Among indigenous populations, there is significant evidence that the rates of completed suicide are much higher than in the general population. The current study examines whether the prevalence and risk factors of suicidal ideation, plans and attempts differ when comparing an American Indian reservation sample to a US general population sample. Data were from the National Comorbidity Survey (n = 5,877) and the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (N = 3,084). The current findings indicate that there are few differences in the likelihood of suicidal behavior in conjunction with particular disorders or traumas. However, American Indians appeared more likely to make a suicide attempt and less likely to have suicidal thoughts in their lifetime when compared with the general population. Although preliminary and exploratory, findings provide evidence that suicide interventions for indigenous populations may require modification based on differential risk factors for suicide.

Among indigenous populations, there is significant evidence that the rates of completed suicide are much higher than in the general population. The current study examines whether the prevalence and risk factors of suicidal ideation, plans and attempts differ when comparing an American Indian reservation sample to a US general population sample. Data were from the National Comorbidity Survey (n = 5,877) and the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (N = 3,084). The current findings indicate that there are few differences in the likelihood of suicidal behavior in conjunction with particular disorders or traumas. However, American Indians appeared more likely to make a suicide attempt and less likely to have suicidal thoughts in their lifetime when compared with the general population. Although preliminary and exploratory, findings provide evidence that suicide interventions for indigenous populations may require modification based on differential risk factors for suicide.

Οι ασθενείς με σχιζοφρένεια βρίσκονται σε υψηλό κίνδυνο για αυτοκτονικό ιδεασμό, απόπειρες αυτοκτονίας, και επιτυχημένες απόπειρες. Παρ’ όλα αυτά, η αυτοκτονική συμπεριφορά κατά τη διάρκεια της πρόδρομης περιόδου της σχιζοφρένειας και μια πιθανή συσχέτιση μεταξύ της πρόδρομης αυτοκτονικής συμπεριφοράς και της αυτοκτονικότητας μετά την έναρξη της ενεργούς ψυχώσεως δεν είχε μελετηθεί. 106 συνεχόμενες εισαγωγές ασθενών με πρόσφατη έναρξη σχιζοφρένειας εκτιμήθηκαν αναδρομικά για πρόδρομα συμπτώματα και αυτοκτονικότητα κατά τη διάρκεια της πρόδρομης φάσης καθώς και μετά την έναρξη της ενεργούς ψυχώσεως. Επιπρόσθετα, 106 σταθμισμένοι μάρτυρες από το γενικό πληθυσμό εκτιμήθηκαν για αυτοκτονική συμπεριφορά κατά τη διάρκεια της ίδιας περιόδου με την πρόδρομη φάση του αντίστοιχου ασθενή. Αυτοκτονικός ιδεασμός και απόπειρες αυτοκτονίας κατά τη διάρκεια της πρόδρομης περιόδου βρέθηκαν στο 25.5% και 7.5% των ασθενών το οποίο είναι αντίστοιχα 3.8 φορές και 8 φορές πιο συχνό από ότι στους μάρτυρες. Οι ασθενείς με αυτοκτονική συμπεριφορά είχαν μεγαλύτερο αριθμό πρόδρομων συμπτωμάτων από ότι οι ασθενείς χωρίς αυτοκτονική συμπεριφορά. Η πρόδρομη καταθλιπτική διάθεση, η εκσεσημασμένη έκπτωση στη λειτουργικότητα, και το κάπνισμα καπνού βρέθηκαν να ασκούν ανεξάρτητη επίδραση στον αυτοκτονικό ιδεασμό, ενώ η καταθλιπτική διάθεση ήταν το πρόδρομο σύμπτωμα σημαντικά πιο συχνό στους ασθενείς με απόπειρες αυτοκτονίας. Οι απόπειρες αυτοκτονίας συσχετίστηκαν με πρώιμη έναρξη της πρόδρομης συμπτωματολογίας και της ενεργού ψυχώσεως. Όλοι οι ασθενείς με απόπειρα αυτοκτονίας στην πρόδρομη περίοδο ήταν καπνιστές. Ο αυτοκτονικός ιδεασμός κατά τη διάρκεια της πρόδρομης φάσης είχε ισχυρή συσχέτιση με την δια βίου αυτοκτονικότητα μετά την έναρξη της ενεργούς ψυχώσεως. Συμπερασματικά, η αυτοκτονική συμπεριφορά είναι αρκετά συχνή κατά τη διάρκεια της πρόδρομης περιόδου. Ο συνδυασμός καπνίσματος, καταθλιπτικής διάθεσης, έκπτωσης λειτουργικότητας, και ενός μεγάλου αριθμού προδρόμων συμπτωμάτων, ειδικά σε ασθενείς με πρώιμη έναρξη συμπτωματολογίας, συνεπάγεται σημαντικά αυξημένο κίνδυνο αυτοκτονικού ιδεασμού. Ιδιαίτερη προσοχή απαιτούν οι ασθενείς με αυτοκτονικό ιδεασμό κατά την πρόδρομη περίοδο μετά την έναρξη της ενεργούς ψυχώσεως διότι ο κίνδυνος απόπειρας αυτοκτονίας είναι υψηλός. / Patients with schizophrenia are at high risk for suicide ideation, attempts and completed suicide. However, suicidal behavior during the prodromal phase of schizophrenia and a possible association between prodromal suicidal behavior and suicidality after the onset of overt psychosis are not studied. 106 consecutively admitted schizophrenia patients with recent onset were evaluated retrospectively for prodromal symptoms and suicidality during the prodromal phase and after the onset of frank psychosis. Additionally, 106 matched control subjects from the general population were evaluated for suicidality during the same age period of the prodromal phase of the corresponding patient. Suicide ideation and attempt during the prodromal period were reported in 25.5% and 7.5% of the patients that is 3.8-fold and 8-fold greater than in the controls, respectively. Patients with suicidal behavior experienced a greater number of prodromal symptoms than those without. Prodromal depressive mood, marked impairment in role functioning, and tobacco smoking exerted an independent effect on suicide ideation, whereas depressive mood was the symptom significantly more frequent in patients with suicide attempt. Suicide attempts were associated with an earlier onset of prodromal symptoms and frank psychosis. All patients with prodromal suicide attempts were cigarette smokers. Suicide ideation during the prodromal phase was strongly associated with lifetime suicidality after the onset of frank psychosis. In conclusion suicidal behavior is quite common during the prodromal period. The association of smoking, depressive mood, impaired functioning, and a large number of prodromal symptoms, particularly in patients with an early onset of symptoma¬tology carries a substantially increased risk for suicide ideation. Particular care is needed in patients with prodromal suicide ideation after the onset of frank psychosis because the risk to attempt suicide is high.

A violência de gênero e a ideação suicida são eventos sociais de elevada incidência e constituem importantes problemas de saúde pública. Este estudo tem como objetivo estudar a violência de gênero e a ideação suicida em mulheres que vivem com hiv usuárias de um Serviço de Atenção Especializada em DST/aids de um município de médio porte do Rio Grande do Sul. Este é um estudo transversal cuja amostra foi constituída por 161 mulheres que vivem com hiv. Elas responderam um questionário aplicado por meio de entrevistas realizadas pelo pesquisador. A violência de gênero foi investigada por meio da versão brasileira reduzida do instrumento World Health Organization Violence Against Women e, para a ideação suicida, foi utilizado o Questionário de Ideação Suicida. A análise estatística foi realizada com o software Statistical Package Social Sciences. Verificou-se a presença de associações entre variáveis utilizando o teste Qui-Quadrado, Correlação de Pearson e Regressão de Poisson. A prevalência da violência de gênero foi de 72,7% e da ideação suicida de 50,9%. Neste estudo, as variáveis que estiveram associadas à violência e à ideação suicida foram praticamente as mesmas. Houve relação com a idade precoce da primeira relação sexual, maior número de filhos, baixas condições financeiras e maior tempo de vida com hiv. Além disso, as mulheres que sofreram violência de gênero apresentaram risco cinco vezes maior de manifestar ideação suicida. Neste trabalho observou-se alta prevalência de violência de gênero e de ideação suicida entre mulheres com hiv, e recomenda-se investigações desses temas nas histórias de vida das mulheres para que se possa propiciar acolhimento e cuidado como parte integrante das políticas voltadas às pessoas que vivem com hiv e da atenção integral à saúde das mulheres. / Gender violence and suicidal ideation are social events of high incidence and are important public health problems. This study aims to study gender violence and suicidal ideation in women living with HIV attending in a Service of Specialized Care in hiv/aids from a medium-sized city of Rio Grande do Sul. This is a cross-sectional study whose sample consisted of 161 women living with hiv. They answered a questionnaire through interviews conducted by the researcher. Gender violence was investigated by means of the Brazilian version of the instrument reduced World Health Organization Violence Against Women, and for suicidal ideation we used the Suicidal Ideation Questionnaire. The statistical analysis was performed with the Statistical Package Social Sciences software. Verified the presence of associations between variables using the Chi-Square test, Pearson Correlation and Poisson Regression. The prevalence for gender violence was of 72.7% and for suicidal ideation of 50.9%. In this study, the variables that were associated with violence and suicidal ideation were practically the same. There was a relationship with early age at first intercourse, higher number of children, few financial conditions and longer time life with hiv. In addition, women who suffer gender violence have fivefold greater risk of manifesting suicidal ideation. In this study, a high prevalence of gender violence and suicidal ideation among women with hiv, and it is recommended that investigations of these themes in the life stories of women so that they can provide shelter and care as an integral part of policies aimed at people who living with hiv and comprehensive health care for women. / La violencia de género y la ideación suicida son eventos sociales de alta incidencia y son importantes problemas de salud pública. Este estudio tiene como objetivo estudiar la violencia de género y la ideación suicida en las mujeres que viven con el hiv asistir a un Servicio de Atención Especializada en hiv/sida de un municipio de tamaño medio de Rio Grande do Sul. Se trata de un estudio transversal que muestra consistió en 161 mujeres que viven con el hiv. Respondieron un cuestionario a través de entrevistas realizadas por el investigador. La violencia de género fue investigado por medio de la versión brasileña del instrumento reducido Violencia Organización Mundial de la Salud contra la mujer y para la ideación suicida, se utilizó el Cuestionario de ideación suicida. El análisis estadístico se realizó con el paquete estadístico Ciencias Sociales. Verificada la presencia de asociaciones entre variables mediante la prueba de chi-cuadrado, correlación de Pearson y la regresión de Poisson. La prevalencia de la violencia de género fue de 72.7% y 50.9% de la ideación suicida. En este estudio, las variables que se asociaron con la violencia y la ideación suicida fueron prácticamente iguales. Hubo una relación con la edad temprana en la primera relación, mayor número de hijos, algunas condiciones financieras y de mayor duración con el vih. Además, las mujeres que sufren violencia de género tienen cinco veces más riesgo de manifestar ideas suicidas. En este estudio, se recomienda una alta prevalencia de la violencia de género y la ideación suicida entre las mujeres con hiv, y que las investigaciones de estos temas en las historias de vida de las mujeres para que puedan brindar refugio y cuidado como parte integrante de las políticas dirigidas a las personas que viven con el hiv y la atención integral de salud para las mujeres.

O papel da religiosidade na determinação do comportamento suicida é controverso, havendo estudos que a consideram um fator protetor e outros um fator de risco. Neste estudo os autores conduziram uma revisão sistemática da literatura para avaliar a relação entre a religiosidade e o comportamento suicida. Dentre os 154 artigos publicados em periódicos científicos inicialmente identificados nas bases Medline, Lilacs, Scielo e PsycInfo, foram selecionados 59 artigos que enfocavam a associação entre religiosidade e comportamento suicida. Para a avaliação dos atributos qualitativos dos artigos foi desenvolvido um Roteiro de Avaliação Qualitativa. Os resultados mostram que grande parte dos artigos encontrados apresentava falta de rigor metodológico na mensuração do conceito de religiosidade, possivelmente devido à característica subjetiva desse constructo. Contudo, verificou-se que o papel protetor contra o comportamento suicida exercido pela religiosidade, sofre variações de acordo com a cultura na qual está inserida, considerando que para algumas culturas o comportamento suicida não é visto com total desaprovação. Porém, a maioria dos estudos reforça a hipótese de que a religiosidade diminui o risco de comportamento suicida nos indivíduos que professam algum tipo de credo e, que participam de algum espaço religioso. Não foram encontrados, nesta pesquisa, estudos que medissem a associação, entre religiosidade e comportamento suicida, em religiões de matriz africana. / The role of religiosity in determining suicidal behavior is controversial, since there are tudies where its considered a protective factor and others, a risk factor. In this study, the authors conducted a systematic literature review to assess the relationship between religiosity and suicidal behavior. Among the 154 articles published in scientific journals initially identified in Medline, Lilacs, SciELO and PsycInfo, we selected 59 articles that focused on the association between religiosity and suicidal behavior. To evaluate the qualitative attributes of the articles, a Qualitative Evaluation Script was developed. The results show that most articles found presented a lack of methodological rigor in measuring the concept of religiosity, possibly due to the subjective characteristic of this construct. However, it was found that the protective role against suicidal behavior exercised by religion, varies according to the culture in which it operates, whereas in some cultures suicidal behavior is not seen with total disapproval. However, most studies support the hypothesis that religiosity reduces the risk of suicidal behavior in individuals who profess some kind of belief, and participates in some religious space. Were not found, in this research, studies which measure the association between religiosity and suicidal behavior in religions of African origin.

O papel da religiosidade na determinação do comportamento suicida é controverso, havendo estudos que a consideram um fator protetor e outros um fator de risco. Neste estudo os autores conduziram uma revisão sistemática da literatura para avaliar a relação entre a religiosidade e o comportamento suicida. Dentre os 154 artigos publicados em periódicos científicos inicialmente identificados nas bases Medline, Lilacs, Scielo e PsycInfo, foram selecionados 59 artigos que enfocavam a associação entre religiosidade e comportamento suicida. Para a avaliação dos atributos qualitativos dos artigos foi desenvolvido um Roteiro de Avaliação Qualitativa. Os resultados mostram que grande parte dos artigos encontrados apresentava falta de rigor metodológico na mensuração do conceito de religiosidade, possivelmente devido à característica subjetiva desse constructo. Contudo, verificou-se que o papel protetor contra o comportamento suicida exercido pela religiosidade, sofre variações de acordo com a cultura na qual está inserida, considerando que para algumas culturas o comportamento suicida não é visto com total desaprovação. Porém, a maioria dos estudos reforça a hipótese de que a religiosidade diminui o risco de comportamento suicida nos indivíduos que professam algum tipo de credo e, que participam de algum espaço religioso. Não foram encontrados, nesta pesquisa, estudos que medissem a associação, entre religiosidade e comportamento suicida, em religiões de matriz africana. / The role of religiosity in determining suicidal behavior is controversial, since there are tudies where its considered a protective factor and others, a risk factor. In this study, the authors conducted a systematic literature review to assess the relationship between religiosity and suicidal behavior. Among the 154 articles published in scientific journals initially identified in Medline, Lilacs, SciELO and PsycInfo, we selected 59 articles that focused on the association between religiosity and suicidal behavior. To evaluate the qualitative attributes of the articles, a Qualitative Evaluation Script was developed. The results show that most articles found presented a lack of methodological rigor in measuring the concept of religiosity, possibly due to the subjective characteristic of this construct. However, it was found that the protective role against suicidal behavior exercised by religion, varies according to the culture in which it operates, whereas in some cultures suicidal behavior is not seen with total disapproval. However, most studies support the hypothesis that religiosity reduces the risk of suicidal behavior in individuals who profess some kind of belief, and participates in some religious space. Were not found, in this research, studies which measure the association between religiosity and suicidal behavior in religions of African origin.

A violência de gênero e a ideação suicida são eventos sociais de elevada incidência e constituem importantes problemas de saúde pública. Este estudo tem como objetivo estudar a violência de gênero e a ideação suicida em mulheres que vivem com hiv usuárias de um Serviço de Atenção Especializada em DST/aids de um município de médio porte do Rio Grande do Sul. Este é um estudo transversal cuja amostra foi constituída por 161 mulheres que vivem com hiv. Elas responderam um questionário aplicado por meio de entrevistas realizadas pelo pesquisador. A violência de gênero foi investigada por meio da versão brasileira reduzida do instrumento World Health Organization Violence Against Women e, para a ideação suicida, foi utilizado o Questionário de Ideação Suicida. A análise estatística foi realizada com o software Statistical Package Social Sciences. Verificou-se a presença de associações entre variáveis utilizando o teste Qui-Quadrado, Correlação de Pearson e Regressão de Poisson. A prevalência da violência de gênero foi de 72,7% e da ideação suicida de 50,9%. Neste estudo, as variáveis que estiveram associadas à violência e à ideação suicida foram praticamente as mesmas. Houve relação com a idade precoce da primeira relação sexual, maior número de filhos, baixas condições financeiras e maior tempo de vida com hiv. Além disso, as mulheres que sofreram violência de gênero apresentaram risco cinco vezes maior de manifestar ideação suicida. Neste trabalho observou-se alta prevalência de violência de gênero e de ideação suicida entre mulheres com hiv, e recomenda-se investigações desses temas nas histórias de vida das mulheres para que se possa propiciar acolhimento e cuidado como parte integrante das políticas voltadas às pessoas que vivem com hiv e da atenção integral à saúde das mulheres. / Gender violence and suicidal ideation are social events of high incidence and are important public health problems. This study aims to study gender violence and suicidal ideation in women living with HIV attending in a Service of Specialized Care in hiv/aids from a medium-sized city of Rio Grande do Sul. This is a cross-sectional study whose sample consisted of 161 women living with hiv. They answered a questionnaire through interviews conducted by the researcher. Gender violence was investigated by means of the Brazilian version of the instrument reduced World Health Organization Violence Against Women, and for suicidal ideation we used the Suicidal Ideation Questionnaire. The statistical analysis was performed with the Statistical Package Social Sciences software. Verified the presence of associations between variables using the Chi-Square test, Pearson Correlation and Poisson Regression. The prevalence for gender violence was of 72.7% and for suicidal ideation of 50.9%. In this study, the variables that were associated with violence and suicidal ideation were practically the same. There was a relationship with early age at first intercourse, higher number of children, few financial conditions and longer time life with hiv. In addition, women who suffer gender violence have fivefold greater risk of manifesting suicidal ideation. In this study, a high prevalence of gender violence and suicidal ideation among women with hiv, and it is recommended that investigations of these themes in the life stories of women so that they can provide shelter and care as an integral part of policies aimed at people who living with hiv and comprehensive health care for women. / La violencia de género y la ideación suicida son eventos sociales de alta incidencia y son importantes problemas de salud pública. Este estudio tiene como objetivo estudiar la violencia de género y la ideación suicida en las mujeres que viven con el hiv asistir a un Servicio de Atención Especializada en hiv/sida de un municipio de tamaño medio de Rio Grande do Sul. Se trata de un estudio transversal que muestra consistió en 161 mujeres que viven con el hiv. Respondieron un cuestionario a través de entrevistas realizadas por el investigador. La violencia de género fue investigado por medio de la versión brasileña del instrumento reducido Violencia Organización Mundial de la Salud contra la mujer y para la ideación suicida, se utilizó el Cuestionario de ideación suicida. El análisis estadístico se realizó con el paquete estadístico Ciencias Sociales. Verificada la presencia de asociaciones entre variables mediante la prueba de chi-cuadrado, correlación de Pearson y la regresión de Poisson. La prevalencia de la violencia de género fue de 72.7% y 50.9% de la ideación suicida. En este estudio, las variables que se asociaron con la violencia y la ideación suicida fueron prácticamente iguales. Hubo una relación con la edad temprana en la primera relación, mayor número de hijos, algunas condiciones financieras y de mayor duración con el vih. Además, las mujeres que sufren violencia de género tienen cinco veces más riesgo de manifestar ideas suicidas. En este estudio, se recomienda una alta prevalencia de la violencia de género y la ideación suicida entre las mujeres con hiv, y que las investigaciones de estos temas en las historias de vida de las mujeres para que puedan brindar refugio y cuidado como parte integrante de las políticas dirigidas a las personas que viven con el hiv y la atención integral de salud para las mujeres.

A violência de gênero e a ideação suicida são eventos sociais de elevada incidência e constituem importantes problemas de saúde pública. Este estudo tem como objetivo estudar a violência de gênero e a ideação suicida em mulheres que vivem com hiv usuárias de um Serviço de Atenção Especializada em DST/aids de um município de médio porte do Rio Grande do Sul. Este é um estudo transversal cuja amostra foi constituída por 161 mulheres que vivem com hiv. Elas responderam um questionário aplicado por meio de entrevistas realizadas pelo pesquisador. A violência de gênero foi investigada por meio da versão brasileira reduzida do instrumento World Health Organization Violence Against Women e, para a ideação suicida, foi utilizado o Questionário de Ideação Suicida. A análise estatística foi realizada com o software Statistical Package Social Sciences. Verificou-se a presença de associações entre variáveis utilizando o teste Qui-Quadrado, Correlação de Pearson e Regressão de Poisson. A prevalência da violência de gênero foi de 72,7% e da ideação suicida de 50,9%. Neste estudo, as variáveis que estiveram associadas à violência e à ideação suicida foram praticamente as mesmas. Houve relação com a idade precoce da primeira relação sexual, maior número de filhos, baixas condições financeiras e maior tempo de vida com hiv. Além disso, as mulheres que sofreram violência de gênero apresentaram risco cinco vezes maior de manifestar ideação suicida. Neste trabalho observou-se alta prevalência de violência de gênero e de ideação suicida entre mulheres com hiv, e recomenda-se investigações desses temas nas histórias de vida das mulheres para que se possa propiciar acolhimento e cuidado como parte integrante das políticas voltadas às pessoas que vivem com hiv e da atenção integral à saúde das mulheres. / Gender violence and suicidal ideation are social events of high incidence and are important public health problems. This study aims to study gender violence and suicidal ideation in women living with HIV attending in a Service of Specialized Care in hiv/aids from a medium-sized city of Rio Grande do Sul. This is a cross-sectional study whose sample consisted of 161 women living with hiv. They answered a questionnaire through interviews conducted by the researcher. Gender violence was investigated by means of the Brazilian version of the instrument reduced World Health Organization Violence Against Women, and for suicidal ideation we used the Suicidal Ideation Questionnaire. The statistical analysis was performed with the Statistical Package Social Sciences software. Verified the presence of associations between variables using the Chi-Square test, Pearson Correlation and Poisson Regression. The prevalence for gender violence was of 72.7% and for suicidal ideation of 50.9%. In this study, the variables that were associated with violence and suicidal ideation were practically the same. There was a relationship with early age at first intercourse, higher number of children, few financial conditions and longer time life with hiv. In addition, women who suffer gender violence have fivefold greater risk of manifesting suicidal ideation. In this study, a high prevalence of gender violence and suicidal ideation among women with hiv, and it is recommended that investigations of these themes in the life stories of women so that they can provide shelter and care as an integral part of policies aimed at people who living with hiv and comprehensive health care for women. / La violencia de género y la ideación suicida son eventos sociales de alta incidencia y son importantes problemas de salud pública. Este estudio tiene como objetivo estudiar la violencia de género y la ideación suicida en las mujeres que viven con el hiv asistir a un Servicio de Atención Especializada en hiv/sida de un municipio de tamaño medio de Rio Grande do Sul. Se trata de un estudio transversal que muestra consistió en 161 mujeres que viven con el hiv. Respondieron un cuestionario a través de entrevistas realizadas por el investigador. La violencia de género fue investigado por medio de la versión brasileña del instrumento reducido Violencia Organización Mundial de la Salud contra la mujer y para la ideación suicida, se utilizó el Cuestionario de ideación suicida. El análisis estadístico se realizó con el paquete estadístico Ciencias Sociales. Verificada la presencia de asociaciones entre variables mediante la prueba de chi-cuadrado, correlación de Pearson y la regresión de Poisson. La prevalencia de la violencia de género fue de 72.7% y 50.9% de la ideación suicida. En este estudio, las variables que se asociaron con la violencia y la ideación suicida fueron prácticamente iguales. Hubo una relación con la edad temprana en la primera relación, mayor número de hijos, algunas condiciones financieras y de mayor duración con el vih. Además, las mujeres que sufren violencia de género tienen cinco veces más riesgo de manifestar ideas suicidas. En este estudio, se recomienda una alta prevalencia de la violencia de género y la ideación suicida entre las mujeres con hiv, y que las investigaciones de estos temas en las historias de vida de las mujeres para que puedan brindar refugio y cuidado como parte integrante de las políticas dirigidas a las personas que viven con el hiv y la atención integral de salud para las mujeres.

Abstract The aim of this thesis was to explore the associations between the use of nervous system medications and suicidal ideation and behaviour in various different diagnostic groups in a large population-based cohort. Information on prescribed antipsychotic, antidepressant, benzodiazepine and antiepileptic medications within the Northern Finland Birth Cohort 1966 was collected from the register of the Social Insurance Institution of Finland and from a postal questionnaire sent to all cohort members in 1997. The presence of suicidal ideation and depression and anxiety symptoms was assessed via the Hopkins Symptom Checklist-25 questionnaire in 1997. Data on suicides were collected from the cause-of-death statistics and on suicide attempts from the Finnish Care Register for Health Care in a 15-year follow up. The use of antipsychotic, antidepressant, or benzodiazepine medication was associated with increased suicidal ideation, suicide attempts, and suicides. Antiepileptic medication was not associated with increased suicidality. The polypharmacy of nervous system medications was associated with increased suicidality. All nervous system medications were associated with increased severity of depression and anxiety symptoms. When depression and anxiety symptoms were taken into account, most of the associations between medication and suicidal ideation were statistically non-significant. Regarding specific groups, among those who did not have psychosis, high doses of antipsychotic medication correlated particularly with increased suicidal ideation even when other symptoms of depression and anxiety were taken into account. Among those with insomnia, the use of antidepressant medication associated with increased suicidal ideation also when other symptoms were taken into account. Although nervous system medication is associated with increased suicidal ideation, the association with other symptoms is also strong, and therefore it could not be stated that medication associates specifically with suicidal ideation. However, certain groups, i.e., non-psychotic subjects with high doses of antipsychotic medication, or subjects with insomnia and using antidepressant medication, should be closely monitored as they could be more vulnerable to suicidal ideation. / Tiivistelmä Tämän väitöstutkimuksen tarkoituksena oli tutkia hermostoon vaikuttavien lääkkeiden, lähinnä psykoosilääkkeiden, masennuslääkkeiden, bentsodiatsepiinien sekä epilepsialääkkeiden, yhteyttä itsetuhoisiin ajatuksiin, itsemurhayrityksiin ja itsemurhiin. Aihetta tutkittiin eri diagnoosiluokissa suuressa väestöaineistossa, Pohjois-Suomen vuoden 1966 syntymäkohortissa. Tieto tutkimushenkilöiden lääkkeenkäytöstä vuodelta 1997 kerättiin Kelan lääkeostorekisteristä sekä postikyselyn avulla. Itsetuhoisten ajatusten ja muiden masennus- ja ahdistusoireiden vakavuutta mitattiin Hopkins Symptom Checklist-25 -kyselyn avulla vuonna 1997. Tieto itsemurhista kerättiin 15 vuoden seurannassa kuolinsyyrekisteristä ja tieto itsemurhayrityksistä hoitoilmoitusrekisteristä. Psykoosilääkkeiden, masennuslääkkeiden ja bentsodiatsepiinien käyttö oli yhteydessä lisääntyneisiin itsetuhoisiin ajatuksiin, itsemurhayrityksiin ja itsemurhiin. Epilepsialääkkeet eivät liittyneet itsetuhoisuuteen. Usean hermostoon vaikuttavan lääkkeen yhtäaikainen käyttö oli yhteydessä lisääntyneeseen itsetuhoisuuteen. Kaikki hermostoon vaikuttavat lääkkeet liittyivät lisääntyneisiin masennus- ja ahdistusoireisiin. Kun lääkityksen yhteys masennus- ja ahdistusoireisiin otettiin huomioon, lääkkeet eivät olleet erityisesti yhteydessä itsetuhoisiin ajatuksiin. Diagnostisten ryhmien välillä ei ollut eroa hermostoon vaikuttavien lääkkeiden ja itsemurhayritysten tai itsemurhien välisessä yhteydessä. Henkilöillä, joilla ei ole psykoosia, suuremmat psykoosilääkeannokset olivat yhteydessä itsetuhoisten ajatusten vakavuuteen kun muiden masennus- ja ahdistusoireiden vakavuus otettiin huomioon. Unettomuudesta kärsivillä henkilöillä masennuslääkkeen käyttö oli liittyi lisääntyneisiin itsetuhoisiin ajatuksiin kun muut oireet huomioitiin. Hermostoon vaikuttavat lääkkeet ovat yhteydessä lisääntyneisiin itsetuhoisiin ajatuksiin, mutta ne ovat myös vahvasti yhteydessä muihin masennus- ja ahdistusoireisiin. Tietyt henkilöt voivat kuitenkin olla erityisen herkkiä nimenomaan itsetuhoisille ajatuksille, ja heitä tulisi seurata erityisen tiiviisti. Tällaisia ovat henkilöt, joilla ei ole psykoosia, mutta jotka käyttävät suuria psykoosilääkeannoksia, sekä vakavasta unettomuudesta kärsivät henkilöt, jotka käyttävät masennuslääkettä.

Bakgrund: Suicid innebär att en människa avsiktligt och självförvållat skadar sig vilket leder till döden. Snabba och oförväntat försämrade tillstånd och död kan upplevas som oro och stress hos sjuksköterskan. Samtidigt är det sjuksköterskans plikt att möta, samtala och tolka patienten då det är i vårdrelationen en förståelse kan skapas för patientens suicidtankar. Attityder, kontext, tolkning av människosyn präglas av hur sjuksköterskans förhåller sig till den suicidala patienten. Syfte: Syftet var att beskriva sjuksköterskors upplevelser och erfarenheter i relation till suicid och den suicidnära patienten. Metod: En systematisk integrativ litteraturöversikt har använts som metod. Både kvantitativa och kvalitativa artiklar har hämtats från databaserna Cinahl, PubMed och PsycInfo. Totalt inkluderades 13 artiklar i resultatet. Resultat: Tre huvudteman teman framkom i resultatet, Sjuksköterskans känslor i mötet med suicid, närhet och distans, samt att förstå suicidhandlingen. Känslor av skuld beskrevs som en konsekvent genomgående i mötet med den suicidala patienten. Även svårigheter i att reglera närhet och distans till patienten medförde en obalans i att distansera sig kontra att närma sig i mötet. Kontext och sociokulturell tillhörighet påverkade relationen mellan sjuksköterskan och patienten. Diskussion: I resultatdiskussionen har delar av resultatet diskuterats utifrån Patrica Benners omvårdnadsteori, det femte och sista stadiet. Det är viktigt att erbjuda sjuksköterskans möjlighet till vidare utbildning i bemötandet men också i de egna psykologiska processer som mötet med negativa känslor och eventuella trauma kan innebära. / Background: Suicide means that a person intentionally and self-inflicted injures himself, which leads to death. Rapid and unexpectedly worsening conditions and deaths can be experienced as nurses' anxiety and stress. At the same time, it is the nurse's duty to meet, talk and interpret the patient as it is in the care relationship that an understanding can be created for the patient's suicidal thoughts. Attitudes, context, interpretation of human view are characterized by how the nurse's attitude to the suicidal patient. Aim: To describe nurses' experiences and experiences in relation to suicide and the suicidal patient. Method: A systematic integrative literature review has been selected. Both quantitative and qualitative articles have been used from the databases Cinahl, Pubmed and PsycInfo Knalf's integrative. Theoretical starting point was based on Patricia Benner's nursing theory where Benner's last and fifth stages were discussed. Results: Three main themes emerged in the result, Nurse's feelings in the meeting with suicide, proximity and distance, and understanding the suicide act. Feelings of guilt were described as consistent throughout the encounter with the suicidal patient. Difficulties in regulating proximity and distance to the patient also led to an imbalance in distancing versus approaching the meeting. Context and sociocultural belonging influenced the relationship between the nurse and the patient. Conclusions: In the result discussion, parts of the result have been discussed based on Patrica Benner's nursing theory, the fifth and last stage. It is important to offer the nurse's opportunity for further education in the treatment, but also in the own psychological processes that the encounter with negative emotions and possible trauma can entail.