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1.
BMJ Case Rep ; 13(10)2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33130587

RESUMO

A previously fit and well 37-year-old male healthcare worker presented with confusion, psychotic symptoms and a suicide attempt in the context of a new COVID-19 diagnosis. Following surgical interventions and an extended admission to the intensive care unit, he made a good recovery in terms of both his physical and mental health. A number of factors likely contributed to his presentation, including SARS-CoV-2 infection, severe insomnia, worry, healthcare worker-related stress, and the unique social and psychological stressors associated with the COVID-19 pandemic. This case highlights the need to further characterise the specific psychiatric sequelae of COVID-19 in community settings, and should remind general medical clinicians to be mindful of comorbid psychiatric symptoms when assessing patients with newly diagnosed COVID-19.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Transtornos Psicóticos/complicações , Transtornos Psicóticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Tentativa de Suicídio/prevenção & controle , Adulto , Infecções por Coronavirus/psicologia , Humanos , Masculino , Enfermeiros/psicologia , Estresse Ocupacional/complicações , Estresse Ocupacional/diagnóstico , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/psicologia , Prognóstico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/fisiopatologia , Medição de Risco , Transtornos de Estresse Pós-Traumáticos/complicações , Estresse Psicológico , Resultado do Tratamento , Reino Unido
2.
J Oral Maxillofac Surg ; 78(11): 2042.e1-2042.e5, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33131549

RESUMO

PURPOSE: Self-inflicted gunshot wounds to the face are one of the most challenging clinical scenarios encountered by oral and maxillofacial surgeons. Knowledge is lacking regarding which factors might influence survival after these devastating injuries, especially pertaining to psychiatric history and substance use. The purpose of the present study was to evaluate the risk factors that might influence the survival of subjects with self-inflicted gunshot wounds to the face. MATERIALS AND METHODS: A retrospective cohort study was designed to analyze the data from subjects presenting to the University of Louisville Trauma Center with self-inflicted gunshot wounds to the face from February 2010 to September 2019. The predictor variables included demographic (eg, age, gender, race), medical and psychiatric history, and toxicology test results. The primary outcome variable was death before hospital discharge. Descriptive, bivariate, and logistic regression models were computed. RESULTS: The sample included 120 subjects, with an age range of 16 to 85 years old (average age, 43.5 years); 90.8% were male, and 56.7% had survived their suicide attempt. Of the 120 patients, 35% had a history of depression, 23.3% tested positive for benzodiazepines, and 33% had a social history positive for smoking, alcohol use, and/or drug use. Depression was the single largest predictor of mortality. Patients with depression were significantly more likely to survive their injuries than were patients without depression (odds ratio, 0.230; P = .003). The presence of benzodiazepines in toxicology tests was also a significant predictor of mortality (odds ratio, 0.297; P = .018); patients testing positive were more likely to survive than were patients with negative test results or positive test results for other drugs. CONCLUSIONS: Subjects who attempt suicide via self-inflicted gunshot wounds to the face were more likely to survive their injury if they had a reported history of depression or test results positive for a benzodiazepine.


Assuntos
Automutilação , Ferimentos por Arma de Fogo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tentativa de Suicídio , Centros de Traumatologia , Adulto Jovem
3.
Medicine (Baltimore) ; 99(40): e22514, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019453

RESUMO

Despite the controversy surrounding electronic cigarette (e-cigarette) safety, global consumption has been rapidly increasing. We investigated the relationship between e-cigarette use and mental health conditions in adults of various ages.We conducted a secondary data analysis of adults aged 19 to 80 who participated in the first year of the 7th Korea National Health and Nutrition Examination Survey (2016). The total number of participants was 5469, including 3398 non-smokers, 1700 smokers who had never used e-cigarettes, and 371 smokers who had previously used e-cigarettes, selected based on self-report questionnaires. Mental health factors including stress status, depressive mood, suicide plan, and suicide attempt were assessed by self-reported questionnaire. The Patient Health Questionnaire (PHQ-9) was used to assess depressive mood, with a cut-off value of 10. The relationship between e-cigarette use and stress status with depressive mood were analyzed with adjustment for potential confounders.Both male and female smokers who previously used e-cigarettes showed higher levels of stress than non-smokers or smokers who had never used e-cigarettes. The average PHQ-9 score was higher among previous e-cigarette-using smokers relative to non-smokers and smokers who had never used e-cigarettes, regardless of gender. The number of participants with depressive mood was significantly higher in the group of smokers who previously used e-cigarettes. In multivariable-adjusted logistic regression analyses, there was a significantly higher odds ratio for higher stress in male smokers who had previously used e-cigarettes and for depressive mood in female smokers who had previously used e-cigarettes, compared with non-smokers.This study analyzed the association between adult e-cigarette use and mental health conditions, including stress and depressive mood, and showed that e-cigarette use was significantly related to both conditions in men and women.


Assuntos
Depressão/epidemiologia , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Estresse Psicológico/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , República da Coreia/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Adulto Jovem
4.
Epidemiol Psychiatr Sci ; 29: e175, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33070799

RESUMO

AIMS: Previous studies regarding associations between depressive symptoms and suicidality (suicidal ideation, plans and attempts) have usually employed a variable-centred approach, without considering the individual variance in time-varying changes of depressive symptoms. Through 10-year follow-up of a large cohort of Chinese adolescents exposed to the 2008 Wenchuan earthquake, this study examined whether individual variance in depressive symptoms during the early phases post-earthquake could generate different suicidality outcomes in young adulthood. METHODS: A total of 1357 Chinese adolescents exposed to the Wenchuan earthquake were surveyed on depressive symptoms and other variables at 6, 18 and 30 months post-earthquake. In total, 799 participants responded to the 10-year follow-up and completed an online survey covering suicidality and other variables. The analytic sample was 744 participants who had valid data on depressive symptoms and suicidality. Data were analysed using logistic regressions. RESULTS: Prevalence estimates of past-year suicidal ideation, suicide plans and suicide attempts measured at 10 years post-earthquake were found to be 10.8%, 7.3% and 3.0%, respectively. Five trajectories of depressive symptoms were classified: resistance (54.4%), chronicity (13.3%), recovery (10.4%), delayed dysfunction (12.0%) and relapsing/remitting (10.0%). After controlling for covariates, whole-sample regressions revealed only the relapsing/remitting depressive trajectory remained significantly predictive of suicidality. Moreover, males not females in the chronic group were more likely to have suicide plans. CONCLUSIONS: The findings highlight the importance of detecting disaster survivors with different trajectories of mental status and providing with them individualised and effective mental health services, to decrease their risk of suicidality in the future.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Terremotos , Transtornos de Estresse Pós-Traumáticos/psicologia , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Adaptação Psicológica , Adolescente , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Estudos de Coortes , Depressão/diagnóstico , Depressão/etnologia , Depressão/psicologia , Feminino , Seguimentos , Humanos , Masculino , Prevalência , Fatores de Risco , Distribuição por Sexo , Transtornos de Estresse Pós-Traumáticos/etnologia , Suicídio/psicologia , Tentativa de Suicídio/psicologia , Inquéritos e Questionários , Sobreviventes
7.
Artigo em Inglês | MEDLINE | ID: mdl-33095519

RESUMO

Objective: To expand knowledge during the coronavirus disease 2019 (COVID-19) pandemic with regard to suicide prevention among the elderly population by providing recommendations for interview strategies using 3 suicide theories. Methods: Two hypothetical geriatric suicide cases (1 low lethality and 1 high lethality) are presented and categorized according to 3 suicide theories: interpersonal theory of suicide, three-step theory of suicide, and hopelessness theory of depression. Results: In crisis intervention, the clinician's interview must match the intrinsic belief of the suicide attempter to enable engagement and rapport. Use of different aspects of the 3 suicide theories can be useful but are dependent on the emergent nature of the attempt. Conclusion: The need for identification and treatment of those with mental health issues, especially among the elderly population, and collaborative multidiscipline management teams is increasing during the current global pandemic. Specific interview strategies are needed when engaging with elderly suicidal patients. Suicide prevention in elderly patients is worthy of strong public attention.


Assuntos
Infecções por Coronavirus/psicologia , Pandemias , Pneumonia Viral/psicologia , Psiquiatria/métodos , Suicídio/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/complicações , Depressão/etiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Pneumonia Viral/complicações , Ideação Suicida , Suicídio/psicologia , Tentativa de Suicídio/psicologia
9.
Isr Med Assoc J ; 9(22): 481-485, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32954693

RESUMO

BACKGROUND: Acetaminophen is the most common drug involved in pediatric poisonings, both intentionally and accidentally, and is the leading cause of acute liver failure among all age groups. OBJECTIVES: To define the characteristics of patients admitted to a pediatric emergency department (ED) where serum acetaminophen concentrations were measured, and to determine which variables are associated with significant risk of acetaminophen toxicity. METHODS: Acetaminophen serum concentrations were measured, in a retrospective case series, of patients younger than 18 years who had been admitted to the ED at Shamir Medical Center between 1 January 2008 and 31 December 2015. RESULTS: During the study period 180,174 children were admitted to the ED. Acetaminophen serum concentrations were measured in 209 (0.12%) patients. Mean age was 12.4 ± 5.9 years. Elevated liver enzymes were found in 12 patients, 5 of whom had documented acute liver injury. All five were older than 11years.Two cases of acute liver injury were attributable to acetaminophen ingestion. In both cases the cause was intentional overdose. Univariate analysis showed a significant (P < 0.05) correlation between detectable acetaminophen blood level and a positive history of drug or acetaminophen ingestion, and suicide attempt. Not all children with non-severe acetaminophen poisoning had been diagnosed during the study period. A positive history of acetaminophen ingestion was associated with a 28-fold higher risk for detectable acetaminophen blood level. CONCLUSIONS: In the absence of a positive history of acetaminophen ingestion and in young children with accidental intoxication, the risk of hepatotoxicity is relatively low.


Assuntos
Acetaminofen/envenenamento , Analgésicos não Entorpecentes/envenenamento , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Overdose de Drogas/epidemiologia , Serviço Hospitalar de Emergência , Acetaminofen/sangue , Adolescente , Analgésicos não Entorpecentes/sangue , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Israel , Masculino , Estudos Retrospectivos , Tentativa de Suicídio/estatística & dados numéricos
10.
Rev Prat ; 70(1): 55-58, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-32877030

RESUMO

Collective measures to prevent suicide. Suicide is a preventable death that requires the implementation of individual and collective preventive actions. A simple and effective action is to limit the access to lethal means. School-based outreach programs reduce suicide attempts. The detection and management of depression by general practitioners plays an important role in suicide prevention. Furthermore, maintaining contact with people at high suicidal risk is a very promising method to prevent suicide.


Assuntos
Tentativa de Suicídio , Humanos , Fatores de Risco , Tentativa de Suicídio/prevenção & controle
11.
BMJ ; 370: m2984, 2020 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-32878868

RESUMO

OBJECTIVE: To analyse the relation between exposure to workplace sexual harassment and suicide, as well as suicide attempts. DESIGN: Prospective cohort study. SETTING: Sweden. PARTICIPANTS: 86 451 men and women of working age in paid work across different occupations responded to a self-report questionnaire including exposure to work related sexual harassment between 1995 and 2013. The analytical sample included 85 205 people with valid data on sexual harassment, follow-up time, and age. MAIN OUTCOME MEASURES: Suicide and suicide attempts ascertained from administrative registers (mean follow-up time 13 years). RESULTS: Among the people included in the respective analyses of suicide and suicide attempts, 125 (0.1%) died from suicide and 816 (1%) had a suicide attempt during follow-up (rate 0.1 and 0.8 cases per 1000 person years). Overall, 11 of 4095 participants exposed to workplace sexual harassment and 114 of 81 110 unexposed participants committed suicide, and 61/4043 exposed and 755/80 513 unexposed participants had a record of suicide attempt. In Cox regression analyses adjusted for a range of sociodemographic characteristics, workplace sexual harassment was associated with an excess risk of both suicide (hazard ratio 2.82, 95% confidence interval 1.49 to 5.34) and suicide attempts (1.59, 1.21 to 2.08), and risk estimates remained significantly increased after adjustment for baseline health and certain work characteristics. No obvious differences between men and women were found. CONCLUSIONS: The results support the hypothesis that workplace sexual harassment is prospectively associated with suicidal behaviour. This suggests that suicide prevention considering the social work environment may be useful. More research is, however, needed to determine causality, risk factors for workplace sexual harassment, and explanations for an association between work related sexual harassment and suicidal behaviour.


Assuntos
Assédio Sexual/psicologia , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Local de Trabalho/psicologia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Autorrelato , Assédio Sexual/estatística & dados numéricos , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Inquéritos e Questionários , Suécia/epidemiologia
12.
PLoS Med ; 17(9): e1003297, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32931504

RESUMO

BACKGROUND: The psychological health of female sex workers (FSWs) has emerged as a major public health concern in many low- and middle-income countries (LMICs). Key risk factors include poverty, low education, violence, alcohol and drug use, human immunodeficiency virus (HIV), and stigma and discrimination. This systematic review and meta-analysis aimed to quantify the prevalence of mental health problems among FSWs in LMICs, and to examine associations with common risk factors. METHOD AND FINDINGS: The review protocol was registered with PROSPERO, number CRD42016049179. We searched 6 electronic databases for peer-reviewed, quantitative studies from inception to 26 April 2020. Study quality was assessed with the Centre for Evidence-Based Management (CEBM) Critical Appraisal Tool. Pooled prevalence estimates were calculated for depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal behaviour. Meta-analyses examined associations between these disorders and violence, alcohol/drug use, condom use, and HIV/sexually transmitted infection (STI). A total of 1,046 studies were identified, and 68 papers reporting on 56 unique studies were eligible for inclusion. These were geographically diverse (26 countries), representing all LMIC regions, and included 24,940 participants. All studies were cross-sectional and used a range of measurement tools; none reported a mental health intervention. Of the 56 studies, 14 scored as strong quality, 34 scored as moderate, and 8 scored as weak. The average age of participants was 28.9 years (age range: 11-64 years), with just under half (46%) having up to primary education or less. The pooled prevalence rates for mental disorders among FSWs in LMICs were as follows: depression 41.8% (95% CI 35.8%-48.0%), anxiety 21.0% (95% CI: 4.8%-58.4%), PTSD 19.7% (95% CI 3.2%-64.6%), psychological distress 40.8% (95% CI 20.7%-64.4%), recent suicide ideation 22.8% (95% CI 13.2%-36.5%), and recent suicide attempt 6.3% (95% CI 3.4%-11.4%). Meta-analyses found significant associations between violence experience and depression, violence experience and recent suicidal behaviour, alcohol use and recent suicidal behaviour, illicit drug use and depression, depression and inconsistent condom use with clients, and depression and HIV infection. Key study limitations include a paucity of longitudinal studies (necessary to assess causality), non-random sampling of participants by many studies, and the use of different measurement tools and cut-off scores to measure mental health problems and other common risk factors. CONCLUSIONS: In this study, we found that mental health problems are highly prevalent among FSWs in LMICs and are strongly associated with common risk factors. Study findings support the concept of overlapping vulnerabilities and highlight the urgent need for interventions designed to improve the mental health and well-being of FSWs.


Assuntos
Profissionais do Sexo/psicologia , Profissionais do Sexo/estatística & dados numéricos , Adolescente , Adulto , Ansiedade , Transtornos de Ansiedade , Criança , Estudos Transversais , Países em Desenvolvimento , Feminino , Infecções por HIV/epidemiologia , Humanos , Saúde Mental , Pessoa de Meia-Idade , Pobreza , Prevalência , Fatores de Risco , Sexo Seguro , Comportamento Sexual , Doenças Sexualmente Transmissíveis/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Ideação Suicida , Tentativa de Suicídio , Violência
13.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32958610

RESUMO

BACKGROUND: Gender-incongruent (GI) youth have high rates of mental health problems. Although gender-affirming medical care (GAMC) provides psychological benefit, some GI youth present to care at older ages. Whether a relationship exists between age of presentation to GAMC and mental health difficulties warrants study. METHODS: A cross-sectional chart review of patients presenting to GAMC. Subjects were classified a priori as younger presenting youth (YPY) (<15 years of age at presentation) or older presenting youth (OPY) (≥15 years of age). Self-reported rates of mental health problems and medication use were compared between groups. Binary logistic regression analysis was used to identify determinants of mental health problems. Covariates included pubertal stage at presentation, social transition status, and assigned sex. RESULTS: Of 300 youth, there were 116 YPY and 184 OPY. After presentation, more OPY than YPY reported a diagnosis of depression (46% vs 30%), had self-harmed (40% vs 28%), had considered suicide (52% vs 40%), had attempted suicide (17% vs 9%), and required psychoactive medications (36% vs 23%), with all P < .05. After controlling for covariates, late puberty (Tanner stage 4 or 5) was associated with depressive disorders (odds ratio 5.49; 95% confidence interval [CI]: 1.14-26.32) and anxiety disorders (odds ratio 4.18 [95% CI: 1.22-14.49]), whereas older age remained associated only with psychoactive medication use (odd ratio 1.31 [95% CI: 1.05-1.63]). CONCLUSIONS: Late pubertal stage and older age are associated with worse mental health among GI youth presenting to GAMC, suggesting that this group may be particularly vulnerable and in need of appropriate care.


Assuntos
Fatores Etários , Disforia de Gênero/psicologia , Disforia de Gênero/terapia , Transtornos Mentais/epidemiologia , Transexualidade/psicologia , Transexualidade/terapia , Adolescente , Antipsicóticos/uso terapêutico , Transtornos de Ansiedade/epidemiologia , Criança , Estudos Transversais , Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Revelação , Humanos , Modelos Logísticos , Transtornos Mentais/tratamento farmacológico , Saúde Mental , Puberdade , Comportamento Autodestrutivo/epidemiologia , Fatores Sexuais , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos
15.
Rev Prat ; 70(1): 32-37, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-32877025

RESUMO

Suicidal behaviors in France: still a public health issue. In 2015, 9,109 deaths by suicide were counted in France, representing 13.7 suicides per 100,000 inhabitants. This rate has been declining for 30 years as in many countries. A significant underestimation is however suggested for various reasons. The risk of suicide is three times higher for men than for women. Suicide rates increase among those over 75 years of age, mostly for men, while the highest suicide frequencies are found among those aged 35-65, and suicide is the second leading cause of death among adolescents and young adults. More than half of suicides are by hanging. Suicide attempts are 10 to 20 times more frequent than suicide, about 100 to 200,000 acts each year, and are also decreasing over the last years. In 2017, 88,712 hospitalizations for suicide attempts were recorded in France. Suicide attempts are associated with an increased risk of death, by suicide in particular, but also by somatic disease. The prevalence of suicidal ideation, appreciated through surveys in the general population, is high, estimated at about 5%. Many suicidal risk factors have been identified with a recognized lack of individual predictive ability. These data are crucial for guiding prevention actions and measuring their effects.


Assuntos
Saúde Pública , Ideação Suicida , Adolescente , Adulto , Idoso , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Tentativa de Suicídio , Adulto Jovem
16.
Rev Prat ; 70(1): 49-54, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-32877029

RESUMO

Suicide prevention after a suicide attempt: how to stay in touch? Attempted suicide is a major risk factor of further re-attempts and death. Self-harm behaviors are related to multiple causes, explaining why it is ineffective to have a single and simple strategy to offer after the clinical assessment in reducing morbidity and mortality. Furthermore, treatment adherence is known to be especially poor, in a context where social connection seems compromised and source of pain. Effective interventions can be divided into two categories: intensive intervention programs (care at home, supported by a series of brief psychotherapy interventions) and, case management programs that rely on a "stay in contact" dimension(letters, telephone, sms, mail, etc.). A prevention algorithm was further proposed to routine care in 2015, in the northern departments of France, Nord et Pas-de-Calais (4.3 million people), taking the name of VigilanS. The inclusion consists in sending a form for every patient assessed after a suicide attempt in the two departments to the medical staff of VigilanS, in order to provide information about the patient and the context of his suicide attempt. The algorithm consist in giving crisis card to all the patients; an information letter, explaining the aim of the monitoring is also given to the patient, and to his general practitioner. The calling staff is composed of4 nurses and 4 psychologists, all trained in suicidal crisis management. They use a phone platform located in the Emergency Medical Assistance Service (SAMU) of the Nord department, and manage the incoming calls from the patients, plus the outgoing calls towards the patients, their relatives and their medical contacts. A set of 4 postcards (1 per month) can be sent if needed incase of an inconclusive or a failed phone call. Built on a monitoring philosophy, VigilanS has further developd a real crisis case management dimension, requiring enough time to insure an effective medical supervision, and strong networking abilities. A specific time is also needed to take care of all the technical aspects of the organization. We measured the evolution of the number of suicide attempts before and after implantation of VigilanS: we found an acceleration of the reduction of stay for suicide attempt in Nord et Pas-de-Calais after 2014(-16% instead of -6%), instead of the two Picardy departments the most comparable show a degradation of the phenomenon (+13%). The system is currently being deployed across France.


Assuntos
Comportamento Autodestrutivo , Tentativa de Suicídio , França , Humanos , Fatores de Risco
17.
Rev Prat ; 70(1): 59-61, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-32877031

RESUMO

Novel insight into suicidal behavior. This article presents four short examples of new insights into suicidal acts and innovative treatments. These include the results of cognitive neuroscience studies that have identified hypersensitivity to rejection, exclusion, and injustice signals in suicide attempters, as well as persisting trend for risky choices and insufficient cognitive control. These processes may be future therapeutic targets. Moreover, several studies showed on early suicidal trajectories, as well as residual epigenetic scars, as a result of childhood abuse. The people who were victims of these events may require specific intervention. In addition, artificial intelligence is a source of hope to account for the etiological and phenotypic complexity of suicidal behavior, and to establish more precise algorithms of medical decision-making. Ethical issues are raised at the same time. Finally, ketamine is today an innovative treatment (pending authorization) for the rapid reduction of suicidal ideation and a more effective crisis management.


Assuntos
Maus-Tratos Infantis , Suicídio , Inteligência Artificial , Criança , Humanos , Ideação Suicida , Tentativa de Suicídio
18.
PLoS One ; 15(9): e0238884, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32913352

RESUMO

In Australia, physiotherapists are registered healthcare practitioners who possess the knowledge and skills to care for clients with poor physical health as a result of musculoskeletal, neurological, and respiratory conditions. Although physiotherapists are not considered a primary profession in the Australian mental health workforce, the association between suicide and poor physical health suggests that they may encounter clients with suicidal thoughts and behaviours. We used a qualitative approach inspired by phenomenology to explore the experiences of nine physiotherapists who encountered clients with suicidal thoughts and behaviours. We used a combination of focus groups and in-depth interviews to collect this data. The data were analysed inductively using framework analysis. The main themes identified in the data were: i) the importance of trust, ii) the mechanism of conversation, and iii) the 'middle space'. The middle space refers to the experience of working with clients at risk of low or medium risk of suicide. A trusting practitioner-client relationship was reported to be essential in facilitating the disclosure of suicidal thoughts and behaviours. Physiotherapists also reported that less structured subjective assessments encourage clients to talk more openly, which in turn facilitates the disclosure of suicidal thoughts and behaviours. Once the disclosure of suicidal thoughts and behaviours occurred, physiotherapists reported a lack of confidence regarding role clarity and issues associated with this. Difficulties were most evident during encounters with clients with low to medium suicide risk due to a lack of confidence in the accuracy of assessment of these clients. The findings suggest that physiotherapists are well placed to detect and/or receive disclosure of suicidal thoughts and behaviours, as well as the need for physiotherapists to be trained in how to support clients who disclose suicidal thoughts and behaviours.


Assuntos
Fisioterapeutas/psicologia , Tentativa de Suicídio/psicologia , Confiança/psicologia , Adulto , Austrália , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Relações Profissional-Paciente , Pesquisa Qualitativa , Fatores de Risco , Ideação Suicida , Revelação da Verdade
19.
Actas esp. psiquiatr ; 48(4): 163-168, jul.-ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193804

RESUMO

INTRODUCCIÓN: La evaluación del riesgo suicida sigue siendo un hándicap para políticas públicas sanitarias. La conducta más predictiva del suicidio consumado es la tentativa suicida previa. Sin embargo, los estudios centrados en factores de riesgo, hasta la fecha, no han disminuido las tasas de muertes por suicidio. OBJETIVO: El objetivo de este estudio sería adaptar el Herth Hope Index (HHI) y la Beck Hopelessness Scale como instrumentos de evaluación de la esperanza y desesperanza en población clínica española que ha realizado una tentativa de suicidio y valorar su validez estructural y validez divergente. METODOLOGÍA: La muestra estuvo constituida por N=682 personas (62,4% mujeres), con edades comprendidas entre 18 y 77 años (M = 39; DT=19,1) con tentativas suicidas previas a los que se les aplicó la Herth Hope Index (HHI), la Beck Hopelessness Scale y la Escala de Resiliencia CD-RISC-10. RESULTADOS: Los resultados muestran que la HHI presenta una estructura bididimensional que explica el 71,2% de la varianza, una alta consistencia interna (alpha = 0,97), y adecua-da validez divergente con desesperanza de -0,77. Y además existen importantes diferencias en esperanza según el nivel de resiliencia de los participantes. CONCLUSIONES: El riesgo de suicidio debe evaluarse mediante enfoques preventivos y clínicos. La esperanza modula la resiliencia ante tentativas de suicidio y se ofrece una nueva escala breve adaptada a población clínica española y fácil de aplicar en urgencias hospitalarias que predice el nivel de vulnerabilidad futura al reintento de suicidio futuro más grave


INTRODUCTION: Suicide risk assessment remains a handicap for public health policies. Suicide is a major global public health problem. The most predictive behavior of completed suicide is prior suicide attempt. However, studies focused on risk factors have to date proved unsuccessful in reducing death by suicide rates. AIM: To adapt the Herth Hope Index and the Beck Hope-lessness Scale as assessment tools for assessing hope and hopelessness to a Spanish clinical population having carried out a suicide attempt, and assess its structural validity and divergent validity. METHODS: The sample comprised 682 people (62.4% female) aged between 18 and 77 years (M = 39; SD =19.1) with previous suicide attempts who were administered the Herth Hope Index (HHI), the Beck Hopelessness Scale, and the CD-RISC-10 Resilience Scale. RESULTS: The findings showed that the HHI had a two-dimensional structure that explains 71.2% of the variance, a high internal consistency (alpha = .97), and adequate divergent validity with hopelessness of -.77. And there are also important differences in hope according to the resilience level of the participants. CONCLUSION: The suicide risk should be assessed by preventive and clinical approaches. Hope modulates resilience to suicide attempts and a new short scale adapted to the Spanish clinical population is offered. This short tool is easy to use in emergency department settings and predicts the level of potential vulnerability to more serious future re-peated attempts


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Tentativa de Suicídio/psicologia , Inquéritos e Questionários , Resiliência Psicológica , Esperança , Fatores Socioeconômicos , Espanha
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