Lúcia Abelha

Satisfação com o trabalho e impacto causado nos profissionais de serviço de saúde mental

OBJECTIVE: To assess job satisfaction and work impact among providers of a mental health service and their potential association with sociodemographic and job-related variables. METHODS: A cross-sectional study was carried out in 321 employees of a long-stay mental health service in Rio de Janeiro, Southeastern Brazil, in 2005. The following instruments were applied: the WHO Mental Health Services Satisfaction and Work Impact scales, and a questionnaire on sociodemographic and job features. Variable associations were analysed using the Mann-Whitney, Kruskal-Wallis, Chi-square tests and multiple linear regression. RESULTS: The mean score of satisfaction was 3.29 (SD=0.64) and the mean score for work impact was 1.77 (SD=0.62). Of all respondents, 61.8% reported a moderate level of satisfaction. Job satisfaction was positively associated with increasing age, lower schooling, being a non-governmental organization employee, developing non-patient-related activities, being involved in an innovative project. The highest levels of work impact were observed among civil servants, young people and females. CONCLUSIONS: Most features associated to the lowest levels of job satisfaction were associated to the highest levels of work impact. Despite the moderate level of satisfaction among providers, there is an evident need for policy changes, mainly those related to increasing availability of supplies and human resources and building restoration.

Evaluation of social disablement, psychiatric symptoms and autonomy in long-stay psychiatric patients

INTRODUCAO: No Brasil ainda sao escassos os dados sobre limitacoes no comportamento social, sintomas psiquiatricos e habilidades de vida independente. Nesse sentido foi realizado um estudo seccional em uma populacao de 881 pacientes psiquiatricos de longa permanencia. METODOLOGIA: Foram coletados dados de todos os pacientes residentes no Instituto Municipal Juliano Moreira, utilizando tres instrumentos: Avaliacao das Limitacoes no Comportamento Social (SBS-BR), Brief Psychiatric Rating Scale (BPRS) e o Inventario de Habilidades de Vida Independente para Pacientes Psiquiatricos - (ILSS-BR). RESULTADOS: Do total de pacientes, 75% apresentaram pouca habilidade de vida independente, score < 2, e limitacoes no comportamento social, especialmente nos itens: cuidados pessoais (50,9%), comunicacao espontânea (46,2%) e retardo psico-motor (hipoatividade) (37,5%); 15.1% dos pacientes com esquizofrenia apresentaram sintomas graves de alucinacoes, delirios e desorganizacao conceitual; 11.5% dos pacientes esquizofrenicos nao apresentaram sintomatologia psiquiatrica, no ultimo mes, e 16% nao apresentaram limitacoes no comportamento social. CONCLUSAO: 50% dos pacientes tem mais de 65 anos e vivem na Instituicao por mais de 38 anos. Apresentam altas taxas de problemas no comportamento e pouca autonomia. Os dados sugerem a importância de programas especificos para estes pacientes. Alem disso, existe um grupo de pacientes sem sintomas psiquiatricos, com bom grau de autonomia e sem limitacoes no comportamento social que poderia viver em residencias terapeuticas na comunidade.

Depressão durante a gestação: um estudo sobre a associação entre fatores de risco e de apoio social entre gestantes

A ausencia de apoio social e outros fatores podem tornar gestantes mais suscetiveis a ocorrencia de transtornos mentais como a depressao. O objetivo deste estudo foi investigar a associacao entre apoio social percebido e prevalencia de depressao em gestantes atendidas em uma unidade basica de saude de Nova Iguacu, Rio de Janeiro. Participaram dele 100 gestantes, das quais foram verificadas as caracteristicas sociodemograficas, condicoes medicas/obstetricas, eventos estressantes e apoio social. A depressao foi avaliada pela Composite International Diagnostic Interview. A prevalencia da depressao na gravidez foi 18% (IC95% 12,2-23,8), sendo os fatores associados na analise final: estar solteira, desempregada, possuir historia anterior de depressao e tabagismo. Houve relacao entre a falta de apoio social e a depressao na analise inicial (p<0,05). A ausencia de apoio de informacao e interacao durante o periodo pre-natal, e sua associacao inicial com a depressao, evidencia a fragilidade do servico de saude no atendimento integral as gestantes. Nossos resultados demonstram que intervencoes psicossociais e politicas sociais deveriam ser implementadas para esta populacao.

Development of Mental Health Services in a Major City in Latin America: Santiago

Two health systems coexist in Chile, with 80% of the population belonging to the public system, supported by general taxation and workers’ regular contributions, and 18% to the private health sector, financed by copayments and prepaid insurance plans, with varied coverage and costs, depending on the characteristics of each client and plan. In 1990, the public sector initiated the formation of mental health service networks based on the community-centered model of care. In the capital city of Santiago, there are currently 147 primary care centers, 35 secondary-level community mental health centers (COSAMs), 8 day hospitals, and 7 short-stay psychiatric services, which serve approximately six million people. Primary care centers resolve around 85% of mental health complaints, typically common mental disorders, while more complex and chronic conditions are referred to COSAMs. However, problems persist in the detection and management of certain disorders, such as psychotic episodes. The lack of effective community-based psychosocial interventions involving users’ support networks, as well as prevalent stigma, has made it difficult to achieve treatment adherence and full social inclusion. R. Alvarado (*) • S. Schilling Mental Health Unit, School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile e-mail: ralvarado@med.uchile.cl; shschilling@gmail.com L. Abelha • G.M. Lovisi Institute of Studies in Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil e-mail: lucia.abelha@gmail.com; giovannimlovisi@gmail.com; glovisi@uol.com.br # Springer Nature Singapore Pte Ltd. 2016 P. Munk-Jorgensen et al. (eds.),Mental Health and Illness in the City, Mental Health and Illness Worldwide 1, DOI 10.1007/978-981-10-0752-1_20-1 1 This chapter focuses specifically on mental health service developments in Santiago, while analyzing future challenges, related to incorporating psychosocial interventions into the care model, increasing capacity to detect mental health cases early on in their evolution, and orienting policies toward the promotion of the population’s mental health and subjective well-being.