RESUMO
Suicide among adolescents has become a major public health problem worldwide. Our study sought to describe the most commonly used methods of suicide among adolescents aged 10 to 19 years in Brazil between 2006 and 2015. Complete data were obtained from the Brazilian Health Informatics Department (DATASUS) and coded into seven categories of suicide methods. The following statistical analyzes were performed: chi-square (χ2) tests to examine the association between the frequency of each suicide method and the year; odds ratios (OR) and 95% confidence intervals (95%CI) compared the relative chances of each suicide method occurring between boys and girls. In total, 8,026 suicides among Brazilian adolescents were registered over the analyzed period. The most commonly used method of suicide by both sexes was hanging (2015 = 70.3%), and the most significant increase was observed in girls (2015 = 65.82%). The proportional use of arms (2006 = 14.2%; 2015 = 9.1%) and poisoning (2006 = 13.3%; 2015 = 9.2%) decreased over the period. The increase in hanging is worrisome, mostly due to difficulties to impose access barriers and to its high lethality. In such context, a comprehensive understanding of suicide behaviors among adolescents in Brazil should be drawn to inform general prevention measures and, more specifically, the reasons for the increase in hanging need to be further investigated.
O suicídio entre adolescentes é um importante problema de saúde pública em nível global. O estudo teve como principal objetivo descrever os métodos de suicídio mais usados por adolescentes brasileiros entre 10 e 19 anos de idade, de 2006 a 2015. Foram obtidos dados completos do Departamento de Informática do SUS (DATASUS), codificados em sete categorias de métodos de suicídio. As seguintes análises estatísticas foram realizadas: testes de qui-quadrado (χ2) para examinar a associação entre a frequência de cada método de suicídio e o ano do óbito. As razões de chances (OR) e intervalos de 95% de confiança (IC95%) compararam as chances relativas entre homens e mulheres para cada método de suicídio. Durante o período analisado, houve 8.026 suicídios entre adolescentes. O enforcamento foi o método de suicídio mais usado em ambos os sexos eram (2015 = 70,3%), com um aumento mais agudo em mulheres (2015 = 65,82%). O uso proporcional de armas (2006 = 14,2%; 2015 = 9,1%) e envenenamento (2006 = 13,3%; 2015 = 9,2%) diminuiu ao longo do período. O aumento dos enforcamentos é preocupante, suscitando questões com dificuldades na imposição de barreiras de acesso e a alta letalidade desse método. Nesse contexto, precisa haver uma compreensão mais abrangente dos comportamentos suicidas entre os adolescentes brasileiros para informar as medidas preventivas em geral e, mais especificamente, para elucidar os motivos para o aumento dos suicídios por enforcamento.
El suicidio entre adolescentes se ha convertido en un importante problema de salud pública en todo el mundo. El objetivo de este estudio fue describir los métodos de suicido usados más comúnmente entre adolescentes, con edades comprendidas entre los 10 y 19 años, en Brasil desde 2006 hasta 2015. Los datos completos se obtuvieron del Departamento de Informática del Sistema Único de Salud (DATASUS) y se codificaron en siete categorías de métodos de suicidio. Se realizaron análisis estadísticos: tests chi-cuadrado (χ2) para examinar la asociación entre la frecuencia de cada método de suicidio y año. Odds ratios (OR) y los intervalos del 95% de confianza (IC95%) compararon las oportunidades relativas de cada método suicidio que se produce entre hombres y mujeres. Se registraron 8.026 suicidios entre adolescentes brasileños durante el período analizado. El método de suicidio más comúnmente usado por ambos sexos fue ahorcamiento (2015 = 70,3%), se observó un aumento más pronunciado en mujeres (2015 = 65,82%). El uso proporcional de armas (2006 = 14,2%; 2015 = 9,1%) y envenenamiento (2006 = 13,3%; 2015 = 9,2%) descendió durante este período. El incremento por ahorcamiento es preocupante, principalmente, en lo que se refiere a las dificultades para imponer barreras de acceso, así como por su alta letalidad. En este contexto, se deberían describir más los comportamientos suicidas entre adolescentes en Brasil para comprenderlos mejor, con el fin de que se tomen medidas de prevención general y, más específicamente, se profundice en las razones del incremento de ahorcamientos.
Assuntos
Suicídio , Adolescente , Adulto , Brasil/epidemiologia , Criança , Feminino , Humanos , Masculino , Razão de Chances , Projetos de Pesquisa , Ideação Suicida , Adulto JovemRESUMO
Abstract: Suicide among adolescents has become a major public health problem worldwide. Our study sought to describe the most commonly used methods of suicide among adolescents aged 10 to 19 years in Brazil between 2006 and 2015. Complete data were obtained from the Brazilian Health Informatics Department (DATASUS) and coded into seven categories of suicide methods. The following statistical analyzes were performed: chi-square (χ2) tests to examine the association between the frequency of each suicide method and the year; odds ratios (OR) and 95% confidence intervals (95%CI) compared the relative chances of each suicide method occurring between boys and girls. In total, 8,026 suicides among Brazilian adolescents were registered over the analyzed period. The most commonly used method of suicide by both sexes was hanging (2015 = 70.3%), and the most significant increase was observed in girls (2015 = 65.82%). The proportional use of arms (2006 = 14.2%; 2015 = 9.1%) and poisoning (2006 = 13.3%; 2015 = 9.2%) decreased over the period. The increase in hanging is worrisome, mostly due to difficulties to impose access barriers and to its high lethality. In such context, a comprehensive understanding of suicide behaviors among adolescents in Brazil should be drawn to inform general prevention measures and, more specifically, the reasons for the increase in hanging need to be further investigated.
Resumo: O suicídio entre adolescentes é um importante problema de saúde pública em nível global. O estudo teve como principal objetivo descrever os métodos de suicídio mais usados por adolescentes brasileiros entre 10 e 19 anos de idade, de 2006 a 2015. Foram obtidos dados completos do Departamento de Informática do SUS (DATASUS), codificados em sete categorias de métodos de suicídio. As seguintes análises estatísticas foram realizadas: testes de qui-quadrado (χ2) para examinar a associação entre a frequência de cada método de suicídio e o ano do óbito. As razões de chances (OR) e intervalos de 95% de confiança (IC95%) compararam as chances relativas entre homens e mulheres para cada método de suicídio. Durante o período analisado, houve 8.026 suicídios entre adolescentes. O enforcamento foi o método de suicídio mais usado em ambos os sexos eram (2015 = 70,3%), com um aumento mais agudo em mulheres (2015 = 65,82%). O uso proporcional de armas (2006 = 14,2%; 2015 = 9,1%) e envenenamento (2006 = 13,3%; 2015 = 9,2%) diminuiu ao longo do período. O aumento dos enforcamentos é preocupante, suscitando questões com dificuldades na imposição de barreiras de acesso e a alta letalidade desse método. Nesse contexto, precisa haver uma compreensão mais abrangente dos comportamentos suicidas entre os adolescentes brasileiros para informar as medidas preventivas em geral e, mais especificamente, para elucidar os motivos para o aumento dos suicídios por enforcamento.
Resumen: El suicidio entre adolescentes se ha convertido en un importante problema de salud pública en todo el mundo. El objetivo de este estudio fue describir los métodos de suicido usados más comúnmente entre adolescentes, con edades comprendidas entre los 10 y 19 años, en Brasil desde 2006 hasta 2015. Los datos completos se obtuvieron del Departamento de Informática del Sistema Único de Salud (DATASUS) y se codificaron en siete categorías de métodos de suicidio. Se realizaron análisis estadísticos: tests chi-cuadrado (χ2) para examinar la asociación entre la frecuencia de cada método de suicidio y año. Odds ratios (OR) y los intervalos del 95% de confianza (IC95%) compararon las oportunidades relativas de cada método suicidio que se produce entre hombres y mujeres. Se registraron 8.026 suicidios entre adolescentes brasileños durante el período analizado. El método de suicidio más comúnmente usado por ambos sexos fue ahorcamiento (2015 = 70,3%), se observó un aumento más pronunciado en mujeres (2015 = 65,82%). El uso proporcional de armas (2006 = 14,2%; 2015 = 9,1%) y envenenamiento (2006 = 13,3%; 2015 = 9,2%) descendió durante este período. El incremento por ahorcamiento es preocupante, principalmente, en lo que se refiere a las dificultades para imponer barreras de acceso, así como por su alta letalidad. En este contexto, se deberían describir más los comportamientos suicidas entre adolescentes en Brasil para comprenderlos mejor, con el fin de que se tomen medidas de prevención general y, más específicamente, se profundice en las razones del incremento de ahorcamientos.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Adulto Jovem , Suicídio , Projetos de Pesquisa , Brasil/epidemiologia , Razão de Chances , Ideação SuicidaRESUMO
Objective: To examine suicide rates among adolescents from six large cities in Brazil and to analyze the relationship between adolescent suicide rates and socioeconomic indicators between 2006 and 2015. Methods: Generalized estimating equation models were used to assess the impact of socioeconomic factors - including social inequality and unemployment rates - on adolescent suicide rates. Results: The rate of adolescent suicide increased by 24% over the course of the study period. Social inequality (assessed using the Gini index), was positively associated with overall adolescent suicide rates (β = 10.68; 95%CI = 2.32-19.05; p ≤ 0.012). After disaggregating the findings by age (10-14 and 15-19 years), social inequality was associated with suicide rate only for adolescents aged 15-19 years (β = 9.63; 95%CI = 2.31-16.96; p ≤ 0.005). Disaggregating these findings by sex, the association with economic variables became significant only among females. Males had a higher overall suicide rate than females, and the highest rate was observed in male adolescents aged 15-19 years. Higher levels of unemployment were associated with higher suicide rates. Conclusion: Our findings suggest that socioeconomic indicators, particularly unemployment and social inequality, are relevant social determinants of suicide in adolescence.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Suicídio/tendências , Suicídio/estatística & dados numéricos , Fatores Socioeconômicos , Fatores de Tempo , Desemprego/estatística & dados numéricos , Brasil/epidemiologia , Fatores Sexuais , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Estatísticas não ParamétricasRESUMO
OBJECTIVE: To examine suicide rates among adolescents from six large cities in Brazil and to analyze the relationship between adolescent suicide rates and socioeconomic indicators between 2006 and 2015. METHODS: Generalized estimating equation models were used to assess the impact of socioeconomic factors - including social inequality and unemployment rates - on adolescent suicide rates. RESULTS: The rate of adolescent suicide increased by 24% over the course of the study period. Social inequality (assessed using the Gini index), was positively associated with overall adolescent suicide rates (ß = 10.68; 95%CI = 2.32-19.05; p ≤ 0.012). After disaggregating the findings by age (10-14 and 15-19 years), social inequality was associated with suicide rate only for adolescents aged 15-19 years (ß = 9.63; 95%CI = 2.31-16.96; p ≤ 0.005). Disaggregating these findings by sex, the association with economic variables became significant only among females. Males had a higher overall suicide rate than females, and the highest rate was observed in male adolescents aged 15-19 years. Higher levels of unemployment were associated with higher suicide rates. CONCLUSION: Our findings suggest that socioeconomic indicators, particularly unemployment and social inequality, are relevant social determinants of suicide in adolescence.
Assuntos
Suicídio/estatística & dados numéricos , Suicídio/tendências , Adolescente , Brasil/epidemiologia , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Fatores Socioeconômicos , Estatísticas não Paramétricas , Fatores de Tempo , Desemprego/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Teenagers and young adults are more exposed to violence and traumatic events than adults, and these factors can be associated with mental disorders. This paper aims at investigating whether young people are more exposed to violence and traumatic events and to compare pattern of mental disorders with adults. METHODS: Cross-sectional study using the Composite International Diagnostic Interview, conducted between 2007 and 2008 with a randomly selected sample of 15 to 75 year-old residents of São Paulo, Brazil. RESULTS: Two thousand five hundred thirty-six participants were divided into two groups: 1096 (43.2 %) young people (15 to 24 years), and 1440 (56.8 %) adults (25 to 75 years). 12-month exposure to traumatic events was higher among young people (32.1 % vs. 20.6 %; p < 0.001). Assaultive violence was reported by 13.4 % of young people and 8.6 % of adults (p = 0.012); 20.1 % of young people and 13 % of adults reported suffering other injury or shocking events (p < 0.001); sudden death/life threatening illness of a close person was declared by 6.1 % of young people and 3.2 % of adults (p = 0.017). Prevalence of alcohol related disorders was higher among young people (5.4 % vs. 2.5 %; P = 0.032); depressive disorders were more prevalent among adults (9.0 % vs. 4.7 %; P = 0.004). Alcohol related disorders were associated to assaultive violence among young people (OR = 3.4; 95 % CI = 1.36 to 8.52; p = 0.004) and adults (OR = 2.38; 95 % CI = 1.23 to 4.61; p = 0.002). Phobic/anxiety disorders were associated to other injury or shocking events among young people (OR = 1.28; 95 % CI = 0.67 to 2.44; p = 0.025). Major depressive disorder was associated to assaultive violence among young people (OR = 2.27; 95 % CI = 1.09 to 4.74; p = 0.004) and adults (OR = 1.28; 95 % CI = 0.85 to 1.93; p = 0.009). CONCLUSION: Exposure to violence and traumatic events was higher among young people. Alcohol related disorders, depression and phobic/anxiety disorders were significantly higher among young people exposed to traumatic events. Despite the study design, high exposure to violence and traumatic events in this age group can be considered important factors in triggering mental disorders in this vulnerable age period.
Assuntos
Transtornos Mentais/epidemiologia , População Urbana/estatística & dados numéricos , Violência/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Fóbicos/epidemiologia , Prevalência , Transtornos de Estresse Pós-Traumáticos/psicologia , Violência/psicologia , Adulto JovemRESUMO
BACKGROUND: Recently Bolivia has implemented a universal health system, but their mental health policy is still emerging. OBJECTIVES: To investigate the current state of the mental health care system in Bolivia and discuss challenges for structuring a coordinated network of services that can effectively meet the needs of the Bolivian population. METHODS: This review was conducted by searching for scholarly articles through the databases Lilacs, Medline OPS, HISA and IBECS REPIDISCA via the search portal in the Virtual Health Library - NLM (http://www.bireme.br). RESULTS: Bolivia has a National Mental Health Plan that is intended to guide mental health promotion, prevention, treatment and rehabilitation of mental illness, but the resources for this area of health are limited. There are 1.06 psychiatrists and 0.46 psychologists per 100, 000 inhabitants. Information on psychiatric morbidity in Bolivia and the impact of mental disorders on the global burden of disease is scarce. Admission statistics reported by psychiatric hospitals in the country show that the main cause of hospitalization is substance abuse (30%). Alcohol consumption is responsible for 90% of these admissions, in addition to being a major cause of deaths in traffic and one of the main risk factors for domestic violence. Almost one in two women in Bolivia (47%) experienced some form of violence from their partner in the last year. Nineteen percent of women living with a partner reported being physically abused, while 7% were sexually abused by their partners. Isolated studies report that suicide rates are disproportionately high in Bolivia. CONCLUSIONS: Although there is a shortage of epidemiological data in Bolivia, it is clear the impact of alcohol addiction in psychiatric admissions, domestic violence and traffic accidents. Violence against women and suicides are important issues to be tackled. Among the proposed strategies to afford human resources for mental health in Bolivia, "task shifting", the delegation of tasks to non-specialists should be extensively adopted in the country to improve mental health care.
RESUMO
Objetivo. Analizar el concepto y conocer las características del cuidador informal. Material y Métodos. El presente estudio de tipo cuantitativo, descriptivo y de corte transversal, con la población que demanda asistencia sanitaria del Hospital de Psiquiatría "Dr. José María Alvarado", dependiente de la Caja Nacional de Salud, en la ciudad de La Paz, Bolivia. Se utilizó la entrevista de carga familiar objetiva y subjetiva (ECFOS). El ECFOS se ha desarrollado tomando como base "The Family Burden Interview Schedule-Short Form" (FBIS/SF). Resultados. En general podemos decir que el perfil del cuidador es el de una mujer (84,2%), de alrededor de 60 años. Normalmente madre del paciente (72,5 %), que no trabaja, pasa con el enfermo más de 4 horas al día (75%), afirma mantener una buena relación con el paciente y que no piensa que el enfermo sea una Carga Negativa ni para ella ni para su familia. Conclusiones. Se debe realizar intervenciones con los familiares de los pacientes esquizofrénicos. Se debe incorporar los programas de psicoeducación familiar debido que han demostrado su utilidad para prevenir recaídas y reducir la tensión familiar.
Objective. To analyze the concept and to know the characteristics of the informal caregiver. Material and Methods. The present study of quantitative, descriptive type and of cross section, with the population that demands medical assistance of the Hospital of Psychiatry "Dr. Jose Maria Alvarado", employee of Caja Nacional de Salud, from La Paz, Bolivia. The interview of objective and subjective familiar load was used (ECFOS). The ECFOS has been developed based on "The Family Burden Interview Schedule-Short Form" (FBIS/SF). Results. In general the profile of the caregiver is that of a woman (84.2%), of around 60 years of age. Normally mother of the patient (72.5%), who does not work, spends more than 4 hours a day with the patient (75%), claims to maintain a good relation with the patient and who does not think that the patient is a Negative load neither for her nor for her family. Conclusions. Interventions with the relatives of the schizophrenic patients should be effected. The programs of familiar psycho education should be incorporated, since they have proven efficient to prevent relapses and to reduce the familiar tensión.
Assuntos
EsquizofreniaRESUMO
Objetivo: Enseñar a las familias sobre la naturaleza de la enfermedad, síntomas, tratamiento o formas de actuación frente a ella. Material y métodos: Participaron en este estudio 8 familias de pacientes esquizofrénicos del Hospital de Psiquiatría CNS. El programa consta de cuatro fases: de evaluación, psicoeducativa, de intervención individualizada y de seguimiento. Resultados: El total de las familias participantes fueron ocho, que hacían un total de 12 personas, entre ellos los padres y algún hermano. El 75% de los participantes no se encontraban informados sobre el tema. Durante las entrevistas que se tenían con los familiares, en dónde se observaba y registraba tanto el lenguaje verbal como el no verbal; se obtuvo que un 90% de los familiares presentaban alta Expresión emocional. Conclusiones: Las emociones que sobresalen son el autosacrificio, emotividad intensa, o pena por el enfermo. Con la Psicoeducación, se debe obtener la disminución del estrés y carga familiar y aumento de los conocimientos sobre la enfermedad.
Objective: To teach to the families about the nature of the Schizophrenia Disorden symptoms, treatment, or forms of action against it. Material and methods: Participated in this study 8 families of schizophrenia patients of Psychiatric Hospital CNS. The program consists of four phases: assessment, psychoeducation, individualized intervention and monitoring. Results: A total of participating families were eight, which made a total of 12 people, including parents and some brother. 75% of participants were not informed about the matter. During the interviews were with the relatives, observed and recorded both the verbal language as the non-verbal one, and it was obtained a 90 percent of the relatives showed high Emotional Expressed. Conclusions: The emotions that stand out are the self-sacrifice, intense emotion or sadness for the patient. With the Psychoeducational approach must be obtained reducing stress, family burden and increased the knowledge about the Schizophrenia Disorder.