2004, Number 5
Percepción de los familiares del intento e ideación suicidas de pacientes con esquizofrenia
Rascon GML, Gutierrez LML, Valencia CM, Diaz M LR, Leaños G C, Rodriguez VS
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Language: Spanish
References: 40
Page: 44-52
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ABSTRACT
Suicide is the leading cause of prematu re death among schizophrenia sufferers, the risk of suicide being 20 to 50 times highe r than among the general population. Some studies have shown th at 40% of people with this diagnosis have had suicidal thoughts or ideation, 20'% to 40% of whom had attempted suicide and 9% to 13% ofwhom had ended their lives by committing suicide.Studies have also shown that 30% to 60% of all suicides had previously attempted to commit suicide. This suggests that suicide attempts are one of the best indicators of the risk of commiting suicide.
The aim of this study is 10 describe th e pe rception of the relative responsible for the schimphrenic patient of the suicide attempt and suicidal ideation o f his or her relative with schizophrenia. This perception was analyzed in relation to diagnostic neo-morbidity, the lengt h of evolution of the disease, the number of relapses and the way in which the patient was admitted .
The study was descriptive usiog a retrospective design of case stu dies with a non-probabilistic circumstantial sample. One hundred and sixty-three relatives of patients diagnosed with schizophrenia were interviewed using the Compositive International Diagnostic Interview, version 1.0, considering one relativ e pe r pa tient receiving integr al treannent. Suicide attempts and suicidal ideation were evaluated by asking the rela tive to answe r the questions in the introduction to the Social Beh avior Assessment Schedule (SBAS) and having the patient answer the section on suicidal ideation and suicide attempts from the questionnaire on symptomatic behavior. Complementary in formation provided by relatives dur ing the interview was also taken into account.
The patient was given the CIDI to evaluate mental disorders in accordance with the definitions and criteria used in the International Classification o f Diseases (lCD-tO).
The results o f the study showed that out of the 163 relatives who participated 79.8% were women and 20.2% men, 71.2% were the patients' mothers, 16.6% the fathers, one was the patient's husband (0.6%) and the rest were another relative in change of the patient (11.7%). The relatives' meariage was 55 years; most of the relatives were married (68.1%); 77.3% had always lived with their sick relative, while 4.9% did not live with the relative who was suffering from schizophrenia, although they did sec him or her frequently.
As for the patients, 75.5% were male and 24.5% female, with an average age of 28, ranging from 17 to 45 years. A total of 91.4% were single and 65% were unemployed, while the mean length of evolution of the disease was three years. According to the Structured Diagnostic Interview (CIO I), the secondary diagnoses of schizophrenia were: depression, 30.1%, social phobia, 21.5%, dysthymia, 18.4%, alcohol dependence, 19%, and other diagnoses, 11%.
Relatives had noticed suicide attempts in 33.7% of all cases (at some time in the patient's lives) and suicidal idcation in 13.5% of all th e patients, while the rest had failed to perceive any tendency towards suicide in their relatives with schizophrenia.
Suicide attempts were more common among female patients (42.5%), 88.2% of whom were spinsters and 82.4% of whom were unemployed . Suicide rates among men totaled 30.9%, 97.4% of whom were bachelors and 68.4% of whom were unemployed. Suicidal ideation was more common among men (13.8%) than women (12.5%). The main ways with which women tried to harm themselves were poisonous drinks and combined methods (23.5% each), followed by overdoses (17.6%) and knives (11.8%), whereas men tended to usc poisonous drinks (28.9%), followed by overdoses (21.1%), combined methods (18.4%) and knives (15. 8%).
As for suicide attempts, hospitalizations and the length of evolution of the disease, patients who had not been hospitalized (29.1%) and those who had (29.1%) were just as likely to attempt suicide, with ›5 years evolution o f the disease, while suicidal ideation was greater (45.5%) among thos e that had not been hospitalized .
The highest rate o f suicide attempts occurred when relatives observed persistent symptomatic behavio r (54.5%), that is, the presence of symptoms such as sadness, isolatio n, irritability, indecision, under-activity, extravagant ideas and lack of self-care in th e patient.
Among the patients who had attempted to commit suicide, 63% had only done so on one occasion, 22.2% on two occasions and 14.8% on more than two occasions.
Patients who arrempred to commit suicide had a higher rare of co-morbidity with affective disorders (21.5%) particularly diagnoses of depression (13.5%) . dysthymia (7.4%), social phobia (8%) and alcohol dependence (7.4%). Among those who thought about committing suicide , the most common diagnosis was an affective disorder (63.6%).
Several analyses were carried out, first from unívariate logistic regression tu determine the interaction between suicide attempts and depression for the whole sample . The independent variable for suicide attemptS was dichotomous, attempt=1, absence=0, while the predictor for depression was presence=1, absence=0. vDepression was found to be significantly associated with suicide attempts X2=3.81 p›.05 and B=.6931; p›.05. At the same time, a multiple logistic regression analysis was carried out as an independent variable. Suicide attempt and predictive variables included age of patient, frecuency of relapses, occupation of patient and method used . The best predictor was the method or way of committing suicide B:.9301, sig: .0000.
The results of this study confirm that people with schizophrenia are at a greater risk of attempting suicide than the general population. The study showed the importance of evaluating the presence of depressive states and despair in patients by both their relatives and a ment al health specialist.
It also revealed that the patients' caretakers do nor know about the disease or the risks they run, which is why psycho-educational programa should be designed to inform, orient and sensitize relatives and patients on how to prevent the risks for schizophrenia sufferen. These programe should also make caretaken aware of the importance of following medical treatment and seeking rehabilitation that will enable patients tu be able tu have a job as well as access tu timely, continuous mental health servíces, both for them and their family members.
REFERENCES