Reasons for attempting suicide among men who use alcohol and other drugs

Tentativa de suicídio por pessoas com transtornos relacionados ao uso de substâncias em tratamento

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

Espacialização da mortalidade por transtornos mentais e comportamentais atribuível ao uso de substâncias psicoativas no Brasil, de 2012 a 2016

Introdução: Os transtornos mentais e de comportamento atribuíveis ao uso de substâncias psicoativas consistem em importante problema de saúde pública, dada a sua prevalência e o risco de promoverem incapacidade e morte. Objetivo: Analisar a distribuição espacial da mortalidade por transtornos mentais e comportamentais atribuível ao uso de substâncias psicoativas no Brasil. Métodos: Estudo ecológico em municípios do Brasil, no período de 2012 a 2016. Analisou-se a distribuição espacial, a intensidade e a significância através do índice de Moran Global, MoranMap e BoxMap. Resultados: A maioria dos óbitos foi atribuível ao uso do álcool (n = 33.177; 77,36%) , seguido do fumo (n = 7.262; 16%) e do uso de múltiplas drogas (n = 1.409; 3,29%), sendo que a maioria (n = 36.861; 85,97%) era do sexo masculino e 46.31% solteiros. Nas faixas de idade entre 40 a 59 anos houve 21.712 óbitos (50,63%), e entre 60 anos e mais, 13.445 óbitos (31,35%). Os municípios que apresentaram as maiores taxas médias de mortalidade padronizadas (óbitos/100 mil hab.) foram: Charrua–RS (43,60), Uru–SP (43,19), Riacho da Cruz–RN (42,21), Senhora do Porto–MG (42,19), Mata–RS (36,81), Pendências–RN (35,26) e Catuji–MG (35,19). O valor do Índice Global de Moran foi de 0,216 (p = 0,01). No MoranMap observou-se formação de cluster de alto/alto nas regiões Nordeste e Sudeste. Conclusão: Existe no Brasil um padrão de dependência espacial na distribuição das taxas de mortalidade atribuíveis ao uso de substâncias psicoativas.

Personal values in adolescence and suicidality: a cross-sectional study based on a retrospective recall

BACKGROUND

This study retrospectively examined the association between personal values in adolescence and suicidality in a community-representative adult sample in Japan.

METHODS

Data were used from wave 1 (2010) and wave 3 (2017) of a Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE) survey. Personal values at age 15 were retrospectively measured in 2017 in two ways: the original value priorities we made were based on the Schwartz theory of basic values; and the Japanese version of the Personal Values Questionnaire II (PVQ-II) was used to assess the degree of commitment to the values. Multivariate logistic regression analysis was used to estimate the association of personal values in adolescence with self-reported suicidal ideation, suicidal planning, and suicide attempt (both during a lifetime and in the most recent year), adjusting for socio-demographics, smoking, alcohol consumption, and economic status among 15 year olds.

RESULTS

Cherishing family and friends was significantly and negatively associated with suicidal ideation over a lifetime and in the most recent year. Commitment to values was also significantly and negatively associated with suicidal ideation in the most recent year.

CONCLUSIONS

Investigating the association between personal values and suicidality could make a significant contribution to the literature by offering a new approach to understanding and preventing suicide.

Clinical Prediction of Suicide and Undetermined Death: A Pseudo-Prospective Clinical and Medico-Legal Study of Substance Abusers

This study examines aspects of prediction of suicide and death of undetermined intent. We investigated all consecutive, autopsied patients between 1993 and 1997 who had been in contact with the Addiction Centre in Malmö from 1968 onwards. The staff was asked, shortly after autopsy but before they knew of the manner of death, if they thought the patient had committed suicide. The case records were blindly evaluated, and toxicological autopsy findings for alcohol in blood samples investigated. The specificity of prediction was 83% and significantly more often correct than the sensitivity, which was only 45% for suicide and for suicide/death of undetermined intent (93% versus 39%). Suicidal communication was more often considered non-serious before death of undetermined intent than before suicide. The former could be predicted by ideation but not by suicide attempt reported in case records, unlike suicide, which was predicted by both. The undetermined group also showed higher levels of alcohol in the blood at autopsy. We concluded that more serious clinical investigation of suicidal feelings, which may be hidden and not taken seriously, and treatment of alcohol use disorders with active follow-up appear urgent in the efforts to prevent suicide.

Harm Reduction and Tensions in Trust and Distrust in a Mental Health Service: A Qualitative Approach

BACKGROUND

People seeking care for substance use (PSCSU) experience deep social and health inequities. Harm reduction can be a moral imperative to approach these persons. The purpose of this study was to explore relationships among users, health care providers, relatives, and society regarding harm reduction in mental health care, using a trust approach rooted in feminist ethics.

METHODS

A qualitative study was conducted in a mental health service for PSCSU, and included fifteen participants who were health care providers, users, and their relatives. Individual in-depth and group interviews, participant observation, and a review of patients' records and service reports were conducted.

RESULTS

Three nested levels of (dis)trust were identified: (dis)trust in the treatment, (dis)trust in the user, and self-(dis)trust of the user, revealing the interconnections among different layers of trust. (Dis)trust at each level can amplify or decrease the potential for a positive therapeutic response in users, their relatives' support, and how professionals act and build innovations in care. Distrust was more abundant than trust in participants' reports, revealing the fragility of trust and the focus on abstinence within this setting.

CONCLUSION

The mismatch between wants and needs of users and the expectations and requirements of a society and mental health care system based on a logic of "fixing" has contributed to distrust and stigma. Therefore, we recommend policies that increase the investment in harm reduction education and practice that target service providers, PSCSU, and society to change the context of distrust identified.