Andréa Tenório Correia da Silva

Esgotamento profissional e transtornos mentais comuns em agentes comunitários de saúde

OBJETIVO: Estimar la prevalencia del sindrome de agotamiento profesional y de trastornos mentales comunes en agentes comunitarios de salud, identificando factores asociados. METODOS: Se hizo estudio transversal con 141 agentes comunitarios activos por al menos seis meses en unidades basicas de salud del municipio de Sao Paulo (Sureste de Brasil), en 2006. Los participantes respondieron a tres encuestas: una sobre caracteristicas sociodemograficas, socioeconomicas, de la salud e del trabajo; el Self Reporting Questionnaire; y el Maslach Burnout Inventory, que permite medir tres dimensiones del sindrome del agotamiento profesional: fatiga emocional, despersonalizacion y decepcion. La regresion logistica multivariada fue usada para verificar asociaciones entre variables. RESULTADOS: De los encuestados el 24,1% presentaron sindrome de agotamiento profesional. Niveles moderados o altos de agotamiento profesional fueron observados en 70,9% de los participantes con fatiga emocional, en 34% con despersonalizacion y en 47,5% con decepcion. La prevalencia de trastornos mentales comunes fue de 43,3%. Se observaron asociaciones positivas entre las dimensiones de agotamiento profesional. La presencia de trastorno mental comun se asocio independientemente con mayores niveles de fatiga emocional y decepcion. CONCLUSIONES: La alta frecuencia de niveles intensos de agotamiento profesional y la elevada ocurrencia de trastornos mentales comunes encontrados entre los agentes comunitarios de salud promueven la necesidad de estrategias de intervencion en el cotidiano de estos individuos y de nuevas investigaciones sobre la dimension y determinantes del agotamiento profesional.

Burnout syndrome and common mental disorders among community-based health agents

OBJETIVO: Estimar la prevalencia del sindrome de agotamiento profesional y de trastornos mentales comunes en agentes comunitarios de salud, identificando factores asociados. METODOS: Se hizo estudio transversal con 141 agentes comunitarios activos por al menos seis meses en unidades basicas de salud del municipio de Sao Paulo (Sureste de Brasil), en 2006. Los participantes respondieron a tres encuestas: una sobre caracteristicas sociodemograficas, socioeconomicas, de la salud e del trabajo; el Self Reporting Questionnaire; y el Maslach Burnout Inventory, que permite medir tres dimensiones del sindrome del agotamiento profesional: fatiga emocional, despersonalizacion y decepcion. La regresion logistica multivariada fue usada para verificar asociaciones entre variables. RESULTADOS: De los encuestados el 24,1% presentaron sindrome de agotamiento profesional. Niveles moderados o altos de agotamiento profesional fueron observados en 70,9% de los participantes con fatiga emocional, en 34% con despersonalizacion y en 47,5% con decepcion. La prevalencia de trastornos mentales comunes fue de 43,3%. Se observaron asociaciones positivas entre las dimensiones de agotamiento profesional. La presencia de trastorno mental comun se asocio independientemente con mayores niveles de fatiga emocional y decepcion. CONCLUSIONES: La alta frecuencia de niveles intensos de agotamiento profesional y la elevada ocurrencia de trastornos mentales comunes encontrados entre los agentes comunitarios de salud promueven la necesidad de estrategias de intervencion en el cotidiano de estos individuos y de nuevas investigaciones sobre la dimension y determinantes del agotamiento profesional.

Prevalence and correlates of depressive symptoms among adults living in the Amazon, Brazil: A population-based study

BACKGROUND Depression is an affective disorder and one of the main contributors to the burden of disease worldwide. Our purpose is to estimate the prevalence of depressive symptoms and associated factors in the population of the Manaus Metropolitan Region. METHODS We conducted a population-based, cross-sectional study with a probabilistic three-phase sampling in 2015, based on a previously calculated sample size. Adults living in Manaus and seven inner cities of the metropolitan region were surveyed for depressive symptoms using the Patient Health Questionnaire (PHQ-9) and a cutoff score of ≥ 9. We performed a Poisson regression with robust variance using a hierarchical approach to calculate the prevalence ratio (PR) of depression and 95% confidence intervals (CIs). RESULTS Among 4001 participants (response rate 76%), the prevalence of current depressive symptoms was 7% (95% CI: 6-8%). Depressive symptoms were more frequent in inhabitants of Manaus than in those from the countryside (PR = 6.13, 95% CI: 2.91-12.91); in women than in men (PR = 2.55, 95% CI: 1.96-3.33); in indigenous than in white people (PR = 2.56, 95% CI: 1.24-5.30); and in those with hypertension (PR = 1.47, 95% CI: 1.13-1.92), cardiac disease (PR = 1.62, 95% CI: 1.12-2.33), and poor health status (fair: PR = 5.10, 95% CI: 2.50-10.37; bad: PR = 10.27, 95% CI: 4.92-21.44 very bad: PR = 21.14, CI 95%: 10.16-43.99). High school education (PR = 0.55, 95% CI: 0.32-0.95) and middle class economic status (PR = 0.33, 95% CI: 0.12-0.89) were protective factors. LIMITATIONS Limitations include the lack of measurement of physical activity, religious beliefs, leisure time, and use of alcohol and other drugs since these factors can affect depression and health status. CONCLUSION Seven out of every 100 adults from the Manaus Metropolitan Region have depressive symptoms. This rate is higher in women, individuals living in Manaus, indigenous people, people with hypertension or chronic cardiac disease, and those with a poor health status.

Work-Related Depression in Primary Care Teams in Brazil

OBJECTIVES To identify work-related factors associated with depressive symptoms and probable major depression in primary care teams. METHODS Cross-sectional study among primary care teams (community health workers, nursing assistants, nurses, and physicians) in the city of São Paulo, Brazil (2011-2012; n = 2940), to assess depressive symptoms and probable major depression and their associations with job strain and other work-related conditions. RESULTS Community health workers presented higher prevalence of probable major depression (18%) than other primary care workers. Higher odds ratios for depressive symptoms or probable major depression were associated with longer duration of employment in primary care; having a passive, active, or high-strain job; lack of supervisor feedback regarding performance; and low social support from colleagues and supervisors. CONCLUSIONS Observed levels of job-related depression can endanger the sustainability of primary care programs. Public Health implications. Strategies are needed to deliver care to primary care workers with depression, facilitating diagnosis and access to treatment, particularly in low- and middle-income countries. Preventive interventions can include training managers to provide feedback and creating strategies to increase job autonomy and social support at work.

Generalized anxiety disorder and associated factors in adults in the Amazon, Brazil: A population-based study

BACKGROUND The purpose of this study was to assess the prevalence and associated factors of generalized anxiety disorder (GAD) in adults using the seven-item GAD scale (GAD-7) and to evaluate the properties of the two-item (GAD-2) as a population screening tool. METHODS We carried out a cross-sectional population-based study in the Manaus Metropolitan Region in 2015, Brazil. Adults aged 18 years or more were eligible to participate. We performed probabilistic three-phase sampling and collected sociodemographic and clinical variables. Descriptive statistics and a Poisson regression with robust variance with corrections for complex sampling were used. The accuracy of GAD-2 was assessed using GAD-7 as the gold standard. RESULTS We included 4001 participants. The prevalence of GAD was 8.4% (95% confidence interval 7.6-9.4%) and was significantly associated with self-reported poor health status and presenting depressive symptoms (p < 0.01). GAD-2 sensitivity was 63.9%, and its specificity was 97.4%. LIMITATIONS Because of the cross-sectional design of the study, the results are prone to reverse causality and recall bias. The surveyed people were not questioned about their medical diagnosis of anxiety, access to mental health services, or alcohol, tobacco or other drug use. The screening tools were not validated in the Brazilian or Amazon population. CONCLUSION About eight in 100 adults living in Manaus presented GAD, and it is more prevalent among people with a poorer health status and depression. Because of its low sensitivity, GAD-2 is not useful as a screening tool.

Depression and violent crime: is there a relationship?

ABSTRACT FROM: Fazel S, Wolf A, Change Z, et al. Depression and violence: a Swedish population study. Lancet Psychiatry 2015;2:224–32. Major mental disorders, such as schizophrenia and personality disorder, have been associated with a higher risk of committing violent crime.1 However, the relationship between depression and violent crime is still unclear. Interestingly, some authors have recently presented evidence that this relationship occurs in the opposite direction: individuals with major depression present a higher risk of having homicidal death. For instance, in Sweden, a nationwide cohort found an increased risk of homicidal death in individuals with major depression than in general population (HR=2.61; 95% CI 1.58 to 4.33).2 To clarify this issue, Fazel et al performed two longitudinal studies. In the first study, outpatients with at least two episodes of major depression, according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), were identified from the National …

Agotamiento profesional y trastornos mentales comunes en agentes comunitarios de la salud

OBJETIVO: Estimar la prevalencia del sindrome de agotamiento profesional y de trastornos mentales comunes en agentes comunitarios de salud, identificando factores asociados. METODOS: Se hizo estudio transversal con 141 agentes comunitarios activos por al menos seis meses en unidades basicas de salud del municipio de Sao Paulo (Sureste de Brasil), en 2006. Los participantes respondieron a tres encuestas: una sobre caracteristicas sociodemograficas, socioeconomicas, de la salud e del trabajo; el Self Reporting Questionnaire; y el Maslach Burnout Inventory, que permite medir tres dimensiones del sindrome del agotamiento profesional: fatiga emocional, despersonalizacion y decepcion. La regresion logistica multivariada fue usada para verificar asociaciones entre variables. RESULTADOS: De los encuestados el 24,1% presentaron sindrome de agotamiento profesional. Niveles moderados o altos de agotamiento profesional fueron observados en 70,9% de los participantes con fatiga emocional, en 34% con despersonalizacion y en 47,5% con decepcion. La prevalencia de trastornos mentales comunes fue de 43,3%. Se observaron asociaciones positivas entre las dimensiones de agotamiento profesional. La presencia de trastorno mental comun se asocio independientemente con mayores niveles de fatiga emocional y decepcion. CONCLUSIONES: La alta frecuencia de niveles intensos de agotamiento profesional y la elevada ocurrencia de trastornos mentales comunes encontrados entre los agentes comunitarios de salud promueven la necesidad de estrategias de intervencion en el cotidiano de estos individuos y de nuevas investigaciones sobre la dimension y determinantes del agotamiento profesional.