Suicidio

medigraphic

Artemisa en línea

EL SUICIDIO,

CONCEPTOS ACTUALES

Ana G. Gutiérrez-García1,2, Carlos M. Contreras2,3, Rosselli Chantal Orozco-Rodríguez2

SUMMARY
One current problem in Public Health relates to suicide and the identification of the risk factors needs to be clarified accurately. The bases of suicide involve complex multiple factors. In a high proportion of nations,mainly in industry-developing countries, suicide is placed among the first three causes of death in groups aged from 15 to 34 years. In Mexico, suicide represents the ninth cause of mortality, within a wide scale of age ranging from 15 to 64 years. Some risk factors have been identified. Epidemiological studies show that males commit suicide more frequently than females, in a proportion of 5:1.Consummate suicide occurs in men about 50 years old, mainly by hanging or fire arms. Females between 20 and 29 years old, on the contrary, carry out more frequent unsuccessful attempts in the same proportion, by using pesticides and medical drugs. However, in recent years an increase in the number of suicides among young people from 15 to 24 years old has been observed, commonly in low-income sectors,in subjects with a previous history of psychiatric disorders, mainly personality disorders, abuse of substances and prior suicidal attempts. The risk of suicide generally increases after 45, and becomes especially serious in older people. The phenomenon of suicide in the elderly deserves special attention, due to the fact that the population over 65 years old is continuously increasing. Thisgroup displays fewer attempts than youths, but they achieve their aim more often through a silent suicide, by refusing to eat or to accept and follow medical prescriptions. Some psychiatric disturbances are intimately related to suicide. It is considered that 50% or more of the consummate suicides are performed by people suffering from an affective disorder, mainly depression. In this sense, it isnoteworthy that most of these patients had been misdiagnosed and in many cases had not received any proper treatment. In addition, the abuse of or dependence on alcohol is present in about 20% of consummate suicides, and high rates of suicide are also observed in schizophrenia. Another common disturbance associated with suicide is anxiety. The simultaneous presence of anxiety and depression mustbe considered as a great risk factor, since the depressed patient has a high risk of committing suicide under phases of increased anxiety. All of these observations imply an alert signal for medical care units concerning the importance of detecting signs of the presence of risk factors and suicidal ideation, and of implementing adequate therapeutic management, namely, a supervised phar1 2macological treatment of depression and anxiety, including hospitalization, if it were the case. The risk factors in potential suicide include isolation, poor health, depression, alcoholism, lowered self-esteem, despair and feelings of social and family refusal. Frequently, the potential suicide directly or indirectly gives behavioral and verbal cues of his or her suicidal intention. Roughly, 60% ofthe victims of suicide had attended some medical care unit in the month previous to the suicide and had commented something about their desires and feelings about death at some moment, and 30% had clearly revealed their suicidal ideation. For such reason, the evaluation of risk of the potentially suicidal patient should be a common practice in medical care units. Therefore, the early detection ofthe presence of risk factors of suicide, including the report of self-harm and of a detectable incapacity for solving problems, mainly of social type may provide an invaluable time to permit its prevention. Another current aspect awaiting conclusive evidence is associated with some controversial data regarding the impact that the use of antidepressants could have upon suicide. The Food and Drug...