The capacity to consent to treatment is altered in suicidal patients.

BACKGROUND: Many patients with depression refuse treatment. Moreover, suicide attempters often display low perceived need of treatment and impaired decision-making. These observations raise questions about the capacity to treatment consent in depressed suicide attempters (SA). METHODS: In patients with current depressive episode (N = 33 SAs and N = 27 non-SAs), consent capacity was evaluated with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), insight with the Beck Cognitive Insight Scale, and depression severity with the Beck Depression Inventory (BDI). RESULTS: The median BDI score in the whole sample (N = 60) was 21 [10;36], and was higher in SAs than non-SAs (27 [11;36] vs. 15 [10:33], p < 0.001). Consent capacity was impaired in 30% (appreciation), 53% (reasoning) and 60% (understanding) of all patients. MacCAT-T sub-scores were lower in SAs than non-SAs (understanding: 4.4 [2.35;5.8] vs. 5.3 [3.13;6]); appreciation: 3 [1;4] vs. 4 [2;4]); reasoning (4 [1;7] vs. 7 [3;8]), and ability to express a choice: 1 [0;2] vs. 2 [0;2]; all p < 0.001). In multivariate analyses, suicide attempt history and depression severity (but not insight) were negatively associated with MacCAT-T sub-scores. CONCLUSION: More research is needed on the capacity to consent to treatment of patients with depression, particularly suicidal individuals, to make informed choices about their treatment. Trial registration The Montpellier University Hospital Institutional Review Board approved the study (No. 202100714).

Suicidal thoughts and burnout among physicians during the first wave of the COVID-19 pandemic in Spain.

BACKGROUND: The exact mechanisms through which the impact of the SARS-CoV-2 pandemic could influence the prevalence of suicidal thoughts are not yet known, both in the general population and in health workers. The objectives of the present study are to determine the prevalence of suicidal thoughts in the physician population and to detect sociodemographic and clinical variables associated with presenting suicidal thoughts during the first wave of COVID-19. METHODS: Cross-sectional observational study via an online survey distributed in Spain in June 2020 via 52 Official Medical Associations. The sample is made up of all practicing and registered physicians in Spain (3,140 of the 270,235 registered physicians in Spain). An online questionnaire which included sociodemographic, professional and work variables, variables related to the pandemic, work data in relation to COVID-19 and clinical variables (medical-psychiatric history and previous suicidal behaviour) was distributed. RESULTS: In our sample, the prevalence of serious suicidal thoughts was 6.31% and up to 17.32% of the subjects reported thoughts about killing themselves during the pandemic. Being female (Exp (B)= 1.989, p=0.001), presence of previous suicide attempts (Exp(B)= 6.127, p=<0.001), taking a psychotropic drug (Exp(B)= 2.470, p=<0.001) and working in a different area during the pandemic (Exp(B)= 1.751, p= 0.037) were associated with a higher risk of suicidal ideation. Cohabiting was a protective factor in the development of suicidal ideation although not in all our measures (Exp(B)=0.940, p=0.850 Vs Exp (B)= 0.620, p=0.018). LIMITATIONS: The main limitation of this study is its cross-sectional nature, which prevents establishing a causal relationship. As a strength, it stands out that it is a large sample of the population studied and in a particularly complex context of the pandemic. CONCLUSIONS: Suicidal thoughts among the Spanish registered physician population during the pandemic is high and mainly associated with socio-demographic factors, clinical mental health variables, and aspects of job satisfaction.

Suicidal Behavior in the First Wave of the COVID-19 Pandemic.

PURPOSE OF REVIEW: Since the declaration of the COVID-19 pandemic, there have been numerous social changes to try to ​​contain the spread of the disease. These sudden changes in daily life have also changed the way we relate to others, in addition to creating a climate of uncertainty and fear. Therefore, the objective of this review is to compile published data of the consequences of suicidal behavior in the first months from the onset of the pandemic. RECENT FINDINGS: The analysis reflects a concern about issues related to suicide since the beginning of the pandemic. A large number of online surveys have been released and have provided data on relatively large populations. The percentage of the population with suicidal ideation in that period seems to be approximately 5-15%. Many studies associate suicidal ideation with being young, female, and presence of sleep problems. Surveys of healthcare workers do not seem to indicate a higher prevalence of suicidal ideation compared to the general population. The incidence of suicide attempts seen in emergency departments did not seem to change, while the number of visits for other issues, unrelated to suicide, did decrease. The few studies on completed suicide do not indicate an increase in incidence in these first 6 months since March 2020, when the WHO declared the start of the pandemic. It does not seem that there have been major changes in the figures related to suicidal behavior in the studies from the first wave of the COVID-19 pandemic, although it is still too early to know the consequences it will have long term. The social and economic damages resulting from the pandemic will certainly take a long time to recover.

Association of Religious Activity with Male Suicide Deaths.

OBJECTIVE: To analyze the relationship between suicide in men and stratified measures of religiosity. METHODS: We studied 192 suicides and 81 controls (nonsuicide, sudden, or accidental death). We employed the psychological autopsy method to compile diagnoses based on DSM-IV criteria. Overall, religiosity and participation in religious associations were determined using a Likert-type scale. Given the limited participation of women in the religious associations of southern Spain, only male subjects were included. RESULTS: Religious participants had decreased risk of suicide compared to nonparticipants (OR = 0.148, 95% CI = 0.049-0.447). This lower risk was further associated with the degree of involvement in religious activity. Suicides accounted for 73.47% of subjects with no religious participation, 61.17% of those with some participation, and 56.52% of frequent participants (linear trend test Z = -2.0329, p = .042). Membership in a religious association was also associated with a lower rate of suicide compared to nonmembers (OR = 0.356, 95% CI = 0.172-0.736). This effect was similarly associated with the degree of involvement in the association. Suicides accounted for 74.67% of subjects who never participated in the activities of a religious association, 69.23% of those who sometimes participated, and 42.86% of frequent participants (linear trend test Z = -3.4082, p < .001). CONCLUSIONS: Religiosity, either as general participation or through a religious association, was associated with protection against suicide proportional to the degree of involvement in religious activities.

¿Es necesario un baremo de secuelas psíquicas postraumáticas? / Is it necessary a scale to evaluate the posttraumatic psychiatric sequelae?

No disponible

Un nuevo método de valoración de la enfermedad psiquiátrica postraumática / A new assessment method of posttraumatic psychiatric pathology

No disponible

Necesidad de mejora en la gestión estadística y proceso de comunicación de los casos de suicidio identificados / The necessity of improvement statistical management and communication of identified suicides

No disponible

Número de suicidios en España: diferencias entre los datos del Instituto Nacional de Estadística y los aportados por los Institutos de Medicina Legal / Number of sucides in Spain: differences between data from the Spanish Statistical Office and the Institutes of Legal Medicine

Fundamento y objetivo. Para poder prevenir el suicidio es necesario conocer su magnitud. Hay discrepancias entre las cifras de suicidios en estudios realizados con médicos forenses y las obtenidas a través del Instituto Nacional de Estadística (INE). Este trabajo pretende comprobar si los datos del INE coinciden o difieren con los registrados por los organismos encargados de la realización de autopsias médico-legales en España (Institutos de Medicina Legal [IML]). Método. Se solicitó a los directores de IML el número de suicidios en un periodo de 5 años (2006-2010) y se comparó con los ofrecidos por el INE en su sede virtual. Se calcularon las tasas de suicidio según ambas fuentes. Resultados. El número total de suicidios según el INE fue menor al obtenido directamente por los IML en todos los años. Con la cifra de suicidio registrado por provincia y año más alta, ya fuera de los IML o del INE, se obtuvo la cifra de casos de suicidio identificados (NSI) y que por algún motivo no quedaron registrados en una u otra entidad. Las cifras de NSI indicaban una tasa media de suicidios por 100.000 habitantes 0,97 (DE: 0,10) más alta que la que señalaba el INE, con una pérdida media de 443,86 (DE: 46,72) casos registrados cada año. Se discuten los posibles factores que influyen en esta pérdida de casos registrados. Conclusiones. Según los resultados obtenidos, existe una discrepancia entre INE e IML sobre el número de suicidios en España sin que ninguna de las fuentes consultadas pueda considerarse más fiable (AU)

Background and objectives. To be able to prevent suicides, The exact magnitude of suicides must be known in order to prevent them. There is evidence that data provided on the number of suicides by the Spanish Statistical Office (Instituto Nacional de Estadística [INE]) differs from that identified by forensic pathologists. This paper aims to determine whether the INE data are to the same as those recorded by the agencies responsible for conducting autopsies in Spain (IML), and calculate the number of missing cases. Method. IML were requested to provide the number of suicides in a five year period (2006-2010) and this was compared with those offered by INE in its site. A new rate of suicides per 100,000 was obtained and used to calculate the number of suicides in Spain. Results. For every year of the studied period, the number of suicides reported by the INE was lower than that obtained directly from the IML. Using the highest annual suicide rate registered by province and the total, a count was obtained of identified suicides that for some reason had not been recorded in the INE or the IML data. Based on these figures, the mean rate of suicides per 100,000 was 0.97 (SD 0.10) higher than official INE data, which indicates a mean loss of 443.86 (SD 46.72) cases reported each year. Possible factors that may influence the missing recorded cases are discussed. Conclusions. According to the results, there is a discrepancy between INE and IML about the number of suicides in Spain. Neither of the two sources can be considered more reliable than the other (AU)

[Medical-legal issues of physical and pharmacological restraint]. / Aspectos medicolegales de la contención física y farmacológica.

The use of physical and pharmacological restraint is controversial but is currently accepted as inevitable. It is indicated for controlling behavioral disorders and psychomotor agitation that put patients and third parties at risk. Its indication should be medical, and we should opt for the least restrictive measure. Restraints represent a possible infringement of patients' fundamental rights and require understanding and strict respect for the medical-legal precepts by physicians and other practitioners involved in its application. This article reviews the current legal framework, as well as the medical-legal premises and aspects of applying restraints, with the objective of ensuring maximum respect for patients' rights and the appropriate legal safety in the activity of practitioners.

[Number of suicides in Spain: differences between data from the Spanish Statistical Office and the Institutes of Legal Medicine]. / Número de suicidios en España: diferencias entre los datos del Instituto Nacional de Estadística y los aportados por los Institutos de Medicina Legal.

BACKGROUND AND OBJECTIVES: To be able to prevent suicides, The exact magnitude of suicides must be known in order to prevent them. There is evidence that data provided on the number of suicides by the Spanish Statistical Office (Instituto Nacional de Estadística [INE]) differs from that identified by forensic pathologists. This paper aims to determine whether the INE data are to the same as those recorded by the agencies responsible for conducting autopsies in Spain (IML), and calculate the number of missing cases. METHOD: IML were requested to provide the number of suicides in a five year period (2006-2010) and this was compared with those offered by INE in its site. A new rate of suicides per 100,000 was obtained and used to calculate the number of suicides in Spain. RESULTS: For every year of the studied period, the number of suicides reported by the INE was lower than that obtained directly from the IML. Using the highest annual suicide rate registered by province and the total, a count was obtained of identified suicides that for some reason had not been recorded in the INE or the IML data. Based on these figures, the mean rate of suicides per 100,000 was 0.97 (SD 0.10) higher than official INE data, which indicates a mean loss of 443.86 (SD 46.72) cases reported each year. Possible factors that may influence the missing recorded cases are discussed. CONCLUSIONS: According to the results, there is a discrepancy between INE and IML about the number of suicides in Spain. Neither of the two sources can be considered more reliable than the other.

Aspectos medicolegales de la contención física y farmacológica / Medical-legal issues of physical and pharmacological restraint

El uso de la contención física y farmacológica resulta controvertido, pero se acepta hoy en día como inevitable, encontrándose indicado en el control de las alteraciones de conducta y la agitación psicomotriz con riesgo para el paciente o para terceros. Su indicación ha de ser médica y optar por la medida que resulte menos restrictiva. Potencialmente, las contenciones suponen una vulneración de derechos fundamentales del paciente y precisan el conocimiento y respeto estricto de los preceptos medicolegales por parte de los facultativos y demás profesionales implicados en su aplicación. El presente artículo revisa el marco legal actual, así como las premisas y aspectos medicolegales de aplicación en las contenciones, con el objetivo de garantizar el máximo respeto a los derechos de los pacientes y la adecuada seguridad jurídica en la actuación de los profesionales (AU)

The use of physical and pharmacological restraint is controversial but is currently accepted as inevitable. It is indicated for controlling behavioral disorders and psychomotor agitation that put patients and third parties at risk. Its indication should be medical, and we should opt for the least restrictive measure. Restraints represent a possible infringement of patients’ fundamental rights and require understanding and strict respect for the medical-legal precepts by physicians and other practitioners involved in its application. This article reviews the current legal framework, as well as the medical-legal premises and aspects of applying restraints, with the objective of ensuring maximum respect for patients’ rights and the appropriate legal safety in the activity of practitioners (AU)

Personality disorders and health problems distinguish suicide attempters from completers in a direct comparison.

BACKGROUND: Whether suicide attempters and completers represent the same population evaluated at different points along a progression towards suicide death, overlapping populations, or completely different populations is a problem still unresolved. METHODS: 446 Adult suicide attempters and knowledgeable collateral informants for 190 adult suicide probands were interviewed. Sociodemographic and clinical data was collected for both groups using semi-structured interviews and structured assessments. Univariate analyses and logistic regression models were conducted to explore the similarities and differences between suicide attempters and completers. RESULTS: Univariate analyses yielded significant differences in sociodemographics, recent life events, impulsivity, suicide intent, and distribution of Axis I and II disorders. A logistic regression model aimed at distinguishing suicide completers from attempters properly classified 90% of subjects. The most significant variables that distinguished suicide from attempted suicide were the presence of narcissistic personality disorder (OR=21.4; 95% CI=6.8-67.7), health problems (OR=20.6; 95% CI=5.6-75.9), male sex (OR=9.6; 95% CI=4.42-20.9), and alcohol abuse (OR=5.5; 95% CI=2.3-14.2). LIMITATIONS: Our study shares the limitations of studies comparing suicide attempters and completers, namely that information from attempters can be obtained from the subject himself, whereas the assessment of completers depends on information from close family or friends. Furthermore, different semi-structured instruments assessed Axis I and Axis II disorders in suicide attempters and completers. Finally, we have no data on inter-rater reliability data. CONCLUSIONS: Suicide completers are more likely to be male and suffer from alcohol abuse, health problems (e.g. somatic illness), and narcissistic personality disorder. The findings emphasize the importance of implementing suicide prevention programs tailored to suicide attempters and completers.

Aportaciones de la medicina forense a la investigación de la conducta suicida / Contributions of forensic medicine to research of suicidal behaviour

El suicidio es la principal causa de muerte violenta en España, por delante de los accidentes de tráfico, y se estima que cada año se suicidan cerca de 3.500 personas. Los factores de riesgo identificados de la conducta suicida se basan, principalmente, en estudios de intentos de suicidio. La centralización de las autopsias en los Institutos de Medicina Legal facilita la homogenización del método de trabajo y la consistencia de los resultados a nivel práctico-judicial y de investigación. La medicina forense debe proyectarse en la investigación en general y de la conducta suicida en particular, en colaboración con otros equipos de investigación. La investigación debe efectuarse según la normativa ética y administrativa vigente y ser aprobada por el Comité Ético de referencia. Con respecto a la investigación de los factores de riesgo del suicidio, el reclutamiento de casos y controles, la obtención de muestras biológicas, la colaboración en la realización de autopsias psicológicas y los estudios epidemiológicos, son aportaciones esenciales de la medicina forense(AU)

In Spain, suicide is the leading cause of violent death, ahead of motor vehicle accidents, with about 3,500 people dying by this mean in Spain. The risk factors identified are primarily based on studies of suicide attempts. The centralization of autopsies in the Institutes of Legal Medicine allows the homogenization of working methods and the consistency of results for both research and legal purposes. Forensics should focus on medical research in general and on suicidal behaviour in particular, in collaboration with other research teams. Research must be conducted according to existing ethical and administrative legislation. All must be approved by the Ethics Committee of reference. With regard to the investigation of risk factors for suicide, forensics are essential in the recruitment of cases and controls-obtaining biological samples, collaborating in conducting psychological autopsies and epidemiological studies(AU)

Psychological autopsy studies: the role of alcohol use in adolescent and young adult suicides.

UNLABELLED: Alcohol abusers seem to be prone to both suicide attempts and completions. The relationship between alcohol abuse and suicide in adolescence is complex. OBJECTIVES: To examine the role of alcohol abuse and dependence in adolescent suicide in psychological autopsy studies. METHOD: A search in the National Library of Medicine (NLM) PubMed database using "adolescents" and "all child: 0-18 years" as the search terms for age and "psychological autopsy" as the search term for title or abstract. RESULTS: Forty articles met the selection criteria and each one is described. There was a high prevalence of alcohol abuse detected in the studies (range 21.42% to 43.47% in samples aged under 20 years). Alcohol misuse was present in suicides in the form of chronic abuse, acute abuse and dependence. CONCLUSIONS: Alcohol abuse and dependence is highly prevalent among adolescent suicides. In many studies, alcohol consumption is analyzed in combination with drug abuse. Further studies are necessary to clarify the prevalence of chronic and acute alcohol abuse in order to identify specific high-risk population groups and design antisuicidal interventions for them. Both acute and chronic alcohol use should be evaluated when assessing suicide risk in adolescents.