Violência autoprovocada no Espírito Santo: uma análise dos casos notificados / Self-inflicted violence in Espírito Santo: an analysis of reported cases / Violencia autoinfligida en Espírito Santo: un análisis de los casos notificados

Objetivo: identificar a frequência de casos notificados de violência autoprovocada no Espírito Santo entre os anos de 2011 a 2018 e os fatores associados. Método: trata-se de um estudo transversal que utilizou todos os casos notificados de violência autoprovocada registrados no Sistema de Informação de Agravos de Notificação entre 2011 e 2018 no estado do Espírito Santo. A análise multivariada foi realizada pela Regressão de Poisson e o estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: a prevalência da violência autoprovocada foi de 25,1% (IC95%: 24,6-25,5). O grupo de 10 a 19 anos de idade teve uma prevalência cerca de 19 vezes maior de notificação de violência autoprovocada, assim como, pessoas de raça/cor branca (RP: 1,26) e com deficiência/transtornos (RP: 2,85) apresentaram maior frequência desse agravo. Foi observado maior prevalência entre aqueles sem suspeita de uso de álcool (RP: 2,36), com a ocorrência cerca de 4 vezes maior na residência, e, um aumento em cerca de 50% dos casos sem caráter de repetição. Conclusão: a violência autoprovocada no Espírito Santo se apresentou elevada no período estudado e esteve associada a características da vítima e do evento. Profissionais de saúde são fundamentais no processo de rastreio desse agravo e consequentemente em traçar estratégias de prevenção e proteção das vítimas.(AU)

Objective: to analyze the prevalence of reported cases of self-inflicted violence and associated factors in Espírito Santo between 2011 and 2018.Method: this is a cross-sectional study that used all reported cases of self-inflicted violence registered in the Sistema de Informação de Agravos de Notificação between 2011 and 2018, in the state of Espírito Santo. Multivariate analysis was performed using Poisson Regression.Results: the prevalence of self-inflicted violence was 25.1%. The 10 to 19-year-old group had a prevalence of approximately 19 times greater self-inflicted violence report, as did people of white race/color (PR: 1.26) and people with disabilities/disorders (PR: 2.85) showed a higher frequency of this problem. A higher prevalence was observed among those without suspected alcohol use (PR: 2.36), with an occurrence approximately four times higher in the home, and an increase in approximately 50% of non-repeating cases.Conclusion: reports of self-inflicted violence in Espírito Santo were high during the period studied and were associated with characteristics of the victim and the event. Health professionals are fundamental in the process of tracking this problem and consequently in the process of designing prevention and protection strategies for victims.(AU)

Objetivo: analizar la prevalencia de casos notificados de violencia autoinfligida en Espírito Santo entre los años 2011 y 2018, así como los factores asociados. Método: se trata de un estudio transversal que utilizó todos los casos notificados de violencia autoinfligida registrados en el Sistema de Información de Agravios de Notificación entre 2011 y 2018 en el estado de Espírito Santo. El análisis multivariado se llevó a cabo mediante la Regresión de Poisson. Resultados: la prevalencia de la violencia autoinfligida fue del 25,1%. El grupo de 10 a 19 años de edad presentó una prevalencia aproximadamente 19 veces mayor de notificación de violencia autoinfligida. Asimismo, las personas de raza/color blanco (RP: 1,26) y con discapacidad/trastornos (RP: 2,85) mostraron una mayor frecuencia de este agravio. Se observó una mayor prevalencia entre aquellos sin sospecha de uso de alcohol (RP: 2,36), con una ocurrencia aproximadamente cuatro veces mayor en la residencia, y un aumento de alrededor del 50% en los casos sin carácter repetitivo. Conclusión: las notificaciones de violencia autoinfligida en Espírito Santo fueron elevadas en el período estudiado y se asociaron con características de la víctima y del evento. Los profesionales de la salud desempeñan un papel fundamental en el proceso de detección de este agravio y, consecuentemente, en el diseño de estrategias de prevención y protección de las víctimas.(AU)

Caracterização das violências autoprovocadas cometidas pelas pessoas idosas na Região Sul do Brasil de 2009 a 2016 / Characterization of self-inflicted violence committed by older people in southern Brazil from 2009 to 2016

Resumo Objetivo Descrever as características das pessoas idosas que cometeram violência autoprovocada, notificados no Sistema de Informação de Agravos de Notificação (SINAN) na região Sul do Brasil, de 2009 a 2016. Método Trata-se de um estudo de abordagem quantitativa, retrospectivo, descritivo e com dados secundários. As variáveis em relação as características sociodemográficas dos locais e dos meios de agressão foram selecionadas com base nas fichas de notificação. As variáveis foram submetidas à análise estatística descritiva por meio de frequência simples e proporção (%), foi estratificado por faixa etária (60-69 anos; 70-79 anos; 80 anos ou mais) e realizado os intervalos de confiança (IC95%). A significância estatística foi testada através do teste qui-quadrado (χ2) e considerado o valor de Resultados Os resultados mostraram que, na região Sul do Brasil, o perfil das pessoas idosas que cometeram violência autoprovocada são predominantemente de 60 a 69 anos (61,3%), do sexo masculino (56,1%), cor de pele branca (90,9%), com baixo nível educacional (56,3%) e casadas (54,0%). Entre os estados, o Rio Grande do Sul registrou o maior número de notificações (50,7%), predominaram como local de ocorrência a zona urbana (81,8%) e a residência/habitação coletiva (90,2%). Os meios de agressão mais utilizados foram o enforcamento (29,9%) e o envenenamento (24,9%). Observou-se a ocorrência de dois desfechos, a repetição (31,5%) da violência autoprovocada e os registros de óbitos (43,8%). Conclusão O delineamento do perfil epidemiológico, na região Sul do Brasil, identificou grupos de pessoas idosas que necessitam de maior atenção nas ações de prevenção e ocorrência da violência autoprovocada, sendo eles os idosos do sexo masculino, mais jovens e com baixa escolaridade.

Abstract Objective To describe the characteristics of older people who committed self-inflicted violence, reported in the Notifiable Diseases Information System (SINAN) in southern Brazil, from 2009 to 2016. Method This is a retrospective, descriptive study with a quantitative approach, and with secondary data. The variables in relation to the sociodemographic characteristics of the places and means of violence were selected based on the notification forms. Variables were subjected to descriptive statistical analysis using simple frequency and proportion (%), stratified by age group (60-69 years; 70-79 years; 80 years or more) and confidence intervals were performed (95%CI). Statistical significance was tested using the chi-square test (χ2) and considered the value of p≤0.05. Results The results showed that, in the southern region of Brazil, the profile of older people who committed self-inflicted violence are predominantly aged 60 to 69 years (61.3%), male (56.1%), white (90.9%), with low educational level (56.3%) and married (54.0%). Among the states, Rio Grande do Sul recorded the highest number of notifications (50.7%), urban areas (81.8%) and residences/collective housing (90.2%) predominated as places of occurrence. The most used means of violence were hanging (29.9%) and poisoning (24.9%). The occurrence of two outcomes was observed, repetition (31.5%) of self-inflicted violence and death records (43.8%). Conclusion The outlining of the epidemiological profile, in the southern region of Brazil, identified groups of older people who need more attention in the actions of prevention and occurrence of self-inflicted violence, being male older people, younger and with low education.

Factores de riesgo asociados a la conducta suicida en el adulto mayor / Risk factors associated with suicidal behavior in the elderly

RESUMEN Introducción: la conducta suicida es una de las cinco primeras causas de mortalidad en el mundo y se define como todo acto cometido en perjuicio propio de quien lo ejecuta, independientemente del grado de letalidad. Objetivo: describir algunos factores de riesgo asociados a la conducta suicida en el adulto mayor. Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo en el Policlínico «Octavio de la Concepción y la Pedraja¼, de Camajuaní. La población estuvo conformada por todos los pacientes adultos mayores, dispensarizados como riesgo de conducta suicida (140). Se realizó una revisión de las historias clínicas y se aplicaron: técnicas de observación, un cuestionario, una entrevista semiestructurada y una escala psicoafectiva. Resultados: la edad de los ancianos con conducta suicida es similar a los que no la tienen, U de Mann-Whitney Z = -1,008 y p = 0,313; el estado civil y la conducta suicida tienen una relación medianamente significativa con el sexo masculino p = 0,08, y muy significativa para el femenino p = 0,000. La relación es estadísticamente significativa para los factores depresión e intento previo, y altamente significativa para los problemas de pareja (55,2 %) y problemas familiares (51,7 %). Al relacionar gravedad de las circunstancias y seriedad de la intención, resultó nula para el ahorcamiento (55,6 %) y poca para la disección de vasos sanguíneos (50 %). Conclusiones: entre los factores de riesgo asociados se destacaron: depresión, intento previo, y drogo-dependencia; entre los métodos suaves o poco letales predominó la ingestión de fármacos en mujeres, y entre los métodos duros: el ahorcamiento y el envenenamiento en el sexo masculino.

ABSTRACT Introduction: suicidal behavior is one of the first five causes of mortality worldwide and is defined as any act committed to the detriment of the person who executes it, regardless of the degree of lethality. Objective: to describe some risk factors associated with suicidal behavior in the elderly. Methods: a descriptive, longitudinal and retrospective study was carried out at "Octavio de la Concepción y la Pedraja" Polyclinic from Camajuaní municipality. The population consisted of all elderly patients, classified as a risk of suicidal behavior (140). A review of the medical records was carried out; a questionnaire, a semi-structured interview, a psycho-affective scale and observation techniques were applied. Results: the age of the elderly with suicidal behavior is similar to those who do not, Mann-Whitney U Test Z = -1.008 and p = 0.313, m; marital status and suicidal behavior have a moderately significant relationship with male gender p = 0.08, and very significant for female gender p = 0.000. The relationship is statistically significant for depression and previous attempts, and highly significant for couple problems (55.2%) and family problems (51.7%). When relating the severity of the circumstances and the seriousness of the intention, it was null for hanging (55.6%) and few for dissection of blood vessels (50%). Conclusions: depression, previous attempts and drug dependence were among the associated risk factors; drug intake in women predominated between the mild or low-lethal methods, as well as, hanging and poisoning predominated in male gender among the hard methods.

Tentativa de suicídio, transtorno de estresse pós-traumático e fatores associados em mulheres do Recife / Suicide attempt, Post-traumatic stress disorder and associated factors in women of Recife

RESUMO: Objetivo: Investigar a associação da tentativa de suicídio (TS) com o transtorno de estresse pós-traumático (TEPT), a violência por parceiro íntimo (VPI) e variáveis relacionadas aos aspectos socioeconômicos e demográficos em uma coorte de mulheres cadastradas na Estratégia Saúde da Família do Recife. Métodos: Foi realizado um estudo transversal, aninhado em um estudo de coorte prospectivo, com 644 mulheres de 18 a 49 anos, cadastradas na Estratégia Saúde da Família do Distrito Sanitário II da cidade do Recife (PE), entre julho de 2013 e dezembro de 2014. A TS foi avaliada pela pergunta "Já tentou pôr fim à sua vida?", e o TEPT, diagnosticado por meio do Post-traumatic Stress Disorder Checklist - Civilian Version (PCL-C). Foram realizadas uma modelagem hierarquizada, a aplicação do teste χ2 e a análise de resíduos padronizados. A associação das variáveis independentes com a TS foi estimada por meio de regressão logística simples e ajustada. Resultados: A prevalência da TS foi de 10,9%, e a frequência de TEPT, de 16%. As mulheres que tinham TEPT e também as que não possuíam religião tiveram maior chance de tentar o suicídio (odds ratio - OR = 5,11, intervalo de confiança de 95% - IC95% 2,9 - 8,7; OR = 1,76, IC95% 1,0 - 2,9, respectivamente). Conclusões: Houve maior risco de TS nas mulheres que tiveram TEPT e baixa adesão a uma religião. Sendo assim, compreendeu-se que o enfrentamento do TEPT se dá prevenindo esse transtorno, tratando dele e promovendo mais conhecimentos sobre ele, além do efeito agregador e protetor social que a religiosidade promove, que também podem ser estratégias de redução e prevenção da TS.

ABSTRACT: Objective: To investigate the association of suicide attempt (SA) with Post-Traumatic Stress Disorder (PSTD), Intimate Partner Violence (IPV) and variables related to socioeconomic and demographic aspects in a cohort of women enrolled in the Family Health Strategy in Recife. Methods: A cross-sectional study was carried out, nested in a prospective cohort study with 644 women aged 18 to 49 enrolled in the Family Health Strategy of the Sanitary District II of Recife, PE, between July 2013 and December 2014. The SA was evaluated by the question "Have you ever tried to end your life?" PTSD was diagnosed through the Post-traumatic Stress Disorder Checklist - Civilian Version (PCL-C). A hierarchical modeling was performed, applying the χ2 test and Standardized Waste Analysis. The association of the independent variables with SA was estimated through simple and adjusted Logistic Regression. Results: The prevalence of SA was 10.9%, and the frequency of PSTD was 16%. Women who had PTSD and those who did not have a religion showed higher risk for suicide (odds ratio - OR = 5.11, 95%CI 2.9 - 8.7, OR = 1.76, 95%CI 1.0 - 2.9 respectively). Conclusions: There was a higher risk of SA in women who had PTSD and low adherence to a religion. Thus, it was understood that coping with PTSD comes from preventing, treating and promoting greater knowledge about this disorder, in addition to aggregating and social protective effect promoted by religiosity, which can be a strategy for the reduction and prevention of SA.

Child and adolescent violence: oral story of women who attempted suicide / Violencia en la infancia y adolescencia: historia oral de mujeres que intentaron suicidio / Violência na infância e adolescência: história oral de mulheres que tentaram suicídio

ABSTRACT Objective: To unveil expressions of intrafamily violence experienced in childhood and/or adolescence by women who attempted suicide. Method: This is a study with a qualitative approach based on Oral Story. Participants were ten women with a history of suicide attempt, who experienced intrafamily violence in childhood and/or adolescence. The research was carried out at the Center for the Study and Prevention of Suicide, linked to a Toxicological Information Center in the city of Salvador, Bahia, Brazil. Results: From the orality of women, the study allowed the emergence of the following representative categories of intrafamily abuse experienced in childhood and/or adolescence: psychological violence, rejection, neglect, physical violence and sexual violence. Final considerations: The study alerts to intrafamily violence as an aggravation related to suicidal behavior, offering elements that help in the identification of their expressions, which will raise awareness to suicidal behavior and consequently suicide prevention.

RESUMEN Objetivo: Desvelar las expresiones de la violencia intrafamiliar vivenciadas en la infancia y/o adolescencia por mujeres que intentaron suicidio. Método: Se trata de un estudio con enfoque cualitativo, fundamentado en la Historia Oral. Participaron diez mujeres con historia de intento de suicidio, que experimentaron violencia intrafamiliar en la infancia y/o adolescencia. La investigación fue realizada en el Núcleo de Estudo e Prevenção do Suicídio (Núcleo de Estudio y Prevención del Suicidio), vinculado a un Centro de Información Toxicológica en la ciudad de Salvador, Bahía, Brasil. Resultados: A partir de la oralidad de las mujeres, el estudio permitió emerger las siguientes categorías representativas de la expresión de abuso intrafamiliar vivenciada en la niñez y/o adolescencia: violencia psicológica (rechazo y negligencia), violencia física y violencia sexual. Consideraciones finales: El estudio alerta sobre la violencia intrafamiliar como agravio relacionado al comportamiento suicida, ofreciendo elementos que auxilian en la identificación de sus expresiones, lo que posibilitará atención para el comportamiento suicida y consecuentemente la prevención del suicidio.

RESUMO Objetivo: Desvelar as expressões da violência intrafamiliar vivenciadas na infância e/ou adolescência por mulheres que tentaram suicídio. Método: Trata-se de um estudo com abordagem qualitativa, fundamentada na História Oral. Participaram dez mulheres com história de tentativa de suicídio, que experienciaram violência intrafamiliar na infância e/ou adolescência. A pesquisa foi realizada no Núcleo de Estudo e Prevenção do Suicídio, vinculado a um Centro de Informação Toxicológica na cidade de Salvador, Bahia, Brasil. Resultados: A partir da oralidade das mulheres, o estudo permitiu emergir as seguintes categorias representativas da expressão de abuso intrafamiliar vivenciada na infância e/ou adolescência: violência psicológica (rejeição, negligência), violência física e violência sexual. Considerações finais: O estudo alerta para a violência intrafamiliar enquanto agravo relacionado ao comportamento suicida, oferecendo elementos que auxiliam na identificação de suas expressões, o que possibilitará atenção para o comportamento suicida e consequentemente prevenção do suicídio.

Factores de riesgo para intento de suicidio en personas con trastorno depresivo en atención secundaria / Risk factors for suicide attempts in people with depressive disorders treated in secondary health care

Background: Depression is the most common psychiatric disorder in people with suicidal behavior. The knowledge of its risk factors should help to design preventive strategies. Aim: To describe suicidal behavior and risk factors for attempted suicide in people with major depressive disorders (MDD). Material and Methods: A 12-month follow-up study was conducted in 112 outpatients at three psychiatric care centers of Ñuble, Chile, with baseline and quarterly assessments. Demographic, psychosocial and clinical factors as potential risk factors of suicide attempts, were assessed. A clinical interview with DSM-IV diagnostic criteria checklist, Hamilton Depression Scale and the List of Threatening Experiences and Multidimensional Scale of Perceived Social Support were applied. Results: Sixty seven percent of participants had suicidal ideation and 43.8% had attempted suicide. Suicide risk was significantly higher in participants with a single major depressive episode (odds ratio [OR] = 3.98; 95% confidence intervals [CI] = 1,29-12,32 p = 0.02) and those with previous suicide attempts (OR = 13.15; 95% CI = 3,87-44.7 p < 0.01). Young age, not having a partner, being unemployed, having a severe major depressive episode, having psychotic symptoms, having a personality disorder and being devoid of medical illness increased the risk of suicide attempts, but they did not reach statistical significance. Conclusions: Significant risk factors should be specially considered when designing suicide preventive strategies in patients with MDD.

Construction and validation of an instrument for the assessment of care provided to people with suicidal behavior / Construção e validação de instrumento para avaliação da assistência ao comportamento suicida

ABSTRACT OBJECTIVE To develop and validate an instrument for evaluating primary health care professionals' assistance to people with suicidal behavior. METHODS This was a methodological study, which began with a literature review, followed by the elaboration of an instrument. In its first version, the instrument had 34 items, divided into four domains: "professional characterization," "professional perception " "professional knowledge/abilities," and "organization of the care network." Contents were validated using the Delphi method. Semantic analysis was performed by college-educated primary health care professionals in greater and lesser strata of ability. For internal consistency analysis, Cronbach's alpha coefficient was calculated. The study was conducted between January and December 2017. RESULTS After four Delphi rounds, the instrument was successfully validated. In its final form, it is comprised of 50 items, divided into five domains: "professional characterization," "professional sensibility," "professional experience," "professional knowledge/abilities," and "organization of the care network." Questions belonging to the last four domains have answers on a five-point Likert scale. In the semantic analysis, 93.6% of the evaluations were "good" and "very good." The instrument's general Cronbach alpha was 0.90. CONCLUSIONS The final version of the instrument was able to fulfill its objectives. It is useful as a support for epidemiological research and planning of health actions. The evaluation of professional approaches to suicidal behavior is crucial for the organization of suicide assistance services in primary health care, and for the integration of services provided by different care units.

RESUMO OBJETIVO Desenvolver e validar um instrumento para avaliação da assistência às pessoas com comportamento suicida por profissionais da atenção primária à saúde. MÉTODOS Estudo metodológico iniciado com revisão de literatura e construção de um instrumento que, em sua primeira versão, continha 34 itens divididos em quatro domínios: "identificação profissional", "percepção profissional", "conhecimento/habilidade profissional" e "organização da rede de atenção". O conteúdo foi validado pela técnica Delphi. A análise semântica foi realizada por profissionais de nível superior de maior e menor habilidades da atenção primária à saúde. Para a análise da consistência interna, foi calculado o coeficiente alfa de Cronbach. O estudo foi realizado entre janeiro e dezembro de 2017. RESULTADOS Após quatro rodadas Delphi, o instrumento foi validado com 50 itens, divididos em cinco domínios: "identificação profissional", "percepção profissional", "experiência profissional", "conhecimento/habilidade profissional" e "organização da rede de atenção". Os últimos quatro domínios foram inseridos em escala Likert de cinco pontos. A análise semântica apresentou 93,6% de avaliações "bom" e "muito bom". O alfa de Cronbach geral do instrumento foi de 0,90. CONCLUSÕES O instrumento final mostrou-se capaz de avaliar o que se propõe. Pode auxiliar em pesquisas epidemiológicas e no planejamento de ações. A avaliação da abordagem profissional ao comportamento suicida é crucial para a organização dos serviços na atenção primária à saúde e para a integração dos diferentes pontos assistenciais de atenção.

Costos médicos directos por intento de suicidio en pacientes del hospital mental de Antioquia, Colombia / Direct medical costs of suicide attempts by patients in Columbia's Antioquia Mental Hospital / Custos médicos diretos por tentativa de suicídio em pacientes do hospital de saúde mental de Antioquia, Colômbia

RESUMEN Objetivo Analizar el comportamiento de los costos médicos directos en relación al número de intentos de suicidio y comparar los costos de atención cognitivo-conductual respecto al tratamiento convencional. Métodos Se cuantificaron los costos por prestación de servicios hospitalarios por intento de suicidio en 248 pacientes con diagnóstico de enfermedad mental atendidos en la empresa social del estado (E.S.E.) Hospital Mental de Antioquia y se implementó una evaluación de costo-consecuencia. Resultados Se encontró que los costos directos promedio de la atención de pacientes con cuatro o más intentos de suicidio fueron equivalentes a 5 641 dólares estadounidenses (USD), con una diferencia de USD 5 490 respecto al grupo con un solo intento. Además, dichos costos aumentaron conforme se incrementó el número de intentos. Por último, el diagnóstico de enfermedad mental (p. ej., cronicidad), el método de intento y la necesidad de servicios especializados se relacionaron con el incremento en los costos directos. Conclusiones La implementación de estrategias preventivas desde la salud pública que evalúen y hagan seguimiento a los factores psicosociales podría reducir la presentación de la problemática y de sus costos médicos directos.

ABSTRACT Objective Analyze the behavior of direct medical costs in relation to the number of suicide attempts and compare the costs of cognitive-behavioral therapy with those of conventional treatment. Methods The cost of hospital services for attempted suicide was quantified for 248 patients with a diagnosis of mental illness treated at the Antioquia Mental Hospital, a state social enterprise (E.S.E.), and a cost-outcome analysis was performed. Results It was found that the average direct cost of care for patients with four or more suicide attempts was equivalent to US$ 5,641, a US$ 5,490 difference vis-à-vis the group with a single attempt. Moreover, the cost increased with the number of attempts. Finally, the diagnosis of mental illness (e.g., chronicity), the method used in the suicide attempt, and the need for specialized services were associated with the increase in direct costs. Conclusions The use of a public health approach involving preventive strategies that assess and monitor psychosocial factors could reduce the problem and its direct medical costs.

RESUMO Objetivo Examinar o comportamento dos custos médicos diretos em relação ao número de tentativas de suicídio e comparar o custo da terapia cognitivo-comportamental e do tratamento convencional. Métodos O custo por prestação de serviços hospitalares por tentativa de suicídio foi mensurado em 248 pacientes com diagnóstico de doença mental atendidos no Hospital Mental de Antioquia, um serviço da previdência social do Estado, e foi conduzida uma análise de custo-consequência. Resultados Verificou-se que os custos diretos médios do atendimento de pacientes com quatro ou mais tentativas de suicídio foram equivalentes a US$ 5.641, com uma diferença de US$ 5.490 em relação aos custos para os pacientes com uma única tentativa de suicídio. Estes custos aumentaram conforme aumentou o número de tentativas. O diagnóstico de doença mental (por exemplo, doença crônica), o método de tentativa de suicídio e a necessidade de serviços especializados foram relacionados ao aumento dos custos diretos. Conclusões A implementação de estratégias de prevenção de uma perspectiva de saúde pública para avaliar e monitorar os fatores psicossociais poderia contribuir para reduzir a ocorrência do problema e os custos médicos diretos correspondentes.

Suicidally motivated intoxication by psychoactive drugs: characterization among the elderly / A intoxicação por psicofármacos com motivação suicida: uma caracterização em idosos

Abstract Objective: to characterize suicidally motivated intoxication by psychoactive drugs among elderly people. Method: a retrospective and documentary study with a quantitative approach was carried out, based on the notification forms of 692 cases of suicidally motivated intoxications by psychoactive drugs, registered by the Centro de Assistência Toxicológica (the Toxicological Care Center) in Fortaleza, Ceará, Brazil from 2010 to 2014. The absolute and relative frequencies of social conditions, intoxication episodes and clinical conducts were obtained, and the Chi-squared Test was applied with a significance of p≤0.05. Results: elderly people aged between 60 and 69 years (65.9%), who were female and retired predominated. The most frequently used psychoactive drugs were antidepressants (48.3%) and anxiolytics/hypnotics (29.0%). The most frequent clinical conducts were the use of activated charcoal and gastric lavage. Moderate poisoning was the most frequent, and the main outcome was discharge arising from cure. There was a significant relationship between the elderly persons and gender, occupation, occurrence of intoxication at home, clinical manifestation and hospital admission. Conclusion: suicidally motivated poisoning by psychoactive drugs in elderly persons suggests the need to promote active aging, as well as the access to and rational use of these drugs, thereby reducing harm and preserving the lives of elderly persons. AU

Resumo Objetivo: caracterizar as intoxicações por psicofármacos com motivação suicida em idosos. Método: documental, retrospectivo, com abordagem quantitativa, desenvolvido a partir de 692 fichas de notificação de intoxicação por psicofármacos com motivação suicida, registradas pelo Centro de Assistência Toxicológica, no período de 2010 a 2014, em Fortaleza, CE, obtendo frequências absoluta e relativa das condições sociais, dos episódios de intoxicação e das condutas clínicas. Ainda houve aplicação do Teste qui-quadrado com significância de p≤0,05. Resultado: predominaram os idosos com idade entre 60 e 69 anos de idade (65,9%), sexo feminino e ocupação aposentado. Os psicofármacos mais utilizados foram os antidepressivos (48,3%) e ansiolíticos/hipnóticos (29,0%). O envenenamento moderado é o mais frequente e o principal desfecho a alta por cura. Conclusão: intoxicação por psicofármacos com motivação suicida em idosos sugere a necessidade de promoção do envelhecimento ativo bem como acesso e uso racional desses medicamentos, o que reduz danos e preserva a vida de idosos. AU

Direct and indirect cost of attempted suicide in a general hospital: cost-of-illness study / Custo direto e indireto de tentativas de suicídio em um hospital geral: estudo de custo de doença

CONTEXT AND OBJECTIVE: Knowledge of socioeconomic impact of attempted suicide may sensitize managers regarding prevention strategies. There are no published data on this in Brazil. The aim here was to describe the direct and indirect costs of care of hospitalized cases of attempted suicide and compare these with the costs of acute coronary syndrome cases. DESIGN AND SETTING: Cost-of-illness study at a public university hospital in Brazil. METHOD: The costs of care of 17 patients hospitalized due to attempted suicide were compared with those of 17 acute coronary syndrome cases at the same hospital, over the same period. The direct costs were the summation of the hospital and out-of-hospital costs resulting from the event, determined from the medical records. The indirect costs were estimated through the human capital lost. The Mann-Whitney test and analysis of covariance (ANCOVA) with transformation adjusted for age were used for comparisons. RESULTS: The average costs per episode of attempted suicide were: direct cost, US$ 6168.65; indirect cost, US$ 688.08; and total cost, US$ 7163.75. Comparative analysis showed a difference between the indirect costs to family members, with significantly higher costs in the attempted suicide group (P = 0.0022). CONCLUSION: The cost of care relating to attempted suicide is high and the indirect cost to family members reinforces the idea that suicidal behavior not only affects the individual but also his social environment. .

CONTEXTO E OBJETIVO: O conhecimento do impacto socioeconômico das tentativas de suicídio pode sensibilizar gestores para programas de prevenção. No Brasil, não há dados publicados a esse respeito. O objetivo foi descrever os custos direto e indireto dos cuidados com as tentativas de suicídio de pacientes internados no hospital de uma universidade pública, e compará-los aos custos de casos de síndrome coronariana aguda. TIPO DE ESTUDO E LOCAL: Estudo de custo de doença em hospital universitário público no Brasil. MÉTODO: Os custos dos cuidados de 17 pacientes hospitalizados por tentativas de suicídio foram comparados aos custos de 17 síndromes coronarianas agudas de pacientes internados no mesmo hospital, no mesmo período. Os custos diretos foram o somatório de custos hospitalares e extra-hospitalares decorrentes do evento, determinados por registro hospitalar. Os custos indiretos foram estimados através da perda de capital humano. Teste de Mann-Whitney e análise da covariância (ANCOVA) com transformação por idade foram utilizados para comparação. RESULTADOS: As médias de custos por episódio de tentativa de suicídio foram: custo direto individual, US$ 6168,65; custo indireto individual, US$ 688,08; e custo total, US$ 7163,75. A análise comparativa indica diferença entre os custos indiretos a familiares dos dois fenômenos, com custos significativamente mais elevados no grupo de tentativas de suicídio (P = 0,0022). CONCLUSÃO: O custo dos cuidados com tentativa de suicídio é elevado e o custo indireto a familiares reforça a ideia de que o comportamento suicida não afeta apenas o indivíduo, mas também seu ambiente social. .

Comportamientos de riesgo para la salud en niños y adolescentes con intentos de suicidio y en sus familiares / Risk factors and behaviors among children and adolescents hospitalized for a suicidal attempt

Background: Suicidal behavior is the result of the interaction of several factors and represents an increasing health problem. Aim: To characterize epidemiologically children and adolescents with suicidal attempts and compare them to a control group. Material and Methods: A case-control and prospective study, based on clinical interviews and tests performed to 30 children and adolescents hospitalized due to a suicidal attempt and their parents or tutors, (GIS) and 40 ambulatory controls without such history (CG). Psychopathological disorders, risk behaviors (substance use, maltreatment, peer violence, sexual abuse and early sexual relations), family factors and their association with suicidal attempts, were analyzed. Results: Seventy seven percent of participants with a history of suicidal attempt had psychopathological disorders (depression in 38%) and a higher prevalence of suicidal behavior, maltreatment, substance and sexual abuse. Male sex was a risk factor for suicide among children under 12 years and female sex was a risk factor for adolescents aged over 12years. Other risk factors detected were a risky communication between parents and siblings. Conclusions: Children and adolescents who attempted suicide and their families have a higher prevalence of risk behaviors than the control group.

Conducta suicida en niños y adolescentes ingresados en un hospital general: Análisis descriptivo / Features of adolescents hospitalized for a suicide attempt in a general hospital

Background: Worldwide, suicide is the third cause of death among adolescents. Aim: To determine the socio-demographic context and clinical characteristics of children and adolescents hospitalized for suicidal behavior in a general hospital. Material and Methods: Between 2007 and 2009, we evaluated 47 patients with a mean age of 15.3 years (87% women) admitted for suicidal behavior at the Clinical Hospital of the Catholic University of Chile. Demographic data of the participants were registered. Clinical interviews were done by a child and adolescent psychiatrist. Results: Fifty seven percent of patients lived with both parents. Fifty one percent had previous suicide attempts and 68% had a previous psychiatric treatment. The main trigger was a conflict with parents in 66%. The psychiatric diagnoses were major depressive episode in 74.5% and pathological development of personality in 43%. All suicide attempts were with drugs and 6.4% were associated with cuts. Seventeen percent of attempts were classified as medically serious and they were more common in older age groups. Non severe attempts were observed mainly in women (92.3%). Acetaminophen intake was recorded in 8.5% of cases. Admission to hospital increased in the final quarter of the year. High costs of hospitalization were observed associated to stays in high complexity units. Conclusions: The population studied shows a high incidence of prior suicidal behavior. Most of the studied patients had attempts that were not classified as serious. These occurred predominantly in women in all age ranges. Medically serious suicidal behavior is mainly observed in older adolescents.

Atendimentos de emergência por tentativas de suicídio, Brasil, 2007 / Emergency room assistance for suicide attempts, Brazil, 2007

Introdução: o suicídio ocupa a terceira posição entre as causas de morte na faixa etária de 15 a 44 anos no mundo. Estima-se que os casos de tentativa de suicídio são 10 vezes mais frequentes do que o suicídio exitoso. Em 2008, a taxa no Brasil foi de 5,6/100.000 habitantes, variando de 2,3/100.000 entre mulheres a 9,1/100.000 entre homens. Objetivo: caracterizar os atendimentos de emergência por tentativa de suicídio nos serviços sentinela do Sistema de Vigilância de Acidentes e Violência-VIVA, de municípios selecionados no Brasil em 2007. Métodos: estudo descritivo conduzido em 84 serviços públicos de emergência, por meio de entrevistas realizadas durante 30 dias consecutivos, em turnos alternados de 12 horas. Resultados: foram registrados 516 atendimentos de emergência por tentativa de suicídio, sendo 58,1% entre mulheres. As mais altas proporções de atendimento ocorreram na faixa etária de 20 a 29 anos (35,9%), nos indivíduos de cor parda (53,9%) e com escolaridade entre nove e 11 anos de estudo. O meio de transporte mais utilizado pelas vítimas para chegar ao hospital foi veículo particular. Aproximadamente 25% dos pacientes relataram consumo de bebida alcoólica e 82,0% dos casos ocorreram na residência. Quanto à natureza da lesão, foram mais comuns os atendimentos por intoxicação (62,0%) e o principal meio utilizado para a tentativa de suicídio foi o envenenamento intencional (70,0%). Conclusão: os resultados apresentados permitiram conhecer o perfil dos atendimentos por tentativa de suicídio, além de subsidiar o planejamento de políticas de controle e prevenção efetivas, fundamentais para a redução do impacto desse agravo na população.

IIntroduction: suicide ranks as third position among death causes in the age group 15 to 44 in the world. Suicide attempts are estimated to be 10 times more frequent than successful suicide. In 2008, Brazil rate was 5, 6/100.000 inhabitants, varying from 2, 3/100.000 among women to 9,1/100.000 among men. Objective: to characterize the emergency room assistance for suicide attempts in the watch services of the Sistema de Vigilância de Acidentes e Violência -VIVA (Surveillance System for Accidents and Violence), in selected municipalities in Brazil in 2007. Methods: descriptive study carried out in 84 public emergency services, through interviews, during 30 consecutive days, in alternate 12 hour shifts. Results: 516 emergency cases of suicide attempts were recorded, 58,1% among women. The highest proportions were found among individuals aged 20 to 29 years (35,9%), of mixed race origin (53.9%) and with schooling between 9 to 11 years of study. The means of transport most used by the victims to reach the hospital was private vehicles. Approximately 25% of patients reported alcoholic beverages use and 82,0 % of cases occurred at home. Concerning the lesions, the most common were poisoning (62,0%) and the main used mean for suicide attemptwas intentional poisoning (70,0%). Conclusion: the findings allowed the assessment of the profile of the attendance for suicide attempts, and the support for planning effective control and prevention policies fundamental for reducing the impact of this injury on the population.

Diferencias clínicas entre adolescentes hospitalizados por intento suicida y adolescentes hospitalizados por otra causa psiquiátrica / Clinical differences between suicide and non suicide attempter hospitalized adolescents

Background: Suicide is the third cause of death among adolescents in United States and between 5 to 12 percent of teenagers have a history of suicide attempt. Therefore, suicide is a public health problem in this age group. Aim: To compare the clinical characteristics of hospitalized adolescents who attempted suicide with those without a history of suicide attempt. Material and Methods: The clinical records of adolescents aged less than 18years, hospitalized in a psychiatric clinic, were analyzed. Forty six patients aged 15 ±2years (72 percent females) had a history of suicide attempt and were considered cases and 81 patients aged 15 ±2 years (52 percent females) did not have a history of suicide attempt and were considered controls. Demographical and clinical characteristics of both groups were compared. Psychiatric diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders IV (DSMIV). Results: No significant differences were found between groups in the length of hospital stay. The most common psychiatric diagnosis was depressive disorder, found in 71 and 35 percent of suicide and non-suicide attempters, respectively (p < 0.01). Personality diagnosis was deferred in most studied cases. Conclusions: Depression is more common among hospitalized adolescents who attempt suicide.

Gender differences in suicide attempts: preliminary results of the multisite intervention study on suicidal behavior (SUPRE-MISS) from Campinas, Brazil / Diferenças entre os sexos nas tentativas de suicídio: resultados iniciais do estudo multicêntrico de intervenção no comportamento suicida (SUPRE-MISS) obtidos em Campinas, Brasil

OBJECTIVE: To identify sociodemographic, psychosocial and clinical differences between men and women who attempted suicide and were seen at a university general hospital. METHOD: This is a non-controlled cross-sectional study, sub-project of the Multisite Intervention Study on Suicidal Behavior by the World Health Organization. A standardized interview that comprised psychometric scales was used. The comparison between genders was made by means of uni and multivariate logistic regression. RESULTS: 210 subjects (68.1 percent women) participated. Women had worse scores on the WHO Well-Being Index (p = 0.005), the Beck Depression Inventory (p = 0.01) and the Psychiatric Disability Assessment Schedule (p = 0.03). In the multivariate logistic regression, men presented more mental disorders due to alcohol and drug use (26.1 percent vs 7 percent, p = 0.02) and used alcohol at the suicide attempt more frequently (28.3 percent vs 16 percent, p = 0.03). Men reported that most of the time they had been feeling "active and vigorous" (50 percent vs 22 percent, p < 0.001). Women had had more physical and sexual abuse (27 percent vs 8.7 percent, p = 0.01). CONCLUSION: There are some distinctive characteristics between men and women who attempt suicide. Such differences may also be present in the general population and suggest there is a need for further studies, as well as the adoption of different strategies in suicide prevention for men and women.

OBJETIVO: Identificar diferenças entre os sexos em variáveis sociodemográficas, psicossociais e clínicas em indivíduos que tentaram o suicídio e foram atendidos em um hospital geral universitário. MÉTODO: Estudo transversal não-controlado, subprojeto do Estudo Multicêntrico de Intervenção no Comportamento Suicida, da Organização Mundial de Saúde. Utilizou-se uma entrevista padronizada, incluindo escalas psicométricas. A comparação entre os sexos foi feita usando-se regressão logística uni e multivariada. RESULTADOS: Dos 210 sujeitos, 143 (68,1 por cento) foram do sexo feminino. As mulheres tiveram piores escores no Índice de Bem-Estar OMS (p = 0,005), na escala de Beck de Depressão (p = 0,01) e na escala de Desempenho do Papel Social (p = 0,03). Na regressão logística multivariada, encontraram-se mais problemas por uso de álcool e drogas entre os homens (26,1 por cento vs 7 por cento, p = 0,02). Estes se valeram mais dessas substâncias na tentativa de suicídio (28,3 por cento vs 16 por cento, p = 0,03) e relataram que "vinham se sentindo vigorosos" a maior parte do tempo (50 por cento vs 22 por cento, p < 0,001). Mulheres relataram ter sofrido mais abuso físico e sexual (27 por cento vs 8,7 por cento, p = 0,01). CONCLUSÃO: Encontraram-se algumas características distintas entre homens e mulheres que tentaram suicídios. Tais diferenças, que podem estar igualmente presente na população geral, sugerem novos estudos e a adoção de diferentes estratégias visando à prevenção do suicídio entre homens e mulheres.

Características clínicas de niños y adolescentes menores de 18 años hospitalizados en una clínica psiquiátrica universitaria / Clinical characteristics of children and adolescent hospitalized in a University Psychiatric Clinic

Blackground: Five percent of children and adolescents consults in mental health services in one year. Approximately one every ten children has a mental health problem. Aim To assess clinical and demographic factors of children and adolescents hospitalized by psychiatric cause in a university psychiatric clinic. Patients and Methods: Review of medical records of 167 subjects aged 9 to 17 years, 97 women, admitted to a Psychiatric Service in the period 2001-2004. The International Classification of Primary Care (ICPC) manual of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) was used to classify admission complaints and symptoms and DSMIV to classify psychiatric disorders. Results: Mean hospital stay was 11+8 days. The main admission causes were suicidal attempts and psychomotor agitation/impulsive behavior in 54 percent and 26 percent of cases, respectively. The main psychiatric diagnoses were depressive disorder, suicide attempt and bipolar disorder. In 69 percent of patients, the personality diagnosis was deferred. Only 25 percent of families were considered functional. Conclusions: Affective disorders and suicidal behavior are the main psychiatric diagnoses at discharge in children and adolescents admitted to a psychiatric impatient service.