Violência autoprovocada na população brasileira: uma revisão de escopo

Abstract

Objective: To analyze publications on self-inflicted violence that address the relationship between causality and perpetration in the Brazilian population. Method: This was a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) protocol. The study question was: What is the relationship between the involvement and causality of self-harm in the Brazilian population? It was performed using the PCC strategy (P: population - Brazilian; C: concept - self-inflicted violence; C: context - causal relationship and commission). The selection of studies took place between June and July 2023, in the Virtual Health Library (VHL) databases and the CAPES journal portal using the following indexed descriptors, in English, from the Decs/ Mesh platform (https://decs.bvsalud.org/): Self-Injurious Behavior; Suicide; Violence; Causality; Health Policy; Social Determinants of Health; Risk Factors; Brazil; Suicide, Assisted, combined by Boolean markers. The articles were analyzed using Bardin's content analysis; three Thematic Units were identified: the first, Causality - Intrinsic Factors; the second, Causality - Extrinsic Factors; and the third, Commitment. Results: Thirteen articles were included, in which the following were identified as intrinsic factors: being a woman, being at a transitional age (either from childhood to adolescence or from adolescence to young adulthood, women earlier and men later), being black, having a low level of education, having a depression or anxiety disorder, substance abuse, having a mental disorder, previous attempts, sequelae of chronic illnesses, loneliness, addiction to digital platforms, immaturity, passion for risk, search for popularity, challenges and monetization of life (especially in adolescents). The predominant extrinsic factors were having difficulty accessing health services, inadequate care, unpreparedness on the part of health professionals and/or the school, unemployment, financial dependence on another or a family with a family income of less than the minimum wage, the pandemic process, increased screen time, social distancing, family history of suicide, violence at school, family violence (especially in childhood), distancing from the family nucleus and/or school due to gender identity. The forms of commitment resulting from intrinsic and extrinsic intersectionalities were linked in 7 articles to suicidal behavior (ideation, attempt and suicide) and in 7 articles to non-suicidal self-injury behavior (self-mutilation). The gaps in knowledge identified were the lack of representation of vulnerable populations (indigenous people, police officers, health professionals, the elderly, trans and non-binary genders and even white men, autism). Conclusion: A complex network of factors interacts and influences self-harm, therefore, there is no way to define the direct cause that precipitated the act, but the sample of articles revealed factors that predispose to increased rates. Social determination was reinforced by the data found, exposing vulnerabilities and the need for public policies in the face of social inequalities. It also highlights the importance of primary health care services and the preparation, training and appreciation of professionals who work in the territories where life happens. Thus, this study has a significant social impact by mapping national publications on the subject as well as pointing out the gaps in these studies, identifying possible populations for new studies.