According to the article, – Given the

According to the article, – Given the alarming incidence of suicide in Puerto Rico, it mentions and discusses how the nursing professional can intervene effectively for the benefit of this population. – Explain how the use of pharmacotherapy can be effective in patients with suicidal thoughts. Article: After years with a steady reduction in reported suicides on the island, 2017 ended with a 29% increase in cases reported by the Department of Health compared to the previous year. After years of a steady reduction in reported suicides on the island, 2017 ended with a 29% increase in cases reported by the Department of Health compared to the previous year. In addition, in the past three months, calls to a government helpline from people who had tried to commit suicide tripled compared to those registered between November 2016 and January 2017. This is part of the picture that emerges from the monthly report published by the Department of Health’s Suicide Prevention Commission. The report indicates that, in 2017, 253 people committed suicide in Puerto Rico, 57 more than the previous year, or an increase of 29%. That report also states that the rate of 7.6 suicides per 100,000 inhabitants in 2017 was the highest since 2013, when the suicide rate was 9. In the same way, the streak of annual reduction in cases that had been consistently recorded for three years until 2016 stopped. Moreover, with the exception of 2013, the trend in the reduction in the incidence of suicide could be observed from 2010 to 2016, which closed with 196 registered suicides and a rate of 5.8. The 2016 numbers were the lowest in 17 years, reported María Coss, educational coordinator of the Commission for the Prevention of Suicide in Health. The same report shows that, in the last four months of 2017, 38% of all cases were recorded in that year. Meanwhile, the 96 suicides between the months of September and December 2017 represent an increase of 34 cases over the same period of the previous year and 22 cases compared to 2015. The hurricane as a factor This whole scenario takes place in the year in which Puerto Rico received the worst hit by a cyclone in decades, but Coss assured that the authorities are not in a position to officially state that the increase in suicides was due to the passage of Hurricane Maria on September 20, 2017. “After Maria, there has been no investigation that would allow me to say with certainty that there is an increase due to the hurricane,” Coss said. The official highlighted that in September, October and November 2017, 27 suicides were reported per month, the same number was recorded in January and May of last year, so that, due to the incidence alone, the relationship with the devastation of the cyclone cannot conclude. He also said that the totals for 2017 do not exceed the totals for years prior to 2014. “It’s regrettable that we saw (in 2017) an increase compared to 2016, but it can be said that we have seen those frequencies in the past five years,” Coss said. In addition, the doctor highlighted that the most recent Health report indicates that seven suicides were reported in January 2018, a much lower number than in previous months. However, Coss said that a study does need to be carried out to confirm or rule out the connection between the increase in suicides in Puerto Rico and the impact of Hurricane Maria. In particular, he indicated that it would be necessary to enter the files of each case at the Institute of Forensic Sciences to analyze the factors present at the time of the suicide. “After research that has been done in the past, such as after Hurricane Katrina (in 2005), there is scientific evidence that yes, in fact, after a natural disaster, more suicides will be reported,” Coss said. “Cases of depression and vulnerable situations can double, especially in children and the elderly,” he added. This was reflected in press reports of the time, such as a story published in “The New York Times” in 2006, which reports that, in the four months after Katrina, the suicide rate in the New Orleans region almost tripled, with an increase from 9 to 26 cases per 100,000 inhabitants. More attempts Although January 2018 saw a reduction of 20 suicides compared to January 2017 -and with those reported the previous month-, a different picture can be seen in the number of people who admitted to trying to commit suicide. The Department of Health reported that the PAS (First Psychosocial Aid) telephone line received 1,075 calls from people who had tried to commit suicide in January of this year alone. That total represents an increase of 696 more than the 379 in January 2017. Meanwhile, in December 2017, the PAS line received 1,002 calls from people who had tried to commit suicide, 796 more than the 206 recorded in December 2016. Also in November 2017, the increase was significant. According to data reported by Salud, out of 297 calls they received in that month of 2016, communications from people who had tried to commit suicide rose to 973 two months after the passage of Hurricane Maria, a difference of 676. In total, in the months of November 2017 to January 2018, PAS 3,050 calls from people with suicidal thoughts, 2,168 more than the 882 recorded in all of 2016. The PAS Line is a service of the Health and Addiction Services Administration (ASSMCA) and serves citizens at a time when they understand that they need preliminary psychosocial monitoring, relief session, crisis counseling and emotional support, coordination of psychiatric and psychological evaluation, tele-liaison and referrals. The records show low numbers for the months of September and October 2017, when telephone services on the island were intermittent and even non-existent in many places. Since the standardization of telephony, call records to the PAS line have increased significantly. In addition to people who tried to commit suicide, the Department of Health report details that, in November 2017, 2,996 people were called “with suicidal ideation”, 1,060 more than the previous year. But the difference in such calls jumped even higher in December 2017, with 3,176 in total, an increase of 2,228 compared to 948 in the same month in 2016. With “suicidal ideation” they also called 3,473 times in January 2018, an increase of 1,085 more than in January of the previous year. It is also noteworthy that overall, PAS received 12,668 more calls in the past three months than the same period a year earlier. Aggravated crisis Although scientific studies are still needed to attribute the increase in suicides, as well as suicide attempts and ideas to the consequences of Hurricane Maria, for psychologist Julio Santana there is no doubt that the cyclone exacerbated the number of suicides on the island. The president of Carlos Albizu University (UCA) also pointed out that this was due to the fact that the hurricane aggravated the crisis of the country’s socio-economic conditions “that guarantee that people find healthy solutions when they face problems in everyday life.” “Before María, there was a marked deterioration due to the high level of unemployment, loss of homes and foreclosures (mortgages), violence linked to unemployment and loss of opportunities. Those conditions that guarantee people’s emotional health were disappearing,” Santana said. “María arrives and adds a level of physical and structural destruction, which generates extraordinary unemployment and causes people to migrate, which generates family and emotional disorganization,” he added. “Although it seems like an escape route, the loss of family members is one of the biggest stressors… Those who stay, their families have been fractured and are left in conditions of greater helplessness and perception of abandonment.” He also said that the lack of electricity service for months becomes a contributing factor because “well-being is when basic aspirations are not met.” “Normally there are conflicts in families, but when you add a stressor of more than five months without electricity, without food, living patterns change… going to bed earlier, looking for gas and spending more money… It makes it more difficult for people to manage everyday life,” he added. Santana advanced part of the findings of a study conducted by researchers from the UCA, which includes visits to communities affected by the hurricane. Through questionnaires, they have found that people in isolated communities who lost their homes have more “suicidal ideation” than other victims, and recalled that it is estimated that the hurricane destroyed 70,000 houses. SCIENCE HEALTH SCIENCE NURSING NURS 2540

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