Letícia Fortes Legay

Análise epidemiológica do suicídio no Brasil entre 1980 e 2006

OBJECTIVE: The objective of this study was to carry out an epidemiological analysis of the suicide rates found in Brazilian regions and state capitals between 1980 and 2006. METHOD: Data on mortality rates due to suicide were collected from the Departamento de Informatica do Sistema Unico de Saude (Information Technology Department of the Brazilian Public Health System - DATASUS). RESULTS: A total of 158,952 suicide cases were registered between 1980 and 2006, excluding those cases in which the individual was less than 10 years old (n = 68). In the period under study, the total suicide rate in Brazil increased from 4.4 to 5.7 deaths per 100,000 inhabitants (29.5%). Higher average rates were found in the South (9.3) and Central-West (6.1) regions. Men were more likely to commit suicide. The highest suicide rates were found in the 70-years or above age range while the highest increases were found in the 20 to 59 year age bracket. The most dominant social-demographic characteristics of the persons who committed suicide in the period under study were low educational level and singlehood. The most common methods of suicide were hanging, fire arms and poisoning. CONCLUSION: Although in Brazil the rate increased 29.5% in 26 years, the national rate is still considered to be low when compared to worldwide suicide rates (average of 4.9 per 100,000 inhabitants). Suicide rates in Brazilian regions vary broadly, ranging from 2.7 to 9.3.

Satisfação com o trabalho e impacto causado nos profissionais de serviço de saúde mental

OBJECTIVE: To assess job satisfaction and work impact among providers of a mental health service and their potential association with sociodemographic and job-related variables. METHODS: A cross-sectional study was carried out in 321 employees of a long-stay mental health service in Rio de Janeiro, Southeastern Brazil, in 2005. The following instruments were applied: the WHO Mental Health Services Satisfaction and Work Impact scales, and a questionnaire on sociodemographic and job features. Variable associations were analysed using the Mann-Whitney, Kruskal-Wallis, Chi-square tests and multiple linear regression. RESULTS: The mean score of satisfaction was 3.29 (SD=0.64) and the mean score for work impact was 1.77 (SD=0.62). Of all respondents, 61.8% reported a moderate level of satisfaction. Job satisfaction was positively associated with increasing age, lower schooling, being a non-governmental organization employee, developing non-patient-related activities, being involved in an innovative project. The highest levels of work impact were observed among civil servants, young people and females. CONCLUSIONS: Most features associated to the lowest levels of job satisfaction were associated to the highest levels of work impact. Despite the moderate level of satisfaction among providers, there is an evident need for policy changes, mainly those related to increasing availability of supplies and human resources and building restoration.

Depression during pregnancy: prevalence and risk factors among women attending a public health clinic in Rio de Janeiro, Brazil

Depression is the most prevalent psychiatric disorder during pregnancy and is associated with psychosocial and clinical obstetric factors. Despite being an important public health issue, there are few studies about this issue in Brazil. A cross-sectional study was carried out, involving 331 pregnant women attending a public primary health service over a one-year period in Rio de Janeiro city, Brazil. Participants were interviewed about their socio-demographic status, obstetric/medical conditions, life events and violence during pregnancy. Depression was assessed using the Composite International Development Interview. The prevalence of depression during pregnancy was 14.2% (95%CI: 10.7-18.5) and associated factors included: previous history of depression and any psychiatric treatment, unplanned pregnancy, serious physical illness and casual jobs. These data emphasize the need for screening for depression and its risk factors during pregnancy in settings where care is available. Psychosocial interventions and social policies need to be devised for this population.

O trabalho em saúde mental: um estudo de satisfação e impacto

Knowledge of job satisfaction and work impact among psychiatric staff is highly useful for policymakers and mental health professionals. Since there are few studies on this issue in Brazil, a cross-sectional study was carried out among mental health professionals. Data were collected for 133 professionals from 4 mental health services in Rio de Janeiro, using SATIS-BR and IMPACTO-BR scales and a socio-demographic questionnaire. Statistical associations were analyzed using the Mann-Whitney, Kruskal-Wallis, and chi-square tests and multiple linear regression. SPSS 10.1 for Windows was used for statistical analyses. Mean satisfaction was 3.30 and mean work impact was 2.08 (on a scale from 1 to 5). 62.4% of subjects reported moderate satisfaction. Mental health workers with less schooling showed higher satisfaction. Work impact was not associated with any explanatory variable. The results for job satisfaction were similar to those of other studies. Work impact was very low. Unlike studies from the United States and Europe, there were no differences between the community-based and in-hospital staff.

Prevalence of mental disorders associated with suicide attempts treated at an emergency hospital in Rio de Janeiro, Brazil

There are few Brazilian studies on prevalence of mental disorders in suicide attempters. The available studies have mainly used secondary data and screening instruments. The principal objective of this study was to estimate the prevalence of mental disorders in 96 suicide attempters seen in an emergency ward in Rio de Janeiro, Brasil (2006-2007) using the Composite International Development Interview. Most were female, young, and illiterate, and the main method was ingestion of psychoactive drugs. Other factors included history of prior attempts and use of alcohol at the time of attempt. The most frequent mental disorders were: depression (38.9%), use of psychoactive substances (21.9%), posttraumatic stress disorder (20.8%), alcohol abuse (17.7%), and schizophrenia (15.6%). Total prevalence of mental disorders was 71.9%. These findings are largely consistent with studies conducted in other developing countries. Besides access to treatment for mental disorders, public policies with an emphasis on the control of suicide methods and social responses for the reduction of suicidal behavior are needed.

Complicações obstétricas, eventos estressantes, violência e depressão durante a gravidez em adolescentes atendidas em unidade básica de saúde

CONTEXTO: A depressao e um transtorno psiquiatrico comum entre as adolescentes gravidas e esta associada a diversos fatores de risco. OBJETIVOS: Estimar a prevalencia da depressao em adolescentes gravidas e identificar os principais fatores de risco. METODOS: Dados seccionais foram coletados de 120 gestantes adolescentes atendidas em uma unidade basica de saude do Rio de Janeiro. Os instrumentos utilizados foram o Composite International Diagnostic Interview (CIDI), para diagnosticar a depressao; a escala Stressful Life Events, para avaliar a presenca de eventos estressantes; o Abuse Assessment Screen (AAS), para o rastreamento de violencia contra a mulher durante a gestacao. RESULTADOS: A prevalencia de depressao gestacional foi de 14,2% (IC: 8,7-21,9), sendo os principais fatores associados: historia anterior de depressao, sangramento anomalo e hospitalizacao na atual gravidez, historia de acidente, incendio ou catastrofe e maus-tratos durante a vida. CONCLUSOES: Os resultados reforcam que a investigacao dos fatores de risco, o diagnostico e o tratamento da depressao devem ser parte integrante do atendimento pre-natal a adolescentes gravidas.

Suicidios e tentativas de suicidios por intoxicacao exogena no Rio de Janeiro: analise dos dados dos sistemas oficiais de informacao em saude, 2006-2008*

OBJECTIVE To describe the profile of suicide and attempts suicide by exogenous intoxication and completeness of data from the Center for Poisoning Control in Niterói City (CCIn), Information System for Notifiable Diseases (Sinan), and Mortality Information System (SIM) for Rio de Janeiro state (RJ). METHODS It was verified the frequency of suicide attempts and mortality in Rio de Janeiro state, period 2006-2008. The variables analyzed were sex, area of occurrence, circumstance, evolution, age, toxic agents and cause (ICD-10: X60-X69). The percentage of unknown information/blank was classified as excellent (≤ 10%), good (10 to 29.9%) and poor (≥ 30%). SPSS was used for statistical analysis. RESULTS Nine hundred and forty records of attempts (CCIn) and 470 (Sinan) were analysed. The female and the age group of 20-39 years predominated, as well as use of toxic agents like medicines and pesticides. About suicide, were identified 33 records (CCIn), 23 (Sinan) and 180 (SIM). In CCIn were more frequent female and age group of 15-29 years, through Sinan and SIM from 40-59 years. For both events, psychotropic drugs accounted for more than 70% of drugs. The Sinan system has shown the worst performance for toxic agents. CONCLUSIONS Despite advances in improving the quality of information generated by the systems, problems regarding the coverage and data completeness remain committing the analysis of the magnitude of injuries. The study points out to the needs of systems compatibility and the improvement of the quality of information that are generated.Objective: To describe the profile of suicide and attempts suicide by exogenous intoxication and completeness of data from the Center for Poisoning Control in Niteroi City (CCIn), Information System for Notifiable Diseases (Sinan), and Mortality Information System (SIM) for Rio de Janeiro state (RJ). Methods: It was verified the frequency of suicide attempts and mortality in Rio de Janeiro state, period 2006-2008. The variables analyzed were sex, area of occurrence, circumstance, evolution, age, toxic agents and cause (ICD-10: X60-X69). The percentage of unknown information/blank was classified as excellent (≤ 10%), good (10 to 29.9%) and poor (≥ 30%). SPSS was used for statistical analysis. Results: Nine hundred and forty records of attempts (CCIn) and 470 (Sinan) were analysed. The female and the age group of 20-39 years predominated, as well as use of toxic agents like medicines and pesticides. About suicide, were identified 33 records (CCIn), 23 (Sinan) and 180 (SIM). In CCIn were more frequent female and age group of 15-29 years, through Sinan and SIM from 40-59 years. For both events, psychotropic drugs accounted for more than 70% of drugs. The Sinan system has shown the worst performance for toxic agents. Conclusions: Despite advances in improving the quality of information generated by the systems, problems regarding the coverage and data completeness remain committing the analysis of the magnitude of injuries. The study points out to the needs of systems compatibility and the improvement of the quality of information that are generated.

Tentativas e suicídios por intoxicação exógena no Rio de Janeiro, Brasil: análise das informações através do linkage probabilístico

Poisoning is one of the three main means used in suicide and suicides attempts. In order to improve the quality of such information, a cross-sectional descriptive study was conducted on case records in the State of Rio de Janeiro, Brazil, from 2006 to 2008, in the databases of the Information System on Diseases of Notification (SINAN), the Mortality Information System (SIM), and the Poison Control Center in Niterói (CCIn-Niterói). Probabilistic linkage was used to develop a model for monitoring suicides and suicide attempts by poisoning. Although 68.8% of the 948 records at CCIn had been reported by health professionals, only 2.6% were included in the other databases. Linking CCIn and SIM showed 61.3% underreporting. Information is important for surveillance, public policy-making, and decision-making. Probabilistic linkage allowed identifying problems in each system and provided better data quality and a more accurate diagnosis of the real situation in a complex and serious problem like suicidal behavior.La intoxicacion exogena es uno de los tres metodos principales utilizados en los intentos de suicido y suicidios. Con el objetivo de mejorar la calidad de esta informacion, se realizo un estudio seccional descriptivo de los registros de casos en el estado de Rio de Janeiro, Brasil, 2006-2008, presentes en las bases de datos del Sistema de Informacion sobre Dolencias Notificables (SINAN por sus siglas en portugues), Sistema de Informacion sobre Mortalidad (SIM) y Centro de Control de Intoxicacion de Niteroi (CCIn-Niteroi). A traves del metodo probabilistico, se desarrollo un modelo para el seguimiento de los casos de intentos/suicidios por envenenamiento. Aunque un 68,8% de la CCIn (948 discos) ha sido reportado por profesionales de salud, solo un 2,6% de ese tipo contenido esta presente en otros sistemas. El emparejamiento CCIn y SIM presento un subregistro de un 61,3%. Conocemos la importancia de esta informacion para la vigilancia, formulacion de politicas publicas y la toma de decisiones. El metodo de relacion probabilistica de bancos de datos permitio la identificacion de los problemas existentes en cada sistema, proporciono una mejor calidad de la informacion y proximidad a la situacion real de las enfermedades graves y complejas como el comportamiento suicida.A intoxicacao exogena e um dos tres principais meios utilizados nas tentativas e suicidios. Com o objetivo de melhorar a qualidade destas informacoes foi realizado um estudo seccional descritivo dos registros sobre casos do Estado do Rio de Janeiro, Brasil, periodo 2006-2008, presentes nos bancos de dados do Sistema de Informacoes sobre Agravos de Notificacao (SINAN), Sistema de Informacoes sobre Mortalidade (SIM) e Centro de Controle de Intoxicacao de Niteroi (CCIn-Niteroi). Atraves do metodo de relacionamento probabilistico desenvolveu-se um modelo de monitoramento dos casos de tentativas/suicidios devido intoxicacao. Embora 68,8% dos 948 registros do CCIn tenham sido reportados por profissionais de saude, apenas 2,6% constavam nos demais sistemas. O pareamento CCIn e SIM apresentou uma subnotificacao de 61,3%. Sabe-se da importância da informacao para a vigilância, formulacao de politicas publicas, alem de tomadas de decisao. O metodo de relacionamento de bancos de dados permitiu a identificacao dos problemas existentes em cada sistema, proporcionou melhor qualidade das informacoes e maior proximidade com a situacao real de agravos complexos e graves como o comportamento suicida.

Evaluation of social disablement, psychiatric symptoms and autonomy in long-stay psychiatric patients

INTRODUCAO: No Brasil ainda sao escassos os dados sobre limitacoes no comportamento social, sintomas psiquiatricos e habilidades de vida independente. Nesse sentido foi realizado um estudo seccional em uma populacao de 881 pacientes psiquiatricos de longa permanencia. METODOLOGIA: Foram coletados dados de todos os pacientes residentes no Instituto Municipal Juliano Moreira, utilizando tres instrumentos: Avaliacao das Limitacoes no Comportamento Social (SBS-BR), Brief Psychiatric Rating Scale (BPRS) e o Inventario de Habilidades de Vida Independente para Pacientes Psiquiatricos - (ILSS-BR). RESULTADOS: Do total de pacientes, 75% apresentaram pouca habilidade de vida independente, score < 2, e limitacoes no comportamento social, especialmente nos itens: cuidados pessoais (50,9%), comunicacao espontânea (46,2%) e retardo psico-motor (hipoatividade) (37,5%); 15.1% dos pacientes com esquizofrenia apresentaram sintomas graves de alucinacoes, delirios e desorganizacao conceitual; 11.5% dos pacientes esquizofrenicos nao apresentaram sintomatologia psiquiatrica, no ultimo mes, e 16% nao apresentaram limitacoes no comportamento social. CONCLUSAO: 50% dos pacientes tem mais de 65 anos e vivem na Instituicao por mais de 38 anos. Apresentam altas taxas de problemas no comportamento e pouca autonomia. Os dados sugerem a importância de programas especificos para estes pacientes. Alem disso, existe um grupo de pacientes sem sintomas psiquiatricos, com bom grau de autonomia e sem limitacoes no comportamento social que poderia viver em residencias terapeuticas na comunidade.

Maternal mental disorders in pregnancy and the puerperium and risks to infant health

Prenatal and postnatal period presents the highest prevalence of mental disorders in womens lives and depression is the most frequent one, affecting approximately one in every five mothers. The aggravating factor here is that during this period psychiatric symptoms affect not only womens health and well-being but may also interfere in the infants intra and extra-uterine development. Although the causes of the relationship between maternal mental disorders and possible risks to a childs health and development remain unknown, it is suspected that these risks may be related to the use of psychotropic drugs during pregnancy, to substance abuse and the mothers lifestyle. Moreover, after delivery, maternal mental disorders may also impair the ties of affection (bonding) with the newborn and the maternal capacity of caring in the post-partum period thus increasing the risk for infant infection and malnutrition, impaired child growth that is expressed in low weight and height for age, and even behavioral problems and vulnerability to presenting mental disorders in adulthood. Generally speaking, research on this theme can be divided into the type of mental disorder analyzed: studies that research minor mental disorders during pregnancy such as depression and anxiety find an association between these maternal disorders and obstetric complications such as prematurity and low birth weight, whereas studies that evaluate severe maternal mental disorders such as schizophrenia and bipolar disorder have found not only an association with general obstetric complications as well as with congenital malformations and perinatal mortality. Therefore, the success of infant growth care programs also depends on the mothers mental well being. Such findings have led to the need for new public policies in the field of maternal-infant care geared toward the population of mothers. However, more research is necessary so as to confirm the association between all factors with greater scientific rigor.