Fátima Gonçalves Cavalcante

Suicídio entre pessoas idosas: revisão da literatura

Foi realizada revisao da literatura sobre os principais fatores associados a ideacao, tentativas e suicidio propriamente dito de pessoas idosas. Foram pesquisadas as seguintes bases de dados: MEDLINE, PsychInfo, SciELO e Biblioteca Virtual em Violencia e Saude da BIREME, referentes ao periodo de 1980 a 2008. Foram selecionadas e analisadas 52 referencias, que mostraram forte relacao entre ideacao, tentativas e efetivacao do ato fatal em pessoas idosas, que resulta da interacao de fatores complexos: fisicos, mentais, neurobiologicos e sociais. O suicidio associado a depressao em idosos e prevenivel desde que a pessoa esteja devidamente tratada. Ha necessidade de investimento em pesquisa no Brasil, dado o crescimento persistente das taxas de suicidio entre idosos, sobretudo do sexo masculino.A literature review was carried out focusing on the main factors associated with suicidal ideation, attempts and completed suicide in elders. The following databases were searched: MEDLINE, PsychINFO, SciELO and Biblioteca Virtual em Violência e Saúde da BIREME (BIREMEs Violence and Health Virtual Library), referring to the period from 1980 to 2008. Fifty-two references were selected and analyzed. They showed a strong relationship among suicide ideation, attempt and completion in elderly individuals, which results from the interaction of complex physical, mental, neurobiological and social factors. Suicide associated with depression in the elderly can be prevented, provided the person is properly treated. In Brazil, it is necessary to invest in research, given the persistent increase in suicide rates among aged people, especially among males.

Methodological proposal for studying suicide as a complex phenomenon

The authors present a methodological proposal for studying suicide and suicide attempts from a combined socio-anthropological, epidemiological, and psychosocial perspective. This interdisciplinary and complex research model simultaneously examined individual, socioeconomic, historical/cultural, and population data as few studies have succeeded to date. Considering that the present study was conducted in a specific social reality, the authors created a methodological approach to comprehend the effects of a crisis in an industrial restructuring process in a mining company town in the State of Minas Gerais, Brazil, that was associated with unusually high suicide rates. Since it referred to a small geographic area (with only 100,000 inhabitants), the research is considered an ideal case study. The authors created different strategies to trace the local epidemiological profile, adapted a psychosocial autopsy technique to elucidate suicide cases and a psychosocial harm assessment technique to comprehend suicide attempts, and conducted a local analysis of the socio-cultural context. The methods proposed here (with advantages and limitations) proved productive for elucidating the study hypothesis.

Suicide in elderly people: a literature review

Foi realizada revisao da literatura sobre os principais fatores associados a ideacao, tentativas e suicidio propriamente dito de pessoas idosas. Foram pesquisadas as seguintes bases de dados: MEDLINE, PsychInfo, SciELO e Biblioteca Virtual em Violencia e Saude da BIREME, referentes ao periodo de 1980 a 2008. Foram selecionadas e analisadas 52 referencias, que mostraram forte relacao entre ideacao, tentativas e efetivacao do ato fatal em pessoas idosas, que resulta da interacao de fatores complexos: fisicos, mentais, neurobiologicos e sociais. O suicidio associado a depressao em idosos e prevenivel desde que a pessoa esteja devidamente tratada. Ha necessidade de investimento em pesquisa no Brasil, dado o crescimento persistente das taxas de suicidio entre idosos, sobretudo do sexo masculino.A literature review was carried out focusing on the main factors associated with suicidal ideation, attempts and completed suicide in elders. The following databases were searched: MEDLINE, PsychINFO, SciELO and Biblioteca Virtual em Violência e Saúde da BIREME (BIREMEs Violence and Health Virtual Library), referring to the period from 1980 to 2008. Fifty-two references were selected and analyzed. They showed a strong relationship among suicide ideation, attempt and completion in elderly individuals, which results from the interaction of complex physical, mental, neurobiological and social factors. Suicide associated with depression in the elderly can be prevented, provided the person is properly treated. In Brazil, it is necessary to invest in research, given the persistent increase in suicide rates among aged people, especially among males.

Tendência da mortalidade por suicídio na população brasileira e idosa, 1980-2006

OBJECTIVE To describe mortality from suicide in Brazil, with emphasis on the older adult population. METHODS Temporal analysis and trend analysis by polynomial regression were conducted on suicide in the population above 10 years old in Brazil and the State of Rio de Janeiro (Southeastern Brazil) from 1980-2006. The data were extracted from the Mortality Information System, and the rates calculated by gender and age per 100,000 inhabitants, considering the resident population provided by DATASUS. For the period between 1980 and 1995, the ninth revision of International Statistical Classification of Diseases and Related Health Problems was used, and for 1996 to 2006, the tenth revision. RESULTS Suicide rates significantly increased in Brazil and in Rio de Janeiro (respectively reaching 5.7 and 3.1 deaths per 100,000 inhabitants in 2006). The change was caused by the increase in suicides among the male population at all ages. The increase occurred especially among men over 60 years. In Rio de Janeiro, the increase was not statistically significant among men, while there was a decrease among women. The principal means utilized for suicide by men were hanging, suffocation, strangulation and firearms. For women, death by hanging also ranks first, followed by ingestion of solids or liquids, smoke or fire, and jumping from heights. The high rate of suicide by unspecified means reveals problems with data quality. CONCLUSIONS Suicides are important events in the male population, especially among older men over time. In Rio de Janeiro, the suicide rate is also higher in men, although the difference is not statistically significant. According to the World Health Organization and the Ministry of Health, suicide is preventable, and established interventions exist for each age group.OBJETIVO: Descrever a mortalidade por suicidio no Brasil, com destaque para a populacao idosa. METODOS: Analise temporal e estudo de tendencia por regressao polinomial de suicidios na populacao acima de dez anos no Brasil e no Estado do Rio de Janeiro de 1980 a 2006. Os dados foram extraidos do Sistema de Informacoes sobre Mortalidade e as taxas, calculadas segundo sexo e faixa etaria, considerando-se a populacao residente fornecida pelo Datasus por 100 mil habitantes. Para os anos de 1980 a 1995, utilizou-se a nona revisao da Classificacao Internacional de Doencas e Problemas Relacionados a Saude, e para 1996 a 2006, a decima revisao. RESULTADOS: Crescimento significativo foi observado nas taxas de suicidio na populacao brasileira e no Rio de Janeiro (5,7 e 3,1 para cada 100 mil habitantes, respectivamente) em 2006. Esse incremento ocorreu pelo aumento dos suicidios na populacao masculina em todas as idades. A curva crescente aconteceu principalmente entre homens maiores de 60 anos. O incremento nao foi estatisticamente significativo entre homens e houve decrescimo entre mulheres no Rio de Janeiro. Os principais meios de suicidio utilizados pelos homens foram enforcamento, sufocacao, estrangulamento e armas de fogo. Para as mulheres, o enforcamento tambem ocupou a primeira posicao, seguido pela ingestao de substâncias, atiramento ao fogo e precipitacao de altura. A elevada taxa de indefinicao dos meios ressaltou problemas na qualidade dos dados. CONCLUSOES: Suicidios sao eventos significantes na populacao masculina, sobretudo entre homens idosos, ao longo do tempo. No Rio de Janeiro, as taxas entre homens idosos tambem sao maiores, mas nao estatisticamente significantes. Segundo a Organizacao Mundial da Saude e o Ministerio da Saude, o suicidio e passivel de prevencao e existem cuidados preconizados para cada grupo etario.

Situational analysis of poverty and violence among children and youth with disabilities in the Americas an agenda proposal

This article reviews the prevalence of poverty in Latin America and the Caribbean discussing the cycle and culture of poverty, their links to violence and maltreatment among disabled children and youth, from 1990 to 2006. There is a discussion of child maltreatment both of typical and disabled children taking into consideration the disabled childs unique needs, the impact on the family and society and the availability of supports and resources. Finally, an agenda is set forth to address poverty and violence, seeking to diminish the prevalence of maltreatment of all children, but especially children with disabilities. In addition, there is the hope of breaking the cycle of poverty and supporting disabled and marginalized individuals. This agenda speaks to the need for multidisciplinary collaboration as well as collaboration regionally and locally among governmental and non-governmental agencies, advocacy groups and the community at large.

Tentativas de suicídio entre pessoas idosas: revisão de literatura (2002/2013)

A literature review was carried out focusing on the main factors associated with suicide attempts among the elderly. The research was conducted between 2002 and 2013 in the MEDLINE, Lilacs, Pubmed, PsychINFO, SciELO, the Virtual Library in Violence and Health from BIREME and the Virtual Library of Public Health databases. 105 texts were selected and 75 were analyzed. Studies are on the increase in North America, Europe and Asia, rare in Latin America and do not exist in Africa. The major causal factors for attempted suicide are degenerative and chronic diseases, physical dependence, mental disturbances and suffering, as well as severe depression. Depression is the most relevant cause found, combined with chronic physical suffering, loss, abandonment, loneliness and family conflicts. Differences in gender, ethnicity, the ageing process, social issues and cultural backgrounds are also major contributing factors. The subject of suicide attempts among the elderly is a problem that is extremely relevant to the Unified Health System (SUS); however, this problem is not addressed in Brazil in theoretical or practical terms. We trust that this review can serve as a model for empirical studies to contribute to health support for the elderly and promote health in old age.Foi realizada revisao da literatura sobre as principais questoes associadas as tentativas de suicidio em pessoas idosas. O estudo abrangeu o periodo de 2002 a 2013, a partir das bases Medline, Lilacs, PubMed, PsychInfo, SciELO, Biblioteca Virtual em Violencia e Saude da Bireme e Biblioteca Virtual de Saude Publica (BVS/SP). Foram selecionadas 105 referencias e analisadas 75. Os estudos se ampliaram na America do Norte, Europa e Asia, sao raros na America Latina e inexistem na Africa. Predominam investigacoes epidemiologicas. Os principais fatores predisponentes sao doencas graves e degenerativas, dependencia fisica, disturbios e sofrimentos mentais e depressao severa. A depressao e o mais relevante fator explicativo associado a sofrimento fisico cronico, perdas, abandonos, solidao e conflitos familiares. Diferencas de genero, etnia, avanco da idade, questoes sociais e tracos culturais foram encontrados. O tema em pauta e da mais alta relevância para o Sistema Unico de Saude, mas nao tem sido abordado no Brasil nem na teoria e nem na pratica. Que esta revisao seja base para estudos empiricos que favorecam o apoio a saude do idoso e promova um envelhecer saudavel.

Diferentes faces da depressão no suicídio em idosos

Pesquisa qualitativa que analisa dois grupos focais realizados em 2009 com vinte trabalhadores de dois CAPS I da regiao de Porto Alegre, para verificar a sua percepcao diante do aumento de demandas que a expansao do crack tende a gerar sobre as redes locais de saude mental. Propos-se que debatessem o que lhes parecia fonte de sobrecarga e insatisfacao em geral e, especificamente, em funcao das demandas de usuarios de crack. Os resultados mostram forte preocupacao com a instabilidade dos contratos de trabalho, levando a falta de projecao no futuro. Alem disso, o acumulo de tarefas para suprir carencias das equipes, justificando-se o limitado interesse em planejar acoes de longo prazo e a opcao por tarefas menos complexas. Consideraram-se problemas na rotina de trabalho as ordens judiciais e a interferencia de agentes publicos, pedido expresso de hospitalizacao, familiares sem postura cooperativa, querelantes e usuarios desmotivados para o tratamento ou reingressando no servico. As equipes parecem estar no centro um conflito entre a impossibilidade de se evitar o surgimento de demandas da populacao usuaria das redes locais de saude, o que se evidencia no contexto do uso de crack, e os limites da gestao, ampliando o desgaste e a sobrecarga percebidos.This article analyzes different aspects of depression association with suicide among the elderly based on psychological autopsies. The retrospective method was used to study indeterminate deaths, based on interviews and reports, which analyze psychosocial circumstances related to suicide. The paper reveals the predominance of gender, social class and race - women, middle and upper class, white - and, in an unprecedented manner, contextualizes depression in a poorly studied population in Brazil and in the world with high risk of suicide. The physical and mental health, social circumstances and predominant biographical characteristics of the suicide victim were reconstructed in order to assess the impact of depression on suicide. Depression was presented in almost all cases, in primary or secondary diagnosis, as the symptom associated with other co-morbidities or as a reaction to social stressors, demanding different therapeutic approaches and procedures. The association between depression and multiple co-morbidity accentuates the case prognosis and cumulatively increases the risk of suicide. Depression followed by suicidal tendencies is a risk factor which justifies immediate preventive measures. Increasing assertive ways to diagnose and treat depression in old age is recommended.

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.

Trends in suicide mortality among Brazilian adults and elderly, 1980 - 2006

OBJECTIVE To describe mortality from suicide in Brazil, with emphasis on the older adult population. METHODS Temporal analysis and trend analysis by polynomial regression were conducted on suicide in the population above 10 years old in Brazil and the State of Rio de Janeiro (Southeastern Brazil) from 1980-2006. The data were extracted from the Mortality Information System, and the rates calculated by gender and age per 100,000 inhabitants, considering the resident population provided by DATASUS. For the period between 1980 and 1995, the ninth revision of International Statistical Classification of Diseases and Related Health Problems was used, and for 1996 to 2006, the tenth revision. RESULTS Suicide rates significantly increased in Brazil and in Rio de Janeiro (respectively reaching 5.7 and 3.1 deaths per 100,000 inhabitants in 2006). The change was caused by the increase in suicides among the male population at all ages. The increase occurred especially among men over 60 years. In Rio de Janeiro, the increase was not statistically significant among men, while there was a decrease among women. The principal means utilized for suicide by men were hanging, suffocation, strangulation and firearms. For women, death by hanging also ranks first, followed by ingestion of solids or liquids, smoke or fire, and jumping from heights. The high rate of suicide by unspecified means reveals problems with data quality. CONCLUSIONS Suicides are important events in the male population, especially among older men over time. In Rio de Janeiro, the suicide rate is also higher in men, although the difference is not statistically significant. According to the World Health Organization and the Ministry of Health, suicide is preventable, and established interventions exist for each age group.OBJETIVO: Descrever a mortalidade por suicidio no Brasil, com destaque para a populacao idosa. METODOS: Analise temporal e estudo de tendencia por regressao polinomial de suicidios na populacao acima de dez anos no Brasil e no Estado do Rio de Janeiro de 1980 a 2006. Os dados foram extraidos do Sistema de Informacoes sobre Mortalidade e as taxas, calculadas segundo sexo e faixa etaria, considerando-se a populacao residente fornecida pelo Datasus por 100 mil habitantes. Para os anos de 1980 a 1995, utilizou-se a nona revisao da Classificacao Internacional de Doencas e Problemas Relacionados a Saude, e para 1996 a 2006, a decima revisao. RESULTADOS: Crescimento significativo foi observado nas taxas de suicidio na populacao brasileira e no Rio de Janeiro (5,7 e 3,1 para cada 100 mil habitantes, respectivamente) em 2006. Esse incremento ocorreu pelo aumento dos suicidios na populacao masculina em todas as idades. A curva crescente aconteceu principalmente entre homens maiores de 60 anos. O incremento nao foi estatisticamente significativo entre homens e houve decrescimo entre mulheres no Rio de Janeiro. Os principais meios de suicidio utilizados pelos homens foram enforcamento, sufocacao, estrangulamento e armas de fogo. Para as mulheres, o enforcamento tambem ocupou a primeira posicao, seguido pela ingestao de substâncias, atiramento ao fogo e precipitacao de altura. A elevada taxa de indefinicao dos meios ressaltou problemas na qualidade dos dados. CONCLUSOES: Suicidios sao eventos significantes na populacao masculina, sobretudo entre homens idosos, ao longo do tempo. No Rio de Janeiro, as taxas entre homens idosos tambem sao maiores, mas nao estatisticamente significantes. Segundo a Organizacao Mundial da Saude e o Ministerio da Saude, o suicidio e passivel de prevencao e existem cuidados preconizados para cada grupo etario.

Diagnóstico situacional da violência contra crianças e adolescentes com deficiência em três instituições do Rio de Janeiro

We present a situational diagnostic about violence against children and adolescent with disability, which were done in three referenced institutions in Rio de Janeiro, from federal and municipal level and from the third sector, based in 53 case studies. This article considered a recent theoretical study of violence in the disability field and it demonstrates that this subject is embryonic in Brazil and Latin American. The relevance of this study is in the description we did of the diversity and richness of the recent forms of assistance in the disability field. It was analyzed how these institutions are being challenged to face violence and rights violation and to build protection strategies. Not only violence, but the poverty is another problem which is pointed out to these organizations. We concluded that when disability is associated to forms of violence and rights violation these institutions have developed social benefits and a social network in order to change disability people s quality of life. The central challenge is to promote change of cumulative disadvantages, to enhance capacities and to offer care and protection to disabled people and their families.