Percepções de adolescentes de escola pública e de escola privada na cidade de Belém-PA acerca de saúde e doença mental

Estudos sobre saúde mental na adolescência destacam este tema como questão relevante, pois essa faixa etária, além de constituir-se como uma grande parcela da população que precisa e não procura atendimento, é identificada como um grupo etário vulnerável e de risco. A família e a escola têm sido consideradas como fatores de proteção à saúde mental de adolescentes. Sendo assim, precisa-se pensar em formas de intervenção mais eficazes, considerando o contexto familiar, cultural e social destes indivíduos. O objetivo do estudo foi investigar percepções sobre saúde e doença mental de adolescentes de escola pública e de escola privada na cidade de Belém-PA, bem como as principais redes de apoio e estratégias de cuidado utilizadas pelos adolescentes. Realizou-se um estudo transversal, do tipo quantitativo, no qual participaram 60 adolescentes, de ambos os sexos, e seus cuidadores. Os adolescentes tinham idades entre 12 a 17 anos, sendo 30 alunos de escola pública, localizada em um bairro periférico, e 30 de escola privada, localizada em um bairro central, na cidade de Belém-PA. Os cuidadores eram do sexo feminino, com idade entre 25 a 57 anos. Como instrumentos foram utilizados: roteiro de entrevista familiar, roteiro de entrevista com os coordenadores das escolas e questionário sobre saúde e doença mental e sobre serviços de saúde (versão para adolescente). Os resultados dos questionários foram analisados preferencialmente pelo teste do Qui-quadrado e o teste G para amostras independentes. Todo o processamento estatístico foi realizado no software BioEstat versão 5.2. Os resultados obtidos nas entrevistas permitiram a análise de aspectos socioeconômicos e de fatores de risco e de proteção na família dos adolescentes. Os resultados obtidos com os questionários revelaram que as percepções dos adolescentes da escola pública acerca da saúde mental estavam associadas a não ser tão sensível/frágil e a pensar positivo, ser otimista. Na escola privada, estavam associadas a sentir-se equilibrado e ser algo muito importante. Quanto às percepções de doença mental, na escola pública estavam relacionadas ao momento em que o corpo não está bem e a quando profissionais aconselham um tratamento; na escola privada, a ter sentimentos feridos e ser algo que não se percebe logo. Com relação à origem das ideias sobre saúde/doença mental, não houve real diferença entre os grupos. No que tange à religião, houve discordância apenas em relação a cura da doença mental. Como estratégia de enfrentamento, na escola pública esta esteve relacionada a falar com alguém sobre o problema enquanto na escola privada os adolescentes relataram que não procuravam ajuda. A mãe foi apontada como principal na busca de ajuda pelos adolescentes da escola pública; na escola particular, a principal referência foi o médico da família. A principal barreira para os adolescentes da escola pública no acesso ao serviço de saúde mental foi não saber o que o psicólogo/psiquiatra vai fazer com ele, e na escola privada foi não querer ser gozado/caçoado. Nos dois grupos, os principais problemas em saúde mental relatados foram problemas na escola e de comportamento. Os adolescentes de escola privada responderam que somente às vezes sentem-se sozinhos e felizes, enquanto na escola pública, os adolescentes afirmaram que sempre estiveram de bom humor e satisfeitos com a vida. Discute-se a necessidade de promover fatores de proteção à saúde mental de adolescentes.

Meaning of aromatherapy massage in mental health

Objective: To understand the meaning of the aromatherapy massage intervention in mental health for the patient during psychiatric hospitalization.Methods: A qualitative study including 22 participants with a diagnosis of personality disorder hospitalized in a psychiatric unit of a general hospital. We used semi-structured interviews with a guiding question for participants, for whom the aromatherapy massage intervention was performed. The content of the interviews was assessed according to content analysis.Results: Among the study subjects, there was a predominance of females and the majority presented a diagnosis of Emotionally Unstable Personality Disorder. Two categories that emerged were identified from qualitative data: "Identifying the benefits of aromatherapy" and "Enabling self-knowledge."Conclusion: The meaning of the aromatherapy massage intervention was represented by improvements in nursing care and treatment during psychiatric hospitalization, while assisting in the reduction of anxiety symptoms and coping with mental illness.

The Flower Workshop: a social self-organizing practice in mental health nursing

Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP)

Matrix Support in Mental Health: Achievements and Limits in Primary Health Care

Changes in mental health care in the city of Fortaleza (Northeastern Brazil) have a recent historical and political process. Compared to other municipalities of the State of Ceara, which in the early 1990s were already pioneers in the process, Fortaleza has not implemented the changes due to the interests of psychiatric hospitals, of psychiatric outpatient clinics of the public network, and because of the difficulty in managing the new mental health devices and equipment present in Primary Care. In the municipality, the reorganization of mental health actions and services has required that the Primary Care Network faces the challenge of assisting mental health problems with the implementation of Matrix Support. In light of this context, we aimed to evaluate Matrix Support in mental health in Primary Care Units and to identify achievements and limitations in the Primary Care Units with Matrix Support. This study used a qualitative approach and was carried out by means of a case study. We interviewed twelve professionals from the Family Health Teams of four Units with implemented Matrix Support. The analysis of the information reveals that access, decision making, participation and the challenges of implementing Matrix Support are elements that are, in a dialectic way, weak and strong in the reorganization of services and practices. The presence of Matrix Support in Primary Care highlights the proposal of dealing with mental health within the network in the municipality. The process has not ended. Mobilization, awareness-raising and qualification of Primary Care have to be enhanced constantly, but implementation has enabled, to the service and professionals, greater acceptance of mental health in Primary Care.

Methodological contributions towards the study of health care production: lessons from a research study on barriers and access in mental health

This article presents methodological contributions and a conceptual innovation for thinking about the production of health care, stemming from a study on access and barriers in mental health carried out in the municipality of Campinas (Sao Paulo, Brazil). The study used a cartographic approach and, after an initial identification of the most complex cases (on the part of the teams of workers), adopted the users as guides to explore the different levels of production of their lives and to evaluate the possibility of forming a network of existential connections that produce life as a fundamental analyzer of access or barriers to care.

Stigma and higher rates of psychiatric re-hospitalization: Sao Paulo public mental health system

Objective: The aim of this study was to assess re-hospitalization rates of individuals with psychosis and bipolar disorder and to study determinants of readmission. Methods: Prospective observational study, conducted in Sao Paulo, Brazil. One hundred-sixty-nine individuals with bipolar and psychotic disorder in need of hospitalization in the public mental health system were followed for 12 months after discharge. Their families were contacted by telephone and interviews were conducted at 1, 2, 6 and 12 months post-discharge to evaluate readmission rates and factors related. Results: One-year re-hospitalization rate was of 42.6%. Physical restraint during hospital stay was a risk factor (OR = 5.4-10.5) for readmission in most models. Not attending consultations after discharge was related to the 12-month point readmission (OR = 8.5, 95% CI 2.3-31.2) and to the survival model (OR = 3.2, 95% CI 1.5-7.2). Number of previous admissions was a risk factor for the survival model (OR = 6.6-11.9). Family's agreement with permanent hospitalization of individuals with mental illness was the predictor associated to readmission in all models (OR = 3.5-10.9) and resulted in shorter survival time to readmission; those readmitted were stereotyped as dangerous and unhealthy. Conclusions: Family's stigma towards mental illness might contribute to the increase in readmission rates of their relatives with psychiatric disorders. More studies should be conducted to depict mechanisms by which stigma increases re-hospitalization rates.

Influence of psychosocial risk factors on the trajectory of mental health problems from childhood to adolescence: a longitudinal study

Background Longitudinal epidemiological studies involving child/adolescent mental health problems are scarce in developing countries, particularly in regions characterized by adverse living conditions. We examined the influence of psychosocial factors on the trajectory of child/adolescent mental health problems (CAMHP) over time. Methods A population-based sample of 6- to 13-year-olds with CAMHP was followed-up from 2002–2003 (Time 1/T1) to 2007–2008 (Time 2/T2), with 86 out of 124 eligible children/adolescents at T1 being reassessed at T2 (sample loss: 30.6%). Outcome: CAMHP at T2 according to the Child Behavior Checklist/CBCL’s total problem scale. Psychosocial factors: T1 variables (child/adolescent’s age, family socioeconomic status); trajectory of variables from T1 to T2 (child/adolescent exposure to severe physical punishment, mother exposure to severe physical marital violence, maternal anxiety/depression); and T2 variables (maternal education, child/adolescent’s social support and pro-social activities). Results Multivariate analysis identified two risk factors for child/adolescent MHP at T2: aggravation of child/adolescent physical punishment and aggravation of maternal anxiety/depression. Conclusions The current study shows the importance of considering child/adolescent physical punishment and maternal anxiety/depression in intervention models and mental health care policies.

Work-related behavior and experience patterns and predictors of mental health in German physicians in medical practice

Background and Objectives: Work-related stress and burnout among physicians are of increasing relevance. The aim of this study was to investigate work-related behavior and experience patterns and predictors of mental health of physicians working in medical practice in Germany. Methods: We surveyed a stratified, random sample of 900 physicians from different specialties. The questionnaire included the standardized instruments Work-related Behavior and Experience Pattern (AVEM) and the Short Form-12 Health Survey (SF-12). Results: Only one third of physicians reported high or very high general satisfaction with their job, but 64% would choose to study medicine again. Only 18% of physicians presented a healthy behavior and experience pattern. Almost 40% presented a pattern of reduced motivation to work, 21% were at risk of overexertion, and 22% at risk for burnout. Willingness to study medicine again, fulfilled job expectations, professional years, marital status, and behavior patterns were significant predictors of mental health and accounted for 35.6% of the variance in mental health scores. Job-related perceptions also had a significant effect on burnout. Conclusions: The strong influence of work-related perceptions suggests a need for realistic expectation management in medical education, as well as support in stress management and coping strategies during medical training.

Aging and Mental Health: Business as Usual?

Cautions that in developing training models in mental health and aging, psychologists must not overlook what experience has taught them about mental health intervention or what they know already about older adults. It is suggested that a life-span developmental view complements a community and preventive approach to the mental health needs of the elderly. Creation of a separate subspecialty of clinical geropsychology will not effectively serve older adults. What is needed is a synthesis ofalready existing expertise in areas such as life-span development, clinical psychology, and community psychology. This synthesis provides a conceptual foundation and set of intervention approaches on which to base training programs in mental health and aging.

The efficacy of psychological interventions for infertile patients: a meta-analysis examining mental health and pregnancy rate

BACKGROUND: Psychological interventions for infertile patients seek to improve mental health and increase pregnancy rates. The aim of the present meta-analysis was to examine if psychological interventions improve mental health and pregnancy rate among infertile patients. Thus, controlled studies were pooled investigating psychological interventions following the introduction of assisted reproductive treatments (ART). METHODS: The databases of Medline, PsycINFO, PSYNDEX, Web of Science and the Cochrane Library were searched to identify relevant articles published between 1978 and 2007 (384 articles). Included were prospective intervention studies on infertile patients (women and men) receiving psychological interventions independent of actual medical treatment. The outcome measures were mental health and pregnancy rate. A total of 21 controlled studies were ultimately included in a meta-analysis comparing the efficacy of psychological interventions. Effect sizes (ES) were calculated for psychological measures and risk ratios (RR) for pregnancy rate. RESULTS: The findings from controlled studies indicated no significant effect for psychological interventions regarding mental health (depression: ES 0.02, 99% CI: -0.19, 0.24; anxiety: ES 0.16, 99% CI: -0.10, 0.42; mental distress: ES 0.08, 99% CI: -0.10, 0.51). Nevertheless, there was evidence for the positive impact of psychological interventions on pregnancy rates (RR 1.42, 99% CI: 1.02, 1.96). Concerning pregnancy rates, significant effects for psychological interventions were only found for couples not receiving ART. CONCLUSIONS: Despite the absence of clinical effects on mental health measures, psychological interventions were found to improve some patients' chances of becoming pregnant. Psychological interventions represent an attractive treatment option, in particular, for infertile patients who are not receiving medical treatment.

Mental health-care utilization in survivors of childhood cancer and siblings: the Swiss childhood cancer survivor study

PURPOSE We aimed to (1) describe the utilization of mental health-care in survivors and siblings, the association with severity of distress, and visits to other professionals in distressed survivors not utilizing mental health-care; and (2) identify factors associated with utilization of mental health-care in distressed survivors. METHODS Within the Swiss Childhood Cancer Survivor Study, we sent postal questionnaires to all participants aged <16 years at diagnosis (1976-2003), who survived ≥5 years after diagnosis and were aged ≥16 years at study. Survivors and siblings could indicate if they utilized mental health-care in the past year. Psychological distress was assessed with the Brief Symptom Inventory-18 (BSI-18). Participants with scores T ≥ 57 on two of three scales or the Global Severity Index were considered distressed. RESULTS We included 1,602 survivors and 703 siblings. Overall, 160 (10 %) and 53 (8 %), utilized mental health-care and 203 (14 %) and 127 (14 %) were considered distressed. Among these, 69 (34 %) survivors and 20 (24 %) siblings had utilized mental health-care. Participants with higher distress were more likely to utilize mental health-care. Distressed survivors not utilizing mental health-care were more likely to see a medical specialist than nondistressed. In the multivariable regression, factors associated with utilizing mental health-care were higher psychological distress and reporting late effects. CONCLUSIONS Our results underline the importance of developing interventional programs and implementing psychological screening in follow-up of survivors. It is also important to systematically address siblings' needs. In follow-up, patients at risk should be informed about existing possibilities or advised to visit mental health professionals.

Behavioral Outcomes of Home-Based Services for Children and Adolescents with Serious Emotional Disorders

The current study evaluates the effectiveness of an intensive home-based treatment program, Families First, on the behaviors of children and adolescents suffering from mental disorders and being at risk for out-ofi home placement. The sample included 85 youngsters and their families from a semi-rural community. The Diagnostic Interview for Children and Adolescents-Revised (DICA-R) was administered to the children, and the Child Behavior Checklist (CBCL) was completed by a parent at pretreatment and posttreatment. The families participated in a 4-6 week, intensive home intervention where crisis intervention, social support services, and needed psychological services were offered. The results indicated that both externalizing and internalizing behavior problems in youngsters with different diagnoses of mental disorders were significantly reduced at posttreatment as indicated by their CBCL scores. Furthermore, youngsters with a diagnosis of Oppositional Defiant Disorder seemed to benefit the most, as evidenced by the improved scores on most subscales of the CBCL. Youngsters with mood disorders and conduct disorders seemed to benefit in their most deficient areas, internalizing behavior problems and delinquent behaviors, respectively. Finally, after participating in Families First, more than half of the youngsters in the sample were able to stay home with their families

Intensive Family Preservation in Children's Mental Health: Predictors of Placement

This article examines the predictors of placement following IFPSfor a sample of child mental health service recipients and their families. Risk and protective factors vary depending on the time frame under consideration. Immediately following service, children 's level of Social/Legal functioning, a previous group home placement, and the presence of mental health problems for other family members increase risk of placement, while the number of follow-up services serves to lessen risk. Three to six months after service, the presence of a child behavior presenting problem and a projected placement in foster care serve as protective factors, while two service targets, alcohol monitoring and time management, serve to increase risk. Appropriate use of results for program design and for structuring access to services is discussed.

Community participation in health services

This study critically analyzes and synthesizes community participation (CP) theory across disciplines, defining and beginning to map out the elements of CP according to a preliminary framework of structure, process, intermediate outcomes, and ultimate outcomes. The first study component sought to determine the impact of Sight N' Soul, a CP project utilizing neighborhood health workers (NHWs), on appointment missing in an indigent urban African-American population. It found that persons entering the vision care system through contact with an NEW were about a third less likely to miss an appointment than those persons entering the system through some other avenue. While theory in this area remains too poorly developed to hypothesize causal relationships between structure, process, and outcomes, a summary of the elements of Sight N' Soul's structure and process both developed the preliminary framework and serves as a first step to mapping these relationships. The second component of the study uncovered the elements of structure and process that may contribute to a sustained egalitarian partnership between community people and professionals, a CP program called Project HEAL. Elements of Project HEAL's structure and process included a shared belief in the program; spirituality; contribution, ownership, and reciprocation; a feeling of family; making it together; honesty, trust, and openness about conflict; the inevitability of uncertainty and change; and the guiding interactional principles of respect; love, care, and compassion; and personal responsibility. The third component analyzed the existing literature, identifying and addressing gaps and inconsistencies and highlighting areas needing more highly developed ethical analysis. Focal issues include the political, economic, and historical context of CP; the power of naming; the issue of purpose; the nature of community; the power to muster and allocate resources; and the need to move to a systems view of health and well-being, expanding our understanding of the universe of potential outcomes of CP, including iatrogenic outcomes. Intermediate outcomes might include change in community, program, and individual capacity, as well as improved health care delivery. Ultimate outcomes include increased positive interdependencies and opportunities for contribution; improved mental, physical, and spiritual health; increased social justice; and decreased exploitation. ^

Towards a new model of care: integrating mental health, substance use, and somatic care

Although research and clinical interventions for patients with dual disorders have been described since as early as the 1980s, the day-to-day treatment of these patients remains problematic and challenging in many countries. Throughout this book, many approaches and possible pathways have been outlined. Based upon these experiences, some key points can be extracted in order to guide to future developments. (1) New diagnostic approaches are warranted when dealing with patients who have multiple problems, given the limitations of the current categorical systems. (2) Greater emphasis should be placed on secondary prevention and early intervention for children and adolescents at an increased risk of later-life dual disorders. (3) Mental, addiction, and somatic care systems can be integrated, adopting a patient-focused approach to care delivery. (4) Recovery should be taken into consideration when defining treatment intervention and outcome goals. (5) It is important to reduce societal risk factors, such as poverty and early childhood adversity. (6) More resources are needed to provide adequate mental health care in the various countries. The development of European guidance initiatives would provide benefits in many of these areas, making it possible to ensure a more harmonized standard of care for patients with dual disorders.