia.

OBJECTIVE: Describe the psychometric properties of the Suicide Resilience Inventory (SRI-25), adapted to Spanish, in a student sample of adolescents and young adults from San Juan de Pasto, Colombia. METHODS: The SRI-25 was adapted to the Spanish language by means of a simple translation. This involved the participation of 573 schoolchildren and college/ university students between 10 and 25 years of age. RESULTS: In an exploratory factorial analysis by principal components, a structure of three factors was found to explain 52.83% of the variance. Factorial analysis was carried out by sex, educational level, and developmental stage. On this basis, it was confirmed that in all the groups, the items are weighted on the same factors as in the original test: namely, internal protection, emotional stability, and external protection. A Cronbach's alpha coefficient of 0.922 was obtained for the total test. Concerning the validity of the construct, the SRI-25 presented significant correlations with measurements of self-esteem, social support, problem-solving skills, reasons for living, depression, despair, and suicidal ideas. CONCLUSIONS: It was proved that the SRI-25 is a useful instrument for measuring resilience to suicide among adolescents and young people pursuing their education in San Juan de Pasto, Colombia.

Adaptación del inventario de resiliencia ante el suicidio (SRI-25) en adolescentes y jóvenes de Colombia / Adapting the suicide resilience inventory (SRI-25) for adolescents and young adults in Colombia

OBJETIVO: Describir las propiedades psicométricas del Suicide Resilience Inventory (SRI-25), adaptado al español, en una muestra de adolescentes y jóvenes escolarizados de San Juan de Pasto, Colombia. MÉTODOS: Se adaptó el SRI-25 al idioma español por medio de una traducción simple. Se contó con 573 participantes, estudiantes de colegios y universidades, de 10 a 25 años de edad. RESULTADOS: En un análisis factorial exploratorio por componentes principales se encontró una estructura de tres factores que explican el 52,83 por ciento de la varianza. Se realizaron análisis factoriales según el sexo, el nivel educativo y la etapa evolutiva, a partir de los cuales se confirmó que en todos los grupos, los ítems cargan en los mismos factores de la prueba original, a saber: protección interna, estabilidad emocional y protección externa. Se obtuvo un coeficiente alfa de Cronbach de 0,922 para la prueba total. En cuanto a la validez de constructo, el SRI-25 presentó correlaciones significativas con medidas de autoestima, apoyo social, solución de problemas, razones para vivir, depresión, desesperanza e ideas suicidas. CONCLUSIÓN: Se comprobó que el SRI-25 es un instrumento útil para medir la resiliencia ante el suicidio en adolescentes y jóvenes escolarizados de San Juan de Pasto, Colombia.

OBJECTIVE: Describe the psychometric properties of the Suicide Resilience Inventory (SRI-25), adapted to Spanish, in a student sample of adolescents and young adults from San Juan de Pasto, Colombia. METHODS: The SRI-25 was adapted to the Spanish language by means of a simple translation. This involved the participation of 573 schoolchildren and college/ university students between 10 and 25 years of age. RESULTS: In an exploratory factorial analysis by principal components, a structure of three factors was found to explain 52.83 percent of the variance. Factorial analysis was carried out by sex, educational level, and developmental stage. On this basis, it was confirmed that in all the groups, the items are weighted on the same factors as in the original test: namely, internal protection, emotional stability, and external protection. A Cronbach's alpha coefficient of 0.922 was obtained for the total test. Concerning the validity of the construct, the SRI-25 presented significant correlations with measurements of self-esteem, social support, problem-solving skills, reasons for living, depression, despair, and suicidal ideas. CONCLUSIONS: It was proved that the SRI-25 is a useful instrument for measuring resilience to suicide among adolescents and young people pursuing their education in San Juan de Pasto, Colombia.

Elementos para una política pública desde la percepción del suicidio en nariño / Elements for a public policy based on the perception of suicide in Nariño

Esta investigación pretende plantear los elementos para una política pública basada en la percepción de las comunidades acerca del suicidio en jóvenes del departamento de Nariño (Colombia). Se realizó un estudio cualitativo a partir de grupos focales y entrevistas individuales con diversos sectores poblacionales en los municipios de Pasto, la Unión, Tumaco e Ipiales. Se analizaron los factores percibidos de protección y de riesgo en los niveles individual, familiar, sociocultural y político, y los resultados se validaron con la población participante. Desde la percepción de los actores sociales, el suicidio es una problemática multideterminada que involucra aspectos cognitivos, relacionales, educativos, económicos, políticos y culturales. Se destaca la necesidad de implementar políticas sociales integradas dirigidas a fomentar factores protectores como el soporte social, la educación integral y la oferta de actividades para el uso del tiempo, e implementar programas que promuevan habilidades y competencias personales, junto con el diseño de estrategias conjuntas para reducir los factores de riesgo.

The objective of this study of community perceptions regarding the suicide of young people in the Department of Nariño (Colombia) was to provide elements for the formulation of a public policy. A qualitative study was carried out on the basis of focal groups and individual interviews with different population sectors in the municipalities of Pasto, la Unión, Tumaco, and Ipiales. Perceived protective and risk factors at the individual, family, socio-cultural, and political levels were analyzed, and the results were validated with the participating population. The social actors perceive suicide as a multi-determined problem that involves cognitive, relational, educational, economic, political, and cultural aspects. The study highlighted the need to implement inclusive social policies aimed at fostering protective factors such as social support, integrated education, and the availability of leisure time activities, and programs that promote personal skills and competences, as well as the need to design joint strategies to reduce risk factors.

Situación de la conducta suicida en estudiantes de colegios y universidades de San Juan de Pasto, Colombia / Suicidal behaivor in high school and college students in San Juan de Pasto, Colombia

Suicidal behavior, in its different manifestations, represents an international public health problem, being one of the ten main causes of general mortality and one of the three top main causes of death in adolescence and young adulthood. The statistics of suicidal attempts are also very worrying, even more if it is considered that for each case of suicide attempt attended in a health-care center, it is estimated that there are four non-reported and non-attended cases. Several studies report the importance of considering the role of some risk factors such as a family loss, a family history of suicidal behaviors, severe mental health problems in the family, economic problems, personality disorders, non-stable mood state, aggressiveness, impulsiveness and social alienation. When those problems are combined with alcohol or drug abuse, the suicide risk is higher. The presence of suicidal behaviors in Latin-Americans high school and university students has been reported by different papers in which the suicidal ideation indicators range from 8% to 25% and the suicide attempts vary from 8% to 12%. In these papers the difference between women and men is highlighted, given that the first group has a higher propensity of suicidal attempts and men group is in full risk of comitted suicide. There are no statistics that confirm the differences between high school and university students. Some studies have confirmed the importance of stressful life events in the suicide phenomenon during adolescents, especially of interpersonal and emotional stressors. Few studies have inquired about the characteristics of suicidal behaviors in student population in Colombia. For this reason, health promotion and suicide prevention actions have not reached the expected effects. The purpose of this study is to know the prevalence and the characteristics of suicidal behavior in high school and college students in the city of San Juan de Pasto. A descriptive study was developed with 463 students belonging to six high schools and two universities, which ensures equal proportions regarding level (high school or university), gender and type of education (public or private). Their ages range from 9 to 30 years old. The Parasuicide Indicators Schedule (CIP- Cédula de Indicadores Parasuicidas) was applied; it was part of a battery of tests of the <> project, which was approved by the ethical committee of the University of Nariño. The stressful life events questionnaire for adolescents (Cuestionario de Eventos Estresantes Vitales para Adolescentes -EEVA-Udenar) was applied to a randomly selected sub-sample. The prevalence of suicidal behavior was of 30%, 18% of the sample analyzed had suicidal thoughts, 4% had suicidal plans and 8% reported previous suicide attempts. The suicidal behavior was more frequent in women than in men and it is unsettling that the proportion of suicide attempts between women and men is 3:1. Suicide behaviors were more frequent in students whose ages ranged from 17 to 20 years old. Suicide attempts are more common in students with ages between 25 and 30 years old and from 13 to 20 years old. Moreover, the suicidal ideation was highly reported in students with ages ranging from 17 to 24 years old. In addition the highest prevalence of suicidal behavior took place during university years, but 9th graders are the group with the highest risk of suicide attempts. However, suicidal behavior is reported to be more common in university students than in high school students. This tendency was equal as for ideations and plans, but the proportions were the same for suicide attempts. The students of public institutions reported a higher presence of suicidal behaviors, specifically in ideations and plans, but the situation is the opposite for suicide attempts. Using the ANOVA procedure, it was found that the presence of stressful life events was different for each kind of suicidal behavior. In this way, the highest frequencies were found in suicide attempters, followed by the <> and the <>. Finally, the lowest frequencies were found in the non-suicidal students. However, these differences were not found in the intensity of stressful life events. The main events related to suicide attempts were: sexual violence, physical family abuse, living far away from one's family and suicidal behaviors in a member of the family. On the other hand, the events mainly related to suicide ideation were: parents divorce, terminal illness, losing a job and suicidal behaviors in a member of the family. Most of the attempters have presented a self-harming behavior at least once, but the main average was 2.25 times during their life. The first attempt was carried out at an age ranging from 7 to 22 years, the average was 14 years old, but the type is in the rank between 13 and 15 years old (47%). Near 40% of attempters had a real intention of ending their lives and 42% of them were not worried about living or dying. The purpose of the suicidal behavior was mainly dying, ending their problems, getting attention and ending suffering. The most highly reported self injury method was cutting themselves with sharp objects, followed by the ingestion of pills. Sixty six percent of the suicide attempts were not reported to somebody and only 22% of the cases were taken to some health center; in other words, only one of five suicide attempts could be registered in government statistics. When these persons carried out a suicide attempt, they doubted about the effectiveness of the method and only one third expected death to be a sure event. More than half of the suicide attempters did not ask for help. However when they did, women turned to friends and spiritual counselors, while men looked for the family and friend support. The high rate of suicidal behaviors in high school and college students in the city of San Juan de Pasto was evidenced. The prevalence of suicidal ideation was higher than the prevalence found in other studies, and the suicide attempts were fewer. The age in which people turned into a full risk group ranged from 17 to 24 years old, although the suicidal behaviors first showed up around 11 years old, which is the tendency showed in other countries. It was identified that stressful life events associated with suicidal ideation had the characteristic of threat, and those related with suicide attempt had the characteristic of harm or loss, proposed by Folkman and Lazarus. The crucial role of some stressful life events in the origin of the suicidal behavior was demonstrated. Specifically, being a victim of sexual abuse is a key event for the beginning of the suicidal process. The presence of repeated suicide attempts is a risk factor to commit suicide, because the predictor value of that event has been demonstrated. Moreover, the presence of suicide ideation makes more probable the presence of a more hazardous behavior in the future. When the students look for ending their problems or stop being a problem for other people, at the moment of the suicide attempt, the serious conflict that the adolescents live in this age is shown. Since the suicide attempt is a very private event, the under-report of the suicide attempts is a matter of concern. That suggests why the governmental statistics are actually so high. This situation demands early preventive actions to identify cases in high risk of suicidal behavior. A new issue studied in this work is the difference between public and private institutions, students belonging to the former have a higher propensity to suicidal ideations while the latter have more risk to attempt suicide. The overview offered by this paper urges coordinated actions to identify and intervene in high risk cases to prevent suicide behavior and to promote life.

La conducta suicida en sus distintas formas representa un problema de salud pública internacional, ya que se encuentra dentro de las diez principales causas de mortalidad general y entre las tres primeras causas de muerte en el grupo de adolescentes y adultos jóvenes. Las estadísticas acerca de los intentos de suicidio también son preocupantes y más aún si se considera que por cada caso de intento de suicidio que recibe ayuda en un centro de salud, se estima que existen cuatro intentos no reportados, ni atendidos. Diversas investigaciones han señalado la importancia de considerar el papel de algunos factores de riesgo, tales como: la pérdida de algún familiar, la presencia previa de una historia de suicidio en la familia, problemas graves de salud mental en la familia, los factores económicos, alteraciones de la personalidad, estado de ánimo inestable, agresividad, impulsividad y alienación social. Cuando éstas se combinan con abuso de alcohol y drogas aumenta el riesgo de suicidio. La presencia de conductas suicidas en estudiantes de educación secundaria y universitaria de Latinoamérica ha sido reportada por diferentes investigaciones, en las cuales se han hallado indicadores de ideación suicida que oscilan entre el ocho y el 25% de los casos, mientras que los intentos de suicidio varían entre el ocho y el 12%. El objetivo de este estudio se centró en conocer la presencia y las características de las conductas suicidas en estudiantes de colegios y universidades de la ciudad de San Juan de Pasto. Se llevó a cabo un estudio de tipo descriptivo, con 463 estudiantes, pertenecientes a seis colegios y dos universidades, de edades comprendidas entre nueve y 30 años, garantizando participaciones similares por nivel (secundaria o superior), género y sector (público o privado). Se aplicó una versión adaptada de la Cédula de Indicadores Parasuicidas (CIP), la cual fue parte de una batería de pruebas del proyecto <>, proyecto avalado por el Comité de ética de la Universidad de Nariño. Los resultados mostraron que cerca de un 30% de los estudiantes encuestados ha tenido alguna conducta suicida durante su vida. De esta manera, se encontró que 18% presentaron ideas suicidas y el 8% llevaron a cabo intentos de suicidio. Los análisis de contingencia demostraron que la conducta suicida se presenta de manera distinta dependiendo del género y del nivel educativo (secundaria o superior). Además, se halló mayor presencia de conductas suicidas en mujeres, en jóvenes entre los 17 y 20 años, en universitarios y en estudiantes del sector público. Igualmente, se halló que el número de episodios de autolesión varía entre 1 y 10, los cuales se presentan por primera vez entre los 13 y 15 años de edad. Además, la mayoría de personas recuerda que no le interesaba si vivía o moría y pensaban que la muerte era posible. Los métodos de suicidio más utilizados fueron el corte con objetos filosos, el consumo de pastillas o medicamentos y la ingesta de otras sustancias. El objetivo de la conducta fue principalmente: morirse, terminar con los problemas y dejar de ser carga para otros. De todas las personas que reportaron un intento de suicidio, tan sólo un 20% acudió a un servicio de salud y otro 48% lo comentó con alguien. Al revisar la presencia de eventos vitales estresantes se halló que quienes habían tenido un intento de suicidio presentaron un mayor número de eventos estresantes. Los eventos asociados con intento de suicidio fueron violación sexual, maltrato físico, vivir alejado de la familia y conductas suicidas de un ser querido. Por otro lado, para la ideación suicida los eventos más relevantes fueron: una enfermedad mortal, la pérdida del empleo en familiares, la separación o divorcio de los padres y la presencia de conductas suicidas en seres queridos. En conclusión, en este estudio se evidenció la alta tasa de conductas suicidas en estudiantes de colegios y universidades de la ciudad de San Juan de Pasto, lo que demanda acciones prontas y coordinadas de detección oportuna y prevención integral de este tipo de comportamientos.