Denise Machado Duran Gutierrez

Autópsia psicológica e psicossocial sobre suicídio de idosos: abordagem metodológica

The article analyzes the quality and consistency of a semi-structured interview script, adapted for the study on suicide among elderly people, and presents the psychological and psychosocial autopsy method, which is the result of application of this instrument. The objective is to demonstrate how the in-depth interview and subsequent data organization and analyses were tested and improved by a network of researchers from eight regions in Brazil. Evaluation of the method was conducted before and after the application of the instruments to collect, systematize and analyze the data. This methodology was applied in 51 cases of elderly people who committed suicide in ten Brazilian municipalities. The study did more than just collect data with scientific rigor, since it also verified the consistency of the instrument used and the applicability of the method. The improved script and the instructions of how to apply and analyze it are thus presented here. The results reveal the rigor and credibility of this methodological approach tested and qualified by a multidisciplinary and inter-institutional procedure.O artigo analisa a qualidade e a consistencia de um roteiro de entrevista semiestruturada, adaptado para o estudo do suicidio de pessoas idosas e apresenta o metodo das autopsias psicossociais que resultou da aplicacao desse instrumento. O objetivo e demonstrar como o uso da entrevista em profundidade e sua forma de organizacao e analise de dados foram testados e aperfeicoados por uma rede de pesquisadores de varios centros de pesquisa do Brasil. O metodo envolveu a aplicacao do instrumento em que se socializou um manual de instrucoes sobre a coleta, sistematizacao e analise de dados. A metodologia foi aplicada no estudo de 51 casos de idosos que faleceram por suicidio em dez municipios brasileiros, e permitiu a verificacao da consistencia do instrumento usado e a aplicabilidade do seu metodo, durante o processo e ao final, por meio de uma avaliacao em rede. O roteiro aperfeicoado e as instrucoes para replica-lo e analisa-lo sao aqui apresentados. Os resultados apontam o rigor e a credibilidade dessa abordagem metodologica testada e qualificada de um modo interdisciplinar e interinstitucional.

Impacto do suicídio da pessoa idosa em suas famílias

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.

Papel da mulher de camadas populares de Manaus na produção de cuidados da saúde

Abstract This work presents the results of an investigation about the woman’s role in the production of health care within the family context. We use categories such as mother’s social role, work sharing, power relations, taking care of the other and self health care. Twenty-one professionals belonging to two Family Health Program teams and eleven families living in a popular area in the city of Manaus were interviewed. We found that the interviewed women provide health care for their family members in a broad way, including many people and many care dimensions, such as physical and environmental care, following medical prescriptions and monitoring health on a daily basis. These actions have great importance to the solving capability of medical interventions. However, we see that the good performance of this care is strongly influenced by aspects of the concrete reality, which delimit resour-ces and possibilities, and by aspects of the relational dynamics of the family to which these women belong, which favor or hinder their performance.Keywords: Health Care; Woman Caregiver; Family He-alth; Professionals of the Family Health Program.

Vivências subjetivas de idosos com ideação e tentativa de suicídio

Discutimos as vivencias subjetivas de idosos que apresentam ideacao e tentativa de suicidio a partir dos seus relatos. Entendemos a subjetividade como vivencia intrapsiquica resultante da condicao social, economica, relacional e biografica. Embora exiguo na literatura, o tema e importante, pois e no campo da subjetividade que as ideacoes e as tentativas de suicidio vao se configurando ate que se concretizem no ato. Dados empiricos foram coletados por meio de entrevista semiestruturada focalizando: caracterizacao social, retrato e modo de vida, estado mental previo, atmosfera da tentativa, impactos na saude do idoso e familia. A partir da analise dos sentidos emergentes foram geradas cinco categorias empiricas: (1) nao lugar do sujeito; (2) falta de aceitacao das perdas; (3) sofrimento pela ingratidao dos familiares; (4) sentimento de inutilidade da e na vida; (5) ressignificacao das situacoes que geram condutas suicidas. Os resultados apontam a necessidade fundamental de incorporar conhecimento sobre os processos subjetivos aos programas de prevencao do suicidio do idoso com ideacao e tentativa de suicidio.

Homens e cuidados de saúde em famílias empobrecidas na Amazônia

Abstract We investigated the position of men in relation to health care in low-income families at the Amazon region. We completed 11 interviews with the men and their families and with 21 health care profes-sionals responsible for them. We made observations of the contexts in which they live and of the use and provision of health service process. Data were analyzed from the perspective of cultural holism-individualism. We found that men tend to follow traditional social roles in managing their own and their family’s health. Health care for themselves is usually emergency care, superficial and mediated by the woman. The man’s care for others is primarily focused on fulfilling the role of provider. However, men dominated by indigenous culture and young men with more modern social and family views tend not to follow this pattern. As a rule, the parents rein-force the main cultural tendencies of male behaviour related to health care. The professionals, in turn, tend to dismiss male’s claims, seeking mistakenly to combat sexism, and fail to recognize differences based on cultural repertoires.Keywords: Man and Health; Health Care in the Fa-mily; Health Family Program.

Tentativa de suicídio em mulheres idosas – uma perspectiva de gênero

This article analyzes the presence of gender inequality and violence in the lives of elderly women who have attempted suicide. This survey is part of a qualitative research study developed in twelve municipal regions in Brazil with high levels of suicide, and is coordinated by Claves-Fiocruz. Information was obtained by means of semi-structured interviews with thirty-two women from a sampling of fifty-nine elderly women with a history of attempted suicide. It was decided not to identify the interviewees, and to construct a narrative based on events that have occurred in the lives of all these women. The study was based on the womens life cycle (infancy, youth, adult life and old age) to see if gender inequality had been an issue in each of these phases. The inequalities began in infancy with differentiated gender upbringing; these continued during their youth and with their sexual initiation, marriage and maturity these continued during their adult life through acts of violence committed by their partners and/ or other family members which culminates in old age, when they are deprived of their independence and have lost ties, possessions and points of reference. These lives permeated with violence result in a feeling of emptiness and unworthiness, and lead many elderly women to view death as their only solution.This article analyzes the presence of gender inequality and violence in the lives of elderly women who have attempted suicide. This survey is part of a qualitative research study developed in twelve municipal regions in Brazil with high levels of suicide, and is coordinated by Claves-Fiocruz. Information was obtained by means of semi-structured interviews with thirty-two women from a sampling of fifty-nine elderly women with a history of attempted suicide. It was decided not to identify the interviewees, and to construct a narrative based on events that have occurred in the lives of all these women. The study was based on the womens life cycle (infancy, youth, adult life and old age) to see if gender inequality had been an issue in each of these phases. The inequalities began in infancy with differentiated gender upbringing; these continued during their youth and with their sexual initiation, marriage and maturity these continued during their adult life through acts of violence committed by their partners and/ or other family members which culminates in old age, when they are deprived of their independence and have lost ties, possessions and points of reference. These lives permeated with violence result in a feeling of emptiness and unworthiness, and lead many elderly women to view death as their only solution.

Instrumentos, estratégias e método de abordagem qualitativa sobre tentativas e ideações suicidas de pessoas idosas

The article analyses the quality and consistency of a comprehensive interview guide, adapted to study attempted suicide and its ideation among the elderly, and imparts the method followed in applying this tool. The objective is to show how the use of a semi-structured interview and the organization and data analysis set-up were tested and perfected by a network of researchers from twelve universities or research centers in Brazil, Uruguay and Colombia. The method involved application and evaluation of the tool and joint production of an instruction manual on data collection, systematization and analysis. The methodology was followed in 67 interviews with elderly people of 60 or older and in 34 interviews with health professionals in thirteen Brazilian municipalities and in Montevideo and Bogotá, allowing the consistency of the tool and the applicability of the method to be checked, during the process and at the end. The enhanced guide and the instructions for reproducing it are presented herein. The results indicate the suitability and credibility of this methodological approach, tested and certified in interdisciplinary and interinstitutional terms.The article analyses the quality and consistency of a comprehensive interview guide, adapted to study attempted suicide and its ideation among the elderly, and imparts the method followed in applying this tool. The objective is to show how the use of a semi-structured interview and the organization and data analysis set-up were tested and perfected by a network of researchers from twelve universities or research centers in Brazil, Uruguay and Colombia. The method involved application and evaluation of the tool and joint production of an instruction manual on data collection, systematization and analysis. The methodology was followed in 67 interviews with elderly people of 60 or older and in 34 interviews with health professionals in thirteen Brazilian municipalities and in Montevideo and Bogota, allowing the consistency of the tool and the applicability of the method to be checked, during the process and at the end. The enhanced guide and the instructions for reproducing it are presented herein. The results indicate the suitability and credibility of this methodological approach, tested and certified in interdisciplinary and interinstitutional terms.