Efetividade de projeto terapêutico singular em adolescentes com tentativa de suicídio e/ou automutilação

Abstract

Introduction: The numbers related to suicide and self-harm have been growing over time. There are several related factors, such as access to psychoactive substances, bullying/cyberbullying situations, and others. In our mental health setting, it is common for such individuals to receive treatment on the outpatient service for evaluation and follow-up with a multidisciplinary team, preventing new episodes and treating psychiatric comorbidities. Objectives: This retrospective cohort aims to understand the Singular Therapeutic Project (STP) implemented in CAPSi (Child Psychosocial Care Center) in Sao Jose do Rio Preto, comparing the group of patients with adherence to the PTS in relation to patients who did not adhere completely. Material and Method: Data were collected from the medical records of adolescents aged from 12 to 18 years old from Sao Jose do Rio Preto with self-harm or suicide attempt, during the period from 01/01/15 to 12/31/19. They were divided into two groups: patients who adhered to the PTS and those who did not. The following primary outcomes were analyzed: recurrence of suicide attempts, self-harm, hospitalization; and secondary outcomes: age, gender, ethnicity, center, education, psychiatric diagnosis, number of appointments with health professionals, negative life events and use of psychoactive substances. Results: From 2015-2019, there were 228 adolescents referred to CAPSi and included in the PTS. Of these, 32 (14.03%) had recurrence in self-harm and 28 (12.28%) had recurrence in a suicide attempt. No consummated suicide has occurred. After multivariate analysis, in the 1st recurrence of self-harm, Social Assistance consultations decreased risk in 94,6% (HR 0.054, 95%CI 0.004 – 0.681), but it was increased by 23 times if there was an episode of self-harm in family members and friends (HR 23.641, 95%CI 1.394 – 400.8). In other recurrences, the higher adherence to Psychology consultations, the lower the risk of self-harm (1% reduction, for every 1.8% adherence). For the first recurrence of suicide attempt, an adherence to Family Interventions reduced the risk by 66.2% (HR 0.338, 95%CI 0.125 – 0.913) and being a victim of prejudice, racism, homophobia, transphobia increased the risk by 3.7 fold (HR 3.766, 95%CI 1.058 – 13.401). Conclusion: The STP interventions were effective in reducing the recurrence of self-harm as well as suicide attempt in adolescents. CAPSi can benefit from this approach, emphasizing Social Assistance for self-mutilations and Family Intervention and Psychology care for suicide, mainly in the first week (1st recurrences) and the first 100 days (next recurrences).