Objective: To provide guidelines for the identification of suicide risk and protective factors and the management of suicidal patients in emergency settings. Method: Literature review to identify relevant and illustrative key cases. Results: The clinical interview is the best method to evaluate the suicidal risk and has a twofold purpose: 1) providing emotional support and creating a bond; 2) collecting information. There is a substantial amount of information to be collected during the clinical interview, including risk and protective factors, epidemiologic data, characterization of the event, psychodynamic aspects, personal and family history, identification models, data on physical health, and social support network. Difficulties can emerge during the clinical interview, but a trained and informed professional will be able to approach and adequately deal with the patient. Although several scales have been proposed, none of them have shown reliable efficiency in determining the suicidal risk. Conclusion: There is no method to predict who is going to commit suicide; nevertheless, it is possible to evaluate the individual risk of each patient by means of a detailed and empathic clinical interview. Keeping the patient alive is the first and fundamental rule.
Descriptors
Brazil is the largest and most populous country in South America (in 2002 the population was approximately 175 million). Although life expectancy in Brazil has increased, suicide and other forms of injury-related mortality, such as homicide and accident, have increased as a proportion of overall mortality (Oswaldo Cruz Foundation, 1984; Brazil Ministry of Health, 2001). The suicide rate in Brazil (3.0–4.0 per 100 000 inhabitants) is not considered high in global terms (World Health Organization, 1999). Nevertheless, it has followed the world tendency towards growth: during 1980–2000, the suicide rate in Brazil increased by 21%. Elderly people present the highest suicide rates in absolute numbers, but the alarming finding in the Brazilian data is that the youth population is increasingly dying by suicide (Mello-Santos et al, 2005). This statistic partially confirms a forecast by Diekstra & Guilbinat (1993) that the number of deaths by suicide would dramatically increase over the next decades, mainly in developing countries, including Latin America. In these regions, socio-economic factors (such as an increase in divorce and unemployment and a decrease in religiosity) increase the risk of self-harm. We discuss the reasons for the low suicide rate in Brazil and highlight the socio-economic factors affecting its increase among the youth population in particular.
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