Prevalência de transtornos mentais nas tentativas de suicídio em um hospital de emergência no Rio de Janeiro, Brasil

The effect of common mental disorders on suicidal attempts by women, during pregnancy and six to nine years after birth

There is scarcity of global data on suicide attempts (SA). The higher frequency of mental disorders places women at a higher risk for SA. Mental disorders (MD) are ranked first in the Global Burden of Diseases (GBD) in terms of years lived with disability (YLD) and common mental disorders (CMD) affect women the most. IN this light, the present study aimed to investigate the impact of CMD during pregnancy, as well as 6 to 9 years after birth, on SA in women who were registered in the Family Health Strategy from the town of Recife, Pernambuco, Brazil. This study consisted of two stages of a prospective cohort. 643 adult women were included. The prevalence of CMD in stage I (pregnancy) and in stage III (six to nine years after birth) were, respectively, 19.3% and 12.6%. The incidence of SA was 10.9%. The multivariate analysis demonstrated a cumulative effect of CMD for SA: only during pregnancy (OR 5.4; 95%CI 2.2-13.3); only in the third stage (OR 5.8; 95%CI 2.3-14.9); and in both stages (OR 6.0; 95%CI 2.5-14.4). The increase of CMD in women increases the chances of SA, hence the importance of implementing public policies for women's health, especially for those with a history of mental disorders and unhealthy habits, and those who suffer violence.

Hospitalization due to mental and behavioral disorders caused by use of alcohol and psychoactive substances among older adults and elderly people in Brazil: a cross-sectional study

BACKGROUND

It has been estimated that 17% of individuals aged 50 years or older suffer from addiction to legal or illegal drugs. Use of alcohol and psychoactive substances has been correlated with several diseases, e.g. psychiatric conditions and cardiovascular and sexual dysfunctions.

OBJECTIVE

To discuss the Brazilian profile of mental and behavioral disorders caused by use of alcohol and psychoactive substances among older adults and elderly people, over the period from 2008 to 2019.

DESIGN AND SETTING

Cross-sectional study conducted among Brazilians aged 50 years or older.

METHODS

Hospitalization due to mental and behavioral disorders caused by use of alcohol and psychoactive substances was assessed through data obtained from the National Health System Department of Informatics (Departamento de Informática do Sistema Único de Saúde, DATASUS).

RESULTS

Decreasing and steady trends of hospitalization due to mental and behavioral disorders caused by use of alcohol among both men and women at all ages were observed. Similar trends were reported for all age ranges among men and women aged 60 years and older. In contrast, a slight increase was seen among women aged 50 to 59 years.

CONCLUSION

These data are crucial for qualifying mental healthcare for older adults and elderly people and for planning mental health services.

Influence of the global crisis of 2008 and the brazilian political oscillations of 2014 on suicide rates: An analysis of the period from 2002 to 2017

Global suicide rates have increased in recent decades becoming a serious social and public health problem. In Brazil, rates have been increasing annually. We aimed to analyze the correlation between suicide mortality rates and global economic and political crisis periods of 2008 and 2014 in Brazil. The analysis of suicide mortality in Brazil was done using a time-series segmented linear regression model that estimated the trend of rates over time. To obtain the model, changes in the trend of both abrupt and gradual suicide rates were investigated. The results indicate statistically significant changes showing an upward trend of suicide rates during the world economic crisis (2008-2013) and during the economic and political crisis in Brazil (2014-2017) compared to previous periods, especially at the extremes of schooling (3 < years and > 8 years). Among white and parda, there were significant trend rates increases in both periods and in different regions. In the Northeast and South regions, we observed a significant increase in the trend rate for males after the Brazilian economic and political crisis (2014 to 2017). We can conclude that the national suicide rates were influenced by the economic and political instability that our country has been going through since 2008, affecting each region differently. Further studies are needed to explore the reasons for interregional differences and the relation of suicide with unemployment rates and possible economic predictors.

Trends in suicidal behavior at a general hospital emergency department in southern Brazil

OBJECTIVE

To assess the prevalence of and factors associated with suicidal behavior in patients seen at the emergency department (ED) of a general hospital in southern Brazil.

METHOD

Descriptive, observational, cross-sectional study. The records of all patients who had an emergency psychiatric consultation at the ED conducted by the emergency psychiatric consultation service at Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul in 2016 and 2017 were analyzed and stratified by sex and by age groups (15-29 years, 30-49 years, 50-69 years, and 70 years and older). Suicidal behavior was characterized by factors such as thoughts of death, suicidal thoughts, and suicidal risk. Suicidal behavior was compared by sex and between age groups with chi-square tests. Multivariate analysis of suicidal behavior and gender, age, and specific diagnoses were compared with Poisson regression.

RESULTS

A total of 1,172 records from January 2016 to December 2017 were examined. There were more ED visits by females (63.1%) than males. Younger patients (15-29 years) had a higher severe risk of suicide than elderly (≥ 70 years) patients (54.1 vs. 19%; p < 0.01). Indicators of suicide behavior stratified by sex and by age group revealed marked differences between age groups for all variables among female patients. Overall, age group patterns for males were very similar in terms of suicidal behavior variables.

CONCLUSIONS

A high prevalence of suicidal behavior was observed in this sample, particularly among young adults and especially associated with female gender and diagnoses of depression and personality disorders.

Suicide attempts notified in a teaching hospital in the state of rio grande do sul, 2014-2016

Objetivo: caracterizar as tentativas de suicídio notificadas em um hospital de ensino no estado do Rio Grande do Sul, Brasil. Método: pesquisa quantitativa e retrospectiva, que foi realizada no Núcleo de Vigilância Epidemiológica de um hospital de ensino, a partir da análise de notificações de tentativa de suicídio registradas entre os anos de 2014 e 2016. Os dados foram analisados segundo estatística descritiva. Resultados: registraram-se 344 notificações de tentativa de suicídio, com uma tendência decrescente no período. As características foram predominantes para o sexo feminino (65,1%), faixa etária de 25 a 59 anos (67,7%), e meio de autoagressão por intoxicação exógena (61,6%). Para 93% das pessoas que tentaram suicídio registrou-se alguma deficiência ou transtorno associado. Conclusão: a tendência decrescente de notificações precisa ser esclarecida, uma vez que os números de suicídios ascendem em nível estadual e nacional. Dar visibilidade a esse panorama possibilita a instrumentalização da gestão.

Psychiatric morbidity and suicidal behaviour in low- and middle-income countries: A systematic review and meta-analysis

BACKGROUND

Psychiatric disorders are reported to be present in 80% to 90% of suicide deaths in high-income countries (HIC), but this association is less clear in low- and middle-income countries (LMIC). There has been no previous systematic review of this issue in LMIC. The current study aims to estimate the prevalence of psychiatric morbidity in individuals with suicidal behaviour in LMIC.

METHODS AND FINDINGS

PubMed, PsycINFO, and EMBASE searches were conducted to identify quantitative research papers (any language) between 1990 and 2018 from LMIC that reported on the prevalence of psychiatric morbidity in suicidal behaviour. We used meta-analytic techniques to generate pooled estimates for any psychiatric disorder and specific diagnosis based on International classification of disease (ICD-10) criteria. A total of 112 studies (154 papers) from 26 LMIC (India: 25%, China: 15%, and other LMIC: 60%) were identified, including 18 non-English articles. They included 30,030 individuals with nonfatal suicidal behaviour and 4,996 individuals who had died by suicide. Of the 15 studies (5 LMIC) that scored highly on our quality assessment, prevalence estimates for psychiatric disorders ranged between 30% and 80% in suicide deaths and between 3% and 86% in those who engaged in nonfatal suicidal behaviour. There was substantial heterogeneity between study estimates. Fifty-eight percent (95% CI 46%-71%) of those who died by suicide and 45% (95% CI 30%-61%) of those who engaged in nonfatal suicidal behaviour had a psychiatric disorder. The most prevalent disorder in both fatal and nonfatal suicidal behaviour was mood disorder (25% and 21%, respectively). Schizophrenia and related disorders were identified in 8% (4%-12%) of those who died by suicide and 7% (3%-11%) of those who engaged in nonfatal suicidal behaviour. In nonfatal suicidal behaviour, anxiety disorders, and substance misuse were identified in 19% (1%-36%) and 11% (7%-16%) of individuals, respectively. This systematic review was limited by the low number of high-quality studies and restricting our searches to databases that mainly indexed English language journals.

CONCLUSIONS

Our findings suggest a possible lower prevalence of psychiatric disorders in suicidal behaviour in LMIC. We found very few high-quality studies and high levels of heterogeneity in pooled estimates of psychiatric disorder, which could reflect differing study methods or real differences. There is a clear need for more robust evidence in order for LMIC to strike the right balance between community-based and mental health focussed interventions.

Promoção de saúde, participação em ações coletivas e situação de violência entre usuários da Atenção Primária à Saúde

RESUMO Este artigo visa a analisar a relação entre a promoção de saúde, mensurada por meio da participação em ações coletivas, e a violência entre usuários das unidades de saúde da atenção primária, no município de Ribeirão das Neves (MG). Trata-se de estudo de abordagem quantitativa, cuja metodologia consiste de entrevistas semiestruturadas com usuários da atenção primária do município de Ribeirão das Neves (MG). A análise estatística foi baseada em tabelas de frequências absolutas e percentuais para as distribuições uni e bivariada, destacando-se o perfil sociodemográfico. As associações e suas significâncias estatísticas foram avaliadas por meio do teste Qui-quadrado e da análise de correspondência. Foram entrevistados 628 usuários de 58 Unidades Básicas de Saúde; as violências mais frequentes foram: verbal, psicológica e tentativa de suicídio. A participação em ações coletivas está predominantemente ligada a cultos religiosos. O desenvolvimento de ações de prevenção à violência na atenção primaria é baixo. Na análise de correspondência, a baixa frequência de ações coletivas se associou fortemente à presença de violência e à tentativa de suicídio. A presença de ações ligadas a atividades esportivas/artísticas se associa à ausência de violência verbal e sexual; a participação em associações/sindicatos se associa à ausência de violência psicológica, física e tentativa de suicídio; por fim, ações de trabalho voluntário se associam à ausência de violência sexual, ter parente assassinado e conhecer alguém que foi assassinado. Concluiu-se que a participação e a não participação em ações coletivas se associam, respectivamente, com menor e maior prevalência de violência.

Suicides by hanging and its association with meteorological conditions in São Paulo

The main goal of this study was to evaluate the association between daily cases of hanging suicides and meteorological conditions in São Paulo, Brazil. We considered a retrospective observational study based on the analysis of all necroscopic medical-expert reports available in digital form from the central unit of the Instituto Médico Legal (Medical Legal Institute) of São Paulo between July 1, 2006 and June 31, 2007. The meteorological variables were combined via Principal Components Analysis. In order to explain their association with the frequency of suicides, Poisson regression models were employed. The analysis suggests that hotter and brighter days are associated with higher incidence of hanging suicides.

Depressão em Adolescentes: Revisão da Literatura e o Lugar da Pesquisa Fenomenológica

Resumo Atualmente a depressão em adolescentes consiste em um fenômeno complexo e cada vez mais recorrente. Visando identificar e discutir os estudos que estão sendo produzidos sobre este tema, realizamos uma revisão de literatura com base em pesquisas indexadas nos bancos de dados SciELO; Portal de Periódicos da Capes; BDTD; APA; ScienceDirect; Redalyc; Lillacs e MedLine, mediante cruzamento das palavras-chave: depressão e adolescência; depressão em adolescentes; depression in adolescentes; depresión en adolescentes. Foram identificados 247 textos, sendo que, após apreciação baseando-se nos critérios de elegibilidade, restaram 159 estudos. Num primeiro momento, essas pesquisas foram organizadas quantitativamente e, a seguir, por uma análise qualitativa. Os estudos evidenciaram cinco categorias temáticas: sintomas depressivos; fatores associados à variabilidade sintomatológica; eventos estressores e fatores de risco; comorbidades associadas à depressão em adolescentes e depressão e suicídio em adolescentes. Os eixos abordados demonstram que ainda existe muito a discorrer sobre essa forma de adoecimento, em virtude dos múltiplos contornos que a constituem. Destacamos a escassez de trabalhos pautados em uma perspectiva fenomenológica, apesar do gradativo crescimento nos últimos anos. Sugere-se a fomentação, bem como a construção de novos espaços de discussão, no intuito de auxiliar os profissionais que estão envolvidos com essa temática em sua praxis.

Prevalence of behavior problems and associated factors in preschool children from the city of Salvador, state of Bahia, Brazil

Objective:

To identify the prevalence of internalizing and externalizing behavior problems among preschoolers from the city of Salvador, state of Bahia, Brazil, and their associations with maternal mental health and family characteristics.

Methods:

This was a cross-sectional study of 349 children aged 49 to 72 months, randomly selected from 20,000 households representing the range of socioeconomic and environmental conditions in Salvador. In 1999, we assessed sociodemographic variables and family environment characteristics. In 2001, we used the Child Behavior Checklist to measure and describe the frequencies of behavior problems. We conducted bivariate and multivariate analysis to estimate associations between family and maternal factors and prevalence of behavior problems.

Results:

The overall prevalence of behavior problems was 23.5%. The prevalence of internalizing problems was 9.7%, and that of externalizing problems, 25.2%. Behavior problems were associated with several maternal mental health variables, namely: presence of at least one psychiatric diagnosis (odds radio [OR] 3.01, 95%CI 1.75-5.18), anxiety disorder (OR 2.06, 95%CI 1.20-3.46), affective disorder (OR 2.10, 95%CI 1.21-3.65), and mental health disorders due to use of psychoactive substances (OR 2.31, 95%CI 1.18-4.55).

Conclusion:

The observed prevalence of child behavior problems fell within the range reported in previous studies. Maternal mental health is an important risk factor for behavior problems in preschool-aged children.

The Quality of Prenatal Period Nursing Care from the Perspective of Pregnant Women

Introducción: la calidad de la atención a la embarazada exige acogimiento, escucha, envolvimiento y compromiso, además de la resolución de problemas o disponibilidad de recursos tecnológicos e infraestructura. Objetivo: describir la visión de las embarazadas acerca de la calidad de la asistencia de enfermería en el periodo prenatal e identificar las expectativas y necesidades de las mujeres en esa perspectiva. Materiales y métodos: investigación cualitativa, exploratoria, realizada en el Hospital de Rio de Janeiro, Brasil. Participaron veinte embarazadas. Se utilizó la entrevista abierta e individual; el referencial metodológico fue el análisis del contenido de Bardin. La investigación fue aprobada por el Comité de Ética, los sujetos fueron las mujeres embarazadas en su mayoría casadas y con la enseñanza media completa. Resultados: como resultados satisfactorios emergieron aquellos referentes por la atención recibida por parte de los enfermeros en el prenatal, mientras la insatisfacción se dio por la infraestructura, los recursos materiales y la falta de una unidad materna para la atención del parto. Conclusiones: la visión de las madres frente a la atención prestada en el prenatal fue positiva en cuanto a sus expectativas y necesidades. La calidad de la asistencia está centrada en la interacción de los profesionales de enfermería durante los momentos de verdad donde las embarazadas entran en contacto con la atención, desde la admisión hasta el alta.

Tentativas e suicídios por intoxicação exógena no Rio de Janeiro, Brasil: análise das informações através do linkage probabilístico

A intoxicação exógena é um dos três principais meios utilizados nas tentativas e suicídios. Com o objetivo de melhorar a qualidade destas informações foi realizado um estudo seccional descritivo dos registros sobre casos do Estado do Rio de Janeiro, Brasil, período 2006-2008, presentes nos bancos de dados do Sistema de Informações sobre Agravos de Notificação (SINAN), Sistema de Informações sobre Mortalidade (SIM) e Centro de Controle de Intoxicação de Niterói (CCIn-Niterói). Através do método de relacionamento probabilístico desenvolveu-se um modelo de monitoramento dos casos de tentativas/suicídios devido intoxicação. Embora 68,8% dos 948 registros do CCIn tenham sido reportados por profissionais de saúde, apenas 2,6% constavam nos demais sistemas. O pareamento CCIn e SIM apresentou uma subnotificação de 61,3%. Sabe-se da importância da informação para a vigilância, formulação de políticas públicas, além de tomadas de decisão. O método de relacionamento de bancos de dados permitiu a identificação dos problemas existentes em cada sistema, proporcionou melhor qualidade das informações e maior proximidade com a situação real de agravos complexos e graves como o comportamento suicida.

Prevalence of suicide risk and comorbidities in postpartum women in Pelotas

OBJECTIVES

To evaluate the prevalence of suicide risk and comorbidities in postpartum women.

METHODS

This is a cross-sectional study of postpartum women. The sample comprised mothers who have received prenatal care from the Brazilian National System of Public Heath in the city of Pelotas. Suicide risk and other mental disorders were evaluated using the Mini International Neuropsychiatric Interview (MINI). A yes answer on one of the six interview questions was considered a sign of suicide risk.

RESULTS

The sample consisted of 919 postpartum women. The 11.5% suicide prevalence was 4.62 (CI 2.45, 8.73) times higher in women with low educational levels. Women with comorbid depression or an anxiety disorder showed a 17.04 (CI 2.27; 19.96) times greater risk of suicide than those who did not suffer from any mood disorder.

CONCLUSION

Lower education levels and psychiatric disorders are associated with suicide risk. Bipolar disorder is the psychiatric disorder with the highest impact on suicide risk.

Suicídios e tentativas de suicídios por intoxicação exógena no Rio de Janeiro: análise dos dados dos sistemas oficiais de informação em saúde, 2006-2008*

Objetivo: Descrever o perfil de suicídios e tentativas por intoxicação exógena e completitude dada pelo Sistema de Informações do Centro de Controle de Intoxicações de Niterói (CCIn), Sistema de Informações de Agravos de Notificação (Sinan) e Sistema de Informações sobre Mortalidade (SIM), para o Estado do Rio de Janeiro (RJ). Métodos: Verificou-se a frequência de suicídios e tentativas no período de 2006 a 2008. As variáveis analisadas foram sexo, idade, zona de ocorrência, circunstância, evolução, agentes tóxicos e causa básica (CID-10: X60-X69). O percentual de informações ignoradas/em branco foi classificado em excelente (≤ 10%), bom (10-29,9%) e ruim (≥ 30%). O programa SPSS foi utilizado para as análises estatísticas. Resultados: Foram analisados 940 registros sobre tentativas do CCIn e 470 do Sinan. O sexo feminino e o grupo etário de 20-39 anos predominaram, assim como o uso dos agentes tóxicos, medicamentos e agrotóxicos. Quanto ao suicídio, foram identificados 33 (CCIn), 23 (Sinan) e 180 (SIM) registros. No CCIn foram mais frequentes mulheres e grupo etário de 15-29 anos através do Sinan, e de 40-59 anos através do SIM. Para ambos os eventos, mais de 70% dos medicamentos eram psicotrópicos. O Sinan apresentou o pior desempenho para os agentes tóxicos. Conclusões: Apesar dos avanços para melhorar a qualidade das informações geradas pelos sistemas, problemas quanto à cobertura e completitude dos dados permanecem comprometendo a análise da magnitude dos agravos. O estudo aponta para a necessidade de compatibilizar os sistemas e aperfeiçoar a qualidade das informações geradas.

Introduction to the special issue "Pharmacotherapies for the treatment of alcohol abuse and dependence" and a summary of patents targeting other neurotransmitter systems

This paper introduces the Special Section: Pharmacotherapies for the Treatment of Alcohol Abuse and Dependence and provides a summary of patents targeting neurotransmitter systems not covered in the other four chapters. The World Health Organization notes that alcoholic-type drinking results in 2.5 million deaths per year, and these deaths occur to a disproportionately greater extent among adolescents and young adults. Developing a pharmacological treatment targeting alcohol abuse and dependence is complicated by (a) the heterogeneous nature of the disease(s), (b) alcohol affecting multiple neurotransmitter and neuromodulator systems, and (c) alcohol affecting multiple organ systems which in turn influence the function of the central nervous system. Presently, the USA Federal Drug Administration has approved three pharmacotherapies for alcoholism: disulfiram, naltrexone, and acamprosate. This chapter provides a summary of the following systems, which are not covered in the accompanying chapters; alcohol and acetaldehyde metabolism, opioid, glycinergic, GABA-A, neurosteroid, dopaminergic, serotonergic, and endocannabinoid, as well as patents targeting these systems for the treatment of alcoholism. Finally, an overview is presented on the use of pharmacogenetics and pharmacogenomics in tailoring treatments for certain subpopulations of alcoholics, which is expected to continue in the future.