Factors associated with suicide risk among Brazilian graduate students during the COVID-19 pandemic.

Though pandemic-related suicides are a concern, little is known about factors potentially linking graduate student life and suicide risk. This study identified factors associated with suicide risk among Brazilian graduate students (N = 5,344) during the COVID-19 pandemic. Utilizing the Mini International Neuropsychiatric Interview, this study revealed that 31.5% of participants presented some risk for suicide: 16.6% "low risk," 4.7% "moderate risk," and 10.2% "high risk." Higher income and religious affiliation were identified as protective factors. Identified risk factors encompass non-heterosexual orientation, a history of depression or posttraumatic stress or common mental disorders diagnoses, the use of medications-both general and psychopharmaceuticals-without medical prescription, antipsychotics use, alcohol consumption, lack of health insurance, and dissatisfaction with life as a result of accessing social media networks. The high vulnerability of graduate students to suicide risk highlights the need for institutional suicide prevention initiatives.

Intentional self-poisoning with medications: Occurrence, recurrence and suicide deaths.

This study aimed to identify the sociodemographic and clinical factors associated with the occurrence and recurrence of intentional self-poisoning with medications (ISP-M), and suicide deaths by ISP-M in the state of Mato Grosso, Brazil. In this cross-sectional analytical study, we used logistic regression models to analyze data obtained through health information systems. Factors associated with use of ISP-M as a method were female gender, white skin color, occurrence in urban areas and at home. The ISP-M as a method was less reported in people presumed under the influence of alcohol. Lower chance of death by suicide using ISP-M was found among young people and adults (under 60 years old).

Mundo de Pólus serious game for people with bipolar disorder.

BACKGROUND: Serious games are play-based technologies designed to teach users a wide range of concepts and skills applicable in the non-virtual environment. OBJECTIVES: This paper describes the process of developing a serious game for people with bipolar disorder to promote symptom recognition and the safe use of medications. METHODS: This study was based on the User-Centered Design methodological model and the theoretical framework for Participatory Design. We conducted interviews with health professionals and discussion circles with people with bipolar disorder and their family members in order to identify the learning needs related to symptom recognition and safe medication use. A categorical analysis was completed of the participants' reports and the scientific literature and formed the basis for the design of Mundo de Pólus. RESULTS: The game development process had three pillars (detailed in this manuscript): missions, simulation, and journal. The serious game focuses on the users' perceptions about their experience with the disorder, their interpersonal relationships, coping strategies, use of medications, and non-pharmacological treatments. CONCLUSIONS: These scientific and technological outcomes are useful to promote literacy and safety in medication therapy for people with bipolar disorder.

Economic burden of depression in Brazil: a cost-of-illness study based on productivity losses and healthcare costs between 2010 to 2018.

BACKGROUND: Depression is disabling disorder and cause functional impairments, and high costs for the health and social security system. OBJECTIVE: The direct and indirect costs of depression from the societal perspective were estimated for the period 2010 to 2018. METHODS: This cost-of-illness study in adults is based on prevalence, with a top-down approach, from the societal perspective. Direct (hospital and outpatient) and indirect (absenteeism) costs were included. Data were extracted from the Hospital and Outpatient Information Systems and the National Social Security Institute. RESULTS: The cost of depression was Int$ 2,288,511,607.39 in the analyzed period, with an average annual cost of Int$ 254,279,067.49. From 2014 to 2018, had a sharp and persistent decrease in the cost of depression (-44.24%), mainly in indirect costs (-55.83%). In the period investigated, indirect costs represented 74.85% of the total cost. Over time, outpatient surpassed hospital cost. In 2017 and 2018, outpatient costs represented 43.22% and 39.57% of total costs. In all the years and cost components analyzed, women predominated. CONCLUSIONS: Depression is a disease with a high economic burden for the healthcare system. Investments are still needed, such as higher coverage of services, multidisciplinary teams, and training of health professionals for psychosocial care.

O significado do consumo de psicofármacos pelos familiares de pessoas com transtorno bipolar / The meaning of psychotropic drugs use by family members of people with bipolar disorder / Significado del consumo de psicotrópicos por familiares de personas com trastorno bipolar

Familiares são importantes cuidadores de pessoas com transtorno bipolar (TB), podendo estar vulneráveis ao assumir esse cuidado e buscarem algum tipo de apoio, como o consumo de psicofármacos. O objetivo deste estudo foi compreender o significado que os familiares cuidadores atribuem para o próprio consumo do psicofármaco. Trata-se de estudo qualitativo com 32 participantes que utilizou o Interacionismo Simbólico (referencial teórico) e a Teoria Fundamentada nos Dados (referencial metodológico). Os dados foram analisados em três etapas: codificação aberta, axial e seletiva. O familiar é impactado por ter que assumir o cuidado e precisa buscar alternativas para se adaptar às dificuldades e efeitos disso. Assim, ele busca o consumo de psicofármacos, mas tal consumo é visto e compreendido de maneiras diferentes ao longo do processo de utilização. Os resultados desta pesquisa oferecem maior compreensão do fenômeno estudado e subsídios para a melhoria da assistência para essa clientela

Family members are essential caregivers of people with bipolar disorder (BD) and may be vulnerable upon assuming this care, seeking some support such as the use of psychotropic drugs. The objective of this study was to understand the meaning that family caregivers attribute to their psychotropics use. This is a qualitative study with 32 participants that used Symbolic Interactionism (theorical reference) and the Grounded Theory (methodological reference). Data were analyzed in three steps: open, axial and selective coding. The family member is impacted by having to assume the care and needs to look for alternatives to adapt to the difficulties and effects of this care. Hence, they seek the use of psychotropics, but this consumption is seen and understood differently throughout the utilization process. This study offers a better understanding of the studied phenomenon and subsidies to improve the assistance to this clientele.

La familia es importante cuidadora de personas con trastorno bipolar (TB) y por asumir ese cuidado se quedan vulnerables a la búsqueda de apoyo por medio del consumo de psicofármaco. Por ese motivo, el objetivo de este estudio fue el de comprender el significado que los familiares cuidadores atribuyen al proprio consumo de psicofármaco. El estudio ocurrió por análisis cualitativo de 32 participantes y utilizó el Interaccionismo Simbólico (referencial teórico) y la Teoría Fundamentada en Datos (referencial metodológico). El análisis de datos ocurrió en tres etapas: la codificación abierta, axial y selectiva. El familiar es impactado por asumir el cuidado y necesita buscar alternativas para adaptarse a las dificultades y efectos de eso. Por lo tanto, se busca el consumo de psicofármacos, pero dicho consumo es visto y comprendido de diferentes maneras a lo largo del proceso de utilización. Los resultados de esta pesquisa ofrecen una comprensión más grande del fenómeno estudiado y ofrecen también subsidio para perfeccionamiento de la asistencia a eses clientes.

Prevention of non-suicidal self-injury: construction and validation of educational material.

OBJECTIVE: to develop and validate educational material to strengthen adolescent health care on non-suicidal self-injury. METHOD: methodological research designed in three stages: (1) construction of the material based on a mixed study on needs related to the theme through social networks and an umbrella review on health care related to non-suicidal self-injury; (2) validation with 10 experts in mental health and/or self-inflicted violence selected through the Lattes Platform; (3) evaluation by the target public, with health professionals being invited, without restriction of training. Validation and evaluation data were collected by using a sociodemographic questionnaire and the Suitability Assessment of Materials for evaluation of health-related information for adults. We used descriptive statistics, content validity index, and Gwet's AC1 test. RESULTS: the material obtained good general acceptance and reliability in the validation by the experts (AC1= 0.633; p=0.0000) and in the evaluation by the target public (AC1=0.716; p=0.0000). All professionals pointed out the personal contribution and educational potential of the material. CONCLUSION: we highlight the construction of science-based educational material to strengthen the health care for adolescents with non-suicidal self-injury. KEYPOINTS: (1) Scientific data-based construction of educational material for prevention of non-suicidal self-injury (NSSI). (2) General acceptance and reliability in the validation of the material by experts. (3) Acceptance and reliability in the evaluation of the material by health professionals. (4) Dissemination of material for health education initiatives to prevent NSSI.

Predictors of job stress and alcohol consumption amongst university professors.

The present study aimed to identify the predictors of job stress and alcohol consumption amongst 253 professors at a public university. Previous history of psychotropic drug use, as well as the Scale of Work Stress, the Alcohol Use Disorders Identification Test, and the Self-Report Questionnaire were used. Being female, younger than 40 years of age; of homosexual orientation; a workload of weekly classes of >10 h in total; and being positive for common mental disorders were identified as predictors of moderate or high work stress. The predictors of risky drinking or probable alcohol dependence were: male; younger than 40 years of age; tobacco use; health problems; teaching applied social sciences; and use of hypnotic medications. The findings could be used to develop strategies for the prevention or reduction of work stress and alcohol consumption amongst university professors.

The Perceptions of Domestic Violence by a Family Member Who Uses Crack or Cocaine: A Secondary Retrospective Cross-Sectional Study.

OBJECTIVE: To evaluate the relationship between crack/cocaine use and domestic violence perpetration from the perspective of substance users' families. A secondary retrospective cross-sectional study, with 3162 family members of crack/cocaine users seeking treatment in the Recomeço Família Programme in São Paulo/Brazil was undertaken. Family members of crack/cocaine users reported that their relatives were more involved in domestic violence such as stealing (money and objects) at home [Odds Ratio Adjusted ORA = 2.17 (CI 95% 1.87; 2.53)], the family gave money to the user to buy drugs [ORA = 1.27 (1.08; 1.48)], and having problems with the judiciary [ORA = 1.48 (CI 95% 1.28; 1.71)]. Relatives of snorted cocaine users reported that there was physical and interpersonal violence, such as fathers being assaulted [ORA = 2.50 (CI 95% 1.08; 5.82)], assaulted someone else [ORA = 1.86 (CI 95% 1.32; 2.60)], threats of violence fights, arguments when the family talk about problematic drug use [ORA = 1.50 (CI 95% 1.13; 1.96)] and threatened some family members [ORA = 1.52 (CI 95% 1.14; 2.04)]. In this sample, there was a connection between crack/cocaine use and the perpetuation of domestic violence, corroborating with important implications for public policies, substance use treatment and prevention of domestic violence interventions.

Tentativa de suicídio por pessoas com transtornos relacionados ao uso de substâncias em tratamento / Intento de suicidio de personas con trastornos relacionados con el uso de sustancias en tratamiento / Suicide attempts by people with substances use disorders undergoing treatment

RESUMO Objetivo: identificar os fatores associados à tentativa de suicídio por pessoas com transtornos relacionados ao uso de substâncias em tratamento nos Centros de Atenção Psicossocial de Álcool e outras Drogas. Método: estudo observacional e transversal realizado com 137 pessoas com transtornos relacionados ao uso de substâncias em tratamento em Centros de Atenção Psicossocial de Álcool e outras Drogas de uma capital da região Sul do Brasil. Os dados foram coletados entre abril e novembro de 2018 por entrevista estruturada e submetidos à análise quantitativa descritiva, univariada e múltipla. Resultados: 51,8% dos participantes apresentaram ao menos uma tentativa de suicídio alguma vez na vida. Pensamentos suicidas ativos com intenção e com planejamento permaneceram associadas de modo independente ao histórico de tentativa de suicídio (RP: 2,87; IC: 1,04-7,91; p: 0,041). Na análise univariada houve associação entre tentativa de suicídio e dias de problema físico, intensidade dos pensamentos suicidas, comportamento preparatório, sentimentos depressivos, histórico familiar de transtorno mental, internamento em hospital psiquiátrico, importância de tratamento em saúde mental e prescrição de medicamentos. Conclusão: mais gravidade de pensamentos suicidas foi identificada como fator associado ao histórico de tentativa de suicídio. Enfatiza-se a importância da escuta ativa na prática profissional em saúde, do vínculo terapêutico e do acolhimento nos serviços de atenção à saúde.

RESUMEN Objetivo: identificar los factores asociados al intento de suicidio de personas con trastornos relacionados con el consumo de sustancias en tratamiento en los Centros de Atención Psicosocial por Alcohol y otras Drogas. Método: estudio observacional y transversal realizado con 137 personas con trastornos relacionados con el consumo de sustancias en tratamiento en los Centros de Atención Psicosocial por Alcohol y otras Drogas de una capital del sur de Brasil. Los datos fueron recolectados entre abril y noviembre de 2018 a través de entrevistas estructuradas y sometidos a análisis cuantitativo descriptivo, univariado y múltiple. Resultados: el 51,8% de los participantes tuvo al menos un intento de suicidio en algún momento de su vida. Los pensamientos suicidas activos con intención y planificación permanecieron asociados de forma independiente con la historia de un intento de suicidio (RP: 2,87; IC: 1,04-7,91; p: 0,041). En el análisis univariado, hubo asociación entre intento de suicidio y días de problema físico, intensidad de pensamientos suicidas, comportamiento preparatorio, sentimientos depresivos, antecedentes familiares de trastorno mental, ingreso en un hospital psiquiátrico, importancia del tratamiento de salud mental y prescripción de medicamentos. Conclusión: la mayor gravedad de los pensamientos suicidas se identificó como un factor asociado a la historia de intento de suicidio. Enfatiza la importancia de la escucha activa en la práctica profesional de la salud, el vínculo terapéutico y la aceptación en los servicios de salud.

ABSTRACT Objective: to identify the factors associated with suicide attempts by people with substance use disorders undergoing treatment at the Psychosocial Care Centers for Alcohol and Other Drugs. Method: observational and cross-sectional study carried out with 137 people with substance use disorders undergoing treatment at Psychosocial Care Centers for Alcohol and Other Drugs in a capital city in the southern region of Brazil. Data were collected between April and November 2018 by structured interview and subjected to descriptive, univariate, and multiple quantitative analysis. Results: 51.8% of participants had at least one suicide attempt at some point in their lives. Active suicidal thoughts with intent and planning remained independently associated with the history of attempted suicide (PR: 2.87; CI: 1.04-7.91; p: 0.041). In the univariate analysis, there was an association between suicide attempt and days of physical problems, intensity of suicidal ideation, preparatory acts, depressive feelings, family history of mental disorder, hospitalization in a psychiatric hospital, importance of mental health treatment and medication prescription. Conclusion: more severity of suicidal ideation was identified as a factor associated with a history of suicide attempt. It emphasizes the importance of active listening in professional health practice, the therapeutic bond and reception in health care services.

Predictors of drug-drug interactions of medications prescribed to patients admitted due to suicidal behavior.

INTRODUCTION: Drug-drug interactions among people with suicidal behavior is a challenging topic, considering the harm it poses for patients already vulnerable and the lack of literature on the thematic. This aspect must not be neglected in research and clinical practice, and thus requires thorough investigation. OBJECTIVE: to investigate predictors of drug-drug interaction of prescribed drugs and the prescription of two or more drugs for people admitted due to suicidal behavior in a psychiatric emergency department (short-stay hospital ward). METHOD: A cross-sectional study with retrospective approach, carried out in a Brazilian psychiatric emergency unit in 2015. Data about first and last medical prescriptions were collected from 127 patients' files. Descriptive statistics and the Zero Adjusted Logarithmic Distribution (ZALG) model were adopted, with the significance level α = 0.05. RESULTS: Potential drug-drug interactions were found in most of the first and last prescriptions. The sample majority were female, with previous suicide attempts, being discharged from the hospital with three drugs (or more) prescribed, and without referral to any health service. Age and comorbidities were predictors of more drug prescriptions and the amount of prescribed drugs was the most important predictor of drug-drug interactions (quantity and severity). CONCLUSIONS: the variables associated with drug-drug interactions and prescription of two or more drugs among people with suicidal behavior needs to be investigated in different contexts and addressed in interventions with the aim to promote patient safety.

The meaning of life after a suicide attempt.

INTRODUCTION: Understanding the meaning of life after a suicide attempt experience provides greater knowledge about the process of resignification, connections and commitment to life, which can be useful in different therapeutic approaches. OBJECTIVE: Understand the meaning of life after a suicide attempt. METHOD: Qualitative study with eight Brazilian adults assisted in mental health service. The data were collected in 2018 by semi-strutured interviews and group meetings that used artistic resources to facilitate expression.The Symbolic Interactionism was the theoretical reference used and the data were submitted to thematic analysis. RESULTS: Three themes were identified: "Searches in the affective, relational and spiritual field" (manifestations of affection, zeal, understanding and welcome and seemed to increase the link and commitment to life, as well as the openness to resignify it); "Life and the constancy of impermanence" (life as an alternation between weakness and strength, crisis and well-being, problems and overcoming); and "Discoveries and relationship with one's own self" (a self previously self-destructive could be resigned as capable of overcoming, resisting and developing resilience). CONCLUSIONS: The study provides important insights to be addressed in clinical practice, in the protocol design, institutional policies, as well as in the training of professionals.

Evaluation of Quality of Life of Primary Health Care Patients in Brazil: Influence of Drug Interactions, Common Mental Disorders, and Use of Psychiatric Medication.

The objectives of this study were to identify the interaction between drug interaction risk, common mental disorders, use of psychiatric medication and quality of life in patients treated in primary health care settings in Brazil. In this quantitative research, 452 patients were interviewed in ten basic Brazilian health units. Sociodemographic and pharmacotherapeutic questionnaires, use of psychiatric medication, prevalence of common mental disorders, and quality of life were utilised. The structural equation model was used to evaluate the relationships among the variables. The prevalence of drug interaction risk was 66.59%. The variables associated with drug interaction risk were polypharmacy and income. The use of psychiatric medication was associated with diagnosis of common mental disorders, income and gender. The use of psychiatric medication and common mental disorders negatively influenced quality of life.

Prevention of non-suicidal self-injury: construction and validation of educational material / Prevenção da autolesão não suicida: construção e validação de material educativo / Prevención de las autolesiones no suicidas: construcción y validación de material educativo

Abstract Objective: to develop and validate educational material to strengthen adolescent health care on non-suicidal self-injury. Method: methodological research designed in three stages: (1) construction of the material based on a mixed study on needs related to the theme through social networks and an umbrella review on health care related to non-suicidal self-injury; (2) validation with 10 experts in mental health and/or self-inflicted violence selected through the Lattes Platform; (3) evaluation by the target public, with health professionals being invited, without restriction of training. Validation and evaluation data were collected by using a sociodemographic questionnaire and the Suitability Assessment of Materials for evaluation of health-related information for adults. We used descriptive statistics, content validity index, and Gwet's AC1 test. Results: the material obtained good general acceptance and reliability in the validation by the experts (AC1= 0.633; p=0.0000) and in the evaluation by the target public (AC1=0.716; p=0.0000). All professionals pointed out the personal contribution and educational potential of the material. Conclusion: we highlight the construction of science-based educational material to strengthen the health care for adolescents with non-suicidal self-injury.

Resumo Objetivo: elaborar e validar um material educativo para fortalecer a assistência em saúde aos adolescentes sobre a autolesão não suicida. Método: pesquisa metodológica delineada em três etapas: (1) construção do material a partir de estudo misto sobre necessidades ligadas à temática por meio das redes sociais e uma revisão guarda-chuva sobre a assistência relacionada à autolesão não suicida; (2) validação com 10 especialistas em saúde mental e/ou violência autoprovocada selecionados pela Plataforma Lattes; (3) avaliação pelo público-alvo, sendo convidados profissionais de saúde, sem restrição de formação. A coleta dos dados de validação e avaliação foi realizada por um questionário sociodemográfico e o Suitability Assessment of Materials for evaluation of health-related information for adults. Foi empregada a estatística descritiva, índice de validade de conteúdo e o teste AC1 de Gwet. Resultados: o material obteve boa aceitação geral e confiabilidade na validação pelos especialistas (AC1=0,633; p=0,0000) e na avaliação pelo público-alvo (AC1=0,716; p=0,0000). Todos os profissionais apontaram a contribuição pessoal e potencial educativo do material. Conclusão: destaca-se a construção de material educativo embasado em ciência para o fortalecimento da assistência aos adolescentes com autolesão não suicida.

Resumen Objetivo: elaborar y validar un material educativo para fortalecer la asistencia en salud a los adolescentes sobre la autolesión no suicida. Método: investigación metodológica delineada en tres etapas: (1) Construcción del material a partir de un estudio mixto sobre las necesidades vinculadas al tema por medio de las redes sociales y una revisión paraguas sobre la asistencia relacionada con la autolesión no suicida; (2) validación con 10 especialistas en salud mental y/o violencia autoprovocada seleccionados por la Plataforma Lattes; (3) Evaluación por parte del público objetivo, siendo invitados profesionales de salud, sin restricción de formación. La recolección de los datos de validación y evaluación fue realizada por un cuestionario sociodemográfico y el Suitability Assessment of Materials for evaluation of health-related information for adults. Se empleó la estadística descriptiva, el índice de validez de contenido y el test AC1 de Gwet. Resultados: el material obtuvo una buena aceptación general y confiabilidad en la validación por parte de los especialistas (AC1=0,633; p = 0,0000) y en la evaluación por el público objetivo (AC1 = 0,716; p=0,0000). Todos los profesionales señalaron la contribución personal y el potencial educativo del material. Conclusión: se destaca la construcción de material educativo basado en ciencia para fortalecer la asistencia a los adolescentes con autolesión no suicida.

The influence of work environment relationships on mental health of Brazilian seamstresses.

BACKGROUND: The work environment is a place in which different kinds of interpersonal relationships are developed and can contribute positively or negatively to productivity and to workers' well-being. Discussion on this topic may contribute to building more coping strategies to fight against gender inequality and the emotional repercussions of these conditions. OBJECTIVE: This is a cross-sectional study that investigated the possible influence of work environment relationships on the mental health of Brazilian seamstresses. METHODS: The participants were seamstresses from four clothing factories in a city in the southwest of Brazil. For data collection, we used the Social Support Perception at Work Scale; Self-Report Questionnaire; Alcohol, Smoking and Substance Involvement Screening Test; and a focus group. The quantitative data were statistically analyzed, and data from the focus groups were analyzed using content analysis. RESULTS: Interpersonal relationships at work were mentioned as sources of conflict and stress but also as emotional and material social support providers. In the sample studied, these relationships did not influence directly the development of mental health disorders. CONCLUSIONS: Study results suggest that a low level of education is an important factor that increases the vulnerability of these women to the precariousness of work, and, consequently to developing mental health symptoms or aggravating previous mental health distress. However, emotional and material support from peers likely protects these workers' mental health.

Factors associated with alcohol use and abuse in Brazilian primary health care settings.

The main goal of this study was to identify the prevalence of alcohol use and associations with selected variables among clients in a primary healthcare setting. A quantitative, cross-sectional study was carried out using structured questionnaires to measure the pattern of alcohol consumption, quality of life and common mental disorders. The results showed that men, people between 18 and 40 years old, with income between $300.00 and 1200.00 and smokers were at a higher risk of problematic alcohol use. Healthcare professionals should include alcohol screening questions to identify the hazardous consumption of alcohol at an early stage and prevent negative consequences.

Mindfulness y Salud Mental: diálogos entre la Enfermería y la Psicología Positiva / Mindfulness and Mental Health: dialogs between Nursing and Positive Psychology

Objetivo principal: Reflexionar sobre la meditación mindfulness como posibilidad de diálogo entre la Enfermería y la Psicología Positiva, enfocándose en la atención de la salud mental, con el respaldo de los efectos y las bases de mindfulness para comprender la forma de atención complementaria que es ajena a la medicalización y al modelo biomédico, y que está alineada con los supuestos de la Psicología Positiva. Metodología: Un estudio teórico de reflexión sobre meditación mindfulness y la interfaz de las contribuciones de la Psicología Positiva. Resultados principales: Mindfulness puede pensarse como un recurso para promover el bienestar y desarrollar estrategias que deriven en resultados más positivos en términos de salud mental. Conclusión principal: El campo de la Enfermería, imbuido de supuestos aportados por el diálogo con la Psicología Positiva, puede delinear intervenciones de salud mental que sirvan para el desarrollo de aspectos considerados esenciales para la salud y la atención. (AU)

Main objective: To reflect on mindfulness meditation as a possibility of dialog between Nursing and Positive Psychology, focusing on mental health care, supported by the effects and foundations of mindfulness to understand a form of complementary care that escapes medicalization and the biomedical model, and which aligns with the assumptions of Positive Psychology. Methodology: A reflection theoretical study on mindfulness meditation and the interface of the contributions from Positive Psychology. Main results: Mindfulness can be thought of as a resource for the promotion of well-being and for the development of strategies that lead to more positive outcomes in terms of mental health. Main conclusion: The field of Nursing, imbued with assumptions brought by the dialog with Positive Psychology, can outline mental health interventions that act in the development of aspects considered essential for health and care. (AU)

Meanings of suicidal behavior from the perspective of primary care professionals.

OBJECTIVE: To explore the meaning of suicidal behavior from the perspective of family health professionals. METHOD: A qualitative study developed during 2017-2018 with 18 primary care professionals from a Brazilian municipality. Grounded theory was used as the methodological framework. Semi-oriented interviews were conducted, transcribed, and analyzed by open, axial, and selective coding. FINDINGS: The professionals perceived themselves as unprepared, emotionally affected, and fearful to work in suicide prevention, prioritizing the referral of people to specialized services regardless of the severity of the situation. Suicide was represented as both a choice and a condition of vulnerability, being more reprehensible when associated with individual choice. CONCLUSION: We identified beliefs related to suicidal behavior that could affect the care of people at risk. Our findings reinforce the need for education and training in the prevention of suicidal behavior in primary care.

Internalized Stigma in People With Mood Disorders: Predictors and Associated Factors.

To analyze the predictors of internalized stigma among people with mood disorders, we conducted an analytical observational cross-sectional study with 108 people with mood disorders in a public service setting in Sao Paulo, Brazil. We applied a sociodemographic and clinical questionnaire, the Internalized Stigma of Mental Illness Scale, the Medication Adherence Scale, the Brief Psychiatric Rating Scale-Anchored, and the Herth Hope Index. We analyzed the data using descriptive statistics, average comparison tests, a correlation test, and multiple linear regression. Internalized stigma was associated with symptomatology, history of aggressive behavior, psychiatric hospitalizations, suicide attempts, hopelessness, nonadherence to psychotropic medications, and unemployment. The predictors of internalized stigma were unemployment, more psychiatric symptoms, history of previous suicide attempts, and less hope. Clinical interventions and investigations for stigma reduction and psychosocial rehabilitation should incorporate the factors associated with self-stigma (aggressive behavior, history of psychiatric hospitalizations, suicide attempts, hopelessness, nonadherence to medication, and unemployment).

The emotional and psychiatric problems of adolescents on parole whose parents are substance users: A Brazilian cross-sectional study.

The aim of this study is to evaluate the associations between having parents with substance use problems, and having suffered neglect within the family, and behavioral problems (psychological and drug use) among adolescents. All the participants were enrolled on the socio-educational parole scheme, 'Assisted Freedom'. In this cross-sectional study, 150 adolescents were interviewed using the Drug Abuse Screening Test, Teen Addiction Severity Index, and Childhood Trauma Questionnaire. Ninety-five percent of the participants were male (n = 143), aged 13-17. Thirty percent of adolescents had a parent who used substances and had experienced neglect from their families. Those adolescents who were living with both parents (odds ratio adjusted (ORA) = 2.7, 95% confidence interval (CI) = 1.13-6.37), from a low-income family (ORA = 6.7, 95% CI = 1.85-24.22), experienced hallucinations (ORA = 2.8, 95% CI = 1.25-6.14), had problems controlling violent behavior (ORA = 2.6, 95% CI = 1.12-5.87), and were physically neglected (ORA = 3.0, 95% CI = 1.24-7.49) were more likely to have parents who used substances and to have experienced parental neglect. This article concludes that adolescents, who are on parole, come from families with high level of psychosocial vulnerabilities, including substance use, experience neglect by their families leading to adverse emotional and psychological states.

Factors associated with mechanical device-related complications in tube fed patients: A multicenter prospective cohort study.

AIMS: To identify the types of nasogastric/nasoenteric tube (NGT/NET)-related adverse events and to analyze the degree of harm and the factors associated with mechanical device-related complications. MATERIALS AND METHODS: A prospective cohort study was conducted from October 2017 to April 2019 in seven Brazilian hospitals. Data from 447 adult patients with NGT/NET were collected through electronic forms. Three methods were used to assess the NGT/NET-related adverse events: (1) encouraging spontaneous reports; (2) regular visits to the wards; and (3) review of medical records. The events were classified as mechanical device-related complications and other events. The degree of harm was classified according to the World Health Organization's International Classification for Patient Safety. Data were analyzed using the R program, version 3.5.3. The following tests were applied to identify associations between the explanatory and response variables: Cochran-Armitage Chi-Square test, Fisher's exact test, and Linear-by-linear Chi-Square test. Logistic regression analysis was performed to verify the predictors of mechanical device-related complications. All analyses were performed considering a 5% significance level. RESULTS: 191 NGT/NET-related adverse events were identified in 116 patients; the majority were mechanical device-related complications and resulted in mild harm to the patient. At the moment of the event, patients had a mean of 3.27 comorbidities, were highly dependent on nursing care, with high risk of death and altered level of consciousness. There was no association between the degree of harm and the care complexity, disease severity or level of consciousness. Intensive care was the strongest predictor for mechanical device-related complications and critical patients had a four times greater likelihood of presenting this type of event when compared to patients receiving minimal care. CONCLUSION: Intensive care patients should receive special attention as the complexity of care is an important predictor for mechanical device-related complications in tube fed patients.