Conocimientos y prácticas de pediatras paraguayos sobre depresión e ideación suicida en niños y adolescentes
DOI:
https://doi.org/10.53732/rccsalud/e8953Palabras clave:
salud mental, suicidio, ideación suicida, niños, adolescentes, pediatrasResumen
Introducción. La depresión y la conducta suicida en niños y adolescentes constituyen problemas crecientes de salud pública. Los pediatras suelen ser el primer punto de contacto asistencial, pero las limitaciones formativas pueden dificultar la detección precoz y el abordaje adecuado. Objetivo. Explorar los conocimientos, prácticas clínicas y barreras percibidas por pediatras en Paraguay respecto a la evaluación y el manejo de la depresión e ideación suicida en población infanto-juvenil. Materiales y Métodos. Estudio observacional, exploratorio y transversal realizado entre abril y agosto de 2025 mediante cuestionario estructurado autoadministrado aplicado a pediatras y residentes en ejercicio. Se evaluaron variables sociodemográficas, nivel de conocimiento, prácticas de cribado y manejo, y barreras percibidas. Se estableció validez de contenido por jueces expertos y adecuada consistencia interna (α ≥ 0,75). Se efectuaron análisis descriptivos y pruebas no paramétricas. Resultados. Participaron 82 pediatras (edad media 46 ± 11 años; 86,6% mujeres). El puntaje medio de conocimiento fue 3,43/6 y solo el 28 % alcanzó niveles altos. El 34,1% carecía de formación formal en salud mental. Aunque el 75,6% atendió casos de ideación o intento suicida, solo el 11% evaluaba síntomas depresivos frecuentemente y el 29,3% empleaba herramientas estandarizadas. La derivación urgente fue la conducta predominante (85,4%). La formación durante la residencia se asoció con mayor conocimiento (p = 0,028). Conclusión. Existe una brecha entre experiencia clínica y capacitación formal que limita la detección sistemática del riesgo suicida, lo que evidencia la necesidad de fortalecer la formación y estandarizar protocolos en pediatría.
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Castaldelli-Maia JM, Ventriglio A, Torales J. The global prevalence of mental disorders among adolescents: Focus on sex, regional and socio-demographic differences. Int Rev Psychiatry. 2025:1-11. https://doi.org/10.1080/09540261.2025.2573752
Arnone D, Karmegam SR, Östlundh L, Alkhyeli F, Alhammadi L, Alhammadi S, et al. Risk of suicidal behavior in patients with major depression and bipolar disorder - A systematic review and meta-analysis of registry-based studies. Neurosci Biobehav Rev. 2024;159:105594. https://doi.org/10.1016/j.neubiorev.2024.105594
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789-1858. https://doi.org/10.1016/S0140-6736(18)32279-7
Torales J, Barrios I, Melgarejo O, Tullo-Gómez JE, Ruiz Díaz N, O'Higgins M, et al. Suicides among adults in Paraguay: An 18-year national exploratory study (2004-2022). Int J Soc Psychiatry. 2023;69(7):1641-1648. https://doi.org/10.1177/00207640231169650
Santacruz E, Duarte-Zoilan D, Benitez Rolandi G, Cañete F, Smits D, Barengo NC, et al. Epidemiology of Suicide Mortality in Paraguay from 2005 to 2019: A Descriptive Study. Int J Environ Res Public Health. 2024;21(3):277. https://doi.org/10.3390/ijerph21030277
Kelly M, Bath E, McNeill-Johnson A, Barnert E. A call to action: the pivotal role of pediatricians in addressing the mental health crisis among youth in custody. Pediatr Res. 2025;97(7):2205-2207. https://doi.org/10.1038/s41390-024-03659-6
Hua LL, Lee J, Rahmandar MH, Sigel EJ; Committee on Adolescence; Council on Injury, Violence, and Poison Prevention. Suicide and Suicide Risk in Adolescents. Pediatrics. 2024;153(1):e2023064800. https://doi.org/10.1542/peds.2023-064800
US Preventive Services Task Force; Mangione CM, Barry MJ, Nicholson WK, Cabana M, Chelmow D, et al. Screening for Depression and Suicide Risk in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;328(15):1534-1542. https://doi.org/10.1001/jama.2022.16946
Cafferty R, Grupp-Phelan J, Anthony B. Children and Adolescents With Suicidal Ideation and the Emergency Department. JAMA. 2024;331(3):193-194. https://doi.org/10.1001/jama.2023.26291
Maldonado-Ontiveros DJ, Ruiz-Jaramillo MC, López-Vargas L. El pediatra y la salud mental en la historia clínica: un estudio exploratorio. Arch Invest Pediatr Mex. 2024;16(2):21-28.
Green C, Gottschlich EA, Burr WH. A National Survey of Pediatricians' Experiences and Practices With Suicide Prevention. Acad Pediatr. 2023;23(7):1403-1410. https://doi.org/10.1016/j.acap.2023.01.010
Peters-Corbett A, Parke S, Bear H, Clarke T. Barriers and facilitators of implementation of evidence-based interventions in children and young people's mental health care - a systematic review. Child Adolesc Ment Health. 2024;29(3):242-265. https://doi.org/10.1111/camh.12672
Torales J, Barrios I. Diseño de investigaciones: algoritmo de clasificación y características esenciales. Med. clín. soc. 2023;7(3):210–235. https://doi.org/10.52379/mcs.v7i3.349
Olson AL, Kelleher KJ, Kemper KJ, Zuckerman BS, Hammond CS, Dietrich AJ. Primary care pediatricians' roles and perceived responsibilities in the identification and management of depression in children and adolescents. Ambul Pediatr. 2001;1(2):91-8. https://doi.org/10.1367/1539-4409(2001)001<0091:pcprap>2.0.co;2
Diamond GS, Herres JL, Krauthamer Ewing ES, Atte TO, Scott SW, Wintersteen MB, et al. Comprehensive Screening for Suicide Risk in Primary Care. Am J Prev Med. 2017;53(1):48-54. https://doi.org/10.1016/j.amepre.2017.02.020
Scivoletto S, Fondello MA, Otoch LN, Celeri EHRV, Caetano SC, Graeff-Martins AS, et al. Child and adolescent psychiatry training in Brazil, Argentina, Uruguay and Chile: current panorama and future challenges. Eur Child Adolesc Psychiatry. 2020;29(1):71-81. https://doi.org/10.1007/s00787-019-01454-x
Fowler FJ Jr. Survey Research Methods. 5th ed. London: SAGE Publications; 2013.
Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer. Front Public Health. 2018;6:149. https://doi.org/10.3389/fpubh.2018.00149
DeVellis RF, Thorpe CT. Scale development: Theory and applications. 4th ed. Thousand Oaks (CA): SAGE Publications; 2021.
Lawshe CH. A quantitative approach to content validity. Pers Psychol. 1975;28(4):563-75. https://doi.org/10.1111/j.1744-6570.1975.tb01393.x
Faytong-Haro M, Camacho-Leon G, Araujo-Contreras R, Gallegos S, Mautong H, Robles-Velasco K, et al. Healthcare attitudes toward depression in Latin America: a latent class analysis from Argentina, Chile, Ecuador, Peru, and Venezuela using the Spanish-validated revised depression attitude questionnaire (SR-DAQ). Int J Equity Health. 2025;24(1):249. https://doi.org/10.1186/s12939-025-02612-1
Kiger ME, Fowler L, Eviston M, Cook A, Forbush J, Nelson S, et al. A Case-Based, Longitudinal Curriculum in Pediatric Behavioral and Mental Health. MedEdPORTAL. 2024;20:11400. https://doi.org/10.15766/mep_2374-8265.11400
Green CM, Leyenaar JK, Nuncio B, Leslie LK. Where Do Future Pediatricians Learn Behavioral and Mental Health Skills? Acad Pediatr. 2021;21(7):1288-1296. https://doi.org/10.1016/j.acap.2021.04.015
Harris E, Bowden J, Greiner E, Duby JC. Mental Health Training in Pediatric Residency: Where Can We Go? J Pediatr. 2019;211:4-6. https://doi.org/10.1016/j.jpeds.2019.05.075
Doan TT, DeJonckheere M, Wright DR, Hutton DW, Prosser LA. Preferences and experiences of pediatricians on implementing national guidelines on universal routine screening of adolescents for major depressive disorder: A qualitative study. Compr Psychiatry. 2023;127:152412. https://doi.org/10.1016/j.comppsych.2023.152412
Wellen BCM, Wright NM, Bickford MA, Bakken EH, Riley AR. Integrated behavioral health services in pediatric primary care and emergency department utilization for suicide risk. Front Psychiatry. 2023;14:1241642. https://doi.org/10.3389/fpsyt.2023.1241642
Schweitzer J, Bird A, Bowers H, Carr-Lee N, Gibney J, Schellinger K, et al. Developing an innovative pediatric integrated mental health care program: interdisciplinary team successes and challenges. Front Psychiatry. 2023;14:1252037. https://doi.org/10.3389/fpsyt.2023.1252037
Davis M, Rio V, Farley AM, Bush ML, Beidas RS, Young JF. Identifying Adolescent Suicide Risk via Depression Screening in Pediatric Primary Care: An Electronic Health Record Review. Psychiatr Serv. 2021;72(2):163-168. https://doi.org/10.1176/appi.ps.202000207
Pan American Health Organization. A New Agenda for Mental Health in the Americas: Report of the Pan American Health Organization High-Level Commission on Mental Health and COVID-19. Washington, D.C.: PAHO; 2023. https://iris.paho.org/handle/10665.2/57671.
Horowitz LM, Bridge JA, Tipton MV, Abernathy T, Mournet AM, Snyder DJ, et al. Implementing Suicide Risk Screening in a Pediatric Primary Care Setting: From Research to Practice. Acad Pediatr. 2022;22(2):217-226. https://doi.org/10.1016/j.acap.2021.10.012














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