Effectiveness of brief intervention and contact for suicide attempters: A randomized controlled trial in five countries

Objective: To determine whether brief intervention and contact is effective in reducing subsequent suicide mortality among suicide attempters in low and middle-income countries. Methods: Suicide attempters (n = 1867) identified by medical staff in the emergency units of eight collaborating hospitals in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, China) participated, from January 2002 to October 2005, in a randomized controlled trial to receive either treatment as usual, or treatment as usual plus brief intervention and contact (BIC), which included patient education and follow-up. Overall, 91 completed the study. The primary study outcome measurement was death from suicide at 18-month follow-up. Findings: Significantly fewer deaths from suicide occurred in the BIC than in the treatment-as-usual group (0.2 versus 2.2, respectively; �2 = 13.83, P < 0.001). Conclusion: This low-cost brief intervention may be an important part of suicide prevention programmes for underresourced low-and middle-income countries

Characteristics of attempted suicides seen in emergency-care settings of general hospitals in eight low- and middle-income countries

Background. The objective was to describe patients presenting themselves at emergency-care settings following a suicide attempt in eight culturally different sites Campinas (Brazil), Chennai (India), Colombo (Sri Lanka), Durban (South Africa), Hanoi (Viet Nam), Karaj (Iran), Tallinn (Estonia), and Yuncheng, (China). Method. Subjects seen for su icide attempts, as identified by the medical staff in the emergency units of 18 collaborating hospitals were asked to participate in a 45-minute structured interview administered by trained health personnel after the patient was medically stable. Result s. Self-poisoning was the main method of attempting suicide in all eight sites. Self-poisoning by pesticides played a particularly important role in Yuncheng (71·6% females, 61·5% males), in Colombo (43·2% males, 19·6% females), and in Chennai (33·8% males, 23·8% females). The suicide attempt resulted in danger to life in the majority of patients in Yuncheng and in Chennai (over 65%). In four of the eight sites less than one-third of subjects received any type of referral for follow-up evaluation or care. Conclus ions. Action for the prevention of suicide attempts can be started immediately in the sites investigated by addressing the one most important method of attempted suicide, namely self-poisoning. Regulations for the access to drugs, medicaments, pesticides, and other toxic substances need to be improved and revised regulations must be implemented by integrating the efforts of different sectors, such as health, agriculture, education, and justice. The care of patients who attempt suicide needs to include routine psychiatric and psychosocial assessment and systematic referral to professional services after discharge. © 2005 Cambridge University Press

Suicide attempts, plans, and ideation in culturally diverse sites: The WHO SUPRE-MISS community survey

Background. The objectives were to assess thoughts about suicide, plans to commit suicide and suicide attempts in the community, to investigate the use of health services following a suicide attempt, and to describe basic socio-cultural indices of the community. Method. The community su rvey was one component of the larger WHO multisite intervention study on suicidal behaviours (SUPRE-MISS). In each site, it aimed at randomly selecting and interviewing at least 500 subjects of the general population living in the catchment area of the emergency department where the intervention component of the study was conducted. Communities of eight SUPRE-MISS sites (in Brazil, China, Estonia, India, Iran, South Africa, Sri Lanka, and Viet Nam) participated plus two additional sites from Australia and Sweden conducting similar surveys. Results. Suicide attempts (0·4-4·2), plans (1·11-5·6), and ideation (2·6-25·4) varied by a factor of 10-14 across sites, but remained mostly within the ranges of previously published data. Depending on the site, the ratios between attempts, plans, and thoughts of suicide differed substantially. Medical attention following a suicide attempt varied between 22 and 88 of the attempts. Conclusions. The idea of the suicidal process as a continuous and smooth evolution from thoughts to plans and attempts of suicide needs to be further investigated as it seems to be dependent on the cultural setting. There are indications, that the burden of undetected attempted suicide is high in different cultures; an improved response from the health sector on how to identify and support these individuals is needed. © 2005 Cambridge University Press

O alcoolismo, suas causas e tratemento nas representacoes sociais de profissionais de Saude da Familia = Alcoholism, its causes and treatment in the social representations constructed by Brazilian Family Health professionals

Health sciences define alcoholism as a multifaceted syndrome. Guidelines for treatment include adoption of the harm reduction paradigm and the essential role of Primary Health Care (PHC) towards the wide range of alcohol problems. This research aimed at understanding the social representations of alcoholism constructed by Brazilian PHC professionals, working at Family Health Centers (FHC). We conducted semi-structured interviews with 40 graduated health professionals who worked in 11 different FHC located in a municipality in southeast Brazil. Data were treated with thematic content analysis. We highlight the following results: professionals objectified the alcoholic as a patient who did not search for treatment and/or who threatened the normal functioning of the FHC; professionals considered social and psychological factors as the main causes of alcoholism; they did not mention the concept of harm reduction, nor well-defined treatment protocols. The causal attribution and the representational field inherent to the social representations contributed to anchor alcoholism as a "plague" of poverty. The FHC were perceived simultaneously as important and impotent towards alcoholism. We conclude that the implementation of alcohol-related care strategies must consider the intergroup relations between professionals and patients

Inequities In Suicide Prevention In Brazil

[No abstract available]37897971137Reichenheim, M.E., De Souza, E.R., Moraes, C.L., De Mello Jorge Mhp, Silva Cmfp, D., De Souza Minayo, M.C., Violence and injuries in Brazil: The eff ect, progress made, and challenges ahead (2011) Lancet, 377, pp. 1962-75Marin-Leon, L., Barros, M.B., Mortes por suicidio: Diferencas de genero e nivel socioeconomico (2003) Rev Saude Publica, 37, pp. 357-63Mello-Santos, C., Bertolote, J.M., Wang, Y.P., Epidemiology of suicide in Brazil (1980-2000) (2005) Rev Bras Psiquiat, 27, pp. 131-3

Le suicide chez la personne âgée en Suisse : à propos de quelques chiffres

Le suicide représente un problème de santé publique majeur dans les pays industrialisés. L'étude l'évolution du suicide en Suisse entre 1969 et 1995 montre que toutes les tranches d'âge sont affectées mais que la population âgée est particulièrement concernée, surtout dans la catégorie des personnes de 80 ans et plus. L'augmentation de l'espérance vie et la diminution du taux de natalité laissent prévoir une augmentation de la population âgée et l'agumentation du taux de mortalité par suicide dans les prochaines années. Il est impératif d'envisager une prévention active, dans laquelle le praticien de première ligne joue un rôle important. <Auteurs> Avec un taux de décès par suicide près de 23 pour 100.000 habitants tous âges confondus (tableau 1), la Suisse se situe parmi les pays européens les plus touchés par ce phénomène. Cependant, en 1995, le taux de suicides est nettement plus élevé chez les personnes âgées de 60 ans et plus (37/100.000 habitants) que dans la moyenne de la population (...) <Auteurs, p. 313, selon des données de l'Office fédéral de la statistique&gt

Detecting Suicide Risk In Psychiatric Emergency Services [detecção Do Risco De Suicídio Nos Serviços De Emergência Psiquiátrica]

Objective: To provide guidelines for the identification of suicide risk and protective factors and the management of suicidal patients in emergency settings. Method: Literature review to identify relevant and illustrative key cases. Results: The clinical interview is the best method to evaluate the suicidal risk and has a twofold purpose: 1) providing emotional support and creating a bond; 2) collecting information. There is a substantial amount of information to be collected during the clinical interview, including risk and protective factors, epidemiologic data, characterization of the event, psychodynamic aspects, personal and family history, identification models, data on physical health, and social support network. Difficulties can emerge during the clinical interview, but a trained and informed professional will be able to approach and adequately deal with the patient. Although several scales have been proposed, none of them have shown reliable efficiency in determining the suicidal risk. Conclusion: There is no method to predict who is going to commit suicide; nevertheless, it is possible to evaluate the individual risk of each patient by means of a detailed and empathic clinical interview. Keeping the patient alive is the first and fundamental rule.32SUPPL. 2S87S95(1998) Primary Prevention of Mental, Neurological and Psychosocial Disorders, , WHO - World Health Organization, Geneva: World Health OrganizationBertolote, J., Fleischmann, A., de Leo, D., Wassserman, D., Suicide and mental disorders: Do we know enough? (2003) Br J Psychiatry, 183, pp. 382-383Bertolote, J.M., Tarsitani, L., Paula-Ramos, F.L., La comorbilidad de la depresión y otras enfermedades: Un antiguo problema sanitario, un nuevo programa de la OMS (2003) Atopos, 7, pp. 56-60Suicide Prevention (SUPRE), , http:www.who.int/mental_health/prevention/suicide/charts, WHO - World Health Organization, [cited 2010 jun 12]. Available fromRoy, A., Suicide: A multi-determined act (1985) Psychiatr Clin North Am, 8 (2), pp. 243-250de Leo, D., Bertolote, J.M., Lester, D., Self-directed violence (2002) World Report On Health and Violence, pp. 183-212. , In: Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors, Geneva: World Health OrganizationBertolote, J.M., Fleischmann, A., A global perspective on the magnitude of suicide mortality (2009) Oxford Textbook of Suicide and Suicide Prevention, pp. 91-98. , In: Wasserman D, Wasserman C, editors, Oxford: Oxford University PressCountry Reports and Charts Web Page, , http://www.who.int/mental_health/prevention/suicide/country_reports/en/index.html, WHO - World Health Organization, [cited 2010 July 25]Mello-Santos, C., Bertolote, J.M., Wang, Y.P., Epidemiology of suicide in Brazil (1980-2000): Characterization of age and gender rates of suicide (2005) Rev Bras Psiquiatr, 27 (2), pp. 131-134Batty, G.D., Whitley, E., Deary, I.J., Gale, C.R., Tynelius, P., Rasmussen, F., Psychosis alters association between IQ and future risk of attempted suicide: Cohort study of 1,109,475 Swedish men (2010) BMJ, 340, pp. c2506Wasserman, D., (2001) Suicide, An Unnecessary Death, , editor, London: Martin DunitzBertolote, J.M., Fleischmann, A., de Leo, D., Wasserman, D., Psychiatric diagnoses and suicide: Revisiting the evidence (2004) Crisis, 25 (4), pp. 147-155Meleiro, A.M.A.S., Teng, C.T., Wang, Y.P., (2004) Suicídio: Estudos Fundamentais, , São Paulo: Segmento FarmaMann, J.J., Arango, V., Integration of neurobiology and psychopathology in a unified model of suicidal behavior (1992) J Clin Psychopharmacol, 12 (2 SUPPL), pp. 2S-7SRapeli, C.B., Botega, N.J., Clinical profiles of serious suicide attempters consecutively admitted to a university-based hospital: A cluster analysis study (2005) Rev Bras Psiquiatr, 27 (4), pp. 285-289(2000) Preventing Suicide: A Resource For General Physicians, , WHO - World Health Organization, Geneva: World Health Organization(2000) Preventing Suicide: A Resource For Primary Health Care Workers, , WHO - World Health Organization, Geneva: World Health OrganizationWeinberg, I., Ronningstam, E., Goldblatt, M.J., Schechter, M., Wheelis, J., Maltsberger, J.T., Strategies in treatment of suicidality: Identification of common and treatment-specific interventions in empirically supported treatment manuals (2010) J Clin Psychiatry, 71 (6), pp. 699-706Claassen, C.A., Larkin, G.L., Occult suicidality in an emergency department population (2005) Br J Psychiatry, 186, pp. 352-353Horowitz, L.M., Ballard, E.D., Pao, M., Suicide screening in schools, primary care and emergency departments (2009) Curr Opin Pediatr, 21 (5), pp. 620-627Practice guideline for the assessment and treatment of patients with suicidal behaviors (2003) Am J Psychiatry, 160 (11), pp. 1-60. , APA - American Psychiatric AssociationMorgan, H.G., Owen, J.H., (1990) Person At Risk of Suicide: Guidelines On Good Clinical Practice, , London: The Boots Company PLCBotega, N.J., Silveira, I.U., Mauro, M.L.F., (2010) Telefonemas Na Crise: Percursos E Desafios Na Prevenção Do Suicídio, , Rio de Janeiro: ABPBertolote, J.M., Fleischmann, A., de Leo, D., Bolhari, J., Botega, N., de Silva, D., Tran, T.T.H., Wasserman, D., Suicide attempts, plans, and ideation in culturally diverse sites: The WHO SUPRE-MISS community survey (2005) Psychol Med, 35 (10), pp. 1457-1465Bertolote, J.M., Fleischmann, A., de Leo, D., Phillips, M.R., Botega, N.J., Vijayakumar, L., de Silva, D., Wasserman, Repetition of suicide attempts: Data from five culturally different low- and middle-income country emergency care settings participating in the WHO SUPRE-MISS study Crisis, , In pressFleischmann, A., Bertolote, J.M., Wasserman, D., de Leo, D., Bolhari, J., Botega, N.J., de Silva, D., Thanh, H.T., Effectiveness of brief intervention and contact for suicide attempters: A randomized controlled trial in five countries (2008) Bull World Health Organ, 86 (9), pp. 703-709da Silva Cais, C.F., Stefanello, S., Fabrício mauro, M.L., de Freitas, V.S.G., Botega, N.J., (2009) Factors Associated With Repeated Suicide Attempts, 30 (2), pp. 73-78. , Preliminary results of the WHO Multisite Intervention Study on Suicidal Behavior (SUPRE-MISS) from Campinas, Brazil. CrisisPajonk, F.G., Gruenberg, K.A.S., Moecke, H., Naber, D., (2002) Suicides and Suicide Attempts In Emergency Medicine Crisis, 23 (2), pp. 68-73Fleischmann, A., Bertolote, J.M., Wasserman, D., Effectiveness of brief intervention and contact for suicide attempters: A randomized controlled trial in five countries (2008) Bull World Health Organ, 86 (9), pp. 657-73

The prevalence of attempted suicides in proportion of referrals to emergency departments in Karaj, Iran

Introduction: The World Health Organization (WHO) has recognized suicidal behaviors as a serious public health problem in developed and developing countries. To increase the knowledge about suicidal behaviors, WHO has carried out the Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS) across eight countries. This paper presents data from the site in Karaj, Islamic Republic of Iran. Method: Karaj, with an urban population of 941,000, was selected as a catchment area. For the duration of the study all emergency departments (EDs) in the city were covered for 24 hours to identify suicide attempters who were presented the SUPRE-MISS questionnaire, consisting of comprehensive personal, family, social, somatic, and psychiatric variables. Results: During 10 months, 945 suicide attempters (the mean of referrals per month was 98) were referred to EDs (0.12 percent of the urban population in one year). Age, education, marriage, employment and occupational status, and the method of the suicide attempt had a significant correlation with the gender of the attempters (p < .001). Overall, 0.2 percent of the particpants died due to the suicide attempt. At the time of discharge, only 5.5 percent of the particpants were referred to psychiatric or consultation services. Conclusions: The comparison of the rate of suicidal behaviors generated from community and EDs studies gives an indication of the mental health services needed for particpants at risk of suicide. © 2008 M.E. Sharpe, Inc. All rights reserved

Community study of suicidal behaviors and risk factors among Iranian adults

The present study is part of the WHO/SUPRE-MISS conducted in Iran. The aim of the study was to determine the lifetime prevalence of suicide behaviors in a community sample of Iranian adults. Five hundred and four families were selected randomly according to electricity bills in Karaj, 45 km from the capital city, represented the catchment area for this investigation. The SUPRE-MISS questionnaires used in this study compromised a variety of aspects of suicidal behaviors. Lifetime prevalence rates for suicidal ideation, planning and attempts were 14, 6.6, and 4.1 respectively. Tobacco users and long-term mental and physical disabilities were significantly higher among subjects with a history of suicidal attempts. Younger ages, tobacco abuse, and long-term mental or physical disabilities could be considered risk factors for attempting suicide. © International Academy for Suicide Research