Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 1 - Jan/Mar - 2017

Imprimir 

Páginas 88 a 96


Suicidal behavior among adolescents: Integrative review of national literature

Comportamiento suicida entre adolescentes: Revisión integral de la literatura nacional

Comportamento suicida entre adolescentes: Revisão integrativa da literatura nacional

Autores: Angélica Moura de Oliveira1; Christiane Mayena Salgado Bicalho2; Fernanda Morais Teruel3; Leonardo Leão Kahey4; Nadja Cristiane Lappann Botti5

1. Specialization in Industrial Nursing, Centro Universitário Internacional University Center (UNINTER). Substitute Teacher, Colégio Técnico Cecon Technical School. Itaúna, Minas Gerais State, Brazil
2. Master's Degree student in Science, São João Del-Rei Federal University (UFSJ). Divinópolis, Minas Gerais State, Brazil. Specialization in Hospital Psychology, FUMEC, University (FUMEC). Belo Horizonte, Minas Gerais State, Brazil. Specialization in Family Health, Faculdade São Camilo College (FASC). Belo Horizonte, Minas Gerais State, Brazil. Psychologist, Clínica Dom Oncology and Family Health Network Clinic, Divinópolis City Hall. Divinópolis, Minas Gerais State, Brazil. Psychologist Family Health Network, Carmo da Mata City Hall. Carmo da Mata, Minas Gerais State, Brazil
3. Specialist Nurse: University and Health Education Lecturer, SUS Instruction Unit. Lecturer, Instituição de Ensino Superior Pitágoras - Rede Kroton. Betim, Minas Gerais State, Brazil. Pitágoras University. Betim, Minas Gerais State, Brazil
4. Master's Degree student in Nursing, São João Del-Rei Federal University (UFSJ). Divinópolis, Minas Gerais State, Brazil. Nurse, Alcohol and Drugs Psychological and Social Care Center. Belo Horizonte, Minas Gerais State, Brazil
5. PhD in Psychiatric Nursing, São Paulo University (USP). Ribeirão Preto, São Paulo State,. Adjunct Professor, São João Del-Rei Federal University(UFSJ). Divinópolis, Minas Gerais State, Brazil

Nadja Cristiane LappannBotti
Universidade Federal de São João Del Rei
Av. Sebastião Gonçalves Coelho, 400, Sala 301.1, Bloco D, Chanadour
Divinópolis, MG, Brasil. CEP: 35501-296
nadjaclb@terra.com.br

PDF Portuguese      


Scielo

Medline


How to cite this article

Keywords: Suicide, suicide attempted, adolescent.
Palabra Clave: Suicidio, intento de suicidio, adolescente.
Descritores: Suicídio, tentativa de suicídio, adolescente.

Abstract:
OBJECTIVE: This study aims to seek scientific evidence to contribute to the understanding of suicidal behavior in adolescence.
DATA SOURCES: Integrative review of literature with search in the databases: Latin American and Caribbean of Health Sciences and National Library of Medicine through the descriptors: suicide, suicide attempt and teenager. We sought to answer the following guiding question: What are the national scientific evidence published in the last 10 years that contribute to the understanding of suicidal behavior in adolescence?
SUMMARY OF THE FINDINGS: thirty-nine national articles were found, nine of which met our inclusion criteria. The articles point out the characteristics of suicidal behavior in general and the risk factors for suicidal behavior among adolescents.
CONCLUSION: Due to the adolescent process itself, it may occur to search for immediate solutions through aggressive and suicidal behavior. The suicidal behavior in adolescent portrays a request for help against intense suffering. The main risk factors for suicide are suicidal idealization, depression and substance abuse among teenagers.

Resumen:
OBJETIVO: El presente estudio tiene como objetivo buscar evidencias científicas que aporten para la comprensión del comportamiento suicida en la adolescencia.
FUENTE DE DATOS: Revisión integral de la literatura con busca en las bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud y National Library of Medicine a través de los descriptivos: suicidio, intento de suicidio y adolescente. Se buscó contestar la siguiente pregunta norte: ¿cuáles son las evidencias científicas nacionales publicadas en los últimos 10 años que aportan para la comprensión del comportamiento suicida en la adolescencia?
SÍNTESIS DE LOS DATOS: Fueron encontrados treinta y nueve artículos nacionales, de los cuales nueve se encuadraron en los criterios de inclusión. Los artículos apuntan a las características del comportamiento suicida de forma general y los factores de riesgo para el comportamiento suicida entre adolescentes.
CONCLUSIÓN: En función del propio proceso de adolescencia, puede ocurrir la búsqueda de soluciones inmediatas por medio de comportamientos agresivos y suicidas. El comportamiento suicida presente en el adolescente retrata un pedido de ayuda frente a un sufrimiento intenso. Los principales factores de riesgo para el suicidio son idealización suicida, depresión y uso de sustancias psicoactivas entre los adolescentes.

Resumo:
OBJETIVO: O presente estudo tem como objetivo buscar evidências científicas que contribuam para a compreensão do comportamento suicida na adolescência.
FONTES DE DADOS: Revisão integrativa da literatura com busca nas bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde e National Library of Medicine através dos descritores: suicídio, tentativa de suicídio e adolescente. Buscou-se responder a seguinte pergunta norteadora: quais são as evidências científicas nacionais publicadas nos últimos 10 anos que contribuem para a compreensão do comportamento suicida na adolescência?
SÍNTESE DOS DADOS: Foram encontrados trinta e nove artigos nacionais, dos quais nove se enquadraram nos critérios de inclusão. Os artigos apontam as características do comportamento suicida de forma geral e os fatores de risco para o comportamento suicida entre adolescentes.
CONCLUSÃO: Em função do próprio processo de adolescer, pode ocorrer à busca de soluções imediatas por meio de comportamentos agressivos e suicidas. O comportamento suicida presente no adolescente retrata um pedido de ajuda frente a um sofrimento intenso. Os principais fatores de risco para o suicídio são idealização suicida, depressão e uso de substâncias psicoativas entre os adolescentes.

INTRODUCTION

Suicide is one of the main causes of death all over the world, with more than a million deaths a year, trending upwards during the next few decades, and becoming a major public health problem. The mean global suicide rate is 16 deaths per 100,000 inhabitants, up 60% during the past 45 years1. In Brazil, this figure reaches 5.7 deaths per 100,000 inhabitants, ranking third among the causes of deaths (6.8%) due to identified external causes2.

Suicide is found in all age brackets, ranking as the second cause of cause of death among young people between 15 to 29 years old, with estimates indicating an upsurge in these figures for Brazil3. Young people are acknowledged as more vulnerable to suicidal behaviors by the World Health Organization, with preventive efforts required for this public3. Demands for change, concomitant with the need to make major life choices endows this age bracket with particular psychic vulnerability4.

Risk factors for suicidal behavior among young people are classified as individual, family, social, adverse life events and the availability of lethal means. Individual factors include age, gender, prior history of suicidal behavior, psychiatric pathology, psychological and biological factors, sexual preferences and medical diseases. Family factors include family histories of suicidal behavior and parental psychopathology. The effects of imitation/persuasion, social isolation and poor social support networks constitute social factors. Adverse life events include bullying, together with physical and sexual abuse; finally, the availability of lethal means is identified as a risk factor for suicide among young people 4.

The Youth Violence Map for Brazil offers an overview of violent deaths that encompass traffic accidents, homicides and suicides, showing that death rates due to external causes rose 32.8% between 1980 and 2012, with homicides up 148.5%, traffic accidents up 38.7% and suicides up 62.5%. It is also important to stress that the number of self-caused deaths rose most steeply for the 15 to 19 years of age bracket between 1990 and 20125.

An epidemiological study of mortality rates due to suicide analyzed data from 1997 to 2011 among adolescents between 10 and 19 years old in Minas Gerais State, showing that 19,898 deaths occurred during this period due to external causes, of which 4.87% were suicides. There are twice as many deaths of this type among young males, compared to females, in the proportion of 2:1. The most frequent means used was hanging for both genders, followed by taking poison among women and firearms for men6.

Suicidal behavior among adolescents is generally under-notified, because many of these deaths are incorrectly classified as non-intentional or accidental. Consequently, the under-notification of these cases not only hampers the possibilities for the system to move into action, but also makes it hard for families and social networks to receive care for dealing with the repercussions and impacts caused by suicides7.

Based on these aspects, which demonstrate the magnitude and importance of preventing suicides, which are ranked as avoidable deaths, the purpose of this study is to seek scientific evidence contributing to an understanding of suicidal behavior during adolescence.


METHODOLOGY

This study consists of an integrative review of the literature based on the establishment of hypotheses or research questions, searches through the literature, categorization and assessment of studies encompassed by the survey, followed by construal and presentation of the results. Its purpose is to gather together and synthesize the findings of research projects on this specific issue or topic, in a systematic and orderly manner, helping expand knowledge of this matter in greater depth8.

The key question for this integrative review was: what is the scientific evidence for Brazil published during the past ten years that enhances understanding of suicidal behavior during adolescence?

The integrative review of the literature was conducted in compliance with the stages proposed by Ursi9. In order to select the papers, the Virtual Health Library (BVS) research portal was used, searching the following databases: Latin American and Caribbean Literature in the Health Sciences (LiLACS) and National Library of Medicine (MEDLINE) through the boolean technique based on Health Sciences Descriptors (DeCS). The descriptors used were suicide and suicide attempts and adolescent.

The inclusion criteria consisted of Brazilian papers published in Portuguese between 2004 and 2014, with the full texts available in the indexed databases, exploring the issue of adolescents with histories of suicidal behaviors. The exclusion criteria were: publications prior to 2004, references not allowing free access to the full texts on-line, and repeat papers. This bibliographic survey was conducted in May 2015.

This search found 131 papers written in Portuguese, published in 39 Brazilian journals. Based on the inclusion criteria, the final sample for this integrative review consisted of nine papers: eight found in LiLACS and one in MEDLINE. Table 1 presents a description of the studies included in the integrative review.




RESULTS AND DISCUSSION

This integrative review encompasses nine papers described in Table 1, presented in decreasing order by year of publication. The BVS identified the papers based on the following subject indexation: psychology - 5, psychiatry - 2, public health - 1, and toxicology - 1. It is noted that the largest number of papers were published in 2006 (33.33%), which was the year of issue of the Brazilian Guidelines for a National Suicide Prevention Plan 19. In terms of the methodological framework, it was noted that the quantitative approach was used in more than half the papers in the sample (66.6%), followed by qualitative studies (22.2%). Only one paper used a quali-quantitative approach for conducting research activities. In terms of their objectives, most of these papers were related to suicidal thoughts (88.8%) (Table 2).




Critical readings and analysis of the papers disclosed two analytical categories: suicidal behavior and suicidal behavior among adolescents.

Suicidal behavior

A public health problem, suicidal behavior causes heavy impacts on healthcare facilities15. This behavior encompasses a set of individual wishes, attitudes or plans to kill oneself12, and is frequently classified into three categories: suicidal thoughts, suicide attempts and consummated suicide 17.

Suicidal thoughts are the first step towards consummated suicide16. In general, suicide means a voluntary act through which people deliberately cause their own death17. In general, suicidal behavior generally encompasses suicidal thoughts at one end and consummated suicide at the other, with suicide attempts between them10.

Supported by Shneidman, Fensterseifer and Werlang10 note that suicide is triggered by unbearable psychological pain, meaning the pain and anguish associated with excessive feelings of guilt, shame, embarrassment, loneliness and fear; where somebody sees death as a way of escaping unbearable pain. In this case, in order to help practitioners identify people at risk for suicide, there is a Psychological Pain Assessment Scale (PPAS)10.

A nationwide study conducted in order to estimate lifetime prevalence rates for suicidal thoughts, plans and attempts among the population showed that suicidal behavior was more frequent among women and young adults. The existence of a plan to take one´s own life, in terms of frequency, is close to the figure for suicide attempts (5:3 ratio). Out of each three attempted suicides, only one victim is seen at a medical facility. In terms of prevalences, 17.1% was found for suicidal thoughts, 4.8% for plans to commit suicide and 2.8% for suicide attempts. These figures are close to those in most of the studies conducted in other countries15.

In terms of the epidemiology of suicide, it is important to mention that the official data are generally under-estimated, due to under-notification that is often due to faulty identification and classification of causes of death14. Under-estimating the data on suicides is related to several factors, especially conceptualization problems, such as difficulties in accurate identification of whether a car crash was really an accident or an attempted suicide attempt17.

Epidemiological data for Brazil show an upsurge in the suicide rate for the general population, reaching the third most important cause of death among adolescents12. As a result, greater efforts by experts in the "suicidology" area have identified risk factors for suicidal acts through developing assessments tools that help pinpoint at-risk groups, identifying their severity and intensity, as well as associations between suicidal acts and other assorted variables10.

Suicidal behavior among adolescents

According to the World Health Organization (OMS), adolescence is viewed as the time between 10 and 19 years of age, divided into early adolescence: between 10 and 14 years of age, and late adolescence: 15 to 19 years old13. Changes taking place during adolescence include the transition from a situation of dependence to relatively autonomous status13, in parallel to psychic reorganization where the past and present must be associated, generally triggering doubts and uncertainties, together with personal and family conflicts and often unbearable pain10. In this case, adolescence - as a phase of many changes - may prompt youngsters to seek immediate solutions through aggressive and suicidal behaviors under some circumstances 12.

Ideas about death during adolescence become matters of concern when suicide offers an alternative for escaping the difficulties faced by these youngsters. Suicidal behavior among teens is actually a call for help with intense suffering12. The factors distinguishing a healthy youngster from someone in a suicidal crisis are: intensity, depth and duration of suicidal thoughts, the contexts within which they arrive and the impossibility of switching these thoughts off14.

It is stressed that suicide generally refers to an anticipated death that could be avoided through preventive actions within the family, school and community context, in addition to the communications media12. In this case, suicide prevention must be undertaken through attempts to lessen individual and collective risk factors18. Risk factors are elements that offer ample possibilities for triggering or linking to the occurrence of an unwanted event, although not essentially a causal factor17. The presence of suicidal thoughts is an important predictor for suicide risks7,10. The main risk factors for suicide include mental disorders and the use of psychoactive substances17,18, recent losses, turbulent family dynamics, very impulsive and aggressive personalities, disabling chronic diseases, easy access to lethal means, male between 15 and 35 years of age or more than 75 years old, in extreme economic conditions (wealth or poverty), unemployment (particularly recent job loss), retirees, atheists, single or separated men, migrants, family history of suicide17 and social stressors18. It is stressed that suicidal thoughts precede the act, consequently making it important to detect these thoughts at an early stage, understand the reasons prompting them and the specific characteristics of this period17.

A nationwide study of 526 adolescents between 15 and 17 years old showed that 36% of them presented suicidal thoughts, also associated with mild, moderate and severe depression among these youngsters, with 67.6% of them being teenage girls12. Ideas about death during the teen years may reflect attempts by these youngsters to find a meaning for life and death. However, when these ideas are linked to the intensity of the depression variable, this may indicate psychic suffering14. Along these lines, it is important to expand studies of depression among adolescents due to the severity of this disease, the harm that it causes and its steady expansion13.

Depression during adolescence has been presented as a problem on the rise that is of much concern to the public health authorities13. Depression is the mental disorder most frequently associated with suicide among adolescents12. Girls present higher levels of suicidal thoughts than boys, which may be related to higher rates depression among girls12.

A nationwide study of 243 adolescents enrolled at government and private schools showed that 34.3% presented suicidal thoughts or suicide attempts. Mild or moderate symptoms of depression were associated with suicidal thoughts, together with moderate symptoms of anxiety, while suicide attempts were associated with severe symptoms of depression and anxiety13.

Another study exploring the clinical relevance of nightmares among patients with depression noted a significant association between suicidal thoughts and nightmares among patients with severe depression: when suicidal thoughts are more apparent, nightmares are more severe, together with rising psychological stress. In this case, the hypothesis that might elucidate the association between nightmares in patients with suicidal thoughts could be sleep alterations11.

The scientific literature also presents an association between suicidal thoughts and aggressive behaviors, linked to the use of psychoactive substances16. Although people dependent on psychoactive substances do not present significant cognitive changes, they undergo emotional alterations in terms of impulsiveness and expressing anger. In this case, they often become violent at equally severe levels, if not more, if actions are not taken to break away from this dynamic18.


CLOSING REMARKS

The growing-up process may prompt youngsters to seek immediate solutions through aggressive and suicidal behaviors. Among these youngsters, suicidal behavior echoes a call for help with severe suffering, particularly unbearable psychological pain. Suicidal thoughts are the main risk factor for suicide, with depression the mental disorder that is most frequently associated with suicide, with an association also noted between suicidal thoughts and aggressive behaviors for the use of psychoactive substances among adolescents.

The importance of drawing up suicide prevention strategies is stressed yet again, through outreach actions grounded on protection factors, with support networks for these youngsters. Teen suicide is a public health problem, sounding a warning for families, schools, healthcare practitioners and communities to act in effective and well-integrated ways in order to ease these youngsters through their emotional suffering, thus preventing avoidable deaths.


REFERENCES

1. Schlösser A, Rosa GFC, More CLO. Revisão: Comportamento Suicida ao Longo do Ciclo Vital. [accessed on: July 22, 2015 ]; Temas em Psicologia 2014; 22(133): 1-145. Available at: http://pepsic.bvsalud.org/pdf/tp/v22n1/v22n1a11.pdf

2. Machado DB, Santos DN. Suicídio no Brasil, de 2000 a 2012. [accessed on: July 22, 2015 ].Jornal Brasileiro de Psicologia 2015; 64(1): 45-54. Available at: http://www.scielo.br/pdf/jbpsiq/v64n1/0047-2085-jbpsiq-64-1-0045.pdf

3. World Health Organization (WHO). Preventing suicide: a global imperative. Geneva: WHO; 2014.

4. Pereira C. Risco suicidário em jovens: avaliação e intervenção em crise. [accessed on: July 22, 2015 ]; Revista do Serviço de Psiquiatria do Hospital Prof. Doutor Fernando Fonseca 2011; 9(1): 11-23, 2011. Available at: http://www.psilogos.com/Revista/Vol9N12/Indice11_ficheiros/Pereira_p11-23.pdf

5. Waiselfisz JJ. Mapa da violência - Jovens do Brasil. Faculdade Latino Americana de Ciências Sociais. Rio de Janeiro; 2014.

6. Cantão L, Botti NCL. Suicídio na população de 10 a 19 anos em Minas Gerais (1997-2011). [accessed on: July 22, 2015 ]; R. Enferm. Cent. O. Min2014; 3(4): 1262-1267. Available at: http://www.seer.ufsj.edu.br/index.php/recom/article/view/761

7. Organização Mundial da Saúde (OMS). Departamento de Saúde Mental e Transtornos Mentais e Comportamentais. Prevenção do suicídio: Manual para médicos clínicos gerais. Genebra: 2000.

8. Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. [mentioned: July 30, 2015]; Texto contexto - enferm 2008;17(4): 758-764. Available at: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-07072008000400018

9. Ursi ESG. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura. (Dissertação). Universidade de São Paulo. Ribeirão Preto; 2005.

10. Fensterseifer L, Werlang BSG. Estudo de fidedignidade e validade da Escala de Avaliação de Dor Psicológica. [accessed on: August 6, 2015]; Psico-USF2005; 10(1): 21-29. Available at: http://www.scielo.br/scielo.php?pid=S1413-82712005000100004&script=sci_arttext

11. Chellappa SL, Araujo JF. Relevância clínica de pesadelos em pacientes com transtorno depressivo. [accessed on: August 6, 2015];Revpsiquiatrclín 2006; 33(4):183-187. Available at: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-60832006000400003

12. Borges VR, Werlang BSG. Estudo de ideação suicida em adolescentes de 15 a 19 anos. [accessed on: August 6, 2015]; Estud. psicol. 2006; 11(3): 345-351. Available at: http://www.scielo.br/scielo.php?pid=s1413-294x2006000300012&script=sci_arttext

13. Jatoba JDVN, Bastos O. Depressão e ansiedade em adolescentes de escolas públicas e privadas. [accessed on: August 6, 2015]; J braspsiquiatr 2007; 56(3): 171-179. Available at: http://www.scielo.br/scielo.php?pid=S0047-20852007000300003&script=sci_arttext

14. Borges VR, Werlang BSG, Copatti M. Estudo de ideação suicida em adolescentes de 13 a 17 anos. [accessed on: August 6, 2015]; Barbarói 2008; 28(1): 109-123. Available at: http://online.unisc.br/seer/index.php/barbaroi/article/view/192

15. Botega NJ, Marín-León L, Oliveira HB, Barros MBA, Azevedo MB, Silva VF, et al. Prevalências de ideação, plano e tentativa de suicídio: um inquérito de base populacional em Campinas, São Paulo, Brasil. [accessed on: August 6, 2015]; Cad. Saúde Pública 2009;25(12): 2632-2638. Available at: http://www.scielo.br/scielo.php?pid=S0102-311X2009001200010&script=sci_arttext

16. Souza LDM, Ores L, Oliveira GT, Cruzeiro ALS, Silva RA, Pinheiro RT, et al. Ideação suicida na adolescência prevalência e fatores associados. J BrasPsiquiatr 2010; 59(4): 286-292. Available at: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0047-20852010000400004

17. Araújo LC, Vieira KFL, Coutinho MPL. Ideação suicida na adolescência: um enfoque psicossociológico no contexto do ensino médio. [accessed on: August 6, 2015]; Psico-USF 2010; 15(1): 47-57. Available at: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-82712010000100006

18. Almeida RMM, Flores ACS, Scheffer M. Ideação suicida, resolução de problemas, expressão de raiva e impulsividade em dependentes de substâncias psicoativas. [accessed on: August 6, 2015];PsicolReflexCrit2013; 26(1): 1-9. Available at: http://www.scielo.br/scielo.php?pid=S0102-79722013000100001&script=sci_arttext

19. Ministério da Saúde (BR). Diretrizes brasileiras para um plano nacional de prevenção do suicídio. Portaria nº 1.876 de 14 de agosto de 2006.
adolescencia adolescencia adolescencia
GN1 © 2004-2017 Revista Adolescência e Saúde. Fone: (21) 2868-8456 / 2868-8457
Núcleo de Estudos da Saúde do Adolescente - NESA - UERJ
E-mail: secretaria@adolescenciaesaude.com