RESUMO
BACKGROUND: Mental health problems among young peoples are a growing public health issue around the world. In low- income countries health systems are characterized by lack of facilities, human resources and primary health care is rarely an integrated part of overall health care services. This study aims at exploring how primary health care professionals in Nicaragua perceive young people's mental health problems, suicidal problems and help-seeking behaviour. METHODS: Twelve in-depth interviews were conducted with nurses and doctors working in primary health care services in León, Nicaragua. A qualitative research design was applied. Data was analysed using thematic analysis approach. RESULTS: This study revealed that doctors and nurses were reluctant to deal with young people presenting with suicidal problems at the primary health care. This was more likely to stem from feelings of incompetence rather than from negative attitudes. Other barriers in providing appropriate care to young people with mental health problems were identified such as lack of time, lack of privacy, lack of human resources, lack of trained professionals and difficulties in communicating with young people. The primary health care (PHC) professionals suggested different solutions to improve care for young people with suicidal problems. CONCLUSION: PHC doctors and nurses in Nicaragua felt that providing skilled mental health services to young people was a priority for them but they also identified a number of barriers to be able to do so. They discussed ways to improve young people's willingness to share sensitive issues with them and suggested ways to make PHC more appreciated by young people.
Assuntos
Atitude do Pessoal de Saúde , Medicina Geral , Transtornos Mentais , Aceitação pelo Paciente de Cuidados de Saúde , Enfermagem de Atenção Primária , Atenção Primária à Saúde , Suicídio , Adolescente , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Saúde Mental , Serviços de Saúde Mental , Nicarágua , Pesquisa QualitativaRESUMO
BACKGROUND: Whereas prevalence of suicidal expressions among young people is fairly similar in different countries, less is known about associated risk factors. This study compares young people in Nicaragua and Cambodia to examine if the pattern of association between mental health problems and suicidal expressions differs. METHODS: 368 and 316 secondary school students, from each country respectively, participated. Self-reported suicidal expressions, exposure to suicidal behavior in significant others and mental health problems among the students were measured using Attitude Towards Suicide (ATTS) and the Youth Self-Report (YSR) questionnaires. RESULTS: Prevalence of serious suicidal expressions (plans and attempts) during recent year, did not differ between countries. Cambodian young people scored significantly higher on all eight YSR-syndromes, except for withdrawn/depressed. In Nicaragua, all YSR-syndromes were significantly associated with serious suicidal expressions in both genders compared to Cambodia where only one syndrome showed an association in each gender; Withdrawn/depressed among girls and Somatic complaints among boys. Associations between being exposed to suicide among significant others and serious suicidal expressions also differed between Cambodia and Nicaragua. CONCLUSIONS: While the magnitude of serious suicidal expressions is similar between these structurally similar but culturally different countries, determinants behave differently. Qualitative studies are warranted to further explore cultural specific determinants for suicidal expressions among young people.
Assuntos
Comportamento do Adolescente/psicologia , Comparação Transcultural , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Camboja/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Nicarágua/epidemiologia , Prevalência , Fatores de Risco , Autorrelato , Caracteres Sexuais , Estudantes/psicologia , Tentativa de Suicídio/psicologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Suicide and suicidal expressions among young people represent a major public health problem worldwide. Most studies are from high-income countries, and it remains unclear whether prevalence and risk factors show a similar pattern in other settings. This study aims to assess the prevalence of suicidal expressions and serious suicidal expressions (ideation, plans and attempts) among adolescents in Nicaragua, in relation to previously reported risk factors, such as exposure to suicide in significant others (parents, siblings, partners or friends) and mental health problems. METHODS: 368 adolescents aged 15-18 years were randomly selected from public secondary schools in León, Nicaragua. Data was collected using Attitude Towards Suicide (ATTS) and Youth Self-Report questionnaires (YSR). Bivariate and multivariate analyses were conducted. RESULTS: Suicide ideation prevalence in the past year was 22.6%, suicide plans 10.3%, and suicide attempts 6.5%. Girls were significantly more likely to report suicidal ideation. Multivariate analyses showed that anxious/depressed, somatic complaints and exposure to suicidal behavior in significant others were significantly associated with own serious suicidal expressions. CONCLUSIONS: The prevalence of serious suicidal expressions among young people in Nicaragua is within the range reported from Western high-income countries. An attempted or completed suicide in someone close, is associated with own suicidal expressions even in the absence of increased mental distress. Furthermore, somatic complaints should alert health care professionals of the possibility of increased suicide risk.
RESUMO
This study examines suicide intent among parasuicide patients in a low-income country, Nicaragua, with special reference to gender patterns and future suicidal behavior. Using the Suicide Intent Scale (SIS), suicide intent was assessed in 204 persons presenting to hospital after parasuicide. Repetition was checked after a mean follow-up period of three years. The total SIS scores did not differ between women and men. However, a higher SIS score among women was significantly associated with older age, having children and use of pesticide as the parasuicide method. The overall method of suicide intent was low in Nicaragua compared to other countries, as was the nonfatal repetition rate (4.8% after three years). Subsequent suicides were found only in three men. Factor structures within the SIS disclosed supported the cross-cultural validity of the instrument. The level of suicide intent at the index attempt did not show any association with future suicidal behavior.
Assuntos
Intenção , Vigilância da População/métodos , Testes Psicológicos , Comportamento Autodestrutivo/psicologia , Tentativa de Suicídio/psicologia , Adolescente , Adulto , Criança , Análise Fatorial , Feminino , Seguimentos , Humanos , Masculino , Nicarágua/epidemiologia , Modelos de Riscos Proporcionais , Curva ROC , Recidiva , Fatores de Risco , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/prevenção & controle , Fatores Sexuais , Fatores Socioeconômicos , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/estatística & dados numéricosRESUMO
BACKGROUND: Suicidal behaviour is a major public health problem among adolescents. In Nicaragua as well as in most other countries, young people aged 15-24 have the highest rate of attempted suicide according to hospital records. The aims of this study were to investigate self-reported life-weariness, death wishes, suicidal ideation, suicidal plans and suicide attempts (i.e. suicidal expressions) among young men and women in the community and to identify factors associated with suicidal expressions. METHODS: The sample was derived from an established study base in the city of León, Nicaragua. From 352 randomly selected subjects aged 15-24 years, 278 individuals (145 males and 133 females) were interviewed using the Attitudes Towards Suicide (ATTS) questionnaire, including questions on suicidal expressions. RESULTS: The overall 1-year prevalence of any suicidal expression was 44.8% among males and 47.4% among females. A suicide attempt in the past year was reported by 2.1% of males and 1.5% of females. There was no significant gender difference in reporting of the separate types of suicidal expressions, except for death wishes, where females reported higher prevalence (33.8% vs. 20.7%). Exposure to suicidal expressions among significant others was significantly associated with own serious suicidal expressions. The study failed to identify any association between suicidal expressions and sociodemographic factors such as poverty or educational level. CONCLUSIONS: The present study highlights that suicidal behaviour is a significant public health problem among young people in Nicaragua. The finding that suicidal behaviour among significant others appears to have a contagious effect on adolescents, needs to be addressed in the prevention of suicidal behaviour.
Assuntos
Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Comportamento Verbal , Adolescente , Adulto , Serviços Comunitários de Saúde Mental , Feminino , Humanos , Masculino , Nicarágua/epidemiologia , Inquéritos e QuestionáriosRESUMO
AIMS: A study was undertaken to assess the incidence of parasuicide in Nicaragua, to identify groups at risk, and to describe the characteristics of parasuicides, such as methods used and seasonal and diurnal patterns. METHOD: All hospital-admitted parasuicide cases in the area of Leon, Nicaragua, were assessed over a three-year period using standardized instruments. RESULTS: Two hundred and thirty-three parasuicide cases were identified in the catchment area giving a parasuicide rate of 66.3/100,000 inhabitants per year based on the population 10 years and older. Corresponding figure for 15 years and older was 71.3. A majority were females (68.8%), who were significantly younger than the males (mean 20.8 years vs. mean 24.6 years). The highest rates were found in the age group 15-19 years with a female rate three times higher than the male rate (302.9 vs. 98.9). Pesticides, a highly lethal substance, were used as method in 19.1% of the attempts. Consistent seasonal variation with peaks in May-June and September-October were found over the years. Among parasuicide cases, 46.5% had been in contact with the healthcare system within 6 months before attempting suicide. CONCLUSIONS: Parasuicides represent a significant health problem among young people in Nicaragua. Preventive efforts should be directed especially towards the life situation for young girls, limitation of availability of suicide means, increased awareness in schools concerning suicidal problems, as well as improved management of patients with mental health problems within primary healthcare.
Assuntos
Vigilância da População , Pobreza/psicologia , Comportamento Autodestrutivo/epidemiologia , Adolescente , Adulto , Criança , Países em Desenvolvimento , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nicarágua/epidemiologiaRESUMO
La Asociación Psiquiátrica de Suecia conjuntamente con el Departamento de Psiquiatria de la Universidad de UmeÕ y el apoyo económico de ASDI-Agencia Sueca para el Desarrollo, organizan un ciclo de seminarios en colaboración con la Organización Panamericana de la Salud. El programa continuará hasta 1995 con opción a cursar estudios formales de post-grado. El propóstio del ciclo es profundizr la orientación epidemiológica y comunitaria de actuales y futuros lideres jóvenes de la psiquiatria centroamericana (AU)
Assuntos
Adulto , Humanos , Masculino , Feminino , Psiquiatria Comunitária/educação , Educação de Pós-Graduação em Medicina , Intercâmbio Educacional Internacional , Suécia , América CentralRESUMO
La Asociación Psiquiátrica de Suecia conjuntamente con el Departamento de Psiquiatria de la Universidad de Umeå y el apoyo económico de ASDI-Agencia Sueca para el Desarrollo, organizan un ciclo de seminarios en colaboración con la Organización Panamericana de la Salud. El programa continuará hasta 1995 con opción a cursar estudios formales de post-grado. El propóstio del ciclo es profundizr la orientación epidemiológica y comunitaria de actuales y futuros lideres jóvenes de la psiquiatria centroamericana
Assuntos
Adulto , Humanos , Masculino , Feminino , Educação de Pós-Graduação em Medicina , Intercâmbio Educacional Internacional , Psiquiatria Comunitária/educação , América Central , SuéciaRESUMO
Se presentan las reformas de la psiquiatría en Suecia - a la expectativa de que la experiencia escandinava contribuya a los cambios que se inican con miras a una restructuración de la atención psiquiátrica en América Latina. Se resalta la importancia de los estudios epidemiológicos, como base de planificación y acción en materia de salud mental; el cierre de los hospitales psiquiátricos en forma progresiva al mismo tiempo que se vayan creando camas en los servicios generales de salud y, finalmente, la organización de la atención no hospitalaria por sectores, con equipos de salud mental comunitarios. Como saldo negativo, se menciona la tendencia a la "psicologización" de los problemas sociales así como cierta postergación de los pacientes afectados por los trastornos más graves (AU)
Assuntos
Atenção à Saúde/tendências , Psiquiatria/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Suécia , Hospitais Psiquiátricos/tendênciasRESUMO
Se presentan las reformas de la psiquiatría en Suecia - a la expectativa de que la experiencia escandinava contribuya a los cambios que se inican con miras a una restructuración de la atención psiquiátrica en América Latina. Se resalta la importancia de los estudios epidemiológicos, como base de planificación y acción en materia de salud mental; el cierre de los hospitales psiquiátricos en forma progresiva al mismo tiempo que se vayan creando camas en los servicios generales de salud y, finalmente, la organización de la atención no hospitalaria por sectores, con equipos de salud mental comunitarios. Como saldo negativo, se menciona la tendencia a la "psicologización" de los problemas sociales así como cierta postergación de los pacientes afectados por los trastornos más graves