Ideación y comportamiento suicida en embarazadas

• Autores: M. Asunción Lara Cantú, Gabriela Letechipía
• Localización: Salud mental, ISSN 0185-3325, Vol. 32, Nº. 5, 2009, págs. 381-388
• Idioma: español
• Títulos paralelos:
  • Suicidal ideation and suicidal behavior in pregnancy
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• Resumen
  • español

    Los objetivos son investigar la ocurrencia de la ideación y comportamiento suicida en embarazadas que acuden a atención prenatal y analizar los motivos de las conductas.

    Hay pocos estudios que evalúen la prevalencia del fenómeno suicida en el periodo perinatal. Algunos señalan que las complicaciones en el embarazo por intento de suicidio se reportan en 0.4 de cada mil pacientes dadas de alta de hospitales y en una de cada 283 embarazadas en servicios especializados de salud mental. La ideación suicida se presenta entre 0.5 y 1.4% de las embarazadas y en 27.8% de este grupo con trastornos psiquiátricos.

    Método Participantes: Se entrevistó a 120 embarazadas que acudieron a control prenatal: 1. a un Centro de Salud que brinda atención primaria y 2. a tres Casas de Salud que proveen servicios médicos básicos en la Ciudad de México. Se excluyeron tres de los 120 cuestionarios debido a información incompleta, lo que dejó un total de 11 7.

    Instrumento: Un cuestionario estructurado con las siguientes áreas: 1. Información sociodemográfica. 2. Indicadores de ideación y comportamiento suicida: a) ¿Ha pensado mucho en la muerte, ya sea en la suya, en la de alguien más o en la muerte en general?, b) ¿Ha deseado morir?, c) ¿Ha estado a punto de quitarse la vida? y d) ¿Alguna vez, a propósito, se ha herido, cortado, intoxicado o hecho daño con el fin de quitarse la vida? 3. Momento en que ocurrió y motivos. Si la conducta ocurrió alguna vez en la vida, se indagó si fue durante el embarazo y las razones para hacerlo.

    Procedimiento: Una psicóloga aplicó el instrumento por medio de una entrevista en la sala de espera del Centro de Salud y en un consultorio en las Casas de Salud. Asistió en días fijos varias veces por semana hasta completar el tamaño de la muestra.

    Resultados Ideación suicida: Pensar mucho en la muerte lo manifestaron 29 (24.8%) alguna vez en la vida y 44 (37.6%) durante la gestación. Los motivos para este último periodo son: separación de la pareja, muerte de un hijo, miedo al parto, temor a accidente o enfermedad e interés en el tema de la muerte. Saberse embarazada, sentirse sola, la muerte o la enfermedad de una persona cercana y tener problemas familiares son razones para los pensamientos de muerte, pero también para el deseo de morir.

    Deseo de morir: Lo expresaron 29 (24.8%) en el pasado y en nueve (7.7%) ocurrió en la preñez. En ésta, los motivos fueron: saberse embarazada, la muerte o la enfermedad de una persona cercana y tener problemas familiares. También aludieron a problemas con la pareja y con los padres.

    Intención suicida: Trece dijeron haber estado a punto de quitarse la vida alguna vez (11.1%) y tres (2.6%), durante el embarazo; los problemas con la pareja son la causa de la intención en este periodo.

    Intento suicida: Diez mujeres hablaron de intento (8.5%) alguna vez en la vida y una (0.9%), durante el embarazo. Este único caso mencionó, como causa, los problemas con la pareja.

    Discusión Pensar mucho en la muerte es el indicador más frecuente. Lo anterior se explica quizá por condiciones sociales desventajosas, pero también por las particularidades del embarazo. En este sentido, existen diversos temores comunes en madres gestantes, quienes se muestran aprensivas por el bienestar del futuro bebé y por anticipar un parto difícil.

    Como era de esperarse, el intento suicida es menos frecuente que la intención y el deseo e ideas de muerte. El deseo de morir, la intención y el intento son a la vez menos frecuentes durante el embarazo que en otro momento de la vida. Esto se debe quizá al sentimiento de responsabilidad de la futura madre o a un posible efecto hormonal, que funcionan como factores protectores. Los problemas con la pareja son un factor de riesgo para la intención y el intento suicida, lo que amerita mayor estudio. Estas observaciones merecen tomarse con cautela debido a limitaciones metodológicas, como el reducido tamaño de la muestra y lo acotado de la indagación.

  • English

    The aim is to explore the occurrence of suicide ideation and behavior in pregnant women receiving prenatal care and to analyze the motives behind these behaviors.

    Although there are very few studies evaluating the prevalence of the suicide phenomenon (suicide, intentional injuries with or without the aim of taking one's own life, ideas of harming oneself or death) during the prenatal period, it has been reported that pregnancy complications due to suicide attempts occur in 0.4 out of every 1 000 patients discharged from hospitals in the state of California in the United States and in one out of every 283 pregnant women in specialized mental health services. Suicide ideation occurs in 1.4% of English expectant mothers, 0.5% of Finnish ones and 27.8% of US pregnant women with psychiatric disorders. In Latin America, it is estimated to occur in 1 6.7% of pregnant teenagers.

    Although suicide ideation and suicide attempts during pregnancy are less frequent than at other times in life, they have major consequences, increasing the risk of death and affecting fetal development and pregnancy itself.

    Method Participants: The interviewees comprised 120 pregnant women who came in for prenatal care at 1.a state Health Center providing primary health care and 2. three Health Homes that provide basic medical services, run by the Health Secretariat in Mexico City. Three of the 120 questionnaires were rejected due to incomplete information, which left a total of 117. Sample characteristics include: mean age, 23.2 years (DS = 5); mean monthly income, $3,876 (SD = $239); schooling, 69% had completed junior high school while 31% had completed senior high school; 71% were housewives while 29% were also engaged in paid employment. Marital status: 18% married, 19% single and 63% cohabiting.

    Instrument: A structured questionnaire with the following areas: 1. Socio–demographic information (age, schooling, etc.). 2. Indicators of suicidal ideation and behavior: a) Have you thought a lot about death, whether your own, someone else's or death in general? b) Have you wished to die ? c) Have you ever been about to take your own life? and d) Have you ever intentionally hurt, cut, poisoned or harmed yourself in order to take your own life? 3. Timing and motives. If the event occurred sometime in their life, the interviewer explored whether the event took place during the current pregnancy as well as the reasons why it happened.

    Procedure: In the waiting room at the Health Center, expectant mothers were told about the purpose of the study and the informed consent form. In the Health Homes, final year medical students did the same and arranged appointments for the interviews. The same researcher conducted the interviews in the two settings.

    Results Suicidal ideation: Thinking a lot about death at some time in their lives was reported by 29 subjects (24.8%) and during pregnancy by 44 (37.6%). The reasons for these thoughts during this last period are: separation from one's partner, death of a child, fear of childbirth, fear of accidents or sickness and interest in the subject of death. Realizing one is pregnant, feeling lonely, the death or illness of someone close and family problems are among the reasons for thoughts about death as well as the desire to die.

    Desire to die: This was expressed by 29 subjects (24.8%) in the past and by nine (7.7%) during pregnancy. Among the latter group, the reasons were: realizing one is pregnant, the death or illness of someone close and family problems. They also mentioned problems with their partners and parents.

    Suicidal intention: Thirteen said that they had been about to take their own lives at some stage (11.1%), while three (2.6% said that they had done so during pregnancy. During this period, this had been caused by problems with their partners.

    Suicide attempts: Ten women mentioned suicide attempts (8.5%) at some time in their lives, while one (0.9%) did so during pregnancy. This particular case mentioned problems with her partner as being the cause.

    Discussion Thinking a lot about death is the most common indicator. It may be explained by disadvantageous social conditions, but also by the particular conditions of pregnancy. In this respect, there are various fears common to expectant mothers who are apprehensive about the well–being of the future baby and anticipate a difficult childbirth. As one would expect, suicide attempts are less common than suicide intentions and the desire for and ideas about death. The desire to die, suicide intentions and attempts are less frequent during pregnancy than at other times in a person's life. This may be due to the future mother's feeling of responsibility, or a possible hormonal effect, which act as protective factors. Problems with one's partner are a risk factor for suicide intention and attempts. This is hardly surprising, since marital problems adversely affect women's mental health at different times in their lives, but during pregnancy, they intensify their insecurity at a time of great transition, making them fearful of the future and leading them to wonder about whether getting pregnant was the right thing to do.

    These observations should be treated with caution due to methodological limitations, such as the small sample size and restricted scope of the research.