Estrategia <strong>de</strong> <strong>interv<strong>en</strong>ción</strong> <strong>para</strong> <strong>la</strong> <strong>prev<strong>en</strong>ción</strong> <strong>de</strong>l <strong>suicidio</strong> <strong>en</strong> adolesc<strong>en</strong>tes: <strong>la</strong> escue<strong>la</strong> como contexto137INTERVENTION STRATEGY FOR THE PREVENTION OF SUICIDE INADOLESCENTS: THE SCHOOL AS CONTEXTAbstractObjectives: The educational interv<strong>en</strong>tion project whose objective was to promote protective behaviors fromthe risk factors for attempting suici<strong>de</strong> i<strong>de</strong>ntified in adolesc<strong>en</strong>ts and to promote knowledge of risk factorsand provi<strong>de</strong> them with tools for the initial approach to educators and par<strong>en</strong>ts. Materials and Methods:The sample consisted of 30 stu<strong>de</strong>nts betwe<strong>en</strong> 9 and 14 years old, <strong>en</strong>rolled in an educational institution inthe city of Cali betwe<strong>en</strong> September 2009 and June 2010, and sev<strong>en</strong> adults betwe<strong>en</strong> educators and par<strong>en</strong>ts.The interv<strong>en</strong>tion was <strong>de</strong>signed in four phases: An initial phase sought to i<strong>de</strong>ntify risk factors in the stu<strong>de</strong>nts.During the second phase, the educational program was <strong>de</strong>veloped. In the third phase the program wasimplem<strong>en</strong>ted un<strong>de</strong>r the principles of health education. And a fourth phase, which the impact of the activitiescarried out, was evaluated. Results: The findings showed the <strong>la</strong>ck of awar<strong>en</strong>ess adults have about suici<strong>de</strong>.From the results after the educational interv<strong>en</strong>tion, more accuracy in regards to the basic concepts of suici<strong>de</strong>and of the interv<strong>en</strong>tions to be performed with adolesc<strong>en</strong>ts at risk was evi<strong>de</strong>nt. Conclusions: The educationalinterv<strong>en</strong>tion allowed the i<strong>de</strong>ntification of risk factors in adolesc<strong>en</strong>ts and showed a significant effectiv<strong>en</strong>essincreading par<strong>en</strong>ts and educators’ level of knowledge. Greater information <strong>en</strong>ables the i<strong>de</strong>ntification andtimely treatm<strong>en</strong>t which leads to the <strong>de</strong>crease of the ev<strong>en</strong>t in this popu<strong>la</strong>tion. It highlights the role of the schoo<strong>la</strong>s appropriate context for the implem<strong>en</strong>tation of interv<strong>en</strong>tions.Key wordsAdolesc<strong>en</strong>t behavior, attempt to commit suici<strong>de</strong>, educators, par<strong>en</strong>ts (source: DeCs).ESTRATEGIA DE INTERVENÇÃO PARA A PREVENÇÃO DO SUICIDIO EMADOLESCENTES: A ESCOLA COMO CONTEXTOResumoObjetivos: Projeto <strong>de</strong> interv<strong>en</strong>ção educativa cujo objetivo foi fom<strong>en</strong>tar condutas protetoras a partir dosfatores <strong>de</strong> risco <strong>para</strong> t<strong>en</strong>to <strong>de</strong> suicídio, i<strong>de</strong>ntificados em adolesc<strong>en</strong>tes e promover o conhecim<strong>en</strong>to dos fatores<strong>de</strong> risco e dotar lhes <strong>de</strong> ferram<strong>en</strong>tas <strong>para</strong> a abordagem inicial a educadores e pais <strong>de</strong> família. Materiais eMétodos: A amostra esteve conformada por 30 estudantes <strong>en</strong>tre 9 e 14 anos, matricu<strong>la</strong>dos em uma instituiçãoeducativa da cida<strong>de</strong> <strong>de</strong> Cali <strong>en</strong>tre setembro <strong>de</strong> 2009 e junho <strong>de</strong> 2010. E sete adultos <strong>en</strong>tre educadores e pais.Des<strong>en</strong>hou se a interv<strong>en</strong>ção em quatro fases: uma inicial buscava i<strong>de</strong>ntificar com os estudantes os fatores <strong>de</strong>risco. Na segunda fase, e<strong>la</strong>borou se o programa educativo. Na terça fase, e<strong>la</strong>borou se o programa baixo osprincípios <strong>de</strong> educação em saú<strong>de</strong>. E uma quarta fase, on<strong>de</strong> se avaliou o impacto das ativida<strong>de</strong>s realizadas.Resultados: Os <strong>de</strong>scobrim<strong>en</strong>tos evi<strong>de</strong>nciaram o <strong>de</strong>sconhecim<strong>en</strong>to dos adultos respeito ao suicídio. A partirdos resultados <strong>de</strong>pois da interv<strong>en</strong>ção educativa, evi<strong>de</strong>nciou se mais precisão respeito aos conceitos básicos<strong>de</strong> suicídio e das interv<strong>en</strong>ções a realizar com adolesc<strong>en</strong>tes em risco. Conclusões: A interv<strong>en</strong>ção educativapossibilitou a i<strong>de</strong>ntificação dos fatores <strong>de</strong> risco nos adolesc<strong>en</strong>tes e amostrou uma significativa efetivida<strong>de</strong> aoaum<strong>en</strong>tar o nível <strong>de</strong> conhecim<strong>en</strong>tos nos pais e educadores. Uma maior informação possibilita a i<strong>de</strong>ntificaçãoe tratam<strong>en</strong>to oportuno o qual leva à diminuição do ev<strong>en</strong>to neste grupo popu<strong>la</strong>cional. Resalta se o papel daesco<strong>la</strong> como contexto apropriado <strong>para</strong> a realização das interv<strong>en</strong>ções.Pa<strong>la</strong>vras chaveConduta do adolesc<strong>en</strong>te, t<strong>en</strong>to <strong>de</strong> suicídio, educadores, pais (fonte: DeCs).Hacia <strong>la</strong> Promoción <strong>de</strong> <strong>la</strong> Salud, Volum<strong>en</strong> 17, No.2, julio - diciembre 2012, págs. 136 - 148
138 Laura Elvira Piedrahita S., Kar<strong>la</strong> Mayerling Paz, Ana Maritza RomeroINTRODUCCIÓNEl <strong>suicidio</strong> repres<strong>en</strong>ta un f<strong>en</strong>óm<strong>en</strong>o universal,atemporal y multicausal con diversasconcepciones culturales y sociopolíticas <strong>de</strong>acuerdo al contexto don<strong>de</strong> se suscribe. Se ha<strong>de</strong>finido <strong>en</strong> <strong>la</strong> C<strong>la</strong>sificación Internacional <strong>de</strong>Enfermeda<strong>de</strong>s (CIE-10) (1), como “un actocon resultado letal, <strong>de</strong>liberadam<strong>en</strong>te iniciado yrealizado por el sujeto, sabi<strong>en</strong>do o esperando suresultado letal y si<strong>en</strong>do consi<strong>de</strong>rado el resultadocomo instrum<strong>en</strong>to <strong>para</strong> obt<strong>en</strong>er cambios <strong>de</strong>seables<strong>en</strong> su actividad consci<strong>en</strong>te y medio social”. Asímismo, se ha propuesto consi<strong>de</strong>rar <strong>la</strong>s conductassuicidas como un espectro continuo que va <strong>de</strong>s<strong>de</strong>aspectos cognitivos como <strong>la</strong> i<strong>de</strong>ación suicida yp<strong>la</strong>nificación, hasta los comportam<strong>en</strong>tales, comoel int<strong>en</strong>to <strong>de</strong> <strong>suicidio</strong> y el <strong>suicidio</strong> consumado (2).Des<strong>de</strong> 1970, <strong>la</strong> Organización Mundial <strong>de</strong> <strong>la</strong> Salud,ha reconocido al <strong>suicidio</strong> como un grave problema<strong>de</strong> salud pública (3). Actualm<strong>en</strong>te es responsable<strong>de</strong> aproximadam<strong>en</strong>te <strong>la</strong> mitad <strong>de</strong> todas <strong>la</strong>s muertesviol<strong>en</strong>tas <strong>en</strong> el mundo, pres<strong>en</strong>tándose más <strong>de</strong> unmillón <strong>de</strong> <strong>suicidio</strong>s anualm<strong>en</strong>te. Sin embargo estacifra no refleja <strong>la</strong> totalidad <strong>de</strong> <strong>la</strong> magnitud <strong>de</strong> <strong>la</strong>problemática, ya que el int<strong>en</strong>to <strong>de</strong> <strong>suicidio</strong> esaún más frecu<strong>en</strong>te y se estima que su inci<strong>de</strong>nciaes <strong>de</strong> 10 a 40 veces <strong>la</strong> <strong>de</strong>l <strong>suicidio</strong> consumado,consi<strong>de</strong>rándose que ocurre un int<strong>en</strong>to <strong>de</strong> <strong>suicidio</strong>cada 3 segundos y una muerte por <strong>suicidio</strong> cada 30segundos (4).En <strong>la</strong>s últimas décadas <strong>la</strong>s notificaciones <strong>de</strong><strong>suicidio</strong> han mostrado un aum<strong>en</strong>to a nivel mundial<strong>en</strong> <strong>la</strong> pob<strong>la</strong>ción <strong>de</strong> adolesc<strong>en</strong>tes y adultos jóv<strong>en</strong>es,particu<strong>la</strong>rm<strong>en</strong>te <strong>en</strong> el rango <strong>de</strong> edad <strong>de</strong> 15 a 24 años,constituyéndose <strong>en</strong>tre una <strong>de</strong> <strong>la</strong>s tres primeras causas<strong>de</strong> muerte <strong>en</strong> este grupo pob<strong>la</strong>cional y <strong>en</strong> <strong>la</strong> sextacausa <strong>de</strong> muerte <strong>para</strong> el grupo pob<strong>la</strong>cional <strong>en</strong>tre 5a 14 años (5). Esta situación es consecu<strong>en</strong>te con elpanorama nacional, ya que <strong>la</strong>s cifras arrojadas porel Estudio Nacional <strong>de</strong> Salud M<strong>en</strong>tal <strong>en</strong> Colombia<strong>en</strong> el año 2003 (6), indicaron que <strong>la</strong> mayorpreval<strong>en</strong>cia <strong>de</strong> int<strong>en</strong>tos <strong>de</strong> <strong>suicidio</strong> <strong>en</strong> nuestro país,se <strong>en</strong>cu<strong>en</strong>tra <strong>en</strong> los jóv<strong>en</strong>es <strong>en</strong>tre 18-29 años <strong>de</strong>edad y correspon<strong>de</strong> a <strong>la</strong> cuarta causa <strong>de</strong> muerte <strong>en</strong>jóv<strong>en</strong>es <strong>de</strong> 12 a 15 años. Los reportes <strong>de</strong>l InstitutoNacional <strong>de</strong> Medicina Legal y Ci<strong>en</strong>cias For<strong>en</strong>ses<strong>para</strong> el año 2010 (7), refier<strong>en</strong> que <strong>la</strong> pob<strong>la</strong>ción<strong>en</strong>tre los 20 y 34 años es más proclive a ejecutaractos suicidas, resaltando el rango <strong>en</strong>tre los 20 a24 años por t<strong>en</strong>er una participación porc<strong>en</strong>tual <strong>de</strong>l16,79%. Por otra parte, al observar <strong>la</strong> pob<strong>la</strong>ción <strong>de</strong>adolesc<strong>en</strong>tes, se i<strong>de</strong>ntifica que los casos <strong>en</strong>tre los15-17 años, superan <strong>la</strong>s frecu<strong>en</strong>cias pres<strong>en</strong>tadas <strong>en</strong>los mayores <strong>de</strong> 40 años, <strong>de</strong>mostrando que se trata<strong>de</strong> un f<strong>en</strong>óm<strong>en</strong>o con una alta mortalidad <strong>en</strong>tre losjóv<strong>en</strong>es.En el Valle <strong>de</strong>l Cauca, <strong>de</strong> acuerdo a los informes<strong>de</strong> vigi<strong>la</strong>ncia epi<strong>de</strong>miológica <strong>de</strong> <strong>la</strong> SecretaríaDepartam<strong>en</strong>tal <strong>de</strong> Salud (8), <strong>en</strong> el periodocompr<strong>en</strong>dido <strong>en</strong>tre 1998 y 2009 se pres<strong>en</strong>taron2.771 <strong>suicidio</strong>s, con un promedio <strong>de</strong> 231 casos/año, <strong>de</strong> los cuales el 73% <strong>de</strong> casos se <strong>en</strong>contraban<strong>en</strong> <strong>la</strong> franja <strong>de</strong> edad <strong>de</strong> 15 a 44 años y el 3,8%correspondía a m<strong>en</strong>ores <strong>de</strong> 15 años. Durante el año2010 se pres<strong>en</strong>tó una tasa g<strong>en</strong>eral <strong>de</strong> 4,7 casos porcada 100.000 habitantes, si<strong>en</strong>do esta 14,6% máselevada que <strong>la</strong> tasa nacional. En lo que respectaa <strong>la</strong>s intoxicaciones autoinfligidas <strong>en</strong> el año 2011,<strong>la</strong> Secretaría Departam<strong>en</strong>tal <strong>de</strong> Salud informa quese reportaron al Sistema Nacional <strong>de</strong> Vigi<strong>la</strong>ncia<strong>en</strong> Salud Publica –SIVIGILA– un total <strong>de</strong> 1.007casos, con un promedio <strong>de</strong> edad <strong>de</strong> 25,8 años,si<strong>en</strong>do el grupo <strong>de</strong> 14 a 23 años qui<strong>en</strong> aporta más<strong>de</strong> <strong>la</strong> mitad <strong>de</strong> los casos <strong>de</strong> int<strong>en</strong>cionalidad suicida(60,5%).En Santiago <strong>de</strong> Cali, <strong>en</strong> 2010 se reportaron alsistema <strong>de</strong> Vigi<strong>la</strong>ncia <strong>en</strong> Int<strong>en</strong>to <strong>de</strong> Suicidio 453casos, con un aum<strong>en</strong>to <strong>de</strong>l 15% <strong>en</strong> número <strong>de</strong>casos <strong>en</strong> re<strong>la</strong>ción a los reportados <strong>en</strong> el año 2009;respecto a <strong>la</strong> edad, el promedio <strong>para</strong> este periodofue <strong>de</strong> 24,9 años. Así mismo se reportaron 12 casos<strong>en</strong> m<strong>en</strong>ores <strong>de</strong> 10 años y 93 casos <strong>en</strong> m<strong>en</strong>ores <strong>de</strong>15 años, lo que repres<strong>en</strong>ta un increm<strong>en</strong>to <strong>para</strong>este grupo <strong>de</strong> edad respecto al año anterior <strong>en</strong> un19,2% (9).