Jorge Barros

Suicide detection in Chile: proposing a predictive model for suicide risk in a clinical sample of patients with mood disorders

Objective: To analyze suicidal behavior and build a predictive model for suicide risk using data mining (DM) analysis. Methods: A study of 707 Chilean mental health patients (with and without suicide risk) was carried out across three healthcare centers in the Metropolitan Region of Santiago, Chile. Three hundred forty-three variables were studied using five questionnaires. DM and machine-learning tools were used via the support vector machine technique. Results: The model selected 22 variables that, depending on the circumstances in which they all occur, define whether a person belongs in a suicide risk zone (accuracy = 0.78, sensitivity = 0.77, and specificity = 0.79). Being in a suicide risk zone means patients are more vulnerable to suicide attempts or are thinking about suicide. The interrelationship between these variables is highly nonlinear, and it is interesting to note the particular ways in which they are configured for each case. The model shows that the variables of a suicide risk zone are related to individual unrest, personal satisfaction, and reasons for living, particularly those related to beliefs in one’s own capacities and coping abilities. Conclusion: These variables can be used to create an assessment tool and enables us to identify individual risk and protective factors. This may also contribute to therapeutic intervention by strengthening feelings of personal well-being and reasons for staying alive. Our results prompted the design of a new clinical tool, which is fast and easy to use and aids in evaluating the trajectory of suicide risk at a given moment.

Journal club experience in a postgraduate psychiatry program in Chile.

ObjectiveLiterature about journal clubs in postgraduate psychiatry programs is scarce, and there is no reference to residents’ preferences.MethodsResidents were asked to respond to a survey about their general satisfaction with the current journal club format and paper preferences, according to subject, scope, and type.ResultsResidents’ general satisfaction was high. Residents preferred clinically relevant meta-analyses and randomized controlled trials about mood and psychotic disorders, neuroscience, and biological therapies.ConclusionThere is a trend to prefer articles related to biological aspects of psychiatry, centered in evidence-based medicine methodology. An effort should be made to broaden the scope of selection of papers, incorporating, for instance, humanistic views, psychotherapy, and other methodologies.

Suicide risk configuration system in a clustered clinical sample: a generalized linear model obtained through the LASSO technique

Objective: To identify clinical and sociodemographic factors that increase or decrease suicidal risk in a clinical sample of subjects seeking mental health care. Method: A cross-sectional study was performed at three health centers in Santiago, Chile. The Parental Bonding Instrument (PBI), Depressive Experience Questionnaire (DEQ), Outcome Questionnaire (OQ-45.2), Reasons for Living Inventory (RFL), and State Trait Anger Expression Inventory (STAXI-2), in addition to a sociodemographic survey, were applied to 544 participants (333 with suicidal behavior and 211 without current suicidal behavior). Through hierarchical clustering analysis, participants were grouped by similarity regarding suicidal risk. Then, a regression analysis was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) technique, and factors that decrease or increase suicide risk (SR) were identified for each cluster. Results: The resultant clusters were grouped mainly by the age of participants. The most important protective factor was having confidence in one’s own coping skills in difficult situations. Relevant risk factors were major depressive disorder (MDD), poor anger management, and difficulties in interpersonal relationships. Conclusions: Suicidal risk manifests differently throughout the life cycle, and different types of bonds may protect from or increase risk of suicide.

“In our own words”: Defining medical professionalism from a Latin American perspective

Background: Latin America has experienced a tremendous growth in a number of medical schools, and there are concerns about their quality of training in critical areas such as professionalism. Medical professionalism is a cultural construct. The aim of the study was to compare published definitions of medical professionalism from Latin American and non-Latin American regions and to design an original and culturally sound definition. Methods: A mixed methods approach was used with three phases. First, a systematic search and thematic analysis of the literature were conducted. Second, a Delphi methodology was used to design a local definition of medical professionalism. Third, we used a qualitative approach that combined focus groups and personal interviews with students and deans from four medical schools in Chile to understand various aspects of professionalism education. The data were analyzed using NVivo software. Results: A total of 115 nonrepeated articles were identified in the three databases searched. No original definitions of medical professionalism from Latin America were found. Twenty-six articles met at least one of the three decisional criteria defined and were fully reviewed. Three theoretical perspectives were identified: contractualism, personalism, and deontology. Attributes of medical professionalism were classified in five dimensions: personal, interpersonal, societal, formative, and practical. Participants of the Delphi panel, focus groups, and personal interviews included 36 medical students, 12 faculties, and four deans. They took a personalistic approach to design an original definition of medical professionalism and highlighted the relevance of respecting life, human dignity, and the virtue of prudence in medical practice. Students and scholars differed on the value given to empathy and compassion. Discussion: This study provides an original and culturally sound definition of medical professionalism that could be useful in Latin American medical schools. The methodology used in the study could be applied in other regions as a basis to develop culturally appropriate definitions of medical professionalism.

Evaluación de la residencia de psiquiatría adultos por los residentes: experiencia 2008-2014

Introduccion El uso de instrumentos de evaluacion se ha propuesto como metodo esencial de mejoramiento de los programas de formacion de especialistas. Incluso el uso de dichos instrumentos es condicion necesaria en investigacion. Existe poca evidencia respecto a evaluaciones realizadas por residentes de psiquiatria su programa de formacion. Objetivo Revisar las evaluaciones del programa de Psiquiatria Adultos, hecha por los residentes de dicha especialidad. Metodologia Se revisan instrumentos de evaluacion del Programa de Psiquiatria Adultos PUC, hecha por los residentes, en los anos 2008, 2010 y 2014. Resultados En las experiencias de los anos 2008 y 2010, se hizo una revision narrativa de cada una de las rotaciones, analizando fortalezas y debilidades. Ademas, se planteo un plan de propuestas por debilidades analizadas. En la experiencia del ano 2014, se evaluaron cinco aspectos (Programa y Objetivos; Aspectos Formales; Docencia; Feedback; Evaluacion) utilizando calificacion de 1 a 7. Se utilizo una encuesta en linea, y las respuestas fueron recolectadas en forma anonima. No existen evaluaciones estandarizadas ni continuas. Conclusiones La evaluacion del programa de Psiquiatria Adultos por parte de los residentes, ha evolucionado de una metodologia cualitativa a una cuantitativa. Sin embargo, aun se hace necesario disenar un instrumento valido, fiable y que permita una evaluacion continua de dicha residencia.