Publicado

2015-10-01

Escalas de evaluación de riesgo suicida en atención primaria

Risk suicide assessment scales in primary care

Palabras clave:

Suicidio, Escalas, Riesgo, Atención primaria (es)
Suicide, Scales, Risk, Primary Care (en)

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Autores/as

  • Claudia Ximena Rangel-Garzón Universidad Nacional de Colombia - Sede Bogotá - Facultad de Medicina - Departamento de Psiquiatría - Bogotá, D.C. - Colombia.
  • María Fernanda Suárez-Beltrán Universidad Nacional de Colombia - Sede Bogotá - Facultad de Medicina - Departamento de Psiquiatría - Bogotá, D.C. - Colombia.
  • Franklin Escobar-Córdoba Universidad Nacional de Colombia - Sede Bogotá - Facultad de Medicina - Departamento de Psiquiatría - Bogotá, D.C. - Colombia.

Antecedentes. El médico de atención primaria debe decidir qué hacer con un paciente que ha atentado contra su vida o manifiesta ideación suicida. Posiblemente puede interconsultar a psiquiatría; sin embargo, ocasionalmente esto se difiere.

Objetivo. Encontrar un instrumento de evaluación del riesgo suicida en adultos que pueda ser aplicado por el médico general en el servicio de urgencias.

Materiales y métodos. Revisión de la literatura en PubMed con los términos MeSH: ‘suicide', ‘risk assessment' y ‘scales'; se encontraron 270 artículos a los que se les analizaron los abstract y finalmente se incluyeron 24 estudios.

Resultados. Se encontraron nueve instrumentos y se descartaron los demás por involucrar diagnóstico específico, grupos de edad distintos, poblaciones específicas diferentes, tiempo prolongado de aplicación y otros determinantes enfocados en los factores protectores y en opiniones del paciente acerca del suicidio.

Conclusiones. Estas escalas se pueden usar como instrumento de ayuda para definir una conducta en un paciente con riesgo suicida, pero no reemplazan la entrevista psiquiátrica. Se postulan las escalas Modified Scale for Suicide Ideation y Plutchik Suicide Risk Scale por cumplir con las características psicométricas, por tener un tiempo de aplicación adecuado en el servicio de urgencias y por sus preguntas sencillas para ser utilizadas en atención primaria.

Background. The primary care physician must decide what to do with a patient who has attempted to commit suicide or has shown suicidal ideas. When it is possible, they must send the patient to a psychiatrist, somehow, sometimes this must be done later.

Objective. To find a means of assessing suicide risk in adults that can be applied by general practitioners in the emergency department.

Materials and methods. A literature review in PubMed with MeSH terms "suicide" and "risk assessment" and "scales" was done. 270 articles were found and their abstracts were analyzed. 24 studies were included.

Results. There were nine instruments in line with the review. Others were discarded because they involved specific diagnosis, different age groups, other special populations, prolonged time of application and other focused on protective factors, as well as patient opinions on suicide.

Conclusions. These scales can be used as a tool to decide if a patient shows suicide risk but do not replace the interview with a psychiatrist. The "Modified Scale for Suicide Ideation" and the "Plutchik Suicide Risk Scale" are suggested because they have psychometric properties, the appropriate application time in the emergency department and simple questions to be used by primary care personnel.

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Cifuentes-Osorio SL. Comportamiento del Suicidio, Colombia, 2013. Forensis. 2014;15(1):127-68.

Maris RW. Suicide. Lancet. 2002;360(9329):319-26. http://doi.org/dkn89q.

Téllez-Vargas J, Taborda L. El suicidio en cifras. In: Téllez-Vargas J, Taborda L, editors. Suicidio: Neurobiología, factores de riesgo y prevención. Bogotá: Nuevo Milenio editores; 2006. p. 24-42.

De la Hoz-Bohórquez GA. Comportamiento del homicidio, Colombia, 2013. Forensis. 2014;15(1):77-125.

Folino JO, Escobar-Córdoba F. Estudios sobre homicidios. Perspectivas forense, clínica y epidemiológica. La Plata: Librería Editorial Platense; 2009.

Mojica CA, Sáenz DA, Rey-Anacona CA. Riesgo suicida, desesperanza y depresión en internos de un establecimiento carcelario colombiano. Rev Colomb. Psiquiatr. 2009;38(4):681-92.

Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for Suicide Ideation. J. Consult. Clin. Psychol. 1979;47(2):343-52. http://doi.org/csc7nb.

Range LM, Knott EC. Twenty suicide assessment instruments: evaluation and recommendations. Death. Stud. 1997;21(1):25-58. http://doi.org/bcnjgr.

Lindqvist D, Nimeus A, Traskman-Bendz L. Suicidal intent and psychiatric symptoms among inpatient suicide attempters. Nord. J. Psychiatry. 2007;61(1):27-32. http://doi.org/ftd544.

Ivannof A, Jang SJ. The role of hopelessness and social desirability in predicting suicidal behavior: A study of prison inmates. J. Consult. Clin. Psychol. 1991;59(3):394-9. http://doi.org/dg9q3f.

Smith K, Conroy RW, Ehler BD. Lethality of Suicide Attempt Rating Scale. Suicide Life Threat. Behav. 1984;14(4):215-42.

Linehan MM. Suicidal behaviors questionnaire. [Unpublished inventory]. Washington, D.C.: University of Washington 1981.

Lindenmayer JP, Czobor P, Alphs L, Nathan A, Anand R, Islam Z, et al. The Inter SePT scale for suicidal thinking reliability and validity. Schizophr. Res. 2003;63(1-2):161-70. http://doi.org/fp6mjx.

Rudd MD. The prevalence of suicide ideation among college students. Suicide Life Threat. Behav. 1989;19(2)173-83.

Fliege H, Kocalevent RD, Walter OB, Beck S, Gratz KL, Gutiérrez PM, et al. Three assessment tools for deliberate self-harm and suicide behavior: evaluation and psychopathological correlates. J. Psychosom. Res. 2006;61(1):113-21. http://doi.org/ftgdnq.

Linehan MM, Goodstein JL, Nielsen SL, Chiles JA. Reasons for staying alive when you are thinking of killing yourself: The Reasons for Living Inventory. J. Consult. Clin. Psychol. 1983;51(2):276-86. http://doi.org/cp43kw.

Westefeld JS, Cardin D, Deaton WL. Development of the College Student Reasons for Living Inventory. Suicide Life Threat. Behav. 1992;22(4):442-53.

Ivannof A, Jang SJ, Smyth NF, Linehan MM. Fewer reasons for staying alive when you are thinking of killing yourself: The Brief Reasons for living Inventory. J. Psychopathol. Behav. Assess. 1994;16(1):1-13. http://doi.org/fv2hp9.

Orbach I, Milstein I, Har-Even D, Apter A, Tiano S, Elizur A. A Multi-Attitude Suicide Tendency Scale for Adolescents. J. Consult. Clin. Psychol. 1991;3(3):398-404. http://doi.org/bnbzh5.

Bagge C, Osman A. The Suicide Probability Scale. Norms and factor structure. Psychol. Rep. 1998;83(2):637-8. http://doi.org/bsgqgh.

Reynolds WM. Suicide Ideation Questionnaire. Professional manual. Odessa: Psychological Assessment Resources; 1987.

Orbach I, Fesbach S, Carlson G, Glaubman H, Gross Y. Attraction and repulsion by life and death in suicidal and in normal children. J. Consult. Clin. Psychol. 1983;51(5):661-70. http://doi.org/dt9wds.

Cotton CR, Range LM. Suicidality, hopelessness and attitudes toward life and death in children. Death Stud. 1993;17:185-91. http://doi.org/bwkqz5.

Domino G, Moore D, Westlake L, Gibson L. Attitudes toward suicide: A factor analytic approach. J. Clin. Psychol. 1982;38(2):257-62. http://doi.org/dmcfbh.

Clum GA, Yang B. Additional support for the reliability and validity of the Modified Scale for Suicide Ideation. Psychol. Assess. 1995;7(1):122-5. http://doi.org/bkw3sr.

Wetzel RD. Semantic differential ratings of concepts and suicide intent. J. Clin. Psychol. 1976;32(1):4-13. http://doi.org/fhf94w.

Wetzel RD. Hopelessness, depression, and suicide intent. Arch. Gen. Psychiatry. 1976;33(9):1069-73. http://doi.org/c32rhh.

Wetzel RD. Ratings of life and death and suicide intent. Psychol. Rep. 1975;37(3):879-85. http://doi.org/cgd6rx.

Beck AT, Steer RA, Kovacs M, Garrison B. Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. Am. J. Psychiatry. 1985;142(5):559-63. http://doi.org/76f.

Beck AT, Steer RA, Ranieri WF. Scale for Suicide Ideation: psychometric properties of a self-report version. J. Clin. Psychol. 1988;44(4):499-505. http://doi.org/bjnm9n.

Rudd MD, Dahm PF, Rajab MH. Diagnostic comorbidity in persons with suicidal ideation and behavior. Am. J. Psychiatry. 1993;150(6):928-34. http://doi.org/76g.

Miller IW, Norman WH, Bishop SB, Dow MG. The Modified Scale for Suicidal Ideation: Reliability and Validity. J. Consult. Clin. Psychol. 1986;54(5):724-5. http://doi.org/fwp5fd.

De Man AF, Leduc CP, Labrèche-Gauthuier L. A French-Canadian scale for suicide Ideation for use with adolescents. Can. J. Behav. Sci. Can. Sci. Comport. 1993;25(1):126-34. http://doi.org/c55cs9.

Pettit JW, Garza MJ, Grover KE, Schatte DJ, Morgan ST, Harper A, et al. Factor structure and psychometric properties of the Modified Scale for Suicidal Ideation among suicidal youth. Depress. Anxiety. 2009;26(8):769-74. http://doi.org/fsfxtj.

Guirao Goris J, Gallud J. Escala de Riesgo Suicida de Plutchik. In: Guirao Goris J, Gallud J, editors Escalas e instrumentos para la valoración en atención domiciliaria. Valencia: Generalitat Valenciana. Conselleria de Sanitat; 2006. p. 113-5.

Patterson WM, Dohn HH, Bird J, Patterson GA. Evaluation of suicidal patients: the SAD PERSONS scale. Psychosomatics. 1983;24(4):343-5, 348-9. http://doi.org/cdrpd5.

Cochrane-Brink KA, Lofchy JS, Sakinofsky I. Clinical rating scales in suicide risk assessment. Gen. Hosp. Psychiatry. 2000;22(6):445-51. http://doi.org/cxfj64.

Bullard MJ. Problems of suicide risk management in the emergency department without fixed, full-time emergency physician. Changgeng Yi Xue Za Zhi. 1993;16(1):30-8.

Stanley B, Traskman-Bendz L, Stanley M. The suicide assessment scale: a scale evaluating change in suicidal behavior. Psychopharmacol. Bull. 1986;22(1):200-5.

Niméus A, Alsén M, Träskman-Bendz L. The suicide assessment scale: an instrument assessing suicide risk of suicide attempters. Eur. Psychiatry. 2000;15(7):416-23. http://doi.org/bf3qr2.

Niméus A, Hjalmarsson-Ståhlfors F, Sunnqvist C, Stanley B, Träskman-Bendz L. Evaluation of a modified interview version and of a self-rating version of the Suicide Assessment Scale. Eur. Psychiatry. 2006;21(7):471-7. http://doi.org/cwq27x.

Beck A, Schuyler D, Herman I. Development of suicidal intent scales. In: Beck AT, Resnik HLP, Lettieri DJ, Editors. The prediction of suicide, Bowie, MD: Charles Press; 1974.

Freedenthal S. Assessing the wish to die: a 30-year review of the suicide intent scale. Arch. Suicide Res. 2008;12(4):277-98. http://doi.org/c6jsb3.

Lohner J, Konrad N. Deliberate self-harm and suicide attempt in custody: Distinguishing features in male inmates self-injurious behavior. Int. J. Law Psychiatry. 2006;29:370-85. http://doi.org/b3jbsb.

Nock MK, Kazdin AE. Examination of affective, cognitive, and behavioral factors and suicide-related outcomes in children and young adolescents. J. Clin. Child. Adolesc. Psychol. 2002;31(1):48-58. http://doi.org/cfx9gx.

Bancroft J, Hawton K, Simkin S, Kingston B, Cumming C, Whitwell D. The reasons people give for taking overdoses: A further inquiry. Br. J. Med. Psychol. 1979;52(4):353-65. http://doi.org/c59q4m.

Watson D, Goldney R, Fisher L, Merritt M. The measurement of suicidal ideation. Crisis. 2001;22(1):12-4. http://doi.org/ck9x42.

Spirito A, Sterling CM, Donaldson DL, Arrigan ME. Factor analysis of Suicide Intent Scale with adolescents suicide attempters. J. Pers. Assess. 1996;67(1):90-101. http://doi.org/ctbn7m.

Hjelmeland H, Nordvik H, Bille-Brahe U, De Leo D, Kerkhof JF, Lönnqvist J, et al. A cross-cultural study of suicide intent of parasuicide patients. Suicide Life Threat Behav. 2000;30(4):380-93.

Levy SR, Jurkovic GL, Spirito A. A multisystems analysis of adolescents attempters. J. Abnorm. Child Psychol. 1995;23(2):221-34. http://doi.org/cxr4ck.

Wetzel RD. Factor structure of Beck´s suicide intent scales. Psychol. Rep. 1977;40:295-302. http://doi.org/bfxfh9.

Harriss L, Hawton K, Zahl D. Value of measuring suicidal intent in the assessment of people attending hospital following self-poisoning or self-injury. Br. J. Psychiatry. 2005;186(1):60-6. http://doi.org/bbjb3m.

Hawton K, Harriss L. Deliberate self-harm in people aged 60 years and over: characteristics and outcome of a 20-year cohort. Int. J. Geriatr. Psychiatry. 2006;21(6):572-81. http://doi.org/c9ngb6.

Niméus A, Alsen M, Traskman-Bendz L. High suicidal intent scores indicate future suicide. Arch. Suicide Res. 2002;6(3):211-9. http://doi.org/dq9fgt.

Pierce D. Deliberate self-harm in the elderly. Int. J. Geriatr. Psychiatry. 1987;2(2):105-10. http://doi.org/cj8jfv.

Suominen K, Isometsä E, Ostamo A, Lönnqvist J. Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study. BMC Psychiatry. 2004;4:11.

Beck AT, Lester D. Components of suicidal intent in completed and attempted suicides. J. Psychol. 1976;92(1):35-8. http://doi.org/cp6252.

Brent DA, Perper JA, Allman CJ, Moritz GM, Wartella ME, Zelenak JP. The presence and accessibility of firearms in the homes of adolescent suicides. A case-control study. JAMA. 1991;266(21):2989-95. http://doi.org/db62vq.

Reynolds WM. Psychometric characteristics of the Adult Suicidal Ideation Questionnaire in college students. J. Pers. Assess. 1991;56(2):289-307. http://doi.org/cn3mk2.

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