Raimunda Matilde do Nascimento Mangas

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.

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.

Impacto do suicídio da pessoa idosa em suas famílias

The scope of this paper is an analysis of suicide of elderly people and the impact on the dynamics of their families is presented. The method used is of the qualitative research type known as psychosocial autopsy and is based on interviews with the family members of 51 elderly people who committed suicide in 10 Brazilian cities. The study in these cities was defined by epidemiological research that revealed the relevance of this phenomenon. Many themes were analyzed in the investigation. However, this text focuses on how the families coped with the death of the elderly person, their impressions regarding the act, and the repercussions on family members and the social network. Pursuant to a comprehensive analysis of the testimonies, the following nuclei of significance were revealed: feelings of guilt for the act; social isolation and its manifestations on health; social stigma and prejudice; prospects of overcoming family suffering; anger and feelings of the improbability of the act; and care for the family members. The families manifested suffering, sadness, and perplexity at the death of the elderly person, which influences and has repercussions on their dynamics and at an individual level. Such consequences are different in each area researched depending on the experiences the family has had with acts of this nature.

É possível superar ideações e tentativas de suicídio? Um estudo sobre idosos

This study presents a qualitative analysis of how older people who had attempted suicide began to overcome the desire and the urge to take their own life. This article is based on a survey of 87 Brazilian men and women aged 60 and over, living in different regions of Brazil, who have demonstrated suicidal behaviour; twenty of whom gave important information about their coping strategies. The analysis in this article only refers to the aforementioned twenty participants. All the participants were heard through semi-structured interviews, which included questions about the process of overcoming suicidal ideation and suicide attempts. The central focus of the analysis - overcoming suicidal ideation and suicide attempts - was based on the following concepts: coping strategies, autonomy, and emotional balance. Irrespective of the gender of the respondents, five centers of meaning emerged from the discourses of the elderly, which highlighted the effectiveness of the following factors: religiosity and religious practices; social and family support; the support of health services; contact with pets; and the recovery of the autonomy to manage their own lives. This study can help to support the primary and secondary prevention of suicidal behavior in older people.This study presents a qualitative analysis of how older people who had attempted suicide began to overcome the desire and the urge to take their own life. This article is based on a survey of 87 Brazilian men and women aged 60 and over, living in different regions of Brazil, who have demonstrated suicidal behaviour; twenty of whom gave important information about their coping strategies. The analysis in this article only refers to the aforementioned twenty participants. All the participants were heard through semi-structured interviews, which included questions about the process of overcoming suicidal ideation and suicide attempts. The central focus of the analysis - overcoming suicidal ideation and suicide attempts - was based on the following concepts: coping strategies, autonomy, and emotional balance. Irrespective of the gender of the respondents, five centers of meaning emerged from the discourses of the elderly, which highlighted the effectiveness of the following factors: religiosity and religious practices; social and family support; the support of health services; contact with pets; and the recovery of the autonomy to manage their own lives. This study can help to support the primary and secondary prevention of suicidal behavior in older people.

Autópsias psicológicas sobre suicídio de idosos no Rio de Janeiro

Esse estudo analisa autopsias psicologicas e contextualiza problemas e fatores que levaram algumas pessoas idosas a acabar com a propria vida na cidade do Rio de Janeiro, entre 2004 e 2007. O estudo parte de 26 laudos periciais de homens e mulheres que cometeram suicidios no centro, na zona norte e na zona sul da cidade. As familias desses idosos foram contatadas por carta e telefone e depois, pessoalmente. Foram oito autopsias psicologicas, por meio das quais foram coletados dados de identificacao, genograma da familia e uma entrevista que reconstituiu o modo de vida e as razoes da violencia autoinfligida. Os entrevistados foram familiares, amigos e conhecidos das vitimas. Os suicidios estao associados a depressao, a enfermidades fisicas e mentais graves e a fatores socioculturais como decadencia profissional e socioeconomica. Esses eventos ocorreram com e sem apoio familiar, com e sem acompanhamento medico. A fragilizacao cumulativa de recursos pessoais e sociais no ciclo vital revela que o risco do suicidio em idosos exige cuidados permanentes de saude publica.

Influências dos problemas e conflitos familiares nas ideações e tentativas de suicídio de pessoas idosas

Conflitos e problemas familiares envolvem significados construidos no decorrer da existencia e se associam a outros fatores nas manifestacoes de pensamentos e tentativas de suicidio em pessoas idosas. Essas questoes sao analisadas por meio de um estudo qualitativo em que os proprios idosos foram ouvidos, em 14 localidades diferentes do Brasil. Participaram 63 homens e mulheres e as entrevistas aconteceram entre 2013 e 2014. Os dados de campo segundo as relevâncias que os idosos apresentaram foram: perdas familiares significativas, conflitos familiares e intergeracionais e violencias explicitas e veladas. A fala dos idosos demonstrou a tristeza, os sentimentos de abandono, o isolamento, a incompreensao de seus desejos pelos familiares e a ausencia de manifestacoes de afeto e respeito, como elementos que os levaram a tentar dar cabo a sua vida. Ao contarem suas historias, eles tambem deram pistas do que esperam de suas familias: acolhimento, compreensao e liberdade para realizar seus pequenos desejos; terminar a vida de forma digna e sem sofrimento; encontrar ajuda e protecao para a progressiva diminuicao de suas capacidades; continuar a participar das decisoes da familia e prolongar ao maximo as conquistas e as prerrogativas sociais, como propriedades, autoridade e respeito.Family conflicts and problems involve meanings that are constructed during the course of an existence, and become associated with other factors in manifestations of suicidal thoughts and suicide attempts in elderly people. These questions are analyzed in a qualitative study of interviews with elderly people in four different locations in Brazil. A total of 63 men and women took part, and the interviews were held in 2013 and 2014. The field data showed the following factors - in order of the importance that the interviewees gave to them: significant family losses; family and inter-generation conflicts; and explicit and veiled violence. The speech of the subjects showed, as elements that led them to try to end their lives: sadness; feelings of abandonment; isolation, incomprehension of their desires by their family members, and absence of manifestations of affection and/or respect. When telling their stories, they also gave clues about what they expect from their families: welcome, acceptance, comprehension and freedom to carry out their minor wishes; to end their lives in a dignified manner without suffering; to find help and protection for the progressive reduction of their capacities; to continue to participate in family decisions, and to prolong to the maximum their social achievements and prerogatives, such as property, authority and respect.

Instrumentos, estratégias e método de abordagem qualitativa sobre tentativas e ideações suicidas de pessoas idosas

The article analyses the quality and consistency of a comprehensive interview guide, adapted to study attempted suicide and its ideation among the elderly, and imparts the method followed in applying this tool. The objective is to show how the use of a semi-structured interview and the organization and data analysis set-up were tested and perfected by a network of researchers from twelve universities or research centers in Brazil, Uruguay and Colombia. The method involved application and evaluation of the tool and joint production of an instruction manual on data collection, systematization and analysis. The methodology was followed in 67 interviews with elderly people of 60 or older and in 34 interviews with health professionals in thirteen Brazilian municipalities and in Montevideo and Bogotá, allowing the consistency of the tool and the applicability of the method to be checked, during the process and at the end. The enhanced guide and the instructions for reproducing it are presented herein. The results indicate the suitability and credibility of this methodological approach, tested and certified in interdisciplinary and interinstitutional terms.The article analyses the quality and consistency of a comprehensive interview guide, adapted to study attempted suicide and its ideation among the elderly, and imparts the method followed in applying this tool. The objective is to show how the use of a semi-structured interview and the organization and data analysis set-up were tested and perfected by a network of researchers from twelve universities or research centers in Brazil, Uruguay and Colombia. The method involved application and evaluation of the tool and joint production of an instruction manual on data collection, systematization and analysis. The methodology was followed in 67 interviews with elderly people of 60 or older and in 34 interviews with health professionals in thirteen Brazilian municipalities and in Montevideo and Bogota, allowing the consistency of the tool and the applicability of the method to be checked, during the process and at the end. The enhanced guide and the instructions for reproducing it are presented herein. The results indicate the suitability and credibility of this methodological approach, tested and certified in interdisciplinary and interinstitutional terms.

Tendencia de la mortalidad por suicidio en la población brasileña y anciana, 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.