The physical effects of substance use (tobacco, alcohol, and marijuana) are well known, but it is not clear whether the use of these substances can be a warning sign for psychological or emotional problems in high school students. The Youth Risk Behavior Survey (YRBS) is a nationwide survey conducted by the Centers for Disease Control and Prevention every other year which asks students questions about risk behaviors such as substance use, sexual activity, the amount of violence in their lives, and suicide attempts. We examined students who were involved in the use of substances more commonly found in high schools (tobacco, alcohol, and marijuana) to see if they were significantly more likely to attempt suicide than their peers who were not involved in this type of activity. A multiple logistic regression analysis was performed on the 2013 Nationwide YRBS data (n = 13,583) to examine this effect while controlling for the following possible covariates: depression, gender, age, race, lack of sleep, and access to weapons. Results of this analysis showed a significant increase in suicide attempts among students who used tobacco and marijuana (OR = 1.987, 95%CI = 1.638, 2.411; OR = 1.273, 95%CI = 1.038, 1.561, respectively). However, the results of this analysis did not show a significant increase in suicide attempts for students that consumed alcohol. It was interesting to see that while possession and use of marijuana for a high school student is a more highly punishable crime, tobacco use is a better indicator for possible attempts at suicide. While there are many variables at play when it comes to substance use and suicide risk, these results indicate that students who are identified as users of tobacco and marijuana should be looked at more closely as they represent a population more susceptible to attempting suicide.

De senaste 20 åren har det skett en ökning av självmordsförsök i Sverige och varje år dör nästan 1 miljon människor i världen på grund av självmord. En stor andel av dessa personer har tidigare varit i kontakt med somatiska vården på grund av självmordsproblematik. Enligt Ida Jean Orlandos interaktionsteori reagerar sjuksköterskan känslomässigt i mötet med patienten och agerar utifrån denna känsla, vilket har en direkt påverkan på bemötandet. Syftet med arbetet var att undersöka sjuksköterskors bemötande av personer som försökt ta sitt liv med utgångspunkt från sjuksköterskan. Arbetet var en litteraturöversikt som grundades på 13 artiklar som granskats enligt Röda Korsets granskningsmall. De övergripande teman som utgjorde resultatet var: bemötande: positiva attityder och negativa attityder, kommunikation, miljö och känslor. De fynd som diskuterades var kopplingen mellan längden av arbetslivserfarenhet och positivt bemötande, att sjuksköterskans bemötande påverkar patienten, samt att öppen, direkt kommunikation om självmordsförsöket var viktigt. Sjuksköterskan bemötande har en betydande inverkan på interaktionen med patienten och det är viktigt att aktivt arbeta för att förbättra detta. / In Sweden there has been an increase of suicide attempts for the last 20 years and every year almost 1 million people in the world die due to suicide. Many of these people have been in contact with healthcare personnel in the past because of previous suicide attempts. According to Ida Jean Orlando's theory of interaction, nurses react emotionally in the encounter with the patient and acts on these emotions, which directly influences the interaction. The aim of this essay was to examine nurses' attitudes towards patients who have tried to commit suicide. The study conducted was a literature review based on 13 articles checked using the audit template of Röda Korset. The themes of the study were: treatment: positive attitudes and negative attitudes, communication, environment and feelings. The findings discussed were the connection between experience and a positive attitude, that the nurses´ attitudes affected the patient and that open, direct communication of the suicide attempt was important. The nurse´s attitude does affect the interaction with the patient and it is important to work on improving nurses' and health-care personnel's attitudes toward this certain group of patients.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Bakgrund: Den psykiska ohälsan har sedan 1990-talet ökat i Sverige och är idag en av de vanligaste dödsorsakerna bland unga i åldrarna 15–29 år. Riskfaktorer som påverkar de ungas psykiska hälsa beskrivs liksom vikten av att sjuksköterskan har förståelse för hur inre och yttre faktorer ökar risken för långvarig sjukdom. Syfte: Att beskriva ungas upplevelser efter ett suicidförsök. Metod: En kvalitativ litteraturstudie som utgår från intervjustudier med unga. Databaser som använts är Cinahl och Medline. Resultat: Resultatet bygger på tio valda artiklar med fokus på ungas upplevelser av vården efter ett suicidförsök. Fem teman framträdde de beskriver ungas upplevelser dessa är: att önska bekräftelse på den inre smärtan, att vilja bli sedd som en individ och inte bli dömd, att vilja bli förstådd och att bli lyssnad till inger förtroende, att inte vilja bli sedd som ett objekt och att vilja leva och förverkliga drömmar med stöd och hjälp Slutsats: Genom att i ett tidigt skede kunna identifiera och se tecken på psykisk ohälsa kan sjuksköterskor ge de unga rätt stöd och hjälp för att undvika onödigt lidande. Genom förbyggande arbete kan fler unga undgå långa vårdtider vilket minskar risken att de hamnar i utanförskap och social isolering. / Background: Psychological ill health has increased in Sweden since the 1990s and is today one of the most common causes of death among young people aged 15–29. Risk factors affecting the mental health of young people are described as well as the importance of the nurse understanding how internal and external factors increase the risk of long-term illness. Purpose: To describe young people's experiences after a suicide attempt. Method: A qualitative literature study based on interviews with young people. Databases used are Cinahl and Medline. Result: The result is based on ten selected articles focusing on young people's experiences of care after a suicide attempt. Five themes emerged they describe the experiences of young people these are: wanting confirmation of inner pain, wanting to be seen as an individual and not being sentenced, wanting to be understood and being listened to trust, not wanting to be seen as an object and wanting to live and realize dreams with support and help Conclusion: By being able to identify and see signs of mental health at an early stage, nurses can provide young people with the right support and help to avoid unnecessary suffering. By preventive work, more young people can avoid long periods of care, which reduces the risk that they end up in exclusion and social isolation.

A tentativa de suicídio é uma causa muito freqüente de atendimento em urgências psiquiátricas. O presente estudo relacionou o fenômeno do suicídio com a adolescência, que é um período de conflitos e de grande vulnerabilidade. Teve como objetivo traçar um perfil epidemiológico descritivo de adolescentes, admitidos em uma unidade de emergência psiquiátrica, diagnosticados como Tentativa de Suicídio. Para isso, foram examinados todos os atendimentos de adolescentes na faixa etária entre 10 e 19 anos, admitidos na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, com o diagnóstico referido, no ano de 2002, obtidos através do Serviço de Arquivo Médico deste Hospital. Os dados foram analisados de forma quantitativa-descritiva. Os resultados mostraram que (77,8%) dos casos de tentativa de suicídio pertencem ao sexo feminino, a maioria está na faixa etária entre 15 e 19 anos com predominância do estado civil solteiro, a cor branca e estudantes, com residência em bairros de baixo nível sócio-econômico. O método mais utilizado foi a ingestão de drogas (medicamentos) e as maiores freqüências foram encontradas nos meses de fevereiro e agosto. A segunda-feira foi o dia da semana preferido e o maior número de atendimentos foi constatado no horário entre as 18 e 24 horas. Esses resultados são semelhantes aos descritos na literatura e sugerem maior atenção a esse problema de saúde pública. / Suicide attempts are a very frequent cause of psychiatric urgency assistance. This study established a relation between the suicide phenomenon and adolescence, which is a period characterized by conflicts and great vulnerability. We aimed to outline a descriptive epidemiological profile of adolescents admitted at a psychiatric emergency unit who were diagnosed as Suicide Attempt. Thus, we examined the assistance given to adolescents between 10 and 19 years, who were admitted at the Emergency Unit of the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas, Brazil, with the above mentioned diagnosis, in 2002. This information was obtained through the Medical Record Service of this Hospital. Data were analyzed quantitatively and descriptively. Results demonstrated that (77,8%) of suicide attempt cases refer to women, most of which are between 15 and 19 years old, predominantly single, white and students, while live in low class neighborhoods. The most frequently used method was drugs (medication) intake and the highest frequency rates were found in February and August. Monday was the most preferred day of the week and most assistance was delivered between 18 and 24 hours. These results are similar to what is found in literature and suggest that greater attention should be given to this public health problem.

O suicídio é um fenômeno complexo, considerado problema de saúde pública devido às altas taxas de tentativas e consequentes óbitos. O contato inicial com o paciente que tentou o suicídio, na maioria das vezes, ocorre no pronto-socorro do hospital geral, sendo, fundamental analisar o relacionamento entre os membros da equipe de saúde e o paciente com comportamento suicida para entender como o cuidado está sendo oferecido. Este estudo teve como objetivo compreender como profissionais de saúde, que atuam no pronto-socorro, vivenciam a assistência prestada ao paciente que tentou suicídio. A pesquisa teve caráter qualitativo e a coleta de dados foi realizada por meio de entrevistas abertas. O material obtido a partir dos depoimentos foi avaliado por meio da técnica da análise temática. As respostas dadas pelos colaboradores foram agrupadas em temas comuns: conceituação do suicídio; importância do atendimento multiprofissional; diferenças entre o SUS e o sistema privado; as distintas posturas dos profissionais de saúde; relação família-paciente; medicamentos como forma de cuidado e tentativa de suicídio; sofrimento psíquico entre os profissionais. A presente investigação apontou que a assistência ao paciente que tentou o suicídio no pronto-socorro é inadequada, marcada pela falta de preparo e fragmentação do cuidado. Evita-se o contato com o sofrimento intenso relacionado com o ato suicida e o cuidado a esse paciente é redirecionado aos profissionais da saúde mental. Os fatores que influenciam na assistência precisam ser reconhecidos e reformulados para que haja melhoria na qualidade dos atendimentos possibilitando um cuidado integral à pessoa com ideação e tentativa de suicídio / Suicide is a complex phenomenon, considered a public health problem given high resultant mortality rates. In the majority of cases, initial contact with patients who attempted suicide occurs in the emergency room of a general hospital. As a result, analyzing the relationship between members of the healthcare team and the patient with suicidal behavior is paramount to understanding how care is being provided. The objective of this study was to understand health care professionals experiences in treating attempted suicide patients while working in the E.R. The study was qualitative in nature and data were collected via open interviews. The data obtained from the depositions were analyzed using thematic analysis. The responses given by the interviewees were grouped into topics: the concept of suicide; the importance of multidisciplinary care; differences between the public and private health systems; the different postures of health care professionals; the patient-family relationship; medication as both a form of treatment and a manner for attempted suicide; and psychic suffering among health care professionals. The present study found that care for patients provided in the E.R. after attempting suicide is inadequate, defined by a lack of preparation on part of the health care professionals and fragmented care. Health care professionals avoid contact with the intense suffering related with the act of suicide and these patients are redirected to mental health professionals. The diverse factors that influence care should be recognized and reconsidered so that the quality of care is improved, which would provide for holistic care of the patient with suicidal thoughts or attempted suicide

Traumatic brain injury (TBI) is considered the “signature injury” for United States Veterans who deployed in support of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) since 2001. Veterans with TBI may be at higher risk for subsequent intentional and unintentional injuries due to cognitive and executive function impairments from the injury and co-occurring psychiatric conditions. This dissertation evaluated the association between TBI and attempted suicide, motor vehicle accidents, and opioid overdose, in a large cohort of United States OEF/OIF/OND Veterans aged 18 to 40 who received care in the Veterans Health Administration (VHA). These studies utilized data from the VHA electronic medical records collected between April 2007 and September 2012. Study 1 evaluated the association between TBI and attempted suicide. Veterans with TBI had approximately a 4-fold increased risk of attempted suicide compared to those without, adjusting for demographics (adjusted hazard ratio (aHR): 3.73, 95% CI = 3.07, 4.53). The mediation analyses suggested that the psychiatric conditions substantially attenuated the impact of TBI on attempted suicide (aHR: 1.25 (95% CI = 1.05, 1.48). Study 2 evaluated the association between TBI and motor vehicle accidents. Veterans with TBI had a 56% increased risk of motor vehicle accident compared to those without, adjusting for demographics (aHR: 1.58, 95% CI = 1.27, 1.97). However, the mediation analyses attenuated this association (aHR: 1.17, 95% CI = 0.96, 1.43). Study 3 evaluated the association between TBI and opioid overdose among OEF/OIF/OND Veterans receiving long-term opioid treatment for non-cancer, chronic pain. Veterans with TBI had 2-fold increased risk for opioid overdose compared to those without, adjusting for demographics (aHR: 2.00, 95% CI = 1.26, 3.16). Nevertheless, the mediation analyses suggested that psychiatric conditions attenuated the impact of TBI on opioid overdose (aHR: 1.38, 95% CI = 0.94, 2.01). In conclusion, these studies add to the literature about risk of intentional and unintentional injuries among Veterans with TBI. Additionally, it highlights that Veterans with TBI and at least one co-morbid psychiatric condition are a particularly vulnerable group with the highest risk for injuries.

Suicide and suicidal attempts have increased over the years and the phenomenon is rapidly increasing countrywide. The rate in increase has not been happe•ning only internationally, but has unsettlingly noted to be rising in South Africa, too. Suicidal attempt has become one of the biggest social problems amongst the youths, and a problem that society has to grapple with. According to the media and statistics presented, the youth engage with destructive behavior and attempted suicide is rampant amongst Black adolescents. The young person imitates his peers and is constantly under pressure to do as the group does. Thus conformity and acceptance are the core words. The adolescent attempts suicide to solve problems. Various reasons are given for suicidal attempts and the youth names amongst others family problems, academic issues, relationship problems and so forth. In the attempt to take own life. different methods are used to commit suicide which range from overdosage, especially amongst females, to ingestion of harmful substances like bleach (clothes detergent) and hair products. Amongst males, more drastic actions in method of attempting suicide are used like hanging, gunshot and jumping from high places like bridges and buildings. There are also instances of self-inflicted burning (immolation) in some cases. Black youths have been found in recent years to engage in suicide and suicidal tendencies, whereas in previous years the tendency was almost non-existent. This calls for an investigation in Black adolescents' way of life and specifically in what their needs are. The latter is drawn from the profile presented; a task which was not easy as there exist little or no literature in this regard. This study should thus be seen as a precursor for further and more comprehensive and exclusive research especially on the social functioning of Blacks and their communities, in general. The results should be used to have sustainable school programmes aimed at the youth in general, but specifically those at risk and displaying destructive behaviour. / PhD (Social Work), North-West University, Potchefstroom Campus, 2014

Suicide and suicidal attempts have increased over the years and the phenomenon is rapidly increasing countrywide. The rate in increase has not been happe•ning only internationally, but has unsettlingly noted to be rising in South Africa, too. Suicidal attempt has become one of the biggest social problems amongst the youths, and a problem that society has to grapple with. According to the media and statistics presented, the youth engage with destructive behavior and attempted suicide is rampant amongst Black adolescents. The young person imitates his peers and is constantly under pressure to do as the group does. Thus conformity and acceptance are the core words. The adolescent attempts suicide to solve problems. Various reasons are given for suicidal attempts and the youth names amongst others family problems, academic issues, relationship problems and so forth. In the attempt to take own life. different methods are used to commit suicide which range from overdosage, especially amongst females, to ingestion of harmful substances like bleach (clothes detergent) and hair products. Amongst males, more drastic actions in method of attempting suicide are used like hanging, gunshot and jumping from high places like bridges and buildings. There are also instances of self-inflicted burning (immolation) in some cases. Black youths have been found in recent years to engage in suicide and suicidal tendencies, whereas in previous years the tendency was almost non-existent. This calls for an investigation in Black adolescents' way of life and specifically in what their needs are. The latter is drawn from the profile presented; a task which was not easy as there exist little or no literature in this regard. This study should thus be seen as a precursor for further and more comprehensive and exclusive research especially on the social functioning of Blacks and their communities, in general. The results should be used to have sustainable school programmes aimed at the youth in general, but specifically those at risk and displaying destructive behaviour. / PhD (Social Work), North-West University, Potchefstroom Campus, 2014

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-06-25T12:25:52Z No. of bitstreams: 1 Karine Viana Maciel.pdf: 2535958 bytes, checksum: 49b9572829afd97dff02ab49891de5f4 (MD5) / Made available in DSpace on 2015-06-25T12:25:52Z (GMT). No. of bitstreams: 1 Karine Viana Maciel.pdf: 2535958 bytes, checksum: 49b9572829afd97dff02ab49891de5f4 (MD5) Previous issue date: 2013 / Nenhuma / Esta dissertação é composta por dois artigos, um de revisão sistemática da literatura e um empírico. A pesquisa desenvolvida teve como foco de investigação as tentativas de suicídio realizadas a partir do uso do fogo. No estudo I, realizou-se uma revisão sistemática da literatura nacional e internacional sobre a temática das tentativas de suicídio através de queimaduras autoinfligidas, no período de 2007-2012, nas bases de dados Academic Search Premier, MEDLINE/Pubmed, Lilacs e Scielo. Encontrou-se 23 artigos, a maioria de natureza quantitativa e que foram publicados em diferentes revistas da área da saúde e por diferentes profissionais. Os resultados apontam que este acontecimento ocorre com maior freqüência nos países subdesenvolvidos, em que as taxas para o suicídio consumado apresentam-se maiores para o sexo masculino e, nos casos de tentativas de suicídio, a grande maioria dos sujeitos é do sexo feminino. Os estudos também averiguaram que as pessoas que tentavam suicídio pelo fogo apresentavam baixo nível de escolaridade, deram na maioria adultos jovens e tinham histórico psiquiátrico e/ou abuso de drogas e dificuldades de relacionamento social e familiar. Já no estudo II, o objetivo foi compreender os significados da escolha do fogo como um dispositivo para a tentativa de suicídio e identificar os aspectos emocionais que permeiam a vida desses indivíduos diante do trauma da queimadura. Participaram do estudo oito mulheres que haviam sofrido queimaduras autoinfligidas há pelo menos um ano e meio e que estavam em acompanhamento médico ambulatorial para reparação das cicatrizes da queimadura em um hospital de Porto Alegre. Todas as participantes responderam a uma entrevista semiestruturada que investigava a história de vida das participantes, o momento de atear-se fogo, a experiência da queimadura, seu atual contexto de vida, os sentimentos após o ato, a reinserção social e como a queimadura tem afetado no seu dia a dia e sua saúde psíquica e física. Além disso, também foi aplicado um questionário de dados sociodemográficos e clínicos. A idade das mesmas variou entre 24 e 55 anos, cinco delas relataram serem casadas/viver junto, duas se separaram após a ocorrência da queimadura e uma delas era viúva. A maioria das participantes colocou fogo em si mesmo num ato impulsivo, em que elas não tinham conhecimento sobre as cicatrizes deixadas pela queimadura e admitiram tê-lo feito para intenção de chamar a atenção de algum familiar próximo a elas. Após o ato, surgiram dificuldades relacionadas à reinserção social, enfrentamento com o olhar de estranhamento do outro e com o seu próprio, diante de uma nova imagem. Concluiu-se que é de extrema importância que se invista em programas de informação e prevenção a fim de evitar que novos casos de queimaduras autoinfligidas venham a ocorrer, causando consequências devastadoras destes sujeitos. / This dissertation consists in two articles, a systematic review of the literature and an empirical. The conducted survey focused on research suicide attempts made from the use of fire. The study 1 carried out a systematic review of national and international literature on the topic of suicide attempts by self-inflicted burns in the period 2007-2012, the databases Academic Search Premier, MEDLINE / PubMed, Lilacs and Scielo. It was found 23 articles, most quantitative and which were published in various journals in the area of health and by different professionals. The results show that this event occurs more frequently in developing countries, where the rates for suicide present higher for males, and in cases of attempted suicide, the vast majority of subjects were female. The studies also found out that people who had attempted suicide by fire had low level of education achievement, were mostly young adults and had psychiatric history and/or substance abuse and difficulties on social and family relationships. In the study 2, the aim was to understand the meanings of the choice of fire as a device for the suicide attempt and identify the emotional aspects that permeate the lives of these individuals before the burn trauma. The study included eight women who had suffered self-inflicted burns for at least a year and a half and were under medical supervision for outpatient repair of burn scars at a hospital in Porto Alegre. All participants completed a semi structured interview that was investigating the life history of the participants, the time to fire themselves, experience the burn, their current life context, the feelings after the act, social reintegration and how the burn has affected in their daily lives and their mental and physical health. In addition, a questionnaire was administered to sociodemographic and clinical data. The age of them ranged between 24 and 55 years old, five of them reported being married/living together, two got divorced after the burn occurrence and one was widowed. Most participants set fire to themselves in an impulsive act, in which they had no knowledge about the scars left by burns and admitted having done so with the intention of calling a close relative’s attention. After the act, there were difficulties related to social reintegration, coping with the look of estrangement from the other and with their own, before a new image. It was concluded that it is extremely important to invest in prevention and information programs to avoid the occurrence of new cases of self-inflicted burns that cause devastating consequences in these people.