Maximiliano Loiola Ponte de Souza

Suicide mortality in São Gabriel da Cachoeira, a predominantly indigenous Brazilian municipality

OBJETIVOS: Descrever as caracteristicas e as taxas brutas de mortalidade por suicidio (TBMS), no periodo de 2000-2007, no municipio brasileiro com a maior proporcao de pessoas autodeclaradas indigenas, Sao Gabriel da Cachoeira (SGC), Estado do Amazonas, Brasil. METODO: Estudo retrospectivo e descritivo, utilizando dados do Departamento de Informatica do Sistema Unico de Saude (DATASUS). Foram considerados obitos por suicidio os registros codificados como lesoes autoprovocadas voluntariamente na Classificacao Estatistica Internacional de Doencas e Problemas Relacionados a Saude, 10a revisao. RESULTADOS: Foram registrados 44 suicidios no periodo. A TBMS media foi 16,8 por 100.000 habitantes (masc., 26,6; fem., 6,3). As taxas mais elevadas foram observadas nas faixas etarias 15-24 e 25-34 anos, com TBMS 43,1 e 30,2 por 100.000 habitantes, respectivamente. A maioria dos suicidios ocorreu entre indigenas (97,7%), do sexo masculino (81,8%) e solteiros (70,5 %). Os obitos ocorreram em sua maioria em casa (86,4%), no final de semana (59,1%) e principalmente por enforcamento (97,7%). CONCLUSAO: O suicidio e um importante problema social e de saude publica em SGC. O perfil dos suicidios observados neste municipio como um todo foi mais proximo daquele encontrado em certos contextos indigenas do que o encontrado em ambientes urbanos e nao indigenas, demonstrando as especificidades socioculturais desses eventos no Brasil.

Modos de vida e modos de beber de jovens indígenas em um contexto de transformações

The interactions among the ways of life and drink of youths indigenous of a populous place of Upper Rio Negro were analyzed through an ethnographic research. It was used a theoretical model that allowed to decompose and to articulate the social reality in different levels. It was observed that there was a multiplication of the situations in which is possible to drink, that are associated to mechanisms as much of belonging demarcation as of exposition of differences inter-group. Nowadays, youths insert themselves in multiple interaction networks. Through these networks they can create juvenile atmospheres of alcohol consumption, drink far away from the parents and buy industrialized drinks. With the introduction of the school and the abandonment of the initiation rituals, the youth status became uncertain, and it occurs in an ambiguous way the social norms of alcohol consumption, in a context in which there is no consensus in daily practice respect of the possible strategies to regulate juvenile drinking. Through this research, theoretical-methodological alternatives could be suggested to investigate the relationships that are established between the ways of life and the production of the health and disease, incorporating in this analysis the culture (and its transformation), the daily life (and its contradictions), the people (and its subjectivities).

Quando, como e o que se bebe: o processo de alcoolização entre populações indígenas do alto Rio Negro, Brasil

This paper analyzes the development of alcoholism among Indian peoples in the Upper Rio Negro, Amazonas State, Brazil. Based on a comprehensive approach to what, how, and when individuals drink, this ethnography emphasizes the socio-cultural and historical context in which alcohol is consumed and interpretation of the issue by Indian people themselves. The article discusses historical transformations in the forms of drinking and their correlations with the status quo and changes in social standards of living. The article concludes that current forms of alcohol consumption are linked to the behaviors and values emerging on the frontier of interethnic relations and the resignification of the traditional culture, currently experiencing difficulties in offering parameters for action and symbolization of social life by the younger generations as they deal with challenges from the modern world.

Desigualdades na mortalidade por suicídio entre indígenas e não indígenas no estado do Amazonas, Brasil

OBJECTIVE: To analyze rates and some characteristics of suicide mortality between indigenous and non-indigenous people in the State of Amazonas. METHOD: Retrospective cohort study, where in data of death were obtained from the Information System on Mortality and data of population from the Brazilian Institute of Geography and Statistics. We used all records of suicide that occurred during the period 2006-2010 and the annual geometric interpolation for the estimation of subpopulations. RESULTS: Six hundred eighty-eight suicide cases were reported in the State of Amazonas, of which 19.0% indigenous people. The standardized mortality rate for suicide (SMRS) in indigenous people, of the 18.4/100.000, was 4.4 times higher than that of non-indigenous people. The SMRS in indigenous people increased 1.6 times in 2010 compared to 2006 year. In the municipalities of Tabatinga and Sao Gabriel da Cachoeira the SMRS were much high, 75.8 and 41.9/100.000, respectively. CONCLUSIONS: Inequalities in the behavior of the suicide mortality rates between indigenous and non indigenous people were proved, exposing not only their local importance, but also a hidden public health problem issue, especially among youth age 15-24.

Desconstruindo o alcoolismo: notas a partir da construção do objeto de pesquisa no contexto indígena

A partir d’une revision de concepts utilises dans la recherche sur l’usage des boissons alcoolisees et de travaux nationaux qui abordent la question de l’usage de l’alcool par les populations indiennes, on met en evidence la difficulte due a l’utilisation inconsideree du terme “alcoolisme”. On presente ici une proposition initiale de modele theorique dans lequel sont articules les concepts de dependance, les problemes en rapport avec l’usage de l’alcool et l’alcoolisation, que les auteurs rencontrent dans la construction de l’objet de recherche dans le domaine de la sante des populations indiennes de la region du Haut Rio Negro, dans le nord-ouest de l’Etat d’Amazonas, au Bresil.

Spatial-temporal trends and risk of suicide in Central Brazil: an ecological study contrasting indigenous and non-indigenous populations

Objective: To examine spatial-temporal distribution and risk of suicide, as well as trends in suicide mortality rates, in the indigenous and non-indigenous population of the state of Mato Grosso do Sul, Brazil. Methods: Data were obtained from the Information Department of the Brazilian Unified Health System. Deaths recorded as voluntary self-inflicted injuries (ICD-10 codes X60.0 to X84.9) were considered suicide. Suicide rates were estimated and adjusted by age in the population > 9 years of age. Kernel analysis was used to assess the spatial distribution of suicide cases, while trend analysis was carried out using a non-parametric test (Mann-Kendall). Results: The suicide risk among the indigenous population was 8.1 (95%CI 7.2-9.0) times higher than in the non-indigenous population. For indigenous residents in the 15-24 age group, the risk was 18.5 (95%CI 17.5-19.6) times higher than in the non-indigenous population. The majority of indigenous cases were concentrated in a few villages in reservation areas, mainly occupied by Guarani-Kaiowá and Guarani-Ñandeva groups. Rate patterns remained stable over time in both groups. Conclusion: Suicide is a serious public health problem in Mato Grosso do Sul, and has had an alarming and disproportionate impact on the indigenous population for more than a decade.

O processo de alcoolização em populações indígenas do Alto Rio Negro e as limitações do CAGE como instrumento de screening para dependência ao álcool

CONTEXTO: Por meio de investigacao qualitativa e interdisciplinar da validade teorica do CAGE como instrumento de screening para dependencia ao alcool em populacoes indigenas do Alto Rio Negro, aborda-se a tematica do uso de alcool em grupos culturalmente diferenciados, estudando a atribuicao de significados do beber e as respostas dadas ao CAGE pelos indigenas entrevistados. METODOS: As contribuicoes de Geertz (1989) e Menendez (1982) viabilizaram a distincao entre o conceito biomedico de dependencia ao alcool e a nocao de problemas relacionados ao uso do alcool, correlata ao plano da transgressao da norma social pelos bebedores. Ambas as nocoes foram subsumidas ao conceito de processo de alcoolizacao que remete as relacoes ambiguas e conflitivas travadas entre bebedores e nao-bebedores em momentos historicos e situacoes sociais especificas. RESULTADOS: A analise das respostas ao CAGE mostrou incongruencia entre seus objetivos e pressupostos e o entendimento indigena sobre o instrumento, invalidando um uso produtivo. CONCLUSAO: Apesar da pretensao universalista do CAGE, a singularidade cultural indigena produziu novos e inesperados sentidos as perguntas-teste e gerou respostas infrutiferas para efetuar triagem de suspeitos de dependencia ao alcool, na realidade estudada.

Jurupari se suicidou?: notas para investigação do suicídio no contexto indígena

Several evidences shows that in Brazil, suicide mortality rates of some indigenous people are significantly higher than national and regional rates. Furthermore, evidence points to the difficulties to transport biomedical categories to the indigenous societies, because they use specific symbolic references to understand the health-disease process and the death. The aim of this paper was to reflect on the difficulties to use the concept of suicide in the indigenous context, an important principle to explore this theme from a less ethnocentric way. The proposed way for this was to resort to the so-called “anthropological strangeness” of the biomedical concept of suicide. To this end, we did an analysis of an indigenous myth that is widespread in the Upper Rio Negro region, the myth of Jurupari, using three guiding questions: Jurupari wanted to die?; Jurupari died?; Who killed Jurupari? To answer these questions we used the ethnographic information about suicide among Brazilian indigenous. Through the performed analysis, the difficulty to transport the biomedical concept of suicide to the indigenous context was demonstrated. This was down when we presented: i) the amplification of the difficulties to speak of intentionality in this context, ii) the different indigenous conceptions about death and dying, iii) the complex correlation between suicide and homicide in native’s etiological systems. Finally, even in a preliminary way, some potential difficulties and possible ways to approach indigenous suicide by qualitative and quantitative strategies was presented.

Histórias-míticas e construção da pessoa: ambiguidade dos corpos e juventude indígena em um contexto de transformações

Representations about youth vary historically and culturally. In the Upper Rio Negro, there are indigenous groups with over three centuries of contact with the non-indigenous world. In recent years, male initiation rites were suppressed and formal schooling was introduced. These events led to a redefinition of significance in forms of representation at different stages of life. This work sought to understand the construction of the Indian representation of youth; how they correlate with the other life cycle phases and how they contribute to configuring structured social practices in this social group. Several mythical stories dealing with intergenerational relationships have been reviewed; these were correlated with significant stages of life, with other local narratives, and with data gathered from direct observation. The study concludes that the representations about youth have been configured by the social roles of the initiating/initiated, in a currently contradictory fashion, under a generic and lengthy student phase, deprived of its own sociological markers, prolonging the threshold condition of this phase of life.

Registro de distúrbios mentais no Sistema de Informação da Atenção Básica do Brasil, 2014

OBJECTIVE to describe the occurrence of the recording of mental disorders (MD) in primary health care (PHC) services in Brazilian municipalities and to analyze associated factors. METHODS an ecological study was conducted using PHC Information System secondary data for the year 2014; the magnitude of the occurrence of MD recording was assessed through indicators developed for this purpose; bivariate analysis was used. RESULTS 15,216 MD cases were recorded in 42 (0.8%) municipalities, corresponding to 16.9 MD cases/100,000 inhabitants for Brazil, with significant variations between the countrys macro-regions; MD recording in PHC was most frequent in the Southeast and Southern macro-regions (p=0.001), in state capital cities (p<0.001), in municipalities with more than 200,000 inhabitants (p<0.001), those with PHC coverage greater than 75% (p=0.005) and those with Psychosocial Care Centers (p=0.001). CONCLUSION recording of MD in PHC is incipient, unequally distributed and possibly dependent on local initiatives.OBJETIVO: descrever a magnitude da ocorrencia de registro de Disturbios Mentais (DM) na Atencao Basica a Saude em municipios brasileiros e analisar os fatores associados. METODOS: realizou-se estudo ecologico, com dados secundarios do Sistema de Informacao da Atencao Basica referentes a 2014; a magnitude da ocorrencia de registro foi avaliada mediante indicadores desenvolvidos para esse fim; foi empregada analise bivariavel. RESULTADOS: foram registrados 15.216 casos de DM em 42 (0,8%) municipios, correspondentes a 16,9/100 mil habitantes no Brasil, com variacoes importantes entre macrorregioes nacionais; o registro de DM na Atencao Basica foi mais frequente nas macrorregioes Sudeste e Sul (p=0,001), nas capitais (p<0,001), em municipios com populacao maior que 200 mil habitantes (p<0,001), cobertura pela Atencao Basica superior a 75% (p=0,005) e dispondo de Centros de Atencao Psicossocial - CAPS (p=0,001). CONCLUSAO: o registro de DM na atencao basica e incipiente, desigualmente distribuido, possivelmente dependente de iniciativas locais para sua efetivacao.