Suicidal behavior in patients at risk: study and analysis

An experimental study of community intervention was carried out in 37 suicidal risk patients, belonging to the Popular Council of Veguitas of the "Ramón Heredia" polyclinic, carried out in the period from October to February 2011 - 2012: the main objective of the research was to achieve the prevention of suicidal behavior with didactic psychotherapy in those subjects identified with risk.

A system of didactic psychotherapy activities was applied to the latter, and the degree of understanding and therapeutic efficacy were determined. For the formation of the group, the results of the practical guide to assess suicide risk were taken into account. In this study of Online Psychology we will talk about the Suicidal behavior in patients at risk.

Index

1. The Suicidal Behavior Study
2. Suicide in different cultures
3. Suicide at the legal level
4. Can suicidal behavior be prevented?
5. The research carried out
6. Objectives of this study
7. Terminology used throughout the investigation
8. Methodology followed
9. Different established criteria
10. Specific object 2
11. Specific object 3 and 4
12. Obtaining the information and analysis
13. Procedures to guarantee ethical aspects
14. Results
15. Study conclusions

The chosen patients were given scheduled activities, two weeks in the bimester and suicidal behavior was observed for a year, after applying the didactic psychotherapy activities predominated in the control group the female sex, chronological ages between 26 to 36 years, primary schooling, housewife occupation and with relationship matrimonial.

Behavior changes were achieved of patients, the following being more significant: reports of cases of first suicide attempt, repetitions of these attempts, and the level of understanding was raised by making patients aware of the community intervention plan psychotherapeutic. Only two patients with suicidal ideas were kept.

Suicide, action of take your own life voluntarily, since ancient times, being the abbe Desfontaine in the 18th century the first to use the terms sui (himself) and cidium (to kill) that means killing oneself, however throughout history the attitude of society towards this act, its form and frequency. (1-2).

On Ancient europe especially during the Roman Empire, suicide was consented and it was even considered an honorable act. The ancient Romans under the influence of Stoicism admitted many legitimate reasons for its practice, and the Roman philosopher Seneca extolled it as the ultimate act of a free person. For Saint Augustine, suicide was a sin, in the Christian church they decreed that whoever committed suicide should not be they would apply religious rituals after his death, suicide is currently condemned in the Christian, Jewish and Islamic. (3,4)

Formerly the Japanese respected the harakiri, a practice on the ashamed person compensated for a failure or breach of duty by sticking a dagger in the chest. It also happened in WWII, Japanese Kamikasis pilots considered an act honorable carry out suicide bombing missions by crashing your planes into the target enemy. Ancient Hebrew laws sanctioned suicide by ordering that his body remain unburied and in England suicide was considered a crime even if the suicide was not present to thumb his sins (5).

Issues Dukheim considered suicide as a consequence of a social maladaptation of an individualor and a lack of integration into society, identifying 4 types of suicide; among them the selfish and altruistic, which was the result of a strong or weak interaction between the individual and society, and the anonymous or fatalistic suicide that was determined respectively by a weak or excessive regulation by the society.

At present they are not identified in this way but in general it is considered suicidal behavior.

Suicide is inevitable in the vast majority of cases so it is necessary to take into account the direct, indirect and general preventive aspects. The direct prevention of suicidal behavior tries to combat the suicidal process (suicidal thoughts, suicide attempt and completed suicide).

The indirect prevention consists of the identification and treatment of conditions that lead to suicidal risk and general prevention encompasses all social measures aimed at promoting mental health and preventing damage and aggression to beings humans. [1-4]

Suicide constitutes a health problem worldwide, being ranked among the top ten causes of death according to data from the World Health Organization (WHO), as more than 1000 commit suicide every day people. In Europe the urban incidence rate is higher than the rural one and in the USA they are almost equal, almost 75 people commit suicide a day and suicide attempts generally occur in those under 40 years of age. [8-10]

The new penal code of Spain of 1995 includes in article 143 imprisonment from 4 to 8 years to the person who cooperates in the induction of a suicide and from 6 to 10 years if the execution of the same occurs.

Suicide is the third cause of death in young people between 15 and 24 years of age, according to the Institute of Mental Health of the University of Virginia (Institute Of. Mental Heatlh University Of. Virginia), where it is established that The main risk factors in adolescents are: major changes in the body, in feelings, changes in the family, parental divorce, moving, difficulties in school and between 12 to 25% see suicide as a solution, so it is important to be aware of warning signs such as are: change in eating habits during sleep, drug use, neglect in personal appearance, feeling of boredom, wishes to die, warning of plans and attempts.

To achieve the prevention of suicidal behavior it is important know all these warning signs, listen to your children, get to know them and seek professional help, give the adolescent a mental evaluation and receive treatment if the trained personnel deems it necessary, this research is carried out by the University of Barcelona in 2008 [11-12].

In spite of the work performed by medical and paramedical personnel Inside and outside the country, the cure for suicide is still not known with certainty, which responds to various biological, psychological and social factors, the detection of these factors risk is a valid strategy for the prevention of suicidal behavior, since it makes it possible to exercise various health actions on them to modify it whenever it is necessary. possible. Among these factors are alcoholism, depression and antisocial personality disorders [13].

exist physical illnesses, that lead to suicidal risk such as: neoplasia, HIV and incipient dementia. In addition to these aforementioned diseases, other conditions are evident such as: unemployment, divorce, humiliating activities towards children, young people, the elderly and the distorted manipulation of the information. [14].

Psychologists and sociologists have found many other personal and situational influences: painful circumstances, revenge, loss of a loved one, chronic, physical and emotional pain, adverse social conditions; however the strongest cause is the perception on the part of the person that life is painful and that only death can provide relief.

We can say that unsuccessful attempts may mean a request for help, that if it is ignored it can be a precursor of subsequent suicide attempts, however, one must know how to differentiate it from other more manipulative forms of attempts or suicide threats seeking attention, whose purpose is to control the emotions and behavior of other people, especially beings dear. [15].

In Cuba it is stated that 90% of those who make suicide attempts suffer from some type of mental disorder, the presence of symptoms psychotics, alcohol consumption, other toxins increase suicidal behavior and it is suggested that 10 to 15% of alcoholics die suicidal, 20% of suicide attempts present personality disorders and propose the monitoring and prevention of behavior suicide. After the suicide attempt, ambulatory follow-up is important, especially the early detection of the attempt and the establishment of development and speed when taking appropriate measures. Due to its high incidence, a program for the prevention of suicidal behavior was created in our country that benefits us all in one way or another. [16].

In Granma province, new strategies were adopted to reduce the rate of suicide attempts due to the high number of suicides in recent years. In 2008 there were more than 450 suicide attempts and 40 suicides in our province, and in people under 15 years of age 10 suicide attempts and 2 completed suicides. [16]

In the municipality where we reside in 2008 there were 50 suicide attempts and 9 completed suicides, especially in the community where we carry out our work Suicidal behavior constitutes a health problem due to the high rate registered in recent years, both in suicide attempt and in completed suicide and high risk suicide. [17]

It was decided to apply didactic psychotherapy to improve suicidal behavior in the municipality and in the health area, considering that the suicide rate will only decrease when this phenomenon is prioritized in the primary care of health and face this effective strategy, to improve the health of the population, based on the understanding of the unity of the biological and the social Giving psychological factors the place and hierarchy they deserve, this therapeutic procedure will allow satisfactory results to be obtained in the area of Health.

For what is declared as a scientific problem of this research: How to achieve the prevention of suicide in patients at risk from the application of a didactic psychotherapy program?

• Object of study: suicide in the population.
• Action field: suicide prevention.

The idea that the application of this program may be important in modifying the risk of suicidal behavior in the population under study is defended.

The Research provides theoretical dividends supported by the applied psychotherapy program and practical dividends supported by prevention itself. preventing the damage that the behavior may cause to the health of these people, in addition to guaranteeing a personal, family and social stability of these people.

We have to differentiate between different types of objectives: general and specific.

General objectives

Prevent suicidal behavior in risk patients through didactic psychotherapy. Yara Municipality. Granma Province, year 2011 - 2012.

Specific

• Determine suicidal risk patients in the population belonging to the Popular Veguitas Council.
• Distribute the patients studied according to the demographic variables: age, sex, occupation, marital status, level of education and history of suicidal behavior of the investigated group.
• Assess the level of understanding about suicidal behavior before and after psychotherapy activities.
• Determine the impact of suicidal behavior on behavior after psychotherapy activities.

• Group didactic psychotherapy: It is the interaction between a qualified and trained staff and a homogeneous group due to their suicidal risks in which they are offered the latter, scientific knowledge about suicide and related topics, allowing free communication between lecturers and audiences in relation to the theme.
• Suicidal idea: people with thoughts, plans and impulses or intention to die [Preparatory phase of suicidal behavior]
• Suicidal attempt: suicidal act without fatal outcome.
• Single suicide attempt: when the suicidal act has occurred only once.
• Multiple suicide attempt: when the act has occurred several times.
• Suicide: suicidal act with a fatal outcome.

A community intervention experimental research in the population at suicide risk of the Popular Council of Veguitas, including in the group people over 15 years of age belonging to the group basic work, which in turn belongs to the "Ramón Heredia Umpierrez" polyclinic of the Yara municipality, Granma province, during 2011 - 2012.

The selected group was subjected to treatment by didactic psychotherapy during two and a half months of the year 2009 [October, November, December] with a sequence of two weekly activities with the In order to achieve the prevention of suicidal behavior in the population chosen for the study through this procedure.

The universe of this work was made up of all patients older than 15 years of this health council (350 people). The interviewed population was made up of 300 people. From the application of the practical guide, 37 patients (sample) were considered suicidal.

Two types of criteria were followed to carry out the research:

Inclusion criteria

• 1. Patients older than 15 years.
• 2. Residents in the popular council of Veguitas.
• 3. Select those with suicidal risk based on the results of the practical guide.
• 4. With the ability and willingness to participate.

Exclusion criteria

• 1. Under 15 years old.
• 2. Those who do not agree to participate or do not have the capacity to do so.

In order to achieve specific objective 1, the practical guide [Annex 1] used to assess suicide risk was applied to the entire population older than 15 years that was interviewed in Family Medical Office by the family researcher, with the help of the nurse and the health brigadista in locating and summoning the patients to perform this proceed.

Endorsed by the National Group of Psychiatry and the Ministry of Public Health, adults with high suicide risk were those who obtained more than 18 points after to apply the practical guide and were not included in these psychotherapy activities because they were admitted to the Psychiatry service as established by the own guide.

The patients who obtained between 2 and 9 points were consulted with Psychology and / or Psychiatry in external consultation and those who oscillated Between 10 and 18 points were followed closely by the mental health team of the polyclinic, including psychotherapy in both didactic.

To output specific objective 2, we proceeded as follows:

The age groups, based on the programming for the prevention of suicidal behavior in Cuba, were:

• From 15 to 25 years old.
• From 26 to 36 years old.
• From 37 to 47 years old.
• From 48 to 58 years old.
• From 59 to 69 years old.
• 70 years and over.

The sex was operationalized as established in:

• Male.
• Feminine.

The occupation It was also divided based on the programs for the prevention of suicidal behavior in Cuba, the groups chosen were the following:

• Housewives
• State workers.
• Retired
• Students.
• Unemployed.

Being present in this area, it was also decided to include the following occupations:

• Self-employed.
• Social assistant.

The civil status It was divided as follows, as established by the civil registry code of the Republic of Cuba:

• Married.
• Single.
• Widower.
• Divorced.

The scholarship in this research it was established as follows:

• Illiterate.
• Unfinished primary.
• Primary finished.
• Unfinished high school.
• Secondary finished.
• Unfinished high school.
• Pre-university finished.
• Unfinished university.
• University finished.

The antecedents of suicidal behavior of the investigated group were determined by applying the practical guide in which the It had the participation of patients and their families, operationalized with a history and without a history of suicide attempt.

To deliver on specific objective 3, a survey was applied to the people in the investigated group to evaluate the level of understanding about suicidal behavior before and after applied psychotherapy activities didactic. The level of understanding was evaluated according to three categories: high, medium and low, according to the following definitions.

• High: when the patient correctly answers all the questions in the survey.
• Medium: when the patient incorrectly answers at least one question in the survey.
• Low: when the patient incorrectly answers all the questions in the survey.

Objective 4

In order to reach objective 4, the behavior of the suicide attempt was studied at the end of the programmed intervention up to a year after it and the results were compared with those existing before carrying out this intervention.

To achieve this objective, didactic psychotherapy was used, conceived as a form of attention to a group vulnerable population whose attention is directed not only from a professional point of view but from a pedagogical approach integral. These activities had the objective as a guiding category and fulfilled the organizational didactic principles from the general to the particular, an organization was used adequate and functional pedagogical content and teaching aids and learning tools adjusted to each activity and the learning level of each patient.

The information necessary to carry out the study has been obtained from the instruments applied to each of the patients under study, they were corroborated by the data issued by the family and family medical history and individual. To obtain data, the survey and a practical guide were used.

After obtaining the information, a database was made on a computer with the statistical program SPSS version 11.5 in Spanish for Windows XP, which allowed the design of the boards. Descriptive and analytical statistics were preferably used for the analysis and discussion of the results, which allowed us to achieve the work objectives and reach conclusions.

The corresponding examinations were carried out respecting the ethical principles and integrity in each patient, as well as the will and the degree of maintenance in the most absolute secrecy about the results individual. Adequate informed consent was given (Annex 5) and the autonomy of those studied was respected in their decision to participate or not in the study. Personal individuality data of the cases studied will not be disclosed.

The Consejo Popular Veguitas family office has a 15-year-old population over 350, with male predominance, as shown in table 1, the practical guide was applied to 300 people, also with slight predominance of the male sex, which represents 85.7% of the population over 15 years of age in this family medical office. Table 2 shows the results of the application of the practical guide, showing that 15 patients (5% of the investigated) with a predominance of the female sex, between 10 and 18 points were found, so they were considered at risk suicide.

Also, 22 people were considered to have a low suicide risk (7% of those investigated, with a predominance of women) for obtaining between 2 and 9 points, they obtained more than 18 points 3 people of the investigated (representing 1% of those investigated) with a predominance also of the female sex and were admitted to the service of Psychiatry. The rest of those investigated showed a normal behavior regarding suicidal behavior (87%) and in this case a male predominance. The majority presence of women in the groups of people with suicide risk (high and low) is a result found by other authors (13,14) reporting that suicide is present more frequently among women.

The major demographic characteristics of the studied subjects are shown in tables 3, 4, 5 and 6. The age of 26 to 36 years (60%) predominated and the married marital status (26.7%) in the case of women was considers that married women (26.7%) commit suicidal acts more frequently than men married.

With regard to schooling, most of the patients belong to the group of those who have completed the primary education or those who have started this level of education and have not finished it (60% of the total investigated). This result is consistent with the average educational level of the adult population of the area and specifically of the people with the characteristics included in the group under study. In the occupation, it is observed that there was an average of housewives (26.7%), which is reported in a study by other authors regarding this topic (1.8, 16)

This result could respond to several factors such as: a special vulnerability of housewives, an increase in this category due to dropping out of school and a sustained exposure to situations of home conflicts (couple, family, home situations, etc.). Table 7 shows the behavior of suicidal behavior in these people before the present research work was carried out and we verified that suicidal ideas were present in most of them (53.4%) and was followed in order of frequency by the single suicide attempt with 5 patients (33.3%) and the multiple suicide attempt with two patients (13,3%).

Note that 46.6% of this group had attempted against their life on one or more occasions; results obtained by other authors in this study on the subject [Sarro C de la Cruz and others who suggested that these people could be carriers of a Hereditary factor not associated with suicidal behavior itself, which is not scientifically proven at present but it can be for other diseases suicidal psychiatric (affective disorders, schizophrenia), or for certain personality traits such as a deficit in the control of impulsive behavior] (17).

The level of understanding about suicidal behavior by the investigated group before and after the didactic psychotherapy activities. Note that 100% of the cases had a low level of understanding before and after the conclusion of our work, the level of understanding was high in 87% and a half in 13.3%. This corresponds to the two patients who maintained suicidal ideas after the investigation and we consider that it is due to the fact that they did not have assistance stable to didactic psychotherapy activities because with them we could not fully achieve the objectives and aspirations that we proposed with this group of patients.

It is striking that when applying the survey it allowed us to elaborate this table, no patient answered that the activities carried out with them stimulate suicide. These results have been addressed in the works of Professor Sergio Pérez Barrero and expressed when dealing with the subject of suicidal behavior on different occasions (18).

Suicidal behavior behavior in patients treated with didactic psychotherapy After one year has elapsed since all the activities planned in this therapeutic procedure have been completed, it is observed in Table 9. To date, none of the patients performed any suicidal act, which constitutes the maximum achievement of this study. Neither first attempts nor repetitions were reported and only two patients maintained ideas suicides, about which the first analysis and discussion of the results.

These results have also been obtained in other studies carried out with the use of didactic psychotherapy by the family doctor, in order to approach the patient at risk suicidal (1, 2, 3, 4 and 8) it should be noted that the present work contributed to its authors equipping the basic knowledge for the management of patients with potential suicidal; Generalized opinion among those who have carried out this type of therapeutic intervention. (19)

This research corroborates the unfoundedness of the taboos that still exist in certain professionals who fear approach the subject of suicide with their patients out of fear of suggesting or increasing the behavior suicide.

Carrying out this work allowed us to reach the conclusions shown below, thus providing a solution to the proposed objectives.

• In the adult population of the Popular Council of Veguitas, 37 people with suicide risk were detected.
• The cases were mostly between 26 and 47 years old, female, housewife, married and elementary schooling. More than half of them had a history of suicidal ideation.
• After a year of concluding the didactic psychotherapy activities there have been no first suicide attempts, repetitions, or suicide and only two people in this group have ideas suicidal.
• The entire population studied had a low level of understanding about suicidal behavior prior to the investigation. After applying the didactic psychotherapy activities In the study group, the level of understanding was predominantly high in most cases.

recommendations

1. Generalize didactic psychotherapy in primary health care, for the prevention of suicidal behavior in identified risk patients.
2. Carry out health actions with patients not considered at risk to prevent them from arriving in these conditions.

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

If you want to read more articles similar to Suicidal behavior in patients at risk: study and analysis, we recommend that you enter our category of Clinical psychology.

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