Servicios Personalizados
Revista
Articulo
nueva página del texto (beta)
Inglés (pdf)
Artículo en XML
Referencias del artículo
Traducción automática
Enviar artículo por emailIndicadores
-
Citado por SciELO -
Accesos
Links relacionados
-
Similares en
SciELO
Compartir
Permalink
Salud mental
versión impresa ISSN 0185-3325
Salud Ment vol.28 no.2 México mar./abr. 2005
Artículos originales
Suicidal behavior in the Mexican National Comorbidity Survey (M-NCS): Lifetime and 12- month prevalence, psychiatric factors and service utilization
1National Institute of Psychiatry, Mexico City.
2Division of Child & Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA.
3Universidad Autónoma Metropolitana, México City.
4Department of Health Care Policy, Harvard Medical School, Boston, MA. USA.
Background:
Nationally representative data from México are presented on the lifetime and 12-month prevalence of the onset of suicide ideation, suicide plans and suicide attempt, as well as associated DSM-IV psychiatric disorders and service utilization.
Methods:
Data are from the Mexican National Comorbidity Survey (M-NCS). This population survey was carried out in 2001-2003 in a sample of 5,782 respondents of 18 years and older. Onset of ideation, a plan, and suicide attempt, as well as psychiatric and service use correlates were estimated using survival analysis.
Results:
Of the respondents, 8.3% reported lifetime ideation, 3.2% reported a lifetime plan and 2.8% reported lifetime suicide attempt(s). The prevalence for 12-month suicidal behaviors was 2.3%, 1.0% and 0.6%, respectively. Suicidal behaviors were more prevalent in early adolescence and early adulthood and became less common after the mid-thirties, with the exception of suicidal ideation that continues into older ages. Having met criteria for one or more of the DSM-IV disorders assessed in the survey was common among suicide ideators (60.9%), planners (75.6%) and attempters (74.6%), and was a strong risk factor for suicidal behaviors, with odds ratios of 4.8 for ideation, 10.2 for plan and 9.6 for attempt. Approximately one of every four lifetime attempters reported to have ever seen a psychiatrist.
Conclusions:
As in many other countries, mental disorders have an important impact on suicidal behaviors in Mexico. Intervention efforts aimed at identifying and treating persons at or before the onset of suicidal ideation is strongly recommended.
Key words: Suicide; suicide attempt; risk factors; epidemiology; survey; psychiatric disorder
Antecedentes:
Se documentan datos representativos a nivel nacional en México sobre las prevalencias para inicio de ideación, plan e intento suicidas, así como trastornos psiquiátricos (de acuerdo con el DSM-IV) y uso de servicios asociados a estos comportamientos suicidas.
Métodos:
Los datos fueron tomados de la Encuesta Nacional de Epidemiología Psiquiátrica de México (ENEP). La población fue tomada de una muestra de 5,782 entrevistados de 18 o más años de edad, durante el periodo 2001-2003. Se estimaron inicios para ideación, plan e intento suicida, así como factores psiquiátricos y de uso de servicios mediante el análisis de supervivencia.
Resultados:
De los entrevistados, el comportamiento suicida alguna vez en la vida fue como sigue: el 8.3% reportó haber tenido ideación, el 3.2% reportó haber tenido un plan y el 2.8% reportó haber tenido intento(s) suicida(s). La prevalencia para los comportamientos suicidas los 12 meses previos a la entrevista fue de 2.3%, 1.0% y 0.6%, respectivamente. Dichos comportamientos prevalecieron en la adolescencia y adultez temprana y fueron menos comunes después de los 35 años de edad, con excepción de la ideación suicida que se mantuvo presente en edades más avanzadas. El presentar uno o más trastornos, evaluados en la encuesta de acuerdo con el DSM-IV, fue común entre las personas con ideación (60.9%), plan (75.6%) e intento (74.6%) suicidas y se encontró que este hecho es un factor de riesgo fuerte para el comportamiento suicida, incrementando en 4.8 veces el riesgo para ideación, 10.2 para plan y 9.6 para intento. Aproximadamente una de cada cuatro personas con intento suicida reportó haber consultado alguna vez un psiquiatra.
Conclusiones:
Como en muchos otros países, en México los trastornos mentales tienen un impacto importante en los comportamientos suicidas. Se recomiendan ampliamente los esfuerzos de intervención enfocados a la identificación y al tratamiento de personas antes o durante el inicio de la ideación suicida.
Palabras clave: Suicidio; intento de suicidio; factor de riesgo; encuesta; epidemiología; trastornos psiquiátricos
Acknowledgments
The Mexican National Comorbidity Survey (M-NCS) is supported by The National Institute of Psychiatry Ramón de la Fuente (INPRFM-DIES 4280) and by the National Council on Science and Technology (CONACyT-G30544-H) , with supplemental support from the Pan American Health Organization (PAHO). Collaborating M-NCS investigators included María-Elena Medina-Mora (Principal Investigator), Guilherme Borges, and Carmen Lara, all from The Mexican Institute of Psychiatry and the Metropolitan Autonomous University (Guilherme Borges). M-NCS are carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis.
References
1. American Psychiatric Association: Diagnosiicand Statistical Manual of Mental Disorders, (DSM-IV). Fourth Edition ed. Washington, 1994. [ Links ]
2. Andrews JA, Lewinsohn PM: Suicidal attempts among older adolescents: prevalence and co-occurrence with psychiatric disorders. J Am Acad Child Adolesc Psychiatry, 31(4):655-62, 1992. [ Links ]
3. Beautrais AL, Joyce PR, Mulder RT, Fergusson DM, Deavoll BJ, Nightingale SK: Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study. Am J Psychiatry, 153(8):1009-14, 1996. [ Links ]
4. Beautrais AL, Joyce PR, Mulder RT: Psychiatric illness in a New Zealand sample of young people making serious suicide attempts. N Z Med J, 111(1060):44-8, 1998. [ Links ]
5. Borges G, Medina-Mora ME, Zambrano J, Garrido G: Epidemiología de la conducta suicida en México Capítulo para el Informe Nacional sobre la Violencia y la Salud en México, Secretaría de Salud, 2004. [ Links ]
6. Caraveo AJ, Martínez N, Rivera E: Un modelo para estudios epidemiológicos sobre la salud mental y la morbilidad psiquiátrica. Salud Mental, 21(1):48-57, 1998. [ Links ]
7. Caraveo J, González C, Ramos L: The concurrent validity of the DIS: Experience with psychiatric patients in Mexico city. Hispanic J Behav Sci, 13:63-77, 1991. [ Links ]
8. Conwell Y, Duberstein PR, Cox C, Herrmann JH, Forbes NT, Caine ED: Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. Am J Psychiatry, 153(8):1001-8, 1996. [ Links ]
9. Desai RA, Liu-Mares W, Dausey DJ, Rosenheck RA: Suicidal ideation and suicide attempts in a sample of homeless people with mental illness. J Nerv Ment Dis, 191(6):365-71, 2003. [ Links ]
10. Desai RA, Liu-Mares W, Dausey DJ, Rosenheck RA: Suicidal ideation and suicide attempts in a sample of homeless people with mental illness. J Nerv Ment Dis, 191(6):365-71, 2003. [ Links ]
11. Fergusson DM, Lynskey MT: Childhood circumstances, adolescent adjustment, and suicide attempts in a New Zealand birth cohort. J Am Acad Child Adolesc Psychiatry, 34(5):612-22, 1995. [ Links ]
12. Garrison C Z, McKeown RE, Valois RF, Vincent ML: Aggression, substance use, and suicidal behaviors in high school students. Am J Public Health, 83(2):179-84 1993. [ Links ]
13. Gonzalez-Forteza C, Villatoro J, Alcantar I, Medina-Mora ME, Fleiz C, Bermudez P, Amador BN: Salud Mental, 25(6.):1-12, 2002. [ Links ]
14. Groholt B, Ekeberg O, Wichstrom L, Haldorsen T: Young suicide attempters: a comparison between a clinical and an epidemiological sample. J Am Acad Child Adolesc Psychiatry, 39(7):868-75, 2000. [ Links ]
15. Harkavy-Friedman JM, Nelson EA, Venarde DF, Mann JJ: Suicidal behavior in schizophrenia and schizoaffective disorder: examining the role of depression. Suicide Life Threat Behav, 34(1):66-76, 2004. [ Links ]
16. Harris EC, Barraclough B: Suicide as an outcome for mental disorders. A meta-analysis. BrJ Psychiatry, 170:205-28, 1997. [ Links ]
17. Hosmer DW, Lemeshow S: Applied Logislic Regression. Second edition ed. John Wiley & Sons, New York, 2000. [ Links ]
18. Hosmer DW, Lemeshow S: Applied Survival Analysis. Regression Modeling of Time to Event Data. John Wiley & Sons, New York, 1999. [ Links ]
19. Juon HS, Ensminger ME: Childhood, adolescent, and young adult predictors of suicidal behaviors: a prospective study of African Americans. J Child Psychol Psychiatry, 38(5):553-63, 1997. [ Links ]
20. Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry, 56(7):617-26, 1999. [ Links ]
21. Kessler RC, Ustun TB: The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res, 13:93-121, 2004. [ Links ]
22. King RA, Schwab-Stone M, Flisher AJ, Green-Wald S, Kramer RA et al.: Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation. J Am Acad Child Adolesc Psychiatry, 40(7):837-46, 2001. [ Links ]
23. Lewinsohn PM, Rohde P, Seeley J: R Psychosocial characteristics of adolescents with a history of suicide attempt. J Am Acad Child Adolesc Psychiatry, 32(1):60-8, 1993. [ Links ]
24. Luoma JB, Martin CE, Pearson JL: Related Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry, 159(6):909-16, 2002. [ Links ]
25. Medina-Mora ME, Borges G, Lara C, Benjet C, Blanco J et al.: Prevalence of mental disorders and use of services: Results from the Mexican Nacional Survey of Psychiatric Epidemiology. Salud Mental, 26:1-16, 2003. [ Links ]
26. Michel K, Runeson B, Valach L, Wasserman D: Contacts of suicide attempters with GPs prior to the event: a comparison between Stockholm and Bern. Acta Psychiatr Scand, 95(2):94, 1997. [ Links ]
27. Mondragon L, Borges G, Gutierrez R: La medición de la conducta suicida en México: estimaciones y procedimientos. Salud Mental, 24(6):4-15, 2001. [ Links ]
28. Petronis KR, Samuels JF. Moscicki EK, Anthony JC: An epidemiologic investigation of potential risk factors for suicide attempts. Soc Psychiatry Psychiatr Epidemiol, 25(4):193-9, 1990. [ Links ]
29. Pirkis J, Burgess P, Dunt D: Suicidal ideation and suicide attempts among Australian adults. Crisis, 21(1):16-25, 2000. [ Links ]
30. Pirkis JE, Burgess PM, Meadows GN, Dunt DR:.Suicidal ideation and suicide attempts as predictors of mental health service use. Med J Aust, 19;175(10):542-5, 2001. [ Links ]
31. Pirkis J, Burgess P, Jolley D: Suicide attempts by psychiatric patients in acute inpatient, long-stay inpatient and community care. Soc Psychiatry Psychiatr Epidemiol, 34(12):634-44, 1999. [ Links ]
32. Reinherz H, Giaconia RM, Silverman AB, Friedman A et al.: Early psychosocial risks for adolescent suicidal ideation and attempts. J Am Acad Child Adolesc Psychiatry, 34(5):599-611, 1995. [ Links ]
33. Robins LN, Wing J, Wittchen H-U et al: The Composite International Diagnostic Interview: an epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry, 45:1069-1077, 1988. [ Links ]
34. Sudaan: Professional Software for Survey Data Analysis [computer program]. Version 8.0.1. Research Triangle Park, NC: Research Triangle Institute; 2002. [ Links ]
35. Suominen K, Henriksson M, Suokas J, Isometsa E, Ostamo A, Lonnqvist J: Mental disorders and comorbidity in attempted suicide. Acta Psychiatr Scand, 94(4):234-40, 1996.. [ Links ]
36. Suominen KH, Isometsa ET, Ostamo AI, Lonnqvist JK: Health care contacts before and after attempted suicide. Social Psychiatry Psychiatric Epidemiology 37(2): 89-94, 2002. [ Links ]
37. Wagner BM, Cole RE, Schwartzman P: Comorbidity of symptoms among junior and senior high school suicide attempters. Suicide Life Threat Behav, 26(3):300-7, 1996. [ Links ]
38. Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG et al.: Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med, 29(1):9-17, 1999. [ Links ]
39. Who World Mental Health Survey Consortium : Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP et al.: Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA. 291(21):2581-90, 2004. [ Links ]
40. Wittchen HU: Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res, 28(1):57-84. 1994. [ Links ]
41. Wolter KM: Introduction to Variance Estimation. Springer-Verlag, New York, 1985. [ Links ]
42. Yuen NY, Nahulu LB, Hishinuma ES: Miyamoto Cultural identification and attempted suicide in Native Hawaiian adolescents. J Am Acad Child Adolesc Psychiatry, 39(3):360-7, 2000. [ Links ]
Received: February 07, 2005; Accepted: March 22, 2005
This is an open-access article distributed under the terms of the Creative Commons Attribution License
