CONTEXT AND OBJECTIVE: Knowledge of socioeconomic impact of attempted suicide may sensitize managers regarding prevention strategies. There are no published data on this in Brazil. The aim here was to describe the direct and indirect costs of care of hospitalized cases of attempted suicide and compare these with the costs of acute coronary syndrome cases. DESIGN AND SETTING: Cost-of-illness study at a public university hospital in Brazil. METHOD:The costs of care of 17 patients hospitalized due to attempted suicide were compared with those of 17 acute coronary syndrome cases at the same hospital, over the same period. The direct costs were the summation of the hospital and out-of-hospital costs resulting from the event, determined from the medical records. The indirect costs were estimated through the human capital lost. The Mann-Whitney test and analysis of covariance (ANCOVA) with transformation adjusted for age were used for comparisons. RESULTS:The average costs per episode of attempted suicide were: direct cost, US$ 6168.65; indirect cost, US$ 688.08; and total cost, US$ 7163.75. Comparative analysis showed a difference between the indirect costs to family members, with significantly higher costs in the attempted suicide group (P = 0.0022). CONCLUSION:The cost of care relating to attempted suicide is high and the indirect cost to family members reinforces the idea that suicidal behavior not only affects the individual but also his social environment. RESUMO

In the case reported here, the absence of intention to lose weight and body-image distortion was initially neglected. Depressive symptoms, personality traits, familial relationship and ambivalence on the perspective of nutritional recovery were overestimated at the expense of clinical history and vomiting characteristics, leading to the initial misdiagnosis.We thus conclude that, when assessing patients with a hypothetical ED, psychopathological symptoms must always be carefully evaluated. The exclusion of organic etiology must be a priority, even when the need of psychiatric and psychotherapeutic interventions is evident. In suspected AN cases without selfinduced vomiting, idiopathic achalasia must always be excluded before the final diagnosis.