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2.
Medicine (Baltimore) ; 99(1): e18136, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895766

RESUMO

RATIONALE: Despite the fact that treatment of paraquat poisoning in pregnant women and their fetuses is challenging and raises ethical issues, it is rarely reported in the literature. We report the case of a pregnant woman who took paraquat intentionally. PATIENT CONCERNS: A 36-year-old woman at 38 weeks gestational age, in an apparent suicide attempt, drank 1 mouthful (about 20 ml) of paraquat solution. Ten hours later, her urine dithionate test showed light blue color with a plasma paraquat concentration of 0.547 µg/ml. Six hours after admission, a male infant, whose plasma paraquat concentration was 0.761 µg/ml, together with 0.673 µg/ml in the amniotic fluid measured by high-performance liquid chromatography, was delivered but the woman's lung, liver, and kidney function declined rapidly. DIAGNOSIS: INTERVENTIONS:: Because of placenta previa and multiple organ failure, emergency cesarean section, and panhysterectomy were performed for the pregnant woman. Intravenous injection of antibiotic to prevent infection and dexamethasone 30 mg once a day were administered. Mechanical ventilation was performed for the infant and meropenem and penicillin injection was administered. OUTCOMES: The infant died 33 hours after birth while the mother died on the 3rd day after ingestion. LESSONS: Paraquat can enter the fetus through the placenta and the amniotic fluid via fluid exchange. The pathological changes of fetal organs may relate to gestational age, and the prognosis was very poor in both the mother and the fetus.


Assuntos
Feto/efeitos dos fármacos , Herbicidas/envenenamento , Paraquat/envenenamento , Morte Perinatal , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Morte Materna , Gravidez , Tentativa de Suicídio
3.
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
4.
Lancet Psychiatry ; 7(1): 41-51, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31826821

RESUMO

BACKGROUND: India accounts for 18% of the global population and 26·6% of global suicide deaths. However, robust population-based, nationally representative data on suicidality are not readily available to plan and implement suicide prevention programmes in India. We aimed to investigate the prevalence and sociodemographic differentials of suicidality using data from the National Mental Health Survey (NMHS) of India, 2015-16. METHODS: Trained field data collectors from the NMHS obtained information on suicidality (during the past month) from a community sample of adults aged 18 years and older using the suicidality module of the Mini-International Neuropsychiatric Interview (version 6.0). Suicidality was categorised as low, moderate, high, and overall (representing any suicidality), and examined for sociodemographic differentials using normalised sampling weights. For each of the 12 surveyed states, we calculated the age-standardised suicidality prevalence for men and women, men-to-women ratio of weighted suicidality prevalence, ratio of suicidality to suicide deaths, and ratio of suicide attempts to suicide deaths. We used logistic regression analysis to examine the association between sociodemographic factors and overall suicidality and severity. FINDINGS: Among 34 748 participants with complete interviews, 5·1% (95% CI 4·7-5·6) had some level of suicidality, and 0·3% (0·2-0·4) had at least one suicide attempt in the past month. The prevalence of overall suicidality was higher in women (6·0% [5·4-6·6]) than in men (4·1% [3·7-4·6]). The prevalence of overall suicidality was highest in those aged 40-49 years among women and in those aged 60 years or older among men. Compared with their counterparts, individuals with lower educational attainment, individuals residing in urban metropolitan cities, individuals who were widowed, separated, or divorced, and unemployed individuals had a higher prevalence of overall suicidality. The men-to-women ratio of overall suicidality prevalence for India was 0·68 (range 0·55-0·85). For every death by suicide in India, there were more than 200 people with suicidality and more than 15 suicide attempts. We found variations for various severities of suicidality. We found an increased risk for overall suicidality in women versus men (odds ratio [OR] 1·54 [95% CI 1·31-1·81]; p<0·0001) and in individuals residing in urban metropolitan cities versus those residing in rural areas (1·75 [1·30-2·35]; p=0·0002). Individuals belonging to the lowest income quintile (reference group with OR <1·00 and p<0·05 for other income quintiles), those with depressive disorders (28·78 [20·04-41·33]; p<0.0001) and those with alcohol use disorders (6·52 [3·83-11·10]; p<0.0001) had an increased risk for high suicidality, compared with their corresponding counterparts. INTERPRETATION: A national suicide prevention strategy that is comprehensive, using multisectoral approaches, is required to address the prevailing sociodemographic and other risk factors for reducing suicidality and suicide deaths in India. This study also has implications for other low-income and middle-income countries in south Asia, where sociodemographic factors play a crucial role for suicide prevention. FUNDING: Ministry of Health and Family Welfare, Government of India.


Assuntos
Alcoolismo/epidemiologia , Transtorno Depressivo/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Idoso , Feminino , Inquéritos Epidemiológicos , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos
5.
J Forensic Sci ; 65(1): 166-169, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31408207

RESUMO

Suicide is a worldwide health problem with multiple causes, including genetic factors. The major histocompatibility complex (MHC) is represented by an assembly of gene encoding the human leukocyte antigen (HLA). The purpose of our study was to determine associations between the HLA profiles and predisposition for suicidal behavior. We harvested blood samples from persons with history of suicidal attempts (case group) and persons never exhibiting such behavior (control group). The DNA was extracted and amplified via polymerase chain reaction (PCR) to determine the HLA-DQB1 profiles. Statistical data processing was performed with the Epi Info program. We found that the presence of the HLA-DQB1*02 allele increases the risk of suicidal behavior, while HLA-DQB1*05 alleviates such risk. The genotype that presented the most increased risk for suicidal behavior was found to be HLA-DQB1*02/HLA-DQB1*03. Our study has demonstrated the presence of several associations between HLA profiles and suicidal behavior.


Assuntos
Alelos , Cadeias beta de HLA-DQ/genética , Tentativa de Suicídio , Adulto , Estudos de Casos e Controles , Feminino , Frequência do Gene , Genótipo , Humanos , Masculino , Reação em Cadeia da Polimerase
6.
Rev. bras. cir. plást ; 34(4): 509-516, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047916

RESUMO

Introdução: O suicídio é um sério problema de saúde pública. Estima-se que para cada óbito existam 10 tentativas. Dentre os meios utilizados, as queimaduras têm destaque devido à gravidade das lesões, a alta taxa de letalidade e os grandes prejuízos funcionais, estéticos e psicológicos. As mulheres, por constituírem a maioria dos pacientes com história de tentativa de suicídio e morte por queimaduras, representam um grupo vulnerável que merece recorte para aprofundamento do estudo. Métodos: Estudo retrospectivo, de caráter descritivo de série temporal. Foi desenvolvido na Unidade Tratamento de Queimados e no Instituto de Medicina Legal em Brasília (DF), entre os anos de 2010 e 2015. Resultados: Foram identificadas 42 mulheres com história de suicídio por queimaduras, tentado ou consumado. Houve 15 óbitos relacionados diretamente à lesão térmica. Houve um predomínio da faixa etária entre 30 e 44 anos, seguida por 15 a 29 anos. Em 64,3% dos casos o evento aconteceu no DF. Em relação aos agentes etiológicos, o mais comum foi o álcool (71,4%). A média de superfície corporal queimada foi de 34,38%, sendo que as pacientes que faleceram apresentaram áreas queimadas maiores (59,53%) do que as que sobreviveram (20,4%). Conclusão: Os dados obtidos no DF corroboram informações da literatura. Apesar do progresso envolvendo manejo e tratamento dos pacientes queimados, a prevenção continua sendo a melhor atitude.


Introduction: Suicide is a serious public health problem. For every death, there are an estimated 10 suicide attempts. Among the means of suicide, burns are prominent due to the lesion severity, the high mortality rate, and the severe functional, aesthetic, and psychological damage. Women comprise the majority of patients with a history of attempting suicide and death by burns and represent a vulnerable group that deserves attention. Methods: This retrospective descriptive time-series study was performed in the Burn Treatment Unit at the Institute of Legal Medicine in Brasília, Distrito Federal (DF) between 2010 and 2015. Results: A total of 42 women with a history of suicide by burns, attempted or consummated, were identified; 15 deaths were directly related to the thermal injury. Suicide by burns was the most predominant among patients aged 30 to 44 years was observed, followed by those aged 15 to 29 years. In 64.3% of cases, the event occurred in the Brasília, Distrito Federal (DF). Alcohol was the most common etiological agent (71.4%). The average burned body surface area was 34.38%, and the patients who died presented larger burned areas (59.53%) than that in those who survived (20.4%). Conclusion: The data obtained from the Brasília, Distrito Federal (DF) corroborate information from the literature. Despite progress involving the management and treatment of burn patients, prevention remains the best strategy.


Assuntos
Humanos , Feminino , Adolescente , Adulto , História do Século XXI , Suicídio , Tentativa de Suicídio , Unidades de Queimados , Queimaduras , Saúde Pública , Funções Essenciais da Saúde Pública , Suicídio/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Unidades de Queimados/normas , Unidades de Queimados/estatística & dados numéricos , Queimaduras/mortalidade , Queimaduras/psicologia , Queimaduras/terapia
7.
Medicine (Baltimore) ; 98(47): e17981, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764807

RESUMO

RATIONALE: Adult hyperammonemia is most often the result of hepatic dysfunction. Hyperammonemia in the setting of normal hepatic function is a much less common phenomenon and has usually been associated with medications and certain disease states. Here, we present an unusual case of severe hyperammonemia caused physiologically by intense muscle activity in a patient lacking any evidence of liver disease. PATIENT CONCERNS: A 36-year-old woman was brought to the emergency department for a suicide attempt after being found covered in Lysol and Clorox germicidal bleach. She was noted to be in a state of violent psychosis with extreme agitation and had to be sedated and intubated for airway protection. DIAGNOSIS AND INTERVENTIONS: Initial labs revealed hyperammonemia, lactic acidosis, and anion gap metabolic acidosis. Aminotransferases, bilirubin, and creatine kinase (CK) were normal. Renal function, prothrombin time, activated partial thromboplastin time, and international normalized ratio were also unremarkable and remained so at 24 hours. Ethyl alcohol, acetaminophen, salicylate, and valproic acid were all undetectable in blood. She received 2 doses of lactulose overnight, with a subsequent bowel movement. Next day, her mentation, serum ammonia level, and lactic acid level were back to normal, and she was extubated. Aminotransferases and CK levels were elevated but improved with supportive care. A detailed history and relevant biochemical investigations were unremarkable for any other etiology of hyperammonemia including the common inborn errors of metabolism (IEM). The combination of clinical findings of extreme skeletal muscle activity along with hyperammonemia and lactic acidosis, and subsequently rhabdomyolysis in the setting of unremarkable history and otherwise normal hepatic function strongly suggest the myokinetic origin of hyperammonemia in the patient. OUTCOME: The patient recovered well with supportive care and was discharged on day 5. LESSONS: This unique case illustrates the important role of skeletal muscle in the human metabolism of ammonia. In our discussion, we also elucidate the underlying pathophysiology, with the objective of improving clinician understanding of various differential diagnoses.


Assuntos
Hiperamonemia/etiologia , Músculo Esquelético/metabolismo , Adulto , Cresóis/envenenamento , Feminino , Humanos , Índice de Gravidade de Doença , Hipoclorito de Sódio/envenenamento , Tentativa de Suicídio
8.
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
9.
Lancet Psychiatry ; 6(12): 1031-1038, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31757590

RESUMO

BACKGROUND: Suicidal ideation due to abortion has been used to justify restrictive US abortion policies. Much research examining abortion and mental health has relied on self-report, has had low participation rates, and did not consider confounding factors. In the present study, we used data that do not rely on self-report and are not affected by low participation rates to examine the association between abortion and non-fatal suicide attempts, adjusting for confounding factors. METHODS: In this longitudinal cohort study of Danish population registries, we linked data on a cohort of women born in Denmark between Jan 1, 1980, and Dec 30, 1998, who did not die or emigrate from Denmark before their 18th birthday or before study entry. Follow-up started on the woman's 18th birthday or Jan 1, 2000, whichever came last. Follow-up ended at the date of first suicide attempt, date of emigration from Denmark, date of death, or Dec 31, 2016, whichever came first. Women were between the ages of 18 and 36 years during the study period. We used a survival analysis to examine the risk of first suicide attempts or self-harm associated with a first abortion compared with no abortion, in the complete study cohort. To examine incidence rate ratios (IRRs) associated with abortion, we used Poisson regression with the logarithm of woman-years at risk as an offset. We also examined whether the risk of suicide attempts changed before and after the abortion, adjusting for age, calendar year, socioeconomic status, and history of childbirth, mental health, parental mental health, and physical health. FINDINGS: Data on 523 280 women were included in this study. Of these, 48 990 (9·4%) women had a record of at least one first-trimester abortion, and 10 216 (2·0%) had a suicide attempt during the study period. Among 48 990 women who had an abortion, 1402 (2·9%) had a first suicide attempt after the first abortion. In our fully-adjusted model which adjusted for all covariates, the risk of first-time non-fatal suicide attempts was similar in the year before an abortion (IRR 2·46 [95% CI 2·22-2·72]) and the year after an abortion (IRR 2·54 [2·29-2·81], p=0·509) compared with women who had not had an abortion, and decreased with increasing time since the abortion (1-5 years IRR 1·90 [1·75-2·06]; ≥5 years IRR 1·73 [1·53-1·96]). INTERPRETATION: We found that women who had abortions had a higher risk of non-fatal suicide attempts compared with women who did not have an abortion. However, because the increased risk was the same both the year before and after the abortion, it is not attributable to the abortion. Thus, policies based on the notion that abortion increases women's risk of suicide attempts are misinformed. FUNDING: Society of Family Planning, American Foundation for Suicide Prevention, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research.


Assuntos
Aborto Legal/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos , Aborto Legal/psicologia , Adolescente , Adulto , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Transtornos Mentais/psicologia , Gravidez , Sistema de Registros , Fatores de Risco , Tentativa de Suicídio/psicologia , Adulto Jovem
11.
Psychiatr Danub ; 31(4): 405-412, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698396

RESUMO

BACKGROUND: Significant changes in the values of temperature, pressure, humidity and cloud cover can participate in the human behaviour including the mood disorders (especially depression and bipolar disorders) which can trigger suicidal ideas or their realization. The aim of this study is to estimate the connection between the aforesaid weather changes and a committed suicide along with the suicide attempts. SUBJECTS AND METHODS: We conducted a retrospective study in Osijek-Baranja County in the period from 2000 to 2011. Meteorological, demographic and epidemiological analysis was performed on 569 suicides and 478 suicide attempts (total of 1047 events). We analyzed the values of the above-mentioned meteorological parameters at the exact time when the event had happened, as well as three days before the event and one day after the event, comparing it with the monthly mean values. RESULTS: The results showed that the changes of temperature and pressure were significantly related with the suicides i.e. suicide attempts in general, while by separating genders, a connection with all examined meteorological factors was found by woman whereas men expressed significance only in the matter of temperature changes. CONCLUSIONS: Despite the fact that suicidality is caused by numerous factors, this study confirms that a sudden change of weather in the days preceding the suicide can be a trigger to suicidal behaviour. The study also suggests that in the matter of suicidal behaviour, female population is more susceptible to sudden weather changes.


Assuntos
Conceitos Meteorológicos , Tentativa de Suicídio/estatística & dados numéricos , Croácia/epidemiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
12.
Adv Exp Med Biol ; 1192: 503-517, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705511

RESUMO

Suicide is a serious public health problem in many countries and has always been a source of apprehension and quest to human mankind, which can be resolved with due diligence. Suicide is a hidden and silent epidemic, with many causative factors. Studying and researching on various causative factors have always been the subject of significance for the researchers. Psychiatric illnesses happen to be the primary reasons for the majority of suicide mortality cases. Not only this, there has been a consistent increase in the no. of cases of mental disorders as well as attempted and completed suicide cases. If one looks at global scenario, an approximate 70,000 people commit suicide, and further alarming is the fact that the rate of suicide attempt cases has gone up to 250% during last 18 years in conflict zones. Poisoning, hanging and self-immolation are some of the common methods to commit suicide. Physical and mental illness, disturbed emotional relationships and economic difficulties were the major reasons for suicide with the predisposed population being women, student and farmers. As per WHO's approximation, there is one suicide every minute and an attempted suicide every third second. It implies that the number of killed due to suicide is greater than that of the ones killed due to the armed conflict.


Assuntos
Transtornos Mentais , Suicídio , Feminino , Humanos , Fatores de Risco , Tentativa de Suicídio
13.
Orv Hetil ; 160(47): 1864-1871, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31736345

RESUMO

Introduction: The analysis of the mortality data of patients is important. Aim: Examination of data from patients treated in the Addictological Out-patient Clinic in Józsefváros and deceased between 2001 and 2018. Method: Patients' data originated from medical records. The national and Budapest data were from the publications of the Hungarian Central Statistical Office. Results: The age of patients was 52.85 ± 11.81 years for women and 51.99 ± 12.47 years for men. Two-thirds, regardless of gender, were alcoholic. There were many violent deaths. A new phenomenon was the high number of drug- and murder-associated deaths. The former group was dominated by men. The latter group showed female dominance. The completed suicide rate was 14.6%. Suicide attempts occurred in 22.4% of patients. The majority of patients were skilled workers. Conclusion: Data support the view that addict patients die earlier. Leading deaths, unlike previous investigations, were violent deaths. The rate of suicide was higher than the national rate, but it was the same as previously reported, indicating a high risk of this population. Gender differences were observed with regard to violent death, requiring further elucidation. Orv Hetil. 2019; 160(47): 1864-1871.


Assuntos
Alcoolismo/mortalidade , Pacientes Ambulatoriais/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Suicídio/estatística & dados numéricos , Adulto , Idoso , Alcoolismo/etnologia , Instituições de Assistência Ambulatorial , Feminino , Homicídio , Humanos , Hungria/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Tentativa de Suicídio , Violência/estatística & dados numéricos
19.
BMC Public Health ; 19(1): 1380, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655571

RESUMO

BACKGROUND: Suicide is a major public health issue worldwide. Those who have made a recent suicide attempt are at high risk for dying by suicide in the future, particularly during the period immediately following departure from a hospital emergency department. As such the transition from hospital-based care to the community is an important area of focus in the attempt to reduce suicide rates. There is a need for evaluation studies to test the effectiveness of interventions directed to this stage (termed 'aftercare' interventions). METHODS: A controlled non-randomised two group (intervention vs treatment-as-usual control) design, using an intention-to-treat model, will evaluate the effectiveness of a suicide prevention aftercare intervention providing follow-up after presentations to a hospital emergency department as a result of a suicide attempt or high risk for suicide. The intervention is a community-based service, utilising two meetings with a mental health clinician and follow-up contacts by peer workers via a combination of face-to-face and telephone for four weeks, with the option of extension to 12 weeks. Seventy-five participants of the intervention service will be recruited to the study and compared to 1265 treatment-as-usual controls. The primary hypotheses are that over 12 months, those who participate in the aftercare follow-up intervention are less likely than controls to present to a hospital emergency department for a repeat suicide attempt or because of high risk for suicide, will have fewer re-presentations during this period and will have lower all-cause mortality. As a secondary aim, the impact of the intervention on suicide risk factors for those who participate in the service will be evaluated using pre- and post-intervention repeated measures of depression, anxiety, stress, hopelessness, belongingness, burdensomeness, and psychological distress. Enrolments into the study commenced on 1 November 2017 and are anticipated to cease in November 2019. DISCUSSION: The study aims to contribute to the understanding of effective interventions for individuals who have presented to a hospital emergency department as a result of a suicide attempt or at high risk for suicide and provide evidence in relation to interventions that incorporate peer-workers. TRIAL REGISTRATION: ACTRN12618001701213 . Registered on 16 October 2018. Retrospectively registered.


Assuntos
Assistência ao Convalescente , Serviços de Saúde Comunitária , Tentativa de Suicídio , Suicídio/prevenção & controle , Adolescente , Adulto , Protocolos Clínicos , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Medição de Risco
20.
Actas esp. psiquiatr ; 47(5): 179-189, sept.-oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185170

RESUMO

Introducción. El suicidio es un problema de salud importante en España. Examinamos la relación entre la reincidencia de los intentos y el nivel de letalidad alcanzado, y el perfil de los pacientes reincidentes que realizan intentos más letales. El objetivo es establecer los factores sociodemográficos y clínicos predictores de una mayor letalidad y reincidencia. Método. Todos los pacientes atendidos por intento suicida en un área sanitaria de 360.000 habitantes de 2009 a 2014 (N = 711) fueron valorados de forma sistemática. Comparamos las características clínicas y demográficas en función de la letalidad (leve versus moderada-severa) y la reincidencia (1-2 intentos versus > 2 intentos) usando análisis univariantes y modelos de regresión. Posteriormente, repe-timos los análisis tras distribuir la muestra en cuatro grupos en función de la presencia o ausencia de alta letalidad y/o reincidencia. Resultados. La reincidencia se asoció con la edad media (35-65 años), inactividad laboral, y los trastornos de personalidad o por uso de sustancias. La letalidad se asoció con el género masculino, edades extremas, método violento y los trastornos afectivos, pero no con la reincidencia. La coincidencia de múltiples intentos y letalidad severa en un mismo paciente parece relacionarse con el grupo de edad de 35-65 años, sexo masculino, uso de métodos violentos, trastornos mentales y la inactividad laboral. Conclusiones. Distintos factores demográficos y clínicos se asocian al riesgo de letalidad médica y de reincidencia. Nuestros resultados muestran que aquellos pacientes que repiten los intentos y realizan al menos un intento de alta letalidad, tienen mayor presencia de psicopatología, sobre todo trastornos afectivos


Introduction. Suicidal behaviour is a major health problem in Spain. The aim of this study is to examine the relationship between the recurrence of suicide attempts and the level of lethality reached, and the profile of repeaters who perform more lethal attempts. Method. All patients admitted for attempted suicide in a health area of 360,000 inhabitants from 2009 to 2014 (N = 711) were systematically assessed. We compared clinical and demographic characteristics of these patients in terms of lethality (low versus moderate-severe) and recidivism (1-2 attempts versus >2 attempts) using univariate analyses and regression models. Later, we repeated the analyses after distributing the sample into four groups depending on the presence or absence of high lethality and/or recidivism. Results. Recidivism was associated with the middle-age group (35-65 years), the lack of professional activity, and personality or substance use disorders. Lethality was associated with male gender, extreme age-groups, the use of a violent method, and affective disorders, but not with recidivism. Multiple suicide attempts and high lethality in a single patient was associated with 35-65 years age-group, male gender, violent methods, mental disorders, and inactivity. Conclusions. Different demographic and clinical factors indicate an increased risk of medical lethality and recurrence in suicidal patients. Our results show that at least some recidivist patients end up making more lethal and violent attempts with the passage of time, especially if they have psychiatric comorbidity


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Tentativa de Suicídio/psicologia , Transtorno da Personalidade Antissocial/mortalidade , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Reincidência/psicologia , Modelos Lineares , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos do Humor/psicologia , Transtornos Mentais/mortalidade , Transtornos Mentais/psicologia
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