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2.
Rev Med Suisse ; 16(681): 314-317, 2020 Feb 12.
Artigo em Francês | MEDLINE | ID: mdl-32049453

RESUMO

Suicide is a common cause of death in Switzerland. It often occurs during a period of crisis marked by a disruption of the subject's intrapsychic, interpersonal or social balance. The management of this crisis is crucial and essentially psychotherapeutic. Drug therapy may be necessary for the management of acute symptoms or for the prevention of long-term suicidal risk. Benzodiazepines and atypical antipsychotics are often used for acute symptoms such as anxiety or sleep disorders while other molecules are recognized in reducing long-term suicidal risk. Some disorders, such as borderline personality disorder, account for more frequent suicidal behaviors. The pharmacological management of these specific situations is discussed.


Assuntos
Antipsicóticos/farmacologia , Suicídio/prevenção & controle , Suicídio/psicologia , Benzodiazepinas/farmacologia , Transtorno da Personalidade Borderline/psicologia , Humanos , Fatores de Risco , Ideação Suicida , Suíça
4.
MMWR Morb Mortal Wkly Rep ; 69(4): 103-108, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31999688

RESUMO

Suicide is a growing public health problem in the United States, claiming approximately 47,000 lives in 2017 (1). However, deaths from suicide represent only a small part of a larger problem because each year millions of persons experience suicidal ideation and engage in suicidal and nonsuicidal self-directed violence, both risk factors for suicide (2). Emergency departments (EDs) are an important setting for monitoring these events in near real time (3-5). From 2001 to 2016, ED visit rates for nonfatal self-harm increased 42% among persons aged ≥10 years (1). Using data from CDC's National Syndromic Surveillance Program (NSSP), ED visits for suicidal ideation, self-directed violence, or both among persons aged ≥10 years during January 2017-December 2018 were examined by sex, age group, and U.S. region. During the 24-month period, the rate of ED visits for suicidal ideation, self-directed violence, or both increased 25.5% overall, with an average increase of 1.2% per month. Suicide prevention requires comprehensive and multisectoral approaches to addressing risk at personal, relationship, community, and societal levels. ED syndromic surveillance data can provide timely trend information and can support more targeted and prompt public health investigation and response. CDC's Preventing Suicide: A Technical Package of Policy, Programs, and Practices includes tailored suicide prevention strategies for health care settings (6).


Assuntos
Comportamento Autodestrutivo/epidemiologia , Vigilância de Evento Sentinela , Ideação Suicida , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
5.
JAMA Netw Open ; 3(1): e1919935, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995212

RESUMO

Importance: Understanding suicide ideation (SI) during combat deployment can inform prevention and treatment during and after deployment. Objective: To examine associations of sociodemographic characteristics, lifetime and past-year stressors, and mental disorders with 30-day SI among a representative sample of US Army soldiers deployed in Afghanistan. Design, Setting, and Participants: In this survey study, soldiers deployed to Afghanistan completed self-administered questionnaires in July 2012. The sample was weighted to represent all 87 032 soldiers serving in Afghanistan. Prevalence of lifetime, past-year, and 30-day SI and mental disorders was determined. Logistic regression analyses examined risk factors associated with SI. Data analyses for this study were conducted between August 2018 and August 2019. Main Outcomes and Measures: Suicide ideation, lifetime and 12-month stressors, and mental disorders were assessed with questionnaires. Administrative records identified sociodemographic characteristics and suicide attempts. Results: A total of 3957 soldiers (3473 [weighted 87.5%] male; 2135 [weighted 52.6%] aged ≤29 years) completed self-administered questionnaires during their deployment in Afghanistan. Lifetime, past-year, and 30-day SI prevalence estimates were 11.7%, 3.0%, and 1.9%, respectively. Among soldiers with SI, 44.2% had major depressive disorder (MDD) and 19.3% had posttraumatic stress disorder in the past 30-day period. A series of analyses of the 23 grouped variables potentially associated with SI resulted in a final model of sex; race/ethnicity; lifetime noncombat trauma; past 12-month relationship problems, legal problems, and death or illness of a friend or family member; and MDD. In this final multivariable model, white race/ethnicity (odds ratio [OR], 3.1 [95% CI, 1.8-5.1]), lifetime noncombat trauma (OR, 2.1 [95% CI, 1.1-4.0]), and MDD (past 30 days: OR, 31.8 [95% CI, 15.0-67.7]; before past 30 days: OR, 4.9 [95% CI, 2.5-9.6]) were associated with SI. Among the 85 soldiers with past 30-day SI, from survey administration through 12 months after returning from deployment, 6% (5 participants) had a documented suicide attempt vs 0.14% (6 participants) of the 3872 soldiers without SI. Conclusions and Relevance: This study suggests that major depressive disorder and noncombat trauma are important factors in identifying SI risk during combat deployment.


Assuntos
Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Ideação Suicida , Suicídio/psicologia , Adaptação Psicológica , Adulto , Campanha Afegã de 2001- , Fatores Etários , Feminino , Humanos , Masculino , Militares/estatística & dados numéricos , Resiliência Psicológica , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Suicídio/estatística & dados numéricos , Adulto Jovem
6.
J Homosex ; 67(2): 159-173, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30403564

RESUMO

Studies of adults who experienced sexual orientation change efforts (SOCE) have documented a range of health risks. To date, there is little research on SOCE among adolescents and no known studies of parents' role related to SOCE with adolescents. In a cross-sectional study of 245 LGBT White and Latino young adults (ages 21-25), we measured parent-initiated SOCE during adolescence and its relationship to mental health and adjustment in young adulthood. Measures include being sent to therapists and religious leaders for conversion interventions as well as parental/caregiver efforts to change their child's sexual orientation during adolescence. Attempts by parents/caregivers and being sent to therapists and religious leaders for conversion interventions were associated with depression, suicidal thoughts, suicidal attempts, less educational attainment, and less weekly income. Associations between SOCE, health, and adjustment were much stronger and more frequent for those reporting both attempts by parents and being sent to therapists and religious leaders, underscoring the need for parental education and guidance.


Assuntos
Homossexualidade/psicologia , Pais , Comportamento Sexual/psicologia , Adulto , Estudos Transversais , Depressão/psicologia , Relações Familiares , Feminino , Humanos , Masculino , Saúde Mental , Pais/psicologia , Minorias Sexuais e de Gênero , Ideação Suicida , Tentativa de Suicídio , Adulto Jovem
7.
Gene ; 726: 144147, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-31629822

RESUMO

BACKGROUND: Suicidal ideation (SI) is the most serious symptom of major depressive disorder (MDD) and considered an extreme state. The serotonin transporter gene (SLC6A4) plays a significant role in MDD and suicide pathophysiology. Previous studies have revealed an association between common variants of SLC6A4 with the risk of MDD and suicide. However, very few studies have so far focused on the degree to which rare variants of SLC6A4 are responsible for the depression observed in adolescent and young adult suicide patients. The aim of this study was to examine the impact of common and rare variants of SLC6A4 on the risk of Han Chinese adolescents and young adults suffering MDD with SI. METHODS: Targeted sequencing of the SLC6A4 gene was conducted using FastTarget technology in Han Chinese adolescents and young adults, of which 74 were MDD patients with SI and 150 were healthy controls. Gene-based association analyses of rare variants were performed using enrichment analysis and a cumulative allele test. An allele association study was performed against common variants. RESULTS: After sequencing and bioinformatics analysis, a total of 15 single nucleotide variants (SNVs) were detected in the targeted regions from all participants, including 9 common and 6 rare variants. Among these, 5 rare variants were identified within the study group. Enrichment analysis of rare variants demonstrated a statistical difference (p = 0.042) between the study and control groups. Using cumulative allele analysis, alternative alleles in the SLC6A4 gene exhibited an association with MDD patients with SI (cumulative allele: OR = 10.18, 95% CI = 1.18-87.32, p = 0.017). No significant association was found between the 9 common SLC6A4 variants and MDD patients with SI. CONCLUSIONS: Our results suggest that rare variants of SLC6A4 may contribute to a genetic risk of adolescents and young adults suffering MDD with SI.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Transtorno Depressivo Maior/genética , Predisposição Genética para Doença/genética , Polimorfismo de Nucleotídeo Único/genética , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Adolescente , Adulto , Alelos , Feminino , Testes Genéticos/métodos , Humanos , Masculino , Fatores de Risco , Ideação Suicida , Suicídio , Adulto Jovem
9.
Psychiatr Hung ; 34(4): 359-368, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31767796

RESUMO

The risk of suicidal behaviour in mood disorders is an inherent severity of the depressive episode. Suicidal behaviour in patients with mood disorders is both state and severity dependent, which means that suicidality markedly decreases or vanishes after clinical recovery. However, since the majority of mood disorder patients never commit or attempt suicide, special clinical characteristics of the illness, as well as some personality, familial and psycho-social factors should also play a contributory role. This paper discusses the clinically explorable suicide risk factors in patients with major mood disorders, with particular regard to the underlying bipolarity. Successful acute and longterm pharmacotherapy - supplemented by psycho-social interventions - markedly reduces the risk of attempted and completed suicide, even in this high-risk population. Keywords: major depressive disorder; bipolar disorders.


Assuntos
Transtorno Bipolar/psicologia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Suicídio/psicologia , Transtorno Bipolar/terapia , Depressão/terapia , Transtorno Depressivo Maior/terapia , Humanos , Fatores de Risco , Ideação Suicida , Tentativa de Suicídio/psicologia
10.
Psychiatr Danub ; 31(4): 392-396, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698394

RESUMO

Suicide is a major global public health problem with significant impact on society. According to the World Health Organization, every year about 800.000 people commit suicide, while at the global level suicide accounts for 50% of all violent deaths among men and for 71% among women. Suicide is a complex phenomenon which cannot be attributed to a single causal factor, but to a combination of simultaneous effects of multiple factors which are expressed in the form of psychological, biological and sociological indicators. Analysis of epigenetic mechanisms (methylation of the DNA, modifications of histone proteins and (networks of) miRNA), which link the interaction between genes and the environment, could importantly contribute to better understanding of suicidal behaviour. Recent studies on suicidal behaviour and DNA methylation show differences in DNA methylation pattern, with numerous sites among suicide victims. Using next generation sequencing, genome-wide studies helped identify novel candidate genes while studies of already known candidate genes (such as glucocorticoid receptor and BDNF) gave us better insight into the interplay of genetics and epigenetics. Epigenetic studies importantly contribute to elucidation of new biomarkers for suicidal behaviour. However, present studies are very different in design and often performed on very small samples, and these limitations could be overcome with more careful study preparation.


Assuntos
Metilação de DNA , Epigênese Genética , Predisposição Genética para Doença/genética , Estudo de Associação Genômica Ampla , Suicídio , Feminino , Humanos , Masculino , Ideação Suicida
11.
Psychiatr Danub ; 31(4): 397-404, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698395

RESUMO

BACKGROUND: The suicide rate of the youth in South Korea has been increasing, and suicide of the youth still has been the most common cause of death since 2007. We aimed to determine the trends and the regional risk factors of youth suicide in South Korea from 2001 to 2010. SUBJECTS AND METHODS: We used the data from the National Statistical Office to calculate the standardized suicide rates and various regional data including population census, employment, and labor. To calculate the effect of individual risk factors, we used the data from the fourth Korean Youth Risk Behavior Web-based Survey (KYRBWS-VI). Conditional autoregressive model for regional standardized mortality ratio (SMR) using inter-regional spatial information was fitted. RESULTS: Suicide rates of adolescents aged 12 to 18 was from 3.5 per 100,000 people in 2001 and 5.3 per 100,000 in 2010. There were no significant gender difference in suicide rates, however, the number of suicides among adolescents aged 15-18 accounted for four times than those of adolescents ages 12-14. High proportion of late adolescents, higher number of recipients of national basic livelihood, and higher number of adolescents who treated with depression were related to elevated suicide rate of adolescent. Total sleep time of adolescents and regional unemployment rate were negatively associated with the suicide risk of respective regions. CONCLUSIONS: Age distribution, economic status, total sleep time, and the number of adolescent patients with depression were different between those in low and in high adolescent suicidal regions in Korea. Our findings suggest that preferential appliance of adolescent suicide prevention program for regions by considering those factors may be important steps to reduce adolescent suicide in Korea.


Assuntos
Suicídio/psicologia , Suicídio/estatística & dados numéricos , Adolescente , Comportamento do Adolescente , Criança , Depressão/epidemiologia , Humanos , República da Coreia/epidemiologia , Fatores de Risco , Ideação Suicida
12.
Psychiatr Danub ; 31(4): 429-439, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698399

RESUMO

BACKGROUND: To the best of our knowledge, no studies have been conducted in order to assess the correlation of these factors with the self-esteem in Lebanon. Therefore, this study aims to assess risk factors associated with self- esteem among a representative sample of the Lebanese population. SUBJECTS AND METHODS: A cross-sectional, conducted between November 2017 and March 2018, enrolled 789 participants. Self-esteem was measured using the Rosenberg scale. An exploratory factor analysis was executed to detect patterns of risk factors associated with self-esteem from our sample. A cluster analysis was then performed with the identified factor scores to identify the different profiles of the participants. RESULTS: Relationship management (Beta=0.117), emotional awareness (Beta=0.074) and personal accomplishment (Beta=0.064) were associated with a higher self-esteem, whereas high depression (Beta=-0.102), alexithymia (Beta=-0.077), burnout depersonalization (Beta=-0.078), suicidal ideation (Beta=-0.391) were associated with a lower self-esteem. Factor 1 (High emotional intelligence & low depersonalization) (Beta=1.819) was associated with increased self-esteem, whereas Factor 2 (High suicidal ideation, high alcohol dependence, high depression and anxiety) and Factor 3 (High burnout, high stress and high alexithymia) were associated with decreased self-esteem (Beta=-1.380 and Beta=-0.751) respectively. Being widowed (Beta=-2.332), belonging to cluster 1 (People with emotional dysregulation) (Beta=-2.850) and cluster 2 (People in distress) (Beta=-3.660) were significantly associated with decreased self-esteem. CONCLUSIONS: Depression, anxiety, burnout, stress, low emotional intelligence, alexithymia, suicide ideation, alcohol dependence and many other factors can be prevented, or reduced, by interventions that improve self-esteem.


Assuntos
Autoimagem , Sintomas Afetivos/epidemiologia , Ansiedade/epidemiologia , Análise por Conglomerados , Estudos Transversais , Depressão/epidemiologia , Inteligência Emocional , Humanos , Líbano/epidemiologia , Fatores de Risco , Ideação Suicida
13.
Psychiatr Danub ; 31(4): 479-482, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31698405

RESUMO

Crisis Intervention is a professional method to help people suffering from acute psychosocial crisis. The basis of effective crisis intervention is a collaborative relationship facilitated by genuineness, respect and acceptance. A thorough assessment of possible endangerment including self harm and suicidal ideations or danger of being a target of violence or even being harmful to others must be established. A facing dialogue offering the possibilities to express and communicate difficult emotional feelings, helping to restore emotional stability and to restore adaptive functioning is an essential basis and might in addition be complemented by medical and/or legal support.


Assuntos
Intervenção na Crise/métodos , Primeiros Socorros/métodos , Comportamento Autodestrutivo/prevenção & controle , Comportamento Autodestrutivo/psicologia , Emoções , Primeiros Socorros/psicologia , Humanos , Ideação Suicida
14.
Nurs Clin North Am ; 54(4): 533-539, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703778

RESUMO

This article offers an alternative conceptualization from which a health care provider can consider and respond to client-based suicidal ideation and behavior. Pragmatically explored through the prism of locus of control, Rogerian psychotherapy principles, Peplau's theory of interpersonal relations, and the work of Kay Redfield Jamison, the Concordant Actions in Suicide Assessment (CASA) model frames clinical decision making along a continuum defined by concordant and state-based action. Therein, cognitive reframes are offered to illustrate how to apply the CASA model in clinical practice.


Assuntos
Controle Interno-Externo , Modelos Psicológicos , Avaliação em Enfermagem , Suicídio/prevenção & controle , Humanos , Papel do Profissional de Enfermagem , Ideação Suicida
15.
Lancet Psychiatry ; 6(12): 1011-1020, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31734106

RESUMO

BACKGROUND: Rates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available. METHODS: We did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4-18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184. FINDINGS: 1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD -0·65, 95% credible interval -1·14 to -0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively. INTERPRETATION: Considering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here. FUNDING: UK National Institute for Health Research.


Assuntos
Ansiedade/prevenção & controle , Depressão/prevenção & controle , Meta-Análise em Rede , Serviços de Saúde Escolar , Adolescente , Ansiedade/terapia , Criança , Pré-Escolar , Terapia Cognitivo-Comportamental , Depressão/terapia , Humanos , Ideação Suicida
20.
Rev Saude Publica ; 53: 96, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644774

RESUMO

OBJECTIVE: To assess the prevalence of some mental disorders and suicide risk, and the association between them in youths. METHODS: Data from the 1993 Pelotas Birth Cohort (Brazil) was used. The prevalence of mental disorders at 22 years [major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), attention-deficit/ hyperactivity disorder (ADHD), bipolar disorders type 1 and 2 (BD1; BD2), post-traumatic stress disorder (PTSD), and antisocial personality disorder (APD)] and of suicide risk were assessed using the Mini International Neuropsychiatric Interview (n = 3,781). Comorbidity between disorders was also assessed. Association of each mental disorder and the number of disorders with suicide risk was assessed using Poisson regression. RESULTS: The prevalence of any mental disorder was 19.1% (95%CI 17.8-20.3), and GAD was the most prevalent (10.4%; 95%CI 9.5-11.4). The prevalence of current suicide risk was 8.8% (95%CI 5.9-9.7). All disorders (except APD) and the suicide risk were higher among women. Mental disorders were associated with a higher suicide risk, with the highest risks being observed for MDD (RR = 5.6; 95%CI 4.1-7.8) and PTSD (RR = 5.0; 95%CI 3.9-6.3). The higher the number of co-occurring mental disorders, the higher the risk of suicide. CONCLUSIONS: Our findings showed that about 20% of the youths had at least one mental disorder. However, this prevalence is underestimated since other relevant mental disorders were not assessed. Mental disorders were associated with higher suicide risk, especially the comorbidity between them.


Assuntos
Transtornos Mentais/epidemiologia , Medição de Risco/métodos , Ideação Suicida , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Coortes , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Distribuição de Poisson , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Adulto Jovem
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