[Suicidal attempt in a school-aged patient and related factors: a case report]. / Intento de suicidio en paciente escolar y factores relacionados: reporte de caso.

Background: Suicide is a public health problem, which has increased in recent years, becoming a serious cause of mortality, mostly in low- and middle-income countries. Suicidal behavior is infrequent before adolescent years, various related factors have been described. The purpose of this work is to describe the case of a patient in school age who attempted suicide and the identified factors that might have contributed. Clinical case: Nine-year-old male attempted suicide by hanging in the bathroom, endangering his life. He received emergency attention and hospitalized in intensive care. During his hospitalization, the mental health service approached him. Amongst the factors previously associated with suicidal intent during school age and identifiable in the patient are family disintegration, symptoms of major depression episodes, reading-related learning difficulties and attention deficit hyperactivity disorder. The patient received treatment and follow up consultation, without showing any suicidal behavior up to this date. The patient is currently 13 years old. Conclusions: It must be recognized that children of school age can present suicidal behavior. It is important to acknowledge the factors associated with this kind of behavior, to reduce risks and provide an opportune attention and handling.

Introducción: el suicidio es un problema de salud pública que se ha incrementado en los últimos años, convirtiéndose en una grave causa de mortalidad principalmente en países de ingresos bajos y medios. Las conductas suicidas son poco frecuentes antes de la adolescencia, por lo que se han descrito diversos factores relacionados. El propósito de este trabajo es describir el caso de un paciente en edad escolar que intentó suicidarse y las causas identificadas que pudieron influir. Caso clínico: paciente masculino de nueve años puso su vida en riesgo al intentar suicidarse por ahorcamiento en el cuarto de baño. Recibió atención de urgencia y estuvo en la terapia intensiva. Durante su hospitalización fue abordado por el servicio de salud mental. Entre los factores que han sido previamente asociados al intento suicida en la edad escolar que pudieron identificarse en el paciente se encuentran: desintegración familiar, síntomas de episodio depresivo grave, dificultad en el aprendizaje para la lectura y un trastorno por déficit de atención con hiperactividad. El paciente recibió tratamiento y seguimiento, hasta el día de hoy no ha vuelto a presentar comportamientos suicidas. Actualmente tiene trece años. Conclusiones: se debe reconocer que los niños en edad escolar pueden presentar comportamientos suicidas, y es importante conocer los factores asociados a este tipo de conductas. Esto, con la finalidad de poder reducir el riesgo, así como otorgar atención y manejo de forma oportuna.

Burden in primary informal caregivers of children and adolescents with type 1 diabetes: Is it associated with depression, family dysfunction, and glycemic control?

Objective: The requirement of a chronic treatment and the increase in life expectancy in children with type 1 diabetes (T1D) leads to the possibility of caregiver burden. The aim of our study was to evaluate the burden in primary informal caregivers (PIC) of children and adolescents with type 1 diabetes and its association with depression, family dysfunction, and glycemic control. Materials and methods: A retrospective study was performed in PIC of children and adolescents with T1D. Zarit Burden Interview Scale (ZBIS) was used to evaluate caregiver burden. Beck Depression Inventory (BDI-II) was used to evaluate depression in PIC, and the Family APGAR questionnaire was used to evaluate the family functionality. Results: A total of 100 PIC of children and adolescents with T1D were included. Caregiver burden was found in 33% of caregivers. The total score of the Zarit scale was 41 (34-49); 19% had mild caregiver burden, and 14% had severe caregiver burden. According to the BDI-II, 82% had minimal depression, 11% mild depression, 5% moderate depression, and 2% severe depression. Family function was good in 69%; 13% had moderate dysfunction, and 18% had severe dysfunction. A positive correlation between caregiver burden and BDI-II score (r = 0.84; p = 0.001) and the grade of depression (r = 0.87; p = 0.001) was found. A logistic regression model showed that BDI-II score was associated with caregiver burden (OR 1.14; 95% CI 1.061-1.23; p = 0.001). A BDI-II cut off of 9 or more had a sensibility and specificity of 58% and 28%, respectively, for caregiver burden [AUC 0.751 (0.64-0.85); p = 0.001]. A BDI-II score ≥9 was a predictor of caregiver burden (OR 3.4; 95% CI 1.4-8.1; p = 0.008). Conclusion: Caregiver burden is present in more than one third of the PIC of patients with T1D and is associated with depression. A BDI-II score ≥9 is a predictor of caregiver burden which may be a point to take into account in the integral approach to the patient with T1D and his or her family nucleus.