Viviane Franco da Silva

Prevalências de ideação, plano e tentativa de suicídio: um inquérito de base populacional em Campinas, São Paulo, Brasil

This study aimed to estimate the lifetime prevalence rates for suicidal ideation, suicide plans, and attempted suicide, based on a cluster sample of 515 residents of Campinas, São Paulo State, Brazil. The Multisite Intervention Study on Suicidal Behavior interview was performed, and lifetime prevalence rates and 95% confidence intervals (95%CI) were calculated. Lifetime prevalence rates were 17.1% (95%CI: 12.9-21.2) for suicidal ideation, 4.8% (95%CI: 2.8-6.8) for suicide plans, and 2.8% (95%CI: 0.09-4.6) for attempted suicide. Suicidal behavior was more frequent among women and young adults. The suicide plan/attempt ratio was approximately 5:3. Only one-third of those who attempted suicide contacted a health service following the attempt. Prevalence rates for suicidal behavior were similar to most studies from other countries. Suicide prevention strategies should take data from community-based studies into account.

Fatores associados à ideação suicida na comunidade: um estudo de caso-controle

This paper aims to identify variables associated with suicidal ideation during the previous 12 months in the city of Campinas, Sao Paulo, Brazil. Using a case-control design, risk factors for suicidal ideation were investigated through analysis of independent variables related to the individual, family, and health. Some 29 cases of suicidal ideation and 166 controls were interviewed. Cases were identified through a previous cross-sectional study, and controls were randomly selected from the same population base among those with no history of suicidal ideation in the previous 12 months. Regression models were used to control for confounders and effect modifiers. According to the results, demographic variables were not associated with suicidal ideation. In the final model, the variables that remained statistically significant were depressive symptoms, emotional difficulties, lack of neighborhood support, and less frequent church attendance. Suicidal ideation was consistently associated with factors related to depressive symptoms, especially lack of energy and depressed mood.

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.

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.

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.