A Cross-Sectional Study on Factors Related to Suicidal Ideation in Individuals with Spiritist Involvement: Comparison before and during the Covid-19 Pandemic
Main Article Content
Abstract
Purpose: Suicide increases in Brazil annually and the population search for spiritual care, as in Spiritism, a religion that attracts people in psychic pain. We sought to identify the factors associated with suicidal ideation among persons with some Level of Spiritism Engagement (LSE), before and during COVID-19.
Methods: This cross-sectional analytical research with 848 inhabitants from Ceará, Brazil, with some LSE, was conducted through digital data collection via snowball, with a bivariate (p < 0,30), multivariate (p < 0,30) and multinomial analysis (p < 0,05) of sociodemographic factors, psychic status, psychic care, spiritual belief and LSE related to suicidal ideation. Afterward, a multinomial regression analysis (p < 0.05) was conducted on all significant factors to identify those most strongly associated with suicidal ideation.
Results: Risk factors of mild/moderate suicidal ideation were to be single (OR=2,32; CI 1,19-4,52), previous psychotherapy before COVID-19 (OR=1,81; CI 1,10-2,98) and to be spiritist (OR=2,43; CI 1,34-4,38). Risk factors of severe suicidal ideation were: to be single (OR=4,05; CI 1,89-8,69), unemployed (OR=2,93; CI 1,45-5,92), have a regular/bad/worse self-perception of emotional health (OR=4,84; CI 2,55-9,17), previous psychotherapy before COVID-19 (OR=2,57; CI 1,40-4,71) and to be spiritist (OR=2,13; CI 1,00-4,52). Pre-pandemic regular/high/very high LSE was a protective factor for severe suicidal ideation during COVID-19 (OR=0,38; CI 0,16-0,90).
Conclusion: Negative self-perception of emotional health, psychotherapeutic follow-up, and identification as spiritist were associated with severe suicidal ideation, which appears to support the notion that spiritism attracts individuals experiencing psychic distress. Despite this disease profile, higher levels of spiritist engagement before the pandemic were protective against severe suicidal ideation during COVID-19, suggesting a potential positive effect of spiritism on mental health.
Keywords:
Suicidal Ideation, Spiritism, COVID-19, Suicide, Spirituality
Article Details
How to Cite
SALES, Tiago Medeiros; MOTA, Rosa Maria Salani; MACENA, Raimunda Hermelinda Maia.
A Cross-Sectional Study on Factors Related to Suicidal Ideation in Individuals with Spiritist Involvement: Comparison before and during the Covid-19 Pandemic.
Medical Research Archives, [S.l.], v. 12, n. 11, nov. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6057>. Date accessed: 12 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i11.6057.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Miranda AGM, de Souza MF, Caldeira VC, Martins MC, Alves JBG, editors. Suicídio: aspectos epidemiológicos relacionados ao sexo, idade, escolaridade, estado civil, CID-10. Anais Colóquio Estadual de Pesquisa Multidisciplinar (ISSN-2527-2500) & Congresso Nacional de Pesquisa Multidisciplinar; 2018.
2. Sadock BJ, Sadock VA, Ruiz P. Compêndio de Psiquiatria: ciência do comportamento e psiquiatria clínica. 11 ed. Porto Alegre: Artmed; 2017. 1466 p.
3. OPAS/OMS-Brasil. Folha Informativo - Suicídio 2018 [https://www.paho.org/bra/index.php?option=com_content&view=article&id=5671:folha-informativa-suicidio&Itemid=839].
4. Arruda VL, Freitas B, Marcon SR, Fernandes FY, Lima NVP, Bortolini J, et al. Suicide in young Brazilian adults: 1997-2019 time series. Cien Saude Colet., 2021. p. 2699-708.
5. Veisani Y, Mohamadian F, Delpisheh A. Prevalence and comorbidity of common mental disorders and associations with suicidal ideation in the adult population. Epidemiology and Health. 2017;39:e2017031-e.
6. Scott J. Common mental disorders: A bio-social model by David Goldberg and Peter Huxley. London: Tavistock/Routledge. No. of pages: 194. Price £12.99. Stress Medicine. 1992;8(4):267-8.
7. Krueger RF. The Structure of Common Mental Disorders. Archives of General Psychiatry. 1999;56(10):921-.
8. Machado DB, Santos DNd. Suicídio no Brasil, de 2000 a 2012. Jornal Brasileiro de Psiquiatria. 2015;64:45-54.
9. Hegerl U. Prevention of suicidal behavior. Dialogues Clin Neurosci. 2016;18(2):183-90.
10. Filgueiras JC, Hippert MIS. A polêmica em torno do conceito de estresse. Psicologia: Ciência e Profissão. 1999;19(3):40-51.
11. Malhi GS, Mann JJ. Depression. The Lancet. 2018;392(10161):2299-312.
12. Martínez LS, Wasser AC. Depresión e ideación suicida en mujeres víctimas de violencia de pareja. Psicología, Conocimiento y Sociedad. 2019;9(1).
13. Barbosa RMR, Lima DF, Cavalcanti DB. Algumas ações para prevenção de suicídio desenvolvidas na UFPE. Revista dos Mestrados Profissionais. 2020;9(1):73-91.
14. IBGE. Censo 2010.
15. Bazley R, Pakenham K, Watson B. Perspectives on Suicide Prevention Amongst Members of Christian Faith-Based Organizations. Community Ment Health J. 2019;55(5):831-9.
16. Lace JW, Evans LN, Merz ZC, Handal PJ. Five-Factor Model Personality Traits and Self-Classified Religiousness and Spirituality. J Relig Health. 2020;59(3):1344-69.
17. Paul Victor CG, Treschuk JV. Critical Literature Review on the Definition Clarity of the Concept of Faith, Religion, and Spirituality. J Holist Nurs. 2020;38(1):107-13.
18. Peres MFP, Kamei HH, Tobo PR, Lucchetti G. Mechanisms Behind Religiosity and Spirituality’s Effect on Mental Health, Quality of Life and Well-Being. Journal of Religion and Health. 2018;57(5):1842-55.
19. Vitorino LM, Lucchetti G, Leão FC, Vallada H, Peres MFP. The association between spirituality and religiousness and mental health. Sci Rep. 2018;8(1):17233.
20. Tavares C. Dimensões do cuidado na perspectiva da espiritualidade durante a pandemia pelo novo coronavírus (COVID-19). Journal Health NPEPS. 2020;5:1-4.
21. Diego-Cordero R, Ávila-Mantilla A, Vega-Escaño J, Lucchetti G, Badanta B. The Role of Spirituality and Religiosity in Healthcare During the COVID-19 Pandemic: An Integrative Review of the Scientific Literature. J Relig Health. 2022;61(3):2168-97.
22. Del Castillo FA. Health, spirituality and Covid-19: Themes and insights. J Public Health (Oxf). 2021;43(2):e254-e5.
23. Kardec A. O que é o Espiritismo. 60, editor. Araras: Instituto de Difusão Espírita; 2004.
24. Kardec A. O Livro dos Espíritos. 1 ed. Rio de Janeiro: Celd; 2008.
25. FEB. Orientação ao Centro Espírita. 2006.
26. Dalgalarrondo P. Estudos sobre religião e saúde mental realizados no Brasil: histórico e perspectivas atuais. Archives of Clinical Psychiatry (São Paulo). 2007;34:25-33.
27. Moreira-Almeida A, Costa MdA, Coelho HS. The Idea of Survival of the Soul in the History of Religions and Philosophy. In: Moreira-Almeida A, Costa MdA, Coelho HS, editors. Science of Life After Death. Cham: Springer International Publishing; 2022. p. 5-11.
28. Isaia AC. Bezerra de Menezes e Gonçalves de Magalhães: muito além do cérebro. Tentativas de enfrentamento ao materialismo científico do século XIX. Revista Brasileira de História. 2020;40:267-88.
29. Swihart DL, Yarrarapu SNS, Martin RL. Cultural Religious Competence In Clinical Practice2023.
30. Shah AK, Becicka R, Talen MR, Edberg D, Namboodiri S. Integrative Medicine and Mood, Emotions and Mental Health. Primary Care: Clinics in Office Practice. 2017;44(2):281-304.
31. Sales TM. Magnitude e fatores associados ao envolvimento espírita, transtornos mentais comuns e ideação suicida: Um estudo seccional no Ceara. Fortaleza: Universidade Federal do Ceara; 2023.
32. IBGE. Censo 2010 2010 [Available from: https://sidra.ibge.gov.br/pesquisa/censo-demografico/series-temporais/series-temporais/.
33. Berg S. Snowball sampling—I. Encyclopedia of statistical sciences. 2004;12.
34. Chu IY, Alam P, Larson HJ, Lin L. Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response. J Travel Med. 27: International Society of Travel Medicine 2020.; 2020.
35. Both LM, Zoratto G, Calegaro VC, Ramos-Lima LF, Negretto BL, Hauck S, et al. COVID-19 pandemic and social distancing: economic, psychological, family, and technological effects. Trends Psychiatry Psychother. 432021. p. 85-91.
36. Granovetter M. Network sampling: Some first steps. American journal of sociology. 1976;81(6):1287-303.
37. Grandcolas U, Rettie R, Marusenko K. Web Survey Bias: Sample or Mode Effect? Journal of Marketing Management. 2003;19(5-6):541-61.
38. Pasquali L. Princípios de Elaboração de Escalas. In: Gorenstein C, Yuan-Pang, Hungerbühler I, editors. Instrumentos de Avaliação em Saúde Mental. Porto Alegre: Artmed; 2016.
39. Gorenstein C, Wang Y, Hungerbuhler I. Instrumentos de avaliação em saúde mental. Porto Alegre: Artmed; 2016.
40. Aquino TAA. Atitudes e intenções de cometer o suicídio: seus correlatos existenciais e normativos. João Pessoa: Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte; 2009.
41. Osman A, Barrios FX, Grittmann LR, Osman JR. The multi-attitude suicide tendency scale: Psychometric characteristics in an american sample. Journal of Clinical Psychology. 1993;49(5):701-8.
42. Aquino TAAd. Atitudes e intenções de cometer o suicídio: seus correlatos existenciais e normativos. João Pessoa, 2009. p. 1-280.
43. Santos WSd, Ulisses SM, Costa TMd, Farias MG, Moura DPFd. The influence of risk or protective factors for suicide ideation. Psicologia, Saúde & Doença. 2016;17(3):515-26.
44. Bethlehem J. Selection Bias in Web Surveys. International Statistical Review / Revue Internationale de Statistique. 2010;78(2):161-88.
45. Calati R, Ferrari C, Brittner M, Oasi O, Olié E, Carvalho AF, et al. Suicidal thoughts and behaviors and social isolation: A narrative review of the literature. J Affect Disord. 2019;245:653-67.
46. Sampaio GN. Uma investigação da relação entre divórcios e suicídios no Brasil e no Estado do Ceará. 2021.
47. Borba LO, Ferreira ACZ, Capistrano FC, Kalinke LP, Maftum MA, Maftum GJ. Fatores associados à tentativa de suicídio por pessoas com transtorno mental. Revista Mineira de Enfermagem. 2020;24:1-9.
48. Barros TF, Borges SM, da Costa VA, dos Santos Santiago JC. Análise do perfil epidemiológico de suicídios no Ceará de 2015 a 2017.
49. Marbin D, Gutwinski S, Schreiter S, Heinz A. Perspectives in poverty and mental health. Front Public Health. 2022;10:975482.
50. Barros FC, Matijasevich A, Santos IS, Horta BL, da Silva BGC, Munhoz TN, et al. Social inequalities in mental disorders and substance misuse in young adults. Social Psychiatry and Psychiatric Epidemiology. 2018;53(7):717-26.
51. Stack S. Contributing factors to suicide: Political, social, cultural and economic. Prev Med. 2021;152(Pt 1):106498.
52. Magnani RM, Staudt ACP. Estilos parentais e suicídio na adolescência: uma reflexão acerca dos fatores de proteção. Pensando famílias. 2018;22(1):75-86.
53. Santos EDGM, Rodrigues GOL, Santos LO, Alves MES, Araújo LF, Santos JVSA. Suicídio entre idosos no Brasil: uma revisão de literatura dos últimos 10 anos. Psicología, Conocimiento y Sociedad. 2019;9:205-20.
54. Bierstetel SJ, Slatcher RB. Couples' behavior during conflict in the lab and diurnal cortisol patterns in daily life. Psychoneuroendocrinology. 2020;115:104633.
55. McEwen BS, Akil H. Revisiting the Stress Concept: Implications for Affective Disorders. J Neurosci. 2020;40(1):12-21.
56. Chikritzhs T, Livingston M. Alcohol and the Risk of Injury. Nutrients. 132021.
57. Darvishi N, Farhadi M, Haghtalab T, Poorolajal J. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis. PLoS One. 2015;10(5):e0126870.
58. Sher L. The impact of the COVID-19 pandemic on suicide rates. QJM: An International Journal of Medicine. 2020;113(10):707-12.
59. Patwardhan P. COVID-19: Risk of increase in smoking rates among England's 6 million smokers and relapse among England's 11 million ex-smokers. BJGP Open. 2020;4(2).
60. Leigh-Hunt N, Bagguley D, Bash K, Turner V, Turnbull S, Valtorta N, et al. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health. 2017;152:157-71.
61. Alkandari A, Law J, Alhashmi H, Alshammari O, Bhandari P. Staying (Mentally) Healthy: The Impact of COVID-19 on Personal and Professional Lives. Tech Innov Gastrointest Endosc. 2021;23(2):199-206.
62. Ganesan B, Al-Jumaily A, Fong KNK, Prasad P, Meena SK, Tong RK. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak Quarantine, Isolation, and Lockdown Policies on Mental Health and Suicide. Front Psychiatry. 2021;12:565190.
63. Bhattacharjee B, Acharya T. "The COVID-19 Pandemic and its Effect on Mental Health in USA - A Review with Some Coping Strategies". Psychiatr Q. 912020. p. 1135-45.
64. John A, Eyles E, Webb RT, Okolie C, Schmidt L, Arensman E, et al. The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: update of living systematic review. F1000Research. 2020;9.
65. Amaral CEM, Treichel C, Francisco P, Onocko-Campos RT. [Mental healthcare in Brazil: a multifaceted study in four large cities]. Cad Saude Publica. 2021;37(3):e00043420.
66. Gourret Baumgart J, Kane H, El-Hage W, Deloyer J, Maes C, Lebas MC, et al. The Early Impacts of the COVID-19 Pandemic on Mental Health Facilities and Psychiatric Professionals. Int J Environ Res Public Health. 182021.
67. Neelam K, Duddu V, Anyim N, Neelam J, Lewis S. Pandemics and pre-existing mental illness: A systematic review and meta-analysis. Brain Behav Immun Health. 10: © 2020 The Authors.; 2021. p. 100177.
68. Sukut O, Ayhan Balik CH. The impact of COVID-19 pandemic on people with severe mental illness. Perspect Psychiatr Care. 57: 2020 Wiley Periodicals LLC.; 2021. p. 953-6.
69. Nason I, Stein DT, Frank RG, Stein MB. Decline In New Starts Of Psychotropic Medications During The COVID-19 Pandemic. Health Aff (Millwood). 2021;40(6):904-9.
70. Gomes BP, da Costa Medeiros G, Aguilar FZ, Zattar T, Franco DCZ. Análise do uso de psicofármacos no Brasil no contexto da pandemia da COVID-19: Analysis of the use of psychotropic drugs in Brazil in the context of the COVID-19 pandemic. Archives of Health. 2022;3(2):94-8.
71. Alcântara AM, Figel FC, Campese M, da Silva MZ. Prescrição de Psicofármacos na Atenção Primária à Saúde no contexto da Pandemia da Covid-19. Research, Society and Development. 2022;11(4):e19911420210-e.
72. Sales TM, Mota RMS, Macena RHM. Formulário Deenvolvimento Espírita (FENE): development and validation of an instrument for assessing the level of spiritual development. Fortaleza: UFC; 2023. Available at: http://repositorio.ufc.br/handle/riufc/74736.
73. Sales TM. Spiritism, mental health, and public health: spiritist therapeutics under discussion. MOJ Public Health. 2023;12(3):145‒150.
2. Sadock BJ, Sadock VA, Ruiz P. Compêndio de Psiquiatria: ciência do comportamento e psiquiatria clínica. 11 ed. Porto Alegre: Artmed; 2017. 1466 p.
3. OPAS/OMS-Brasil. Folha Informativo - Suicídio 2018 [https://www.paho.org/bra/index.php?option=com_content&view=article&id=5671:folha-informativa-suicidio&Itemid=839].
4. Arruda VL, Freitas B, Marcon SR, Fernandes FY, Lima NVP, Bortolini J, et al. Suicide in young Brazilian adults: 1997-2019 time series. Cien Saude Colet., 2021. p. 2699-708.
5. Veisani Y, Mohamadian F, Delpisheh A. Prevalence and comorbidity of common mental disorders and associations with suicidal ideation in the adult population. Epidemiology and Health. 2017;39:e2017031-e.
6. Scott J. Common mental disorders: A bio-social model by David Goldberg and Peter Huxley. London: Tavistock/Routledge. No. of pages: 194. Price £12.99. Stress Medicine. 1992;8(4):267-8.
7. Krueger RF. The Structure of Common Mental Disorders. Archives of General Psychiatry. 1999;56(10):921-.
8. Machado DB, Santos DNd. Suicídio no Brasil, de 2000 a 2012. Jornal Brasileiro de Psiquiatria. 2015;64:45-54.
9. Hegerl U. Prevention of suicidal behavior. Dialogues Clin Neurosci. 2016;18(2):183-90.
10. Filgueiras JC, Hippert MIS. A polêmica em torno do conceito de estresse. Psicologia: Ciência e Profissão. 1999;19(3):40-51.
11. Malhi GS, Mann JJ. Depression. The Lancet. 2018;392(10161):2299-312.
12. Martínez LS, Wasser AC. Depresión e ideación suicida en mujeres víctimas de violencia de pareja. Psicología, Conocimiento y Sociedad. 2019;9(1).
13. Barbosa RMR, Lima DF, Cavalcanti DB. Algumas ações para prevenção de suicídio desenvolvidas na UFPE. Revista dos Mestrados Profissionais. 2020;9(1):73-91.
14. IBGE. Censo 2010.
15. Bazley R, Pakenham K, Watson B. Perspectives on Suicide Prevention Amongst Members of Christian Faith-Based Organizations. Community Ment Health J. 2019;55(5):831-9.
16. Lace JW, Evans LN, Merz ZC, Handal PJ. Five-Factor Model Personality Traits and Self-Classified Religiousness and Spirituality. J Relig Health. 2020;59(3):1344-69.
17. Paul Victor CG, Treschuk JV. Critical Literature Review on the Definition Clarity of the Concept of Faith, Religion, and Spirituality. J Holist Nurs. 2020;38(1):107-13.
18. Peres MFP, Kamei HH, Tobo PR, Lucchetti G. Mechanisms Behind Religiosity and Spirituality’s Effect on Mental Health, Quality of Life and Well-Being. Journal of Religion and Health. 2018;57(5):1842-55.
19. Vitorino LM, Lucchetti G, Leão FC, Vallada H, Peres MFP. The association between spirituality and religiousness and mental health. Sci Rep. 2018;8(1):17233.
20. Tavares C. Dimensões do cuidado na perspectiva da espiritualidade durante a pandemia pelo novo coronavírus (COVID-19). Journal Health NPEPS. 2020;5:1-4.
21. Diego-Cordero R, Ávila-Mantilla A, Vega-Escaño J, Lucchetti G, Badanta B. The Role of Spirituality and Religiosity in Healthcare During the COVID-19 Pandemic: An Integrative Review of the Scientific Literature. J Relig Health. 2022;61(3):2168-97.
22. Del Castillo FA. Health, spirituality and Covid-19: Themes and insights. J Public Health (Oxf). 2021;43(2):e254-e5.
23. Kardec A. O que é o Espiritismo. 60, editor. Araras: Instituto de Difusão Espírita; 2004.
24. Kardec A. O Livro dos Espíritos. 1 ed. Rio de Janeiro: Celd; 2008.
25. FEB. Orientação ao Centro Espírita. 2006.
26. Dalgalarrondo P. Estudos sobre religião e saúde mental realizados no Brasil: histórico e perspectivas atuais. Archives of Clinical Psychiatry (São Paulo). 2007;34:25-33.
27. Moreira-Almeida A, Costa MdA, Coelho HS. The Idea of Survival of the Soul in the History of Religions and Philosophy. In: Moreira-Almeida A, Costa MdA, Coelho HS, editors. Science of Life After Death. Cham: Springer International Publishing; 2022. p. 5-11.
28. Isaia AC. Bezerra de Menezes e Gonçalves de Magalhães: muito além do cérebro. Tentativas de enfrentamento ao materialismo científico do século XIX. Revista Brasileira de História. 2020;40:267-88.
29. Swihart DL, Yarrarapu SNS, Martin RL. Cultural Religious Competence In Clinical Practice2023.
30. Shah AK, Becicka R, Talen MR, Edberg D, Namboodiri S. Integrative Medicine and Mood, Emotions and Mental Health. Primary Care: Clinics in Office Practice. 2017;44(2):281-304.
31. Sales TM. Magnitude e fatores associados ao envolvimento espírita, transtornos mentais comuns e ideação suicida: Um estudo seccional no Ceara. Fortaleza: Universidade Federal do Ceara; 2023.
32. IBGE. Censo 2010 2010 [Available from: https://sidra.ibge.gov.br/pesquisa/censo-demografico/series-temporais/series-temporais/.
33. Berg S. Snowball sampling—I. Encyclopedia of statistical sciences. 2004;12.
34. Chu IY, Alam P, Larson HJ, Lin L. Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response. J Travel Med. 27: International Society of Travel Medicine 2020.; 2020.
35. Both LM, Zoratto G, Calegaro VC, Ramos-Lima LF, Negretto BL, Hauck S, et al. COVID-19 pandemic and social distancing: economic, psychological, family, and technological effects. Trends Psychiatry Psychother. 432021. p. 85-91.
36. Granovetter M. Network sampling: Some first steps. American journal of sociology. 1976;81(6):1287-303.
37. Grandcolas U, Rettie R, Marusenko K. Web Survey Bias: Sample or Mode Effect? Journal of Marketing Management. 2003;19(5-6):541-61.
38. Pasquali L. Princípios de Elaboração de Escalas. In: Gorenstein C, Yuan-Pang, Hungerbühler I, editors. Instrumentos de Avaliação em Saúde Mental. Porto Alegre: Artmed; 2016.
39. Gorenstein C, Wang Y, Hungerbuhler I. Instrumentos de avaliação em saúde mental. Porto Alegre: Artmed; 2016.
40. Aquino TAA. Atitudes e intenções de cometer o suicídio: seus correlatos existenciais e normativos. João Pessoa: Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte; 2009.
41. Osman A, Barrios FX, Grittmann LR, Osman JR. The multi-attitude suicide tendency scale: Psychometric characteristics in an american sample. Journal of Clinical Psychology. 1993;49(5):701-8.
42. Aquino TAAd. Atitudes e intenções de cometer o suicídio: seus correlatos existenciais e normativos. João Pessoa, 2009. p. 1-280.
43. Santos WSd, Ulisses SM, Costa TMd, Farias MG, Moura DPFd. The influence of risk or protective factors for suicide ideation. Psicologia, Saúde & Doença. 2016;17(3):515-26.
44. Bethlehem J. Selection Bias in Web Surveys. International Statistical Review / Revue Internationale de Statistique. 2010;78(2):161-88.
45. Calati R, Ferrari C, Brittner M, Oasi O, Olié E, Carvalho AF, et al. Suicidal thoughts and behaviors and social isolation: A narrative review of the literature. J Affect Disord. 2019;245:653-67.
46. Sampaio GN. Uma investigação da relação entre divórcios e suicídios no Brasil e no Estado do Ceará. 2021.
47. Borba LO, Ferreira ACZ, Capistrano FC, Kalinke LP, Maftum MA, Maftum GJ. Fatores associados à tentativa de suicídio por pessoas com transtorno mental. Revista Mineira de Enfermagem. 2020;24:1-9.
48. Barros TF, Borges SM, da Costa VA, dos Santos Santiago JC. Análise do perfil epidemiológico de suicídios no Ceará de 2015 a 2017.
49. Marbin D, Gutwinski S, Schreiter S, Heinz A. Perspectives in poverty and mental health. Front Public Health. 2022;10:975482.
50. Barros FC, Matijasevich A, Santos IS, Horta BL, da Silva BGC, Munhoz TN, et al. Social inequalities in mental disorders and substance misuse in young adults. Social Psychiatry and Psychiatric Epidemiology. 2018;53(7):717-26.
51. Stack S. Contributing factors to suicide: Political, social, cultural and economic. Prev Med. 2021;152(Pt 1):106498.
52. Magnani RM, Staudt ACP. Estilos parentais e suicídio na adolescência: uma reflexão acerca dos fatores de proteção. Pensando famílias. 2018;22(1):75-86.
53. Santos EDGM, Rodrigues GOL, Santos LO, Alves MES, Araújo LF, Santos JVSA. Suicídio entre idosos no Brasil: uma revisão de literatura dos últimos 10 anos. Psicología, Conocimiento y Sociedad. 2019;9:205-20.
54. Bierstetel SJ, Slatcher RB. Couples' behavior during conflict in the lab and diurnal cortisol patterns in daily life. Psychoneuroendocrinology. 2020;115:104633.
55. McEwen BS, Akil H. Revisiting the Stress Concept: Implications for Affective Disorders. J Neurosci. 2020;40(1):12-21.
56. Chikritzhs T, Livingston M. Alcohol and the Risk of Injury. Nutrients. 132021.
57. Darvishi N, Farhadi M, Haghtalab T, Poorolajal J. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis. PLoS One. 2015;10(5):e0126870.
58. Sher L. The impact of the COVID-19 pandemic on suicide rates. QJM: An International Journal of Medicine. 2020;113(10):707-12.
59. Patwardhan P. COVID-19: Risk of increase in smoking rates among England's 6 million smokers and relapse among England's 11 million ex-smokers. BJGP Open. 2020;4(2).
60. Leigh-Hunt N, Bagguley D, Bash K, Turner V, Turnbull S, Valtorta N, et al. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health. 2017;152:157-71.
61. Alkandari A, Law J, Alhashmi H, Alshammari O, Bhandari P. Staying (Mentally) Healthy: The Impact of COVID-19 on Personal and Professional Lives. Tech Innov Gastrointest Endosc. 2021;23(2):199-206.
62. Ganesan B, Al-Jumaily A, Fong KNK, Prasad P, Meena SK, Tong RK. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak Quarantine, Isolation, and Lockdown Policies on Mental Health and Suicide. Front Psychiatry. 2021;12:565190.
63. Bhattacharjee B, Acharya T. "The COVID-19 Pandemic and its Effect on Mental Health in USA - A Review with Some Coping Strategies". Psychiatr Q. 912020. p. 1135-45.
64. John A, Eyles E, Webb RT, Okolie C, Schmidt L, Arensman E, et al. The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: update of living systematic review. F1000Research. 2020;9.
65. Amaral CEM, Treichel C, Francisco P, Onocko-Campos RT. [Mental healthcare in Brazil: a multifaceted study in four large cities]. Cad Saude Publica. 2021;37(3):e00043420.
66. Gourret Baumgart J, Kane H, El-Hage W, Deloyer J, Maes C, Lebas MC, et al. The Early Impacts of the COVID-19 Pandemic on Mental Health Facilities and Psychiatric Professionals. Int J Environ Res Public Health. 182021.
67. Neelam K, Duddu V, Anyim N, Neelam J, Lewis S. Pandemics and pre-existing mental illness: A systematic review and meta-analysis. Brain Behav Immun Health. 10: © 2020 The Authors.; 2021. p. 100177.
68. Sukut O, Ayhan Balik CH. The impact of COVID-19 pandemic on people with severe mental illness. Perspect Psychiatr Care. 57: 2020 Wiley Periodicals LLC.; 2021. p. 953-6.
69. Nason I, Stein DT, Frank RG, Stein MB. Decline In New Starts Of Psychotropic Medications During The COVID-19 Pandemic. Health Aff (Millwood). 2021;40(6):904-9.
70. Gomes BP, da Costa Medeiros G, Aguilar FZ, Zattar T, Franco DCZ. Análise do uso de psicofármacos no Brasil no contexto da pandemia da COVID-19: Analysis of the use of psychotropic drugs in Brazil in the context of the COVID-19 pandemic. Archives of Health. 2022;3(2):94-8.
71. Alcântara AM, Figel FC, Campese M, da Silva MZ. Prescrição de Psicofármacos na Atenção Primária à Saúde no contexto da Pandemia da Covid-19. Research, Society and Development. 2022;11(4):e19911420210-e.
72. Sales TM, Mota RMS, Macena RHM. Formulário Deenvolvimento Espírita (FENE): development and validation of an instrument for assessing the level of spiritual development. Fortaleza: UFC; 2023. Available at: http://repositorio.ufc.br/handle/riufc/74736.
73. Sales TM. Spiritism, mental health, and public health: spiritist therapeutics under discussion. MOJ Public Health. 2023;12(3):145‒150.