Daniela Dantas Lima

Factors associated with suicide ideation among medically and surgically hospitalized patients

OBJECTIVE To identify the factors associated with suicide ideation among medically and surgically hospitalized patients. METHODS A consecutive sample of 4328 individuals admitted to a general hospital completed a screening questionnaire comprised of demographic and clinical information, the Mini International Neuropsychiatric Interview item on current suicide ideation, the Hospital Anxiety and Depression Scale subscale for depression and the Alcohol use Disorder Identification Test. A multiple logistic regression produced a discriminate profile of individuals with suicide ideation. RESULTS The prevalence rate for current suicide ideation was 4.9% (95% CI: 4.3-5.6). Patients admitted to the Infectious Disease, Oncology and Hematology units presented higher rates of suicide ideation (7.9%, 7.8% and 7.2%, respectively). Suicidal ideation was associated to depression [odds ratio (OR)=8.3], young age (18-35 years old: OR=2.5), alcohol use disorders (OR=2.3), and smoking (OR=1.8). CONCLUSION Suicidal ideation was consistently associated with indicators of mental disorders. It is proxy, not for completed suicide, but for a variety of common psychiatric conditions that can and should be dealt with in the medical/surgical setting.

Depression, alcohol use disorders and nicotine dependence among patients at a general hospital

OBJECTIVE To determine prevalence rates and identify patient characteristics associated with depression, alcohol use disorders and nicotine dependence among individuals admitted to a general teaching hospital. METHOD Using the Hospital Anxiety and Depression Scale and Alcohol Use Disorder Identification Test, we assessed 4,352 consecutive medical and surgical patients admitted over a 13-month period. The patients were also asked to report their daily cigarette smoking habits during the last month. Multiple logistic regression analyses were performed, and odds ratios (ORs) were calculated. RESULTS The mean age of the sample was 49.3 years, and 56.6% were male. Prevalence rates of depression, alcohol use disorders and nicotine dependence were, respectively, 14%, 9.8% and 16.9%. In the multivariate analysis, depression was associated with previous suicide attempts (OR = 8.7), lower level of education (OR = 3.6), prior use of psychotropic medications (OR = 3.1), cancer (OR = 1.7) and pain (OR = 1.7). Alcohol use disorders were associated with male sex (OR = 6.3), smoking (OR = 3.5), admission for an external cause of injury, such as a traffic accident (OR = 2.4), and previous suicide attempts (OR = 2.3). Nicotine dependence was associated with alcohol use disorders (OR = 3.4), young adulthood (OR = 2.3), widowhood (OR = 2.2) and previous suicide attempts (OR = 1.8). CONCLUSION This is the largest sample of medical and surgical patients ever surveyed with standardized screening instruments in a general hospital in Brazil. The high prevalence rates of psychiatric disorders and the profiles of the patients evaluated in this study underscore the need to develop methods that are more effective for detecting and managing such disorders. Hospital admission should be considered a major opportunity for the detection of psychiatric disorders and the subsequent implementation of the appropriate specific treatment strategies.

Tentativa de suicídio entre pacientes com uso nocivo de bebidas alcoólicas internados em hospital geral

OBJETIVO: Detectar fatores associados a historico de tentativa de suicidio (TS) em pacientes internados em hospital geral que fazem uso nocivo de bebidas alcoolicas. METODO: 4.352 pacientes admitidos consecutivamente foram avaliados utilizando-se um rastreamento do qual constavam as escalas AUDIT (Alcohol Use Disorder Identification Test) e HAD (Escala Hospitalar de Ansiedade e Depressao). Fixando-se historico de tentativa de suicidio ao longo da vida como variavel dependente, foram realizados testes do qui-quadrado e regressao logistica multipla. RESULTADOS: Uso nocivo de alcool (AUDIT > 8) foi detectado em 423 pacientes. Dentre eles, 60 (14,2%) apresentavam sintomas de depressao (HAD > 8) e 34 (8%) tinham historico de TS. Este se associou a ser adulto jovem [razao de chance (RC) = 3,4], depressao (RC = 6,6), uso pregresso de psicofarmaco (RC = 7) e ter SIDA (RC = 24). CONCLUSAO: Os resultados fortalecem a necessidade de detectar e tratar adequadamente condicoes que, combinadas, aumentam consideravelmente o risco de suicidio.

The phenomenological-existential comprehension of chronic pain: going beyond the standing healthcare models

A distinguishing characteristic of the biomedical model is its compartmentalized view of man. This way of seeing human beings has its origin in Greek thought; it was stated by Descartes and to this day it still considers humans as beings composed of distinct entities combined into a certain form. Because of this observation, one began to believe that the focus of a health treatment could be exclusively on the affected area of the body, without the need to pay attention to patient’s subjectivity. By seeing pain as a merely sensory response, this model was not capable of encompassing chronic pain, since the latter is a complex process that can occur independently of tissue damage. As of the second half of the twentieth century, when it became impossible to deny the relationship between psyche and soma, the current understanding of chronic pain emerges: that of chronic pain as an individual experience, the result of a sum of physical, psychological, and social factors that, for this reason, cannot be approached separately from the individual who expresses pain. This understanding has allowed a significant improvement in perspective, emphasizing the characteristic of pain as an individual experience. However, the understanding of chronic pain as a sum of factors corresponds to the current way of seeing the process of falling ill, for its conception holds a Cartesian duality and the positivist premise of a single reality. For phenomenology, on the other hand, the individual in his/her unity is more than a simple sum of parts. Phenomenology sees a human being as an intending entity, in which body, mind, and the world are intertwined and constitute each other mutually, thus establishing the human being’s integral functioning. Therefore, a real understanding of the chronic pain process would only be possible from a phenomenological point of view at the experience lived by the individual who expresses and communicates pain.ResumoUma característica marcante do modelo biomédico é a visão de homem compartimentalizada na qual se embasa. Esta forma de ver o ser humano teve origem no pensamento grego, foi afirmada por Descartes e permanece até hoje como sendo este ser composto por entidades distintas que se combinam em determinada sorte. Como fruto desta constatação passou-se a acreditar que o foco da atenção de um tratamento de saúde poderia ser dado especificamente à área do corpo acometida, sem que fosse necessária atenção à subjetividade do doente. Compreendendo a dor como mera resposta sensorial, este modelo não pôde alcançar o que seria a dor crônica, por esta se tratar de um processo complexo podendo existir independente de lesão tecidual. A partir da segunda metade do século XX, quando se torna impossível negar a interferência entre psique e soma, surge a compreensão de dor crônica que se tem hoje: de uma experiência individual, resultado de uma soma de fatores físicos, psicológicos e sociais, não podendo por isso ser abordada de modo desvinculado ao indivíduo que a expressa. Este entendimento permitiu um grande avanço de ponto de vista por ressaltar sua característica de vivência particular. Entretanto, a compreensão de dor crônica enquanto soma de fatores faz jus ao modo atual de compreensão do adoecimento mantendo em sua concepção a dualidade cartesiana e a premissa positivista de se voltar a uma única realidade. Para a fenomenologia, em contra partida, o indivíduo em sua unidade é mais que a mera soma de partes. Entende o ser humano como entidade intenciona l, onde corpo, mente e mundo são entrelaçados e constituem-se mutuamente, estabelecendo, assim, um tipo de funcionamento completamente integral do ser humano. Deste modo, o real entendimento de um processo de dor crônica só seria possível a partir de um olhar fenomenológico da experiência como vivida pelo indivíduo que a expressa e comunica.

General hospital admission as an opportunity for smoking-cessation strategies: a clinical trial in Brazil

OBJECTIVE To compare the results of 6-month follow-ups for hospitalized patients who were divided into two groups of low- and high-intensity treatments for smoking cessation and compared to the results of standard hospital treatment. METHODS A total of 2414 patients were screened. Two hundred thirty-seven current smokers were randomly assigned to high-intensity intervention (HII; 30-min motivational interview plus seven routine telephone calls after hospital discharge) or to low-intensity intervention (LII; 15-min counseling about the benefits of quitting) and 80 comprised the usual care (UC) group. Six months after hospital discharge, all participants were contacted by phone. The main outcome measure was smoking cessation. RESULTS The smoking-cessation rates were 44.9%, 41.7% and 26.3% for the HII, LII and UC groups, respectively (P = .03). The multivariable analysis identified the following variables which are associated with the failure to stop smoking: the absence of a tobacco-related disease (TRD), younger age and a low motivation for cessation at the initial contact. CONCLUSIONS There was a great difference between intervention and nonintervention. The LII had an impact similar to the HII. The variables associated with no smoking cessation demonstrate the need for more personalized interventions for smokers who present lower indexes of motivation, are younger and do not have smoking-related diseases.

Depressão e comportamento suicida em pacientes oncológicos hospitalizados: prevalência e fatores associados

OBJECTIVE: To determine prevalence rates of depression and suicidal behavior among cancer inpatients and factors associated with these conditions. METHODS: A total of 5357 patients consecutively admitted to a university hospital were assessed by means of the Hospital Anxiety and Depression Scale (HAD) and the suicide risk section of the Mini International Neuropsychiatric Interview (MINI). Univariate analyses adjusted for gender and age groups were performed with depression and suicide risk as dependent variables. RESULTS: Of those assessed, 675 had cancer. The prevalence rates for depression and suicide risk were 18.3% (95%CI = 15.4 - 21.4) and 4.7% (95%CI = 3.2 - 6.7) respectively. Depression was more frequently found in cancer bearers than in the other inpatients (13.2%; p = 0.0009). Female gender, low schooling level, long time of disease, pain, use of psychotropic drugs and suicide risk were associated with depression (p < 0.05). Pain and depression were associated with suicide risk. CONCLUSION: Because prevalence rates of depression and suicide risk are high among cancer inpatients, simple screening instruments and specific questions during interviews are needed to detect these clinical conditions.OBJECTIVE To determine prevalence rates of depression and suicidal behavior among cancer inpatients and factors associated with these conditions. METHODS A total of 5357 patients consecutively admitted to a university hospital were assessed by means of the Hospital Anxiety and Depression Scale (HAD) and the suicide risk section of the Mini International Neuropsychiatric Interview (MINI). Univariate analyses adjusted for gender and age groups were performed with depression and suicide risk as dependent variables. RESULTS Of those assessed, 675 had cancer. The prevalence rates for depression and suicide risk were 18.3% (95%CI = 15.4 - 21.4) and 4.7% (95%CI = 3.2 - 6.7) respectively. Depression was more frequently found in cancer bearers than in the other inpatients (13.2%; p = 0.0009). Female gender, low schooling level, long time of disease, pain, use of psychotropic drugs and suicide risk were associated with depression (p < 0.05). Pain and depression were associated with suicide risk. CONCLUSION Because prevalence rates of depression and suicide risk are high among cancer inpatients, simple screening instruments and specific questions during interviews are needed to detect these clinical conditions.

Emoção e soma (des)conectadas em páginas de revista: as categorias temáticas do discurso prescritivo sobre os fenômenos da vida e da doença

As revistas vendidas nas bancas tem se tornado textos de autoajuda e o estudo de suas materias possibilita compreender como seus discursos sao construidos, como se tornam repertorios utilizados para dar sentido a vida. No caso das revistas que versam sobre a esfera da saude, que prescrevem receitas de tratamento, prevencao e ate estilos de vida saudaveis, os estudos permitem compreender os significados dos discursos sobre corpo e saude. Em algumas materias, por vezes o destaque dado ao fisico se faz acompanhar da insercao de aspectos mentais. Tal fato originou o presente estudo que tem por objetivo clarificar como esta conexao mente e corpo e conceituada e prescrita nessas paginas. Seis materias de uma revista brasileira de saude, publicadas entre agosto de 2005 e fevereiro de 2006, foram analisadas quanto ao conteudo dos textos e ao destaque grafico e textual. Considerou-se significativo o formato em que esta midia opera, pois associado as categorias tematicas: autodiagnostico, o lugar das emocoes, as prescricoes e a causalidade reforca estilos de vida saudaveis. Para tanto o leitor deve aprender a se autodiagnosticar e controlar suas emocoes, consideradas contrapostas ao fisico. As materias delineiam um campo de saude em que a cisao mente corpo se adensa e se prolonga, instaurando a medicalizacao da sociedade.

Depression and suicidal behavior of cancer inpatients: prevalence and associated factors

OBJECTIVE: To determine prevalence rates of depression and suicidal behavior among cancer inpatients and factors associated with these conditions. METHODS: A total of 5357 patients consecutively admitted to a university hospital were assessed by means of the Hospital Anxiety and Depression Scale (HAD) and the suicide risk section of the Mini International Neuropsychiatric Interview (MINI). Univariate analyses adjusted for gender and age groups were performed with depression and suicide risk as dependent variables. RESULTS: Of those assessed, 675 had cancer. The prevalence rates for depression and suicide risk were 18.3% (95%CI = 15.4 - 21.4) and 4.7% (95%CI = 3.2 - 6.7) respectively. Depression was more frequently found in cancer bearers than in the other inpatients (13.2%; p = 0.0009). Female gender, low schooling level, long time of disease, pain, use of psychotropic drugs and suicide risk were associated with depression (p < 0.05). Pain and depression were associated with suicide risk. CONCLUSION: Because prevalence rates of depression and suicide risk are high among cancer inpatients, simple screening instruments and specific questions during interviews are needed to detect these clinical conditions.OBJECTIVE To determine prevalence rates of depression and suicidal behavior among cancer inpatients and factors associated with these conditions. METHODS A total of 5357 patients consecutively admitted to a university hospital were assessed by means of the Hospital Anxiety and Depression Scale (HAD) and the suicide risk section of the Mini International Neuropsychiatric Interview (MINI). Univariate analyses adjusted for gender and age groups were performed with depression and suicide risk as dependent variables. RESULTS Of those assessed, 675 had cancer. The prevalence rates for depression and suicide risk were 18.3% (95%CI = 15.4 - 21.4) and 4.7% (95%CI = 3.2 - 6.7) respectively. Depression was more frequently found in cancer bearers than in the other inpatients (13.2%; p = 0.0009). Female gender, low schooling level, long time of disease, pain, use of psychotropic drugs and suicide risk were associated with depression (p < 0.05). Pain and depression were associated with suicide risk. CONCLUSION Because prevalence rates of depression and suicide risk are high among cancer inpatients, simple screening instruments and specific questions during interviews are needed to detect these clinical conditions.

[Emotion and soma (dis)connected in magazine pages: the thematic categories of the prescriptive discourse on phenomena of life and illness].

Magazines sold on newsstands have become self-help texts, and the study of the topics covered makes it possible to understand how the discourses are constructed, how they become repositories used to give meaning to life. In the case of magazines that deal with the sphere of health, prescribing methods of treatment, prevention and even healthy lifestyles, the studies allow us to understand the meanings of discourses about body and health. In some articles, the emphasis that sometimes highlights the physical aspect is accompanied by the inclusion of mental aspects. This fact gave rise to this study, which seeks to clarify how this mind-body connection is conceptualized and prescribed in these pages. Six articles of a Brazilian health magazine published between August 2005 and February 2006 were analyzed regarding the content of the texts as well as graphic and textual features. The way this media format operates was considered significant, and when associated with the themes: self-diagnosis, the place of emotion, the prescriptions and causality reinforce healthy lifestyles. Readers must learn to self-diagnose and control their emotions, considered to be juxtaposed to the physical emotions. The articles outline a field of health in which the mind-body split deepens and extends, establishing the medicalization of society.

P01-264 - Depression, alcohol use disorders and nicotine dependence in the general hospital

Objectives: to identify prevalence rates and related patient characteristics associated with depression, alcohol use disorders (AUD), and nicotine dependence among individuals admitted to a university general hospital. Methods: 4352 consecutively admitted patients were assessed using the HAD scale and AUDIT. They were also asked on daily cigarette smoking during the previous month. Multivariate logistic regression analyses were performed. Results: 56.6% were male. The average age was 49.3. Prevalence rates of depressive disorder, AUD and nicotine dependence were, respectively, 14%, 9.8% and 16.9%. In the multivariate analysis depression was associated with previous suicide attempt (OR = 8.7), less schooling (3.6), prior use of psychotropic medicines (3.1), cancer (1.7) and pain (1.7). AUD were associated with male sex (OR = 6.3), smoking (3.5), admission for an external cause (2.4), mainly road accidents, and previous suicide attempt (2.3). Nicotine dependence was associated with AUD (OR = 3.4), young adulthood (2.3), widowhood (2.2) and previous suicide attempt (1.8). Conclusion: High prevalence rates and respective patient profiles highlight the need to develop more effective methods for detecting and managing these disorders. Hospital admission should be considered a milestone in a person’s life from which a psychiatric disorder is detected and specific treatment strategies are implemented.