Patients hospitalized for suicidal ideation and suicide attempt in a mental health hospital: clinico-demographical features and 6-month follow-up

Introducción: El suicidio es un problema de alto impacto para la salud pública. En la Argentina son pocos los estudios publicados sobre suicidio e intento de suicidio. Objetivo: Determinar el porcentaje de internaciones motivadas por intento o ideación suicida en un Hospital de Salud Mental de la Ciudad de Buenos Aires, describir las características clínico-demográficas de estas pacientes y analizar la frecuencia de eventos desfavorables en el seguimiento a 6 meses. Métodos: En el presente estudio se emplean los datos basales y de seguimiento de un estudio analítico, observacional, de cohorte prospectivo. Resultados: Los datos basales muestran que de la totalidad de pacientes que ingresaron al Servicio de Guardia, el 27% lo hizo por ideación o intento de suicidio. Los diagnósticos más frecuentes fueron: trastorno límite de la personalidad (41%), trastorno depresivo mayor (38%), trastorno bipolar (20%) y esquizofrenia (16%). El método utilizado con más frecuencia en el intento de suicidio fue la sobreingesta medicamentosa. En la mitad de las pacientes, el proceso suicida se desarrolló en menos de 10 minutos. Los datos del seguimiento muestran que el 22% de las pacientes presentó un nuevo intento de suicidio y el 34% tuvo una reinternación a 6 meses. Conclusiones: En conjunto, estos resultados describen las características de las pacientes suicidas asistidas en un Hospital de Salud Mental, muestran la baja eficacia de las intervenciones y plantean la necesidad de diseñar nuevas estrategias para el manejo de las mismas.Background: Suicide is an issue of high public health impact. In Argentina there are few published studies on suicide and suicide attempt. Objective: To determine the percentage of hospitalizations caused by suicidal attempt or suicidal ideation in a Mental Health Hospital of the City of Buenos Aires, describe the clinical and demographic characteristics of these patients and to analyze the frequency of adverse events at a 6-month follow-up. Methods: In the present study, baseline and follow-up data of an analytical, observational, prospective cohort study are used. Results: Baseline data show that of all patients who entered the Emergency Department, 27% did so for ideation or suicide attempt. The most frequent diagnoses were: borderline personality disorder (41%), major depressive disorder (38%), bipolar disorder (20%) and schizophrenia (16%). The method most commonly used during the suicide attempt was drug poisoning. In half of the patients, the suicidal process was developed in less than 10 minutes. Monitoring data show that 22% of patients had a new attempted suicide and 34% had a readmission in a 6-month period. Conclusions: Together, these results describe the characteristics of suicide patients admitted to a Mental Health Hospital and show the low efficacy of interventions and the need to devise new strategies for the management of suicidal patients.Fil: Teti, Germán Leandro. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; ArgentinaFil: Rebok, Federico. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; ArgentinaFil: Grendas, Leandro Nicolás. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; ArgentinaFil: Fógola, Agustina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; Argentin

Differences between female suicidal patients with family history of suicide attempt and family history of completed suicide

Background: Family history of suicidal behavior and suicide are both risk factors for suicide. However, the effects of family history of suicide versus suicide attempts on patient suicidal behavior remain unclear. The aim of the present study was to understand if family history of suicide as compared to family history of suicide attempts or no family history of suicidal behavior evidences different associations with suicidal behavior among psychiatric patients. Method: Participants included 157 female patients between the ages of 18 and 65 years admitted at the Dr. Braulio A. Moyano Neuropsychiatric Women's Hospital. Results: Seventy-nine patients (50.3%) reported no family history of suicidal behavior (NFHSB), while 78 patients (49.7%) reported a family history of suicidal behavior. Specifically, 41 patients (26.1%) reported a family history of suicide attempt (FHSA) and 37 patients (23.6%) reported a family history of suicide (FHS). These groups showed significant differences between family history of psychopathology and number of previous suicide attempts. Patients with an FHSA were more likely to present with a greater number of previous suicide attempts as compared to patients with NFHSB and FHS. Conclusion: There is an association between the number of suicide attempts and family history of suicide attempts in female patients hospitalized for suicidal behavior.Fil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Rojas, S. M.. University of Arkansas; Estados UnidosFil: Feldner, M. T.. University of Arkansas; Estados Unidos. Laureate Institute for Brain Research; Estados UnidosFil: Dutton, C.. University of Arkansas; Estados UnidosFil: Rebok, Federico. Ciudad Autónoma de Buenos Aires. Hospital Neuropsiquiátrico “Dr. Braulio A. Moyano”; ArgentinaFil: Teti, Germán Leandro. Ciudad Autónoma de Buenos Aires. Hospital Neuropsiquiátrico “Dr. Braulio A. Moyano”; ArgentinaFil: Grendas, Leandro Nicolás. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Fógola, Agustina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Time Left for Intervention in the Suicidal Process in Borderline Personality Disorder

The objective of this study was to measure the duration of the suicidal process among patients diagnosed with Borderline Personality Disorder (BPD). The sample included 110 female patients who met DSM-IV-TR criteria for BPD and were consecutively admitted after suicide-related behavior. A total of 63 patients (58%) reported that their suicidal process lasted 10 minutes or less. After being adjusted, the β coefficient of impulsivity scales in women with a suicidal process ≤10 minutes was lower compared to those observed in women with >10 min (β = −0.03, 95% CI = −0.06 = −0.01, p < 0.01). Suicidal patients with BPD can be divided into two groups; patients who report a suicidal process less than 10 minutes show a higher degree of impulsivity.Fil: Daray, Federico Manuel. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Teti, Germán Leandro. Gobierno de la Ciudad de Buenos Aires. Hospital Neuropsiquiátrico "Braulio A. Moyano"; ArgentinaFil: Rojas, Sasha M.. University Of Arkansas - Fayetteville; Estados UnidosFil: Fantini, Adrian Pablo. Gobierno de la Ciudad de Buenos Aires. Hospital Neuropsiquiátrico "Braulio A. Moyano"; ArgentinaFil: Cárdenas Delgado, Christian. Gobierno de la Ciudad de Buenos Aires. Hospital Neuropsiquiátrico "Braulio A. Moyano"; ArgentinaFil: Armesto, Arnaldo Raúl. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Derito, María N. C.. Gobierno de la Ciudad de Buenos Aires. Hospital Neuropsiquiátrico "Braulio A. Moyano"; ArgentinaFil: Rebok, Federico. Gobierno de la Ciudad de Buenos Aires. Hospital Neuropsiquiátrico "Braulio A. Moyano"; Argentin

Revisión sistemática de los factores de riesgo de suicidio e intento de suicidio entre los pacientes psiquiátricos de América Latina y el Caribe

OBJETIVO: Analizar los datos probatorios publicados de la región de América Latina y el Caribe (ALC) que fueran pertinentes a los factores de riesgo de suicidio consumado e intentos de suicidio entre las poblaciones psiquiátricas. MÉTODOS: Se seleccionaron los posibles estudios mediante búsquedas electrónicas sistemáticas en MEDLINE y LILACS. Se incluyeron estudios cuyos diseños de investigación fueran de cohortes, de casos y controles, o transversales de muestras psiquiátricas, y en los que el suicidio o un intento de suicidio se notificaran como un resultado, y se evaluaran mediante alguna medida de la repercusión (razón de posibilidades, razón de riesgos o razón de riesgos instantáneos). Se evaluó la calidad metodológica mediante el uso de las recomendaciones de la iniciativa de Fortalecimiento de la Notificación de los Estudios Observacionales en Epidemiología (STROBE, por sus siglas en inglés). RESULTADOS: Se analizaron 17 de los 2 987 estudios seleccionados con objeto de determinar los posibles factores de riesgo de suicidio. Once estudios usaron un diseño de casos y controles, cinco usaron un diseño transversal, y un único estudio usó un diseño de cohortes prospectivo. Los principales factores de riesgo de intento de suicidio en ALC fueron el trastorno depresivo mayor (TDM), la disfunción familiar y el intento de suicidio previo, mientras que los principales factores de riesgo de suicidio consumado fueron el sexo masculino y el TDM. La mayor parte de los estudios mostraron una mala calidad metodológica. CONCLUSIONES: Esta revisión aporta datos probatorios de que la mayor parte de los factores de riesgo pertinentes al suicidio y los intentos de suicidio en la región de ALC son similares a los observados en las sociedades occidentales pero diferentes a los notificados en las sociedades orientales. Se necesitan estudios regionales de mayor calidad metodológica para apoyar estos resultados.-To analyze published evidence from the Latin America and Caribbean (LAC) region pertaining to risk factors for completed suicide and suicide attempts among psychiatric populations. METHODS- Potential studies were identified through systematic electronic searches in MEDLINE and LILACS. Included studies were cohort, case-control, and cross-sectional designed investigations of psychiatric samples in which suicide or a suicide attempt was reported as an outcome and evaluated with some measure of impact (odds ratio, risk ratio, or hazard ratio). Methodological quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations. RESULTS- Of the 2 987 identified studies, a total of 17 studies were reviewed to determine potential suicidal risk factors. Eleven studies used a case-control design, five used a cross-sectional design, and only one study used a prospective-cohort design. The main risk factors for suicide attempts in LAC included major depressive disorder (MDD), family dysfunction, and prior suicide attempt, while the main risk factors for completed suicide were male gender and MDD. The methodological quality of most of the studies was low. CONCLUSIONS- This review provides evidence that the majority of relevant risk factors for suicide and suicide attempts in the LAC region are similar to those observed in Western societies but different from those reported in Eastern societies. Studies of higher methodological quality from the region are needed to support these results-Fil: Teti, Germán. Hospital "Braulio A. Moyano"; ArgentinaFil: Rebok, Federico. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; ArgentinaFil: Rojas, Sasha M.. University Of Arkansas For Medical Sciences; Estados UnidosFil: Grendas, Leandro. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Systematic review of risk factors for suicide and suicide attempt among psychiatric patients in Latin America and Caribbean

OBJECTIVE: To analyze published evidence from the Latin America and Caribbean (LAC) region pertaining to risk factors for completed suicide and suicide attempts among psychiatric populations. METHODS: Potential studies were identified through systematic electronic searches in MEDLINE and LILACS. Included studies were cohort, case-control, and cross-sectional designed investigations of psychiatric samples in which suicide or a suicide attempt was reported as an outcome and evaluated with some measure of impact (odds ratio, risk ratio, or hazard ratio). Methodological quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations. RESULTS: Of the 2 987 identified studies, a total of 17 studies were reviewed to determine potential suicidal risk factors. Eleven studies used a case-control design, five used a cross-sectional design, and only one study used a prospective-cohort design. The main risk factors for suicide attempts in LAC included major depressive disorder (MDD), family dysfunction, and prior suicide attempt, while the main risk factors for completed suicide were male gender and MDD. The methodological quality of most of the studies was low. CONCLUSIONS: This review provides evidence that the majority of relevant risk factors for suicide and suicide attempts in the LAC region are similar to those observed in Western societies but different from those reported in Eastern societies. Studies of higher methodological quality from the region are needed to support these results

Validation and calibration of the patient health questionnaire (PHQ-9) in Argentina

Background: The Patient Health Questionnaire-9 (PHQ-9) is a brief tool to assess the presence and severity of depressive symptoms. This study aimed to validate and calibrate the PHQ-9 to determine appropriate cut-off points for different degrees of severity of depression in Argentina. Methods: We conducted a cross-sectional study on an intentional sample of adult ambulatory care patients with different degrees of severity of depression. All patients who completed the PHQ-9 were further interviewed by a trained clinician with the Mini International Neuropsychiatric Interview (MINI) and the Beck Depression Inventory-II (BDI-II). Reliability and validity tests, including receiver operating curve analysis, were performed. Results: One hundred sixty-nine patients were recruited with a mean age of 47.4 years (SD = 14.8), of whom 102 were females (60.4%). The local PHQ-9 had high internal consistency (Cronbach's alpha = 0.87) and satisfactory convergent validity with the BDI-II scale [Pearson's correlation = 0.88 (p < 0.01)]. For the diagnosis of Major Depressive Episode (MDE) according to the MINI, a PHQ-9 ≥ 8 was the optimal cut-off point found (sensitivity 88.2%, specificity 86.6%, PPV 90.91%). The local version of PHQ-9 showed good ability to discriminate among depression severity categories according to the BDI-II scale. The best cut off points were 6-8 for mild cases, 9-14 for moderate and 15 or more for severe depressive symptoms respectively. Conclusions: The Argentine version of the PHQ-9 questionnaire has shown acceptable validity and reliability for both screening and severity assessment of depressive symptoms.Fil: Urtasun, María. Instituto de Efectividad Clínica y Sanitaria; Argentina. Universidad de Alcalá; EspañaFil: Daray, Federico Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; ArgentinaFil: Teti, Germán Leandro. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital Neuropsiquiátrico Braulio Aurelio Moyano; ArgentinaFil: Coppolillo, Fernando Enrique. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Herlax, Gabriela. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Saba, Guillermo. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Araya, Ricardo. London School of Hygiene and Tropical Medicine; Reino UnidoFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin