Simone Agadir Santos

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.

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.

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.

Depression During Pregnancy: Review of Epidemiological and Clinical Aspects in Developed and Developing Countries

Contrary to general belief, gestation is not always characterized by joy and accomplishments. Many women experience sadness or anxiety in these periods of their lives. Gestation and postpartum (puerperium) are periods of woman s life which involve many physical, hormonal, psychic and social insertion changes which can have a direct effect on her mental health (Camacho et al., 2006). The changes caused by the newborn arrival are not limited to psychological and biochemical variables but also involve socioeconomic factors, especially in societies in which women are active in the labor market, contributing to the family income, and pursuing diverse professional and social interests (Maldonado, 1997). The scientific literature indicates that in the gestational-postpartum period is the phase with the highest prevalence of mental disorders of women s life, particularly in the first and third quarters of gestation and during the first 30 days of postpartum (Botega & Dias, 2006). The intensity of these mental health alterations depend and are regulated by interaction of multiple factors, including organic, family, marital, social, cultural aspects and the pregnant woman’s personality (Falcone et al., 2005). Approximately one fifth of pregnant women and women in puerperium present symptoms of depression (Limlomwongse & Liabsuetrakul, 2006). Most of these women are not diagnosed neither adequately treated (Andersson et al, 2003). Depression is the most prevalent mental disorder during pregnancy and the puerperium period (Bennett et al., 2004) and is associated with risk factors such as a psychiatric history, financial hardships, low education level, teenage pregnancy, lack of social support, stressful events and a history of domestic violence. There is evidence that pre-natal depression is not only more common, but it constitutes the main risk factor for postpartum depression. Indeed, in many cases it is the continuation of the depression that started during pregnancy (Alami et al., 2006; Andersson et al., 2006; Da Costa et al., 2000; Heron et al., 2004; Josefsson et al., 2001; Lovisi et al., 2005; Patel et al., 2003; Rich-Edwards et al., 2006; Ryan et al., 2005). Current studies suggest that gestational depression needs to be addressed in a more consistent manner. Although there is a consensus that the factors that affect the relationship

Intentos de suicidio y suicidios por envenenamiento exógeno en Río de Janeiro, Brasil: análisis de la información a través de una relación probabilística

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.

Suicide and suicide attempts by exogenous poisoning in Rio de Janeiro, Brazil: information analysis through probabilistic linkage

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.