Impacto do suicídio da pessoa idosa em suas famílias Impact of suicide of the elderly on their families

Apresenta-se uma análise sobre o impacto do suicídio de idosos, na dinâmica de suas famílias. O artigo é fruto de um tipo de pesquisa qualitativa a que se denomina autópsia psicossocial e está baseado em entrevistas com familiares de 51 idosos suicidas de 10 cidades brasileiras. O estudo nessas localidades foi definido por levantamento epidemiológico que revelou a relevância do fenômeno. Foram vários os temas analisados na investigação. Mas este texto se debruça sobre como a família enfrentou a morte da pessoa idosa, suas impressões sobre o ato e as repercussões nos seus membros e na rede social. A partir da análise compreensiva dos depoimentos, foram construídos os seguintes núcleos de sentido: culpa pelo ato, isolamento social e suas manifestações na saúde, estigma e preconceito social, sofrimento familiar e perspectivas de superação, raiva e crença na improbabilidade do ato e atenção aos familiares. As famílias manifestaram sofrimento, tristeza e perplexidade pela morte do idoso, o que influi e tem repercussões na sua dinâmica e no âmbito individual. Tais consequências são diferenciadas nos locais pesquisados e dependendo das experiências da família com atos dessa natureza.<br>The scope of this paper is an analysis of suicide of elderly people and the impact on the dynamics of their families is presented. The method used is of the qualitative research type known as psychosocial autopsy and is based on interviews with the family members of 51 elderly people who committed suicide in 10 Brazilian cities. The study in these cities was defined by epidemiological research that revealed the relevance of this phenomenon. Many themes were analyzed in the investigation. However, this text focuses on how the families coped with the death of the elderly person, their impressions regarding the act, and the repercussions on family members and the social network. Pursuant to a comprehensive analysis of the testimonies, the following nuclei of significance were revealed: feelings of guilt for the act; social isolation and its manifestations on health; social stigma and prejudice; prospects of overcoming family suffering; anger and feelings of the improbability of the act; and care for the family members. The families manifested suffering, sadness, and perplexity at the death of the elderly person, which influences and has repercussions on their dynamics and at an individual level. Such consequences are different in each area researched depending on the experiences the family has had with acts of this nature

Psychiatric diagnoses in 3275 suicides: a meta-analysis

<p>Abstract</p> <p>Background</p> <p>It is well known that most suicide cases meet criteria for a psychiatric disorder. However, rates of specific disorders vary considerably between studies and little information is known about gender and geographic differences. This study provides overall rates of total and specific psychiatric disorders in suicide completers and presents evidence supporting gender and geographic differences in their relative proportion.</p> <p>Methods</p> <p>We carried out a review of studies in which psychological autopsy studies of suicide completers were performed. Studies were identified by means of MEDLINE database searches and by scanning the reference list of relevant publications. Twenty-three variables were defined, 16 of which evaluating psychiatric disorders. Mantel-Haenszel Weighted Odds Ratios were estimated for these 16 outcome variables.</p> <p>Results</p> <p>Twenty-seven studies comprising 3275 suicides were included, of which, 87.3% (SD 10.0%) had been diagnosed with a mental disorder prior to their death. There were major gender differences. Diagnoses of substance-related problems (OR = 3.58; 95% CI: 2.78–4.61), personality disorders (OR = 2.01; 95% CI: 1.38–2.95) and childhood disorders (OR = 4.95; 95% CI: 2.69–9.31) were more common among male suicides, whereas affective disorders (OR = 0.66; 95% CI: 0.53–0.83), including depressive disorders (OR = 0.53; 95% CI: 0.42–0.68) were less common among males. Geographical differences are also likely to be present in the relative proportion of psychiatric diagnoses among suicides.</p> <p>Conclusions</p> <p>Although psychopathology clearly mediates suicide risk, gender and geographical differences seem to exist in the relative proportion of the specific psychiatric disorders found among suicide completers.</p

Psychiatric Disorders in Older Primary Care Patients

OBJECTIVE: Most older people with psychiatric disorders are never treated by mental health specialists, although they visit their primary care physicians regularly. There are no published studies describing the broad array of psychiatric disorders in such patients using validated diagnostic instruments. We therefore characterized Axis I psychiatric diagnoses among older patients seen in primary care. DESIGN: Survey of psychopathology using standardized diagnostic methods. SETTING: The private practices of three board-certified general internists, and a free-standing family medicine clinic. PARTICIPANTS: All patients aged 60 years or older who gave informed consent were eligible. MEASUREMENTS AND MAIN RESULTS: For the 224 subjects completing the study, psychiatric diagnoses were based on the Structured Clinical Interview for DSM-III-R. Point prevalence estimates used weighted averages based on the stratified sampling method. For the combined sites, 31.7% of the patients had at least one active psychiatric diagnosis. Prevalent current disorders included major depression (6.5%), minor depression (5.2%), dementia (5.0%), alcohol abuse or dependence (2.3%), and psychotic disorders (2.0%). Dysthymic disorder and primary anxiety and somatoform disorders were less common and frequently comorbid with major depression. CONCLUSIONS: Mental disorders, particularly depression, are common among older persons seen in these primary care settings. Clinicians should be particularly vigilant about depression when evaluating older patients with anxiety or putative somatoform symptoms, given the relatively low prevalences of primary anxiety and somatoform disorders

Underdiagnosis of Depression in HIV: Who Are We Missing?

OBJECTIVE: To determine the sociodemographic and service delivery correlates of depression underdiagnosis in HIV. DESIGN: Cross-sectional survey. PATIENTS/PARTICIPANTS: National probability sample of HIV-infected persons in care in the contiguous United States who have available medical record data. MEASUREMENTS AND MAIN RESULTS: We interviewed patients using the Composite International Diagnostic Interview (CIDI) survey from the Mental Health Supplement. Patients also provided information regarding demographics, socioeconomic status, and HIV disease severity. We extracted patient medical record data between July 1995 and December 1997, and we defined depression underdiagnosis as a diagnosis of major depressive disorder based on the CIDI and no recorded depression diagnosis by their principal health care provider in their medical records between July 1995 and December 1997. Of the 1,140 HIV Cost and Services Utilization Study patients with medical record data who completed the CIDI, 448 (37%) had CIDI-defined major depression, and of these, 203 (45%) did not have a diagnosis of depression documented in their medical record. Multiple logistic regression analysis revealed that patients who had less than a high school education (P < .05) were less likely to have their depression documented in the medical record compared to those with at least a college education. Patients with Medicare insurance coverage compared to those with private health insurance (P < .01) and those with ≥3 outpatient visits (P < .05) compared to <3 visits were less likely to have their depression diagnosis missed by providers. CONCLUSIONS: Our results suggest that providers should be more attentive to diagnosing comorbid depression in HIV-infected patients

Applied Resiliency and Suicide Prevention: a Strengths-based, Risk- Reduction Framework

Book Summary: This inspiring resource presents theories, findings, and interventions from Positive Suicidology, an emerging strengths-based approach to suicide prevention. Its synthesis of positive psychology and suicidology theories offers a science-based framework for promoting wellbeing to complement or, if appropriate, replace traditional deficit-driven theories and therapies used in reducing suicidal thoughts and behaviors. Coverage reviews interpersonal, intrapersonal, and societal risk factors for suicide, and identifies protective factors, such as hope and resilience, that can be enhanced in therapy. From there, chapters detail a palette of approaches and applications of Positive Suicidology, from the powerful motivating forces described in Self-Determination Theory to meaning-building physical and social activities. Among the topics covered: Future-oriented constructs and their role in suicidal ideation and enactment. Gratitude as a protective factor for suicidal ideation and behavior: theory and evidence. Considering race and ethnicity in the use of positive psychological approaches to suicide. The Six R’s framework as mindfulness for suicide prevention. Community-based participatory research and empowerment for suicide prevention. Applied resiliency and suicide prevention: a strengths-based, risk-reduction framework. Psychotherapists, counselors, social workers, psychiatrists, and health psychologists, as well as educators, clergy and healthcare professionals, will find A Positive Psychological Approach to Suicide an invaluable source of contemporary evidence-based strategies for their prevention and intervention efforts with suicidal clients