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Enrique Baca García CUESTIONES VIGILANCIA DE LA SALUD MENTAL: LA GRAN AUSENTE ¿Sabemos cómo abordar hoy la vigilancia y prevención del suicidio? Enrique Baca García CUESTIONES Datos SMARTCRISIS 05 01 03 CON INT 02 EXP 04 DATA SC C Introducción Experiencia CONCLUSIONES E. Baca-García 2 01 INT ¿QUÉ ES EL SUICIDIO? “Suicide is a permanent solution to a temporary problem” Edwin Schneidman, MD. Founder of Suicidology Enrique Baca-García 3 02 INT ANTE TODO UN GRAN PROBLEMA 1 Una cause importante de muerte 2 Años potenciales de vida perdidos 3 Constelaciones de conductas 4 Impacto sistema sanitario: Urgencias 5 Impacto sobre supervivientes Enrique Baca-García 4 03 INT CON UNA DEFINICIÓN TEMPORAL Espectro de conductas Terminología imprecisa Práctica incluida por concepciones apriorísticas Paradojas edad - genero Datos parciales con falta de integración: clínicos, biológicos, ambientales, sociales Enrique Baca-García 5 Macneil (2013) 04 PS MODELOS DEL TRAYECTO SUICIDA PE Lutz et al. Neuropathology of suicide. Molecular Psychiatry Enrique Baca-García 6 (2017), 1395 – 1412 05 PS MODELOS DEL RIESGO SUICIDA Biological Gene Clinical Life experience Enrique Baca-García 7 Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet 2016; 387: 1227–39 06 PS PONDERANDO FACTORES DE RIESGO Biological Gene Clinical Life experience 35 30 Theorical distribution Blood donors 25 Psychiatric patients 20 15 10 5 0 Menses 5-Ht2a HTR1E~GABRP~ACTN2 Aggresivity Cluster B Interpersonal Enrique Baca-García 8 Neuropsychophram 2001; Psychos Med 2003; JCP 2006; Stress and Health, 2007; AM J Med Gen 2008; JCP 2008, AM J Med Gen 2009. J Psych Res 2010; JAD 2011 07 PS ESTILOS DE VIDA Y SUICIDIO Relaciones interpersonales 16-30 Addition internet Alcohol, drogas Tabaco Estrés laboral 30-65 Sedentarismo Nutrición, patrones dietéticos Desnutrición, obesidad >65 Berardelli et al. Lifestyle Interventions and Prevention of Suicide. Front. Enrique Baca-García 9 Psychiatry, 06 November 2018 | https://doi.org/10.3389/fpsyt.2018.00567 08 PS DEATH CLASSIFICATION PROCESS Claassen CA. National Suicide Rates a Century after Giner L & Guija JA. Number of sucides in Durkheim: Do We Know Enough to Estimate Error? Spain: Differences between data from the Spanish Statistica office and the Institutes Suicide and Life-Threatening Behavior 40(3) 2010 of Legal MedicineRev Psiquiatr Salud Ment (Barc.). 2014;7(3):139-146 Enrique Baca-García 10 09 PS Quality of suicide mortality data, 2012 Enrique Baca-García Preventing11 suicide. A global imperative. World Health Organization 2014 PRODUCCIÓN CIENTÍFICA Y TASAS DE SUICIDO 2010- 10 PS 14 Lopez-Castroman et al. Are we studying the right populations to understand. Enrique Baca-García 12 World Psychiatry 2015, 14 (3): 369 CUESTIONES Datos SMARTCRISIS 05 10 03 CON INT 02 EXP 04 DATA SC C Introducción Experiencia CONCLUSIONES E. Baca-García 13 01 DATA SUICIDIOS 2012 Los intentos de suicidio son 20 veces más frecuentes que los suicidios Enrique Baca-García 14 Preventing suicide. A global imperative. World Health Organization 2014 02 DATA Suicide mortality rate by WHO region, 2016 Enrique Baca-García 15 https://www.who.int/gho/mental_health/suicide_rates_crude/en/ 03 DATA SUICIDIO EN ESPAÑA 1981-2012 Global Hombres Alvaro-Meca A. Epidemiology of suicide in Spain, 1981e2008: A spatiotemporal Enrique Baca-García 16 analysis. Public Health. http://dx.doi.org/10.1016/j.puhe.2012.12.007 04 DATA NATURAL FLUCTUATION 50% “fluctuation between 10.0 per 100,000 and 19.0 per 100,000 over the past 100 years.” Nock MK et al. Suicide and Suicidal Behavior. Epidemiol Rev. 2008 ; 30(1): Enrique Baca-García 17 133–154 05 DATA US Emergency department visits for attempted suicide Nationwide Emergency Department Sample (NEDS) 2006-13 * 3.567.084 visits * 163.1 - 173.8/100 000 Canner JK et al. Emergency department visits for attempted suicide and self Enrique Baca-García 18 harm in the USA: 2006–2013. Epidemiol Psychiatr Sci. 2018;27(1):94-102. 06 DATA IMPACTO SOCIEDAD: COSTES 2003 2013 2016 POISONING SUICIDE ATTEMPT 47.5% Drug abuse SUICIDE ATTEMPT 15.000-25.000 38.1%Suicide attempt 200.000 €730,105/y 10.000 treated 6 6 £162 10 direct cost Permanent occupation of 4 CHF 191 10 direct cost beds/year. SUICIDE $58.4 109 reported 2013 $93.5 109 incl undereport. Lost productivity 97.1% Suicide and Life-Threatening Behavior 2016; 46 (3):352-362 Swiss Med Wkly. 2012;142:w13648 Lancet Psychiatry 2017; 4: 759–67 Enrique Baca-García 19 PLoS ONE 2016; 11(4):e0152876. doi:10.1371/journal.pone.0152876 07 DATA ESTRATEGIAS DE PREVENCION SUICIDIO 0-25 Clinical interventions at the post-intervention assessment. Robinson J et al. What Works in Youth Suicide Prevention? Enrique Baca-García 20 EClinicalMedicine 4–5 (2018) 52–91 08 DATA ESTRATEGIAS DE PREVENCION SUICIDIO 0-25 Clinical interventions at the longest follow-up assessment Robinson J et al. What Works in Youth Suicide Prevention? Enrique Baca-García 21 EClinicalMedicine 4–5 (2018) 52–91 09 DATA ESTRATEGIAS DE PREVENCION SUICIDIO 0-25 Educational interventions at the post-intervention assessment Educational interventions at the longest follow-up assessment Robinson J et al. What Works in Youth Suicide Prevention? Enrique Baca-García 22 EClinicalMedicine 4–5 (2018) 52–91 CUESTIONES Datos SMARTCRISIS 05 12 03 CON INT 09 EXP 04 DATA SC C Introducción Experiencia CONCLUSIONES E. Baca-García 23 01 PRE C GDP (PPP) per capita and rate of suicide per 100,000 (WHO) Blasco-Fontecilla H. Worldwide impact of economic cycles on suicide trends Enrique Baca-García 24 over 3 decades: Differences according to level of development. BMJ Open 2012 (2 (3):000785 02 PRE C GDP and rate of suicide Blasco-Fontecilla H. Worldwide impact of economic cycles on suicide trends Enrique Baca-García 25 over 3 decades: Differences according to level of development. BMJ Open 2012 (2 (3):000785 03 PRE C Enrique Baca-García 26 04 PRE C SUICIDIO GALICIA Fernandez-Navarro et al. Suicide mortality trends in Galicia, Spain and their relationship Enrique Baca-García 27 with economic indicators. Epidemiology and Psychiatric Sciences. 2016;25(5):475-484 05 PRE C ATENCION CONDUCTA SUICIDA MADRID Martínez-Alés G et al. A Real-World Effectiveness Study Comparing a Priority Enrique Baca-García 28 Appointment, an Enhanced Contact Intervention, and a Psychotherapeutic Program Following Attempted Suicide. J Clin Psychiatry. 2019 Feb 26;80 CUESTIONES Datos SMARTCRISIS 05 12 05 CON INT 09 EXP 04 DATA SC C Introducción Experiencia CONCLUSIONES E. Baca-García 29 01 INT ya es pasado… Enrique Baca-García 30 02 INT MONITORIZACIÓN DE SUICIDIO Solano Pet al. A Google-based approach for monitoring suicide risk. Enrique Baca-García 31 Psychiatry Research 246 (2016) 581–586 03 INT Celebridades Y CONDUCTA SUICIDA Enrique Baca-García 32 Ueda M e 04 INT ANÁLISIS DE REDES SOCIALES Name Dates Topic 2000- Optimisation of suicide prevention programs and their implantation in Europe OSPI 2013 2016- Peer leadership program using a social connectedness approach to improving help-seeking for Sources of Strength suicide and general psychological distress. Evaluated in a randomised controlled trial, with Australia Project consistent evidence of a positive intervention effect. Interventions include social media. 2008- Prevention of risk-taking and self-destructive behaviours for student living in Europe SEYLE 2011 2014- SAVYP deals with “understanding the determinants of suicidal behaviour, serious accidents and 2019 violence in young people”. The data used in this project concerns over one million of Danish SAVYP singleton births during 1980-1996. This cohort was followed until 31st December 2011. People are from 15 to 29 years old. 2014 Monitoring Twitter with specific keywords in order to detect suicidal ideationThis application Samaritan Radar scans Twitter with specific keywords in order to detect suicidal ideation. This application has been App pull only a week after its launch under the pressures from a petition that points some problems with privacy. Durkheim Since The objective is a better coverage of suicide risk detection and a better understanding of the 2013 expression of suicide ideation through data mining of text and images issued from social network. Project Lopez-Castroman J et al. Mining social networks to improve suicide Enrique Baca-García 33 prevention: A scoping review. J Neurosci Res. 2019- DOI: 10.1002/jnr.24404 05 INT RESEARCH DESIGN Epidemiological survey Clinical Trial Pragmatical trial Ecological Momentary Assessment E. Baca-García 34 06 INT Monitorización: densidad de datos Enrique Baca-García 35 07 INT TIEMPO DE USO DIARIO (Android) p<0,001 Horas/día Enrique Baca-García 36 08 INT PATRÓN DE USO SMART UCV WHODAS COMUNICACIÓN SALUD p<0,001 p=0,244 p=0,184 p<0,001 p=0,001 SOCIAL games OTROS Enrique Baca-García 37 09 INT RETENCION EMA Active Log Rank (Mantel-Cox) =,411, DF=1, P=0,522 E. Baca-García 38 10 INT 5 CLINICAL RELEVANCE: Detection 29/6/2018 Unstable 4/7/2018 EA Suicide Attempt STABILITY Cambio patrón What's behind it? E. Baca-García 39 CUESTIONES RIESGO SMARTCRISIS 05 08 03 CON SN 02 PREV 04 RISK SC C REDES PREVENCION CONCLUSIONES SOCIALES E. Baca-García 40 01 CON CONCLUSIONES C Grandes oportunidades Validez Datos de mejora poblacionales DETECCION vs Complejidad prediccion Problemas Nuevas fuentes de definición suicidio datos E. Baca-García 41.
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