Trends in suicidal behavior at a general hospital emergency department in southern Brazil
Lejderman, Betina; Parisotto, Aline; Spanemberg, Lucas
Abstract
Objective
To assess the prevalence of and factors associated with suicidal behavior in patients seen at the emergency department (ED) of a general hospital in southern Brazil.
Method
Descriptive, observational, cross-sectional study. The records of all patients who had an emergency psychiatric consultation at the ED conducted by the emergency psychiatric consultation service at Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul in 2016 and 2017 were analyzed and stratified by sex and by age groups (15-29 years, 30-49 years, 50-69 years, and 70 years and older). Suicidal behavior was characterized by factors such as thoughts of death, suicidal thoughts, and suicidal risk. Suicidal behavior was compared by sex and between age groups with chi-square tests. Multivariate analysis of suicidal behavior and gender, age, and specific diagnoses were compared with Poisson regression.
Results
A total of 1,172 records from January 2016 to December 2017 were examined. There were more ED visits by females (63.1%) than males. Younger patients (15-29 years) had a higher severe risk of suicide than elderly (≥ 70 years) patients (54.1 vs. 19%; p < 0.01). Indicators of suicide behavior stratified by sex and by age group revealed marked differences between age groups for all variables among female patients. Overall, age group patterns for males were very similar in terms of suicidal behavior variables.
Conclusions
A high prevalence of suicidal behavior was observed in this sample, particularly among young adults and especially associated with female gender and diagnoses of depression and personality disorders.
Keywords
References
1 World Health Organization (WHO). Preventing suicide: a global imperative. Geneva: WHO; 2014.
2 Brasil. Ministério da Saúde. Setembro Amarelo: Ministério da Saúde lança agenda estratégica de prevenção do suicídio [Internet]. 2017. http://portalarquivos.saude.gov.br/images/pdf/2017/setembro/21/Coletiva-suicidio-21-09.pdf » http://portalarquivos.saude.gov.br/images/pdf/2017/setembro/21/Coletiva-suicidio-21-09.pdf
3 World Health Organization. Suicide estimates [Internet]. 2016. https://www.who.int/mental_health/prevention/suicide/estimates/en/.https://www.who.int/mental_health/prevention/suicide/estimates/en/ » https://www.who.int/mental_health/prevention/suicide/estimates/en/.https://www.who.int/mental_health/prevention/suicide/estimates/en/
4 Centro Estadual em Vigilância em Saúde (CEVS). Boletim de Vigilância Epidemiológica de Suicídio e Tentativa de Suicídio [Internet]. 2018. https://www.cevs.rs.gov.br/upload/arquivos/201809/05162957-boletim-de-vigilancia-epidemiologica-de-suicidio-n1-2018.pdf » https://www.cevs.rs.gov.br/upload/arquivos/201809/05162957-boletim-de-vigilancia-epidemiologica-de-suicidio-n1-2018.pdf
5 Rodrigues CD, de Souza DS, Rodrigues HM, Konstantyner TC. Trends in suicide rates in Brazil from 1997 to 2015. Braz J Psychiatry. 2019;41:380-8.
6 Nock MK, Green JG, Hwang I, McLaughlin KA, Sampson NA, Zaslavsky AM, et al. Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry. 2013;70:300-10.
7 Borges G, Angst J, Nock MK, Ruscio AM, Kessler RC. Risk factors for the incidence and persistence of suicide-related outcomes: a 10-year follow-up study using the National Comorbidity Surveys. J Affective Disord. 2008;105:25-33.
8 Horwitz AG, Czyz EK, King CA. Predicting future suicide attempts among adolescent and emerging adult psychiatric emergency patients. J Clin Child Adolesc Psychol. 2015;44:751-61.
9 Mahajan P, Alpern ER, Grupp-Phelan J, Chamberlain J, Dong L, Holubkov R, et al. Epidemiology of psychiatric-related visits to emergency departments in a multicenter collaborative research pediatric network. Pediatr Emerg Care. 2009;25:715-20.
10 American Academy of Pediatrics, Committee on Pediatric Emergency Medicine; American College of Emergency Physicians and Pediatric Emergency Medicine Committee; Dolan MA, Mace SE. Pediatric mental health emergencies in the emergency medical services system. Pediatrics. 2006;118:1764-7.
11 McHugh CM, Corderoy A, Ryan CJ, Hickie IB, Large MM. Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value. BJPsych Open. 2019;5:e18.
12 Pearson A, Saini P, Da Cruz D, Miles C, While D, Swinson N, et al. Primary care contact prior to suicide in individuals with mental illness. Br J Gen Pract. 2009;59:825-32.
13 Miller IW, Camargo CA, Arias SA, Sullivan AF, Allen MH, Goldstein AB, et al. Suicide prevention in an emergency department population: the ED-SAFE study. JAMA Psychiatry. 2017;74:563-70.
14 Amorim P. Mini International Neuropsychiatric Interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais. Rev Bras Psiquiatr. 2000;22:106-15.
15 Santos SA, Lovisi G, Legay L, Abelha L. Prevalência de transtornos mentais nas tentativas de suicídio em um hospital de emergência no Rio de Janeiro. Cad. Saúde Pública. 2009;25:2064-74.
16 Werneck GL, Hasselmann MH, Phebo LB, Vieira DE, Gomes VLO. Tentativas de suicídio em um hospital geral no Rio de Janeiro. Cad. Saúde Pública. 2006;22:2201-6.
17 Sá NNB, Oliveira MGC, Mascarenhas MDM, Yokota RTC, Silva MMA, Malta DC. Atendimentos de emergência por tentativas de suicídio. Rev Med Minas Gerais.2010;20:145-152.
18 Tonezer J, Muller T, Rocha GP, Recondo R, Nogueira EL, Spanemberg L. Clinical profile and sex differences in Brazilian children and adolescents receiving psychiatric services in the emergency department. Pediatr Emergency Care. 2015 Jun 27. doi: 10.1097/PEC.0000000000000505. Online ahead of print.
19 Canner J, Giuliano K, Selvarajah S, Hammond E, Schneider E. Emergency department visits for attempted suicide and self harm in the USA: 2006-2013. Epidemiol Psychiatr Sci. 2018;27:94-102.
20 Brasil. Secretaria de Vigilância em Saúde − Ministério da Saúde. Perfil epidemiológico das tentativas de óbitos por suicídio no Brasil e a rede de atenção à saúde. Boletim Epidemiológico, vol. 48. nº 30. In: Suicídio. Saber, agir e prevenir. [Internet]. Secretaria de Vigilância em Saúde (SVS). (2017b); 2017. http://www.crianca.mppr.mp.br/arquivos/File/publi/ms/perfil_epidemiologico_suicidio_ms2017.pdf » http://www.crianca.mppr.mp.br/arquivos/File/publi/ms/perfil_epidemiologico_suicidio_ms2017.pdf
21 Baptista MN, Cardoso HF, Carneiro AM, Gomes JO. Análise epidemiológica do suicídio em duas regiões do estado de São Paulo entre 2004 e 2008. Psicol Pesq. 2012;6:2-12.
22 Alves VM, Francisco LC, de Melo AR, Novaes CR, Belo FM, Nardi AE. Trends in suicide attempts at an emergency department. Rev Bras Psiquiatr. 2017;39:55-61.
23 Röcker S, Bachmann S. Suicidality in mental illness–prevention and therapy. Ther Umsch. 2015;72:611-7.
24 Cho SE, Na KS, Cho SJ, Im JS, Kang SG. Geographical and temporal variations in the prevalence of mental disorders in suicide: systematic review and meta-analysis. J. Affect. Disord. 2016;190:704-13.
25 Lépine J-P, Briley M. The increasing burden of depression. Neuropsych Dis Treat. 2011;7(Suppl 1):3.
26 Mojtabai R, Olfson M, Han B. National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics. 2016;138:e20161878.
27 Curtin SC, Warner M, Hedegaard H. Increase in suicide in the United States, 1999-2014. NCHS Data Brief. 2016;Apr:1-8.
28 Crowell SE, Beauchaine TP, McCauley E, Smith CJ, Stevens AL, Sylvers P. Psychological, autonomic, and serotonergic correlates of parasuicide among adolescent girls. Dev Psychopathol. 2005;17:1105-27.
29 Mercado MC, Holland K, Leemis RW, Stone DM, Wang J. Trends in emergency department visits for nonfatal self-inflicted injuries among youth aged 10 to 24 years in the United States, 2001-2015. Jama. 2017;318:1931-3.
30 La Vonne AD, Zun LS, Burke T. Undiagnosed mental illness in the emergency department. J Emerg Med. 2012;43:876-82.
31 Kemball RS, Gasgarth R, Johnson B, Patil M, Houry D. Unrecognized suicidal ideation in ED patients: are we missing an opportunity? Am J Emerg Med. 2008;26:701-5.
32 Horowitz LM, Bridge JA, Boudreaux ED. Screening youth for suicide risk in medical settings: time to ask questions. Am J Prev Med. 2014;47:S170-S5.
33 Wintersteen MB. Standardized screening for suicidal adolescents in primary care. Pediatrics. 2010; 125:938-44.
34 Babeva K, Hughes JL, Asarnow J. Emergency department screening for suicide and mental health risk. Curr Psychiatry Rep. 2016;18:100.
35 López-Goñi JJ, Goñi-Sarriés A, Azcárate-Jiménez L, Sabater-Maestro P. Suicidal behaviour recurrence in psychiatric emergency departments of patients without a prior suicide attempt, index and reattempters: a prospective study. Rev Psiquiatr Salud Ment. 2018;S1888-9891(18)30074-0. Online ahead of print.