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Ciênc. saúde coletiva vol.17 n.8 Rio de Janeiro Aug. 2012
A series of articles on suicide among the elderly in Brazil is presented, resulting from a national survey sponsored by ENSP/Fiocruz, within the InovaENSP program that fosters and supports new research themes that can contribute strategically to the advancement of public health. The project "Is it possible to prevent anticipating the end? Suicide among the elderly in Brazil and possibilities for action by the health sector," on a nationwide basis, the scope of which was to conduct in-depth study into this issue that has as yet been insufficiently addressed, and disseminate the knowledge generated among managers, professionals and researchers in the health sector and social area.
The study combined the quantitative and qualitative approaches. The first charted the magnitude of the problem on a national scale through the description of mortality rates by sex, segments of the elderly and geographic location of the phenomenon; it identified the municipalities with the highest incidence of suicide; and conducted in-depth ecological analysis of those municipalities in which the problem is more prevalent. The qualitative approach was based on the use of the psychological and psychosocial autopsy technique through interviews with relatives of elderly people who committed suicide in 10 municipalities where rates are high, seeking to understand the circumstances in which the cases occurred. The choice of locations for conducting qualitative research was based on the list of 200 municipalities with the highest rates, taking into account issues of convenience for transport of the teams and distribution of the sample across the five regions of the country. The study was conducted in Manaus, Fortaleza, Teresina, Tauá, Campo Grande, Dourados, Candelária, São Lourenço, Venâncio Aires and Campos dos Goytacazes. Due to the difficulty in conducting and analyzing psychosocial autopsies, a minimum of no less than five cases was decided for each location, bringing the total to 51, in which 84 people were interviewed, almost all being family members who had accompanied the elderly.
In addition to researchers from the Fundação Oswaldo Cruz which led the study, the research included doctoral, masters and undergraduate scientific initiation students and investigators from seven academic institutions (Universidade Federal de Manaus, Universidade de Fortaleza, Universidade Federal de Teresina, Universidade de Dom Bosco de Mato Grosso do Sul, Universidade Federal e Escola Estadual de Saúde Pública do Rio Grande do Sul, Universidade Veiga de Almeida do Rio de Janeiro).
The study was conducted in a participatory and networking manner, disseminating decisions regarding: definition of the scope; characteristics of the epidemiological research; choice of the municipalities for the qualitative research; construction of instruments; deadlines for each stage of the project; inclusion of students; critical reflection on the study and division of tasks for the academic production, based on the data and information.
The result of this work is to be found in this thematic issue: three articles of an epidemiological nature deal with the magnitude of the phenomenon across the country, by regions and municipalities, according to sex, age segment of the elderly, the means used and ecology of the phenomenon. Another set of texts discuss qualitative aspects of self-inflicted death, introducing circumstantial details of the cases; analysis of the tools used for research; description of the fieldwork; socio-anthropological aspects that involve explanations for the events; classification by gender; consequences of suicide among the family of the elderly, and, finally, the most important aspect, namely analysis of an attempt at prevention.
Of all the conclusions that can be drawn from this study, one is fundamental: everything that contributes to enhancement of the quality of life of elderly individuals - respecting their personal wishes always present in the act of suicide - also contributes to them not trying to anticipate their demise.
de Souza Minayo, Fátima Gonçalves Cavalcante