Marisa Lúcia Fabrício Mauro

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.

Factors associated with repeated suicide attempts. Preliminary results of the WHO Multisite Intervention Study on Suicidal Behavior (SUPRE-MISS) from Campinas, Brazil.

BACKGROUND This study compares sociodemographic and clinical characteristics of 102 first-time hospital-treated suicide attempters (first-evers) with a group of 101 repeat suicide attempters (repeaters) consecutively admitted to a general hospital in Brazil, during the intake phase of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS). AIMS To compare sociodemographic and clinical characteristics of first-time hospital-treated suicide attempters (first-evers) with a group of repeat suicide attempters (repeaters). METHODS A standardized interview and psychometric scales were administered to all patients. RESULTS Repetition was associated with being of female sex (OR = 2.7; 95% confidence interval (CI) = 1.2-6.2), a housewife (OR = 3.8; 95% CI = 1.2-11.8), and having a score above median on the Beck Depression Inventory (OR = 5.2; 95% CI = 1.7-15.6). CONCLUSIONS The findings suggest that repeaters, namely, depressed housewives who have attempted suicide previously, need specific treatment strategies in order to avoid future suicide attempts.

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.

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.

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.

Depression in general hospital inpatients: challenges for consultation-liaison psychiatry.

. As part of this research project we screened all patients by means of the Hospital Anxiety and Depression Scale (HAD). The first 50 cases of depressive episode confirmed by the Mini International Neuropsychiatric Interview were given standardized information about depression and referred to a public health service to start treatment for depressive disorder. Because of the naturalistic nature of the present study, there was no interference on the assistant doctors’ treatment provided to patients during hospitalization. After six months of hospital discharge, all the patients were reassessed by a telephone interview. In spite of the limitations of this assessment strategy, it made possible to contact (or have news from) all patients, including those living far from the hospital. The criterion used for depression improvement was a decrease of at least 50% on the HAD depression score. Statistical analyses were performed using STATA version 7.0. Patients’ mean age was 49.3 years old (standard deviation: 14.5). Infections, malign neoplasms, renal and gastrointestinal diseases were the major reasons for hospitalization, most of which were associated with underlying diseases (mainly high blood pressure, diabetes and heart diseases).After six months of discharge, five patients died, six could not be contacted by telephone and one refused to participate in a new interview. Out of 38 reassessed patients, 44.7% received treatment for depression, 58% of whom an antidepressant medication.Two-thirds continued depressed. In this group there were fewer reports of pain and more previous suicidal behavior at the baseline assessment (see Table 1). It might be that those in pain received more treatment/analgesics for the underlying disease and that the pain relief was followed by fewer reports of depressive symptoms at the follow-up assessment.The discredit regarding depressive symptoms, the fear of becoming dependent on psychopharmacological medication and the disbelief in antidepressant drugs and psychotherapies were barriers that led 21 patients not to seek treatment for depression. Out of 17 who searched for treatment at public healthcare services, 5 could not get it: “I have been waiting for an appointment for four months”, said one patient at the follow-up interview.Although the patients were assessed by several physicians, only one out of three patients received some treatment for depression; only one, out of five, received an antidepressant medication. Many adverse consequences may occur when depression is not treated such as the increase of morbidity-mortality, costs, non-adherence to proposed treatments and suicidal risk.Our findings raise the awareness of psychiatrists to create politically effective strategies in order to claim workspaces in general hospitals, in addition to university services. Regarding depressive disorders, there are three challenges for the consultation-liaison psychiatrist: a) to accurately diagnose depressive disorders in comorbidity situations; b) to teach health professionals about how depression is related to other clinical diseases (such as coronary artery disease, diabetes, stroke); and c) to define who treats, and in which way, depressive episodes in comorbid physical diseases

P02-205 Maintained attitudinal changes in nursing personnel after a brief training on suicide prevention

Aim To verify whether nursing personnel working at a general hospital change their attitudes after a brief training course on suicide prevention and if these newly acquired attitudes persist over a 6-month time. Method 317 nursing personnel attended a 6-hour training program. They answered anonymously pre- and post-training the Suicide Behavior Attitude Questionnaire (SBAQ) which comprises 21 visual analogue scale items divided in three factorial sub-scales. The scores on each SBAQ sub-scale (dependent variable) were compared along the time using ANOVA for repeated measures with rank transformation. The time of the measurement and characteristics of the nursing staff were considered as independent variables. Results There have been positive changes in the attitudes and these gains were significantly maintained at the 6-month follow-up evaluation. Improvement was in the Feelings and Professional Capacity factorial subscales (p = 0.0001 and 0.01, respectively). There was no change on the Right to Suicide subscale. Conclusion It was possible to demonstrate positive changes in the attitudes of nursing personnel as assessed six months after a brief training course on suicide prevention. As attitudes influence the effectiveness of the health care personnel interventions our findings may have important implications for the development of suicide prevention programs.

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.