Sabrina Stefanello

Saúde mental na atenção primária à saúde: estudo avaliativo em uma grande cidade brasileira

Primary Healthcare (PHC) is internationally acknowledged to be responsible for dealing with most community health problems, including mental health issues. The scope of this work was to evaluate the links between primary care and mental health in areas of high social vulnerability in a large Brazilian city (Campinas, State of Sao Paulo) using parameters defined in this study. Evaluative and participative - mainly qualitative - research, was conducted. Two groups were defined by cluster technique: one group of Basic Health Units with a higher degree of innovative strategies and another with a lower level of innovation, and the two were then compared. Matrix support was observed as a powerful tool to define workflows, to qualify the teams and to promote joint and shared care. The strategic role of community health agents was seen to identify potential benefits and listen more closely to the populations needs. Health promotion practices are not consolidated as yet. When innovative strategies take the professionals into extra-mural activities, users acknowledge and occupy new spaces, with actions that are different from the traditional complaint-behavior model.

Psychiatric comorbidity and suicidal behavior in epilepsy: A community-based case-control study

Purpose:  To provide information about psychiatric comorbidity and suicidal behavior in people with epilepsy compared to those without epilepsy from a community sample in Brazil.

Quais são os recentes achados clínicos sobre a associação entre depressão e suicídio

OBJECTIVE Suicide is one of the leading causes of mortality worldwide, especially among young subjects. Suicide is considered the outcome of a multidimensional and complex phenomenon, which is a result of the interaction between several factors. The association between psychopathology and suicide has been extensively investigated. Major depression plays an important role among the psychiatric diagnoses associated with suicide. This finding seems to be confirmed by different study designs, and in distinct populations. The present paper aims to briefly review the recent findings regarding the suicide-related clinical features of depression. Moreover, strategies for suicide prevention were also reviewed. REVIEW Recent references were identified and grouped in order to illustrate the main contributions about depression and suicide. Briefly, the literature review stresses the high prevalence of major depression among subjects presenting suicide behaviors. Psychopathological traits, such as aggression and impulsivity play a relevant role in triggering suicidal behaviors. Strategies for suicide prevention were also reviewed in Brazil and internationally. In general, detection and treatment are effective in reducing suicide rates. CONCLUSION Studies regarding suicide behaviors have had a pragmatic approach, and generated a large body of evidence about correlates of suicide. However, these studies have not been able to provide a consistent theoretical explanation for this phenomenon. The recent adoption of modern strategies represents a possibility of enhancing the research capability of such studies. In order to be clinically useful, findings should make it possible to deepen the understanding over the experience of a suicidal person, as well as to design specific strategies for prevention and treatment in population subgroups.

Suicidal thoughts in epilepsy: A community-based study in Brazil

Epilepsy has been associated with increased risk of suicide; however, few studies have examined the relationship between epilepsy and suicidal behavior. The aims of this study were to evaluate the frequency of suicidal behavior in people with epilepsy and to identify characteristics that are associated with suicidal ideation in epilepsy. Of 171 people with epilepsy identified in a previous survey, 139 were included. A structured interview was conducted, and a second psychiatric evaluation was scheduled for those who agreed. The frequencies of suicidal thoughts, plans, and attempts during lifetime were 36.7, 18.2, and 12.1%, respectively. The following conditions were strongly associated with suicidal thoughts: anxiety (OR=3.3, 95% CI=1.4-7.5, P=0.001), depression (OR=4.8, 95% CI=1.9-12.5, P=0.001), and two or more standardized psychiatric diagnoses (OR=21.6, 95% CI=4.4-105.9, P<0.0001). Although specific characteristics of epilepsy were found to be related to suicidal thoughts, psychiatric diseases also play an essential role.

Factors associated with repeated suicide attempts. Preliminary results of the WHO Multisite Intervention Study on Suicidal Behavior (SUPRE-MISS) from Campinas, Brazil.

BACKGROUND This study compares sociodemographic and clinical characteristics of 102 first-time hospital-treated suicide attempters (first-evers) with a group of 101 repeat suicide attempters (repeaters) consecutively admitted to a general hospital in Brazil, during the intake phase of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS). AIMS To compare sociodemographic and clinical characteristics of first-time hospital-treated suicide attempters (first-evers) with a group of repeat suicide attempters (repeaters). METHODS A standardized interview and psychometric scales were administered to all patients. RESULTS Repetition was associated with being of female sex (OR = 2.7; 95% confidence interval (CI) = 1.2-6.2), a housewife (OR = 3.8; 95% CI = 1.2-11.8), and having a score above median on the Beck Depression Inventory (OR = 5.2; 95% CI = 1.7-15.6). CONCLUSIONS The findings suggest that repeaters, namely, depressed housewives who have attempted suicide previously, need specific treatment strategies in order to avoid future suicide attempts.

Depression and anxiety in a community sample with epilepsy in Brazil

OBJECTIVE To estimate the frequency of depression/anxiety and to establish the social, epilepsy and psychiatric characteristics in individuals with epilepsy. METHOD A cross-sectional study was employed to evaluate 153 subjects with epilepsy who were identified in a previous community-based survey. First, a structured interview was conducted, followed by a psychiatric evaluation. Subjects with depression were compared to those without, and subjects with anxiety were compared to those without. RESULTS The prevalence of anxiety and depression was 39.4 and 24.4%, respectively. Both were associated with low schooling (OR 3.8, 95% CI 1.6 to 9.0 and OR 2.8, 95% CI 1.2 to 6.5 for depression and anxiety, respectively), lifetime suicidal thoughts (OR 4.4, 95% CI 1.9 to 10.3 and OR 3.6, 95% CI 1.7 to 7.7) and lifetime suicide attempts (OR 9.3, 95% CI 2.6 to 32.8 and OR 6.9, 95% CI 1.8 to 26.4). CONCLUSION The high rates of depression and anxiety reinforced the need for recognition and treatment of mental disorders in epilepsy.

Suicide prevention training for professionals in the public health network in a large Brazilian city.

The objective of this study was to improve health professionals’ knowledge and attitudes toward suicide prevention. A suicide prevention training of 18 hours duration was conducted with 270 health professionals, mainly primary care workers, who were routinely involved with patients at high risk for suicide. Questionnaires were used to assess changes in attitudes and knowledge. The score in the knowledge questionnaire, with 21 points as maximum value, increased from 8.9 to 13 points (p < .001, significance level of 95%). Of the 25 questionnaire items representing attitudes, 18 showed significant change after the training. This training model has enhanced knowledge and attitudes toward suicide prevention in healthcare workers.

Adaptação multicêntrica do guia para a gestão autônoma da medicação

O uso crescente de psicofarmacos e o baixo empowerment dos usuarios mostram-se criticos a qualificacao da assistencia em Saude Mental no Brasil. Este estudo, abrangendo tres cidades brasileiras, objetivou a elaboracao do Guia Brasileiro da Gestao Autonoma da Medicacao (GGAM-BR), com base na traducao e adaptacao de guia desenvolvido no Canada; e a avaliacao dos efeitos do uso do GGAM-BR na formacao de trabalhadores de saude mental. Constituiram-se grupos de intervencao (GIs) para compartilhamento das experiencias com tratamento medicamentoso, a partir dos temas propostos no guia; e foram realizados grupos focais antes e apos os GIs. Importantes mudancas em relacao ao texto original do guia Canadense foram implementadas, levando em conta a realidade brasileira. Constatou-se que o GGAM-BR constitui estrategia potente de fomento a participacao ativa dos usuarios na gestao do tratamento e do servico, incidindo positivamente na formacao de trabalhadores.

Multicenter adaptation of the guide for autonomous management of medication

O uso crescente de psicofarmacos e o baixo empowerment dos usuarios mostram-se criticos a qualificacao da assistencia em Saude Mental no Brasil. Este estudo, abrangendo tres cidades brasileiras, objetivou a elaboracao do Guia Brasileiro da Gestao Autonoma da Medicacao (GGAM-BR), com base na traducao e adaptacao de guia desenvolvido no Canada; e a avaliacao dos efeitos do uso do GGAM-BR na formacao de trabalhadores de saude mental. Constituiram-se grupos de intervencao (GIs) para compartilhamento das experiencias com tratamento medicamentoso, a partir dos temas propostos no guia; e foram realizados grupos focais antes e apos os GIs. Importantes mudancas em relacao ao texto original do guia Canadense foram implementadas, levando em conta a realidade brasileira. Constatou-se que o GGAM-BR constitui estrategia potente de fomento a participacao ativa dos usuarios na gestao do tratamento e do servico, incidindo positivamente na formacao de trabalhadores.

Human rights and the use of psychiatric medication

Purpose – Formal recognition of the human rights of people living with mental health problems has greatly progressed. We must ask ourselves, however, to what extent the formal recognition of these rights has transformed the culture of psychiatric care and improved their quality of life. Gaining Autonomy & Medication Management (GAM) is an approach that strives to empower service users and providers and promotes the exercise of users’ rights by transforming their relationship with the central component of psychiatric treatment in community services: psychopharmacology. The purpose of this paper is to show how GAM highlights the issues surrounding the establishment of a culture of rights. Design/methodology/approach – For this analysis qualitative data were collected in Brazil and in Quebec, Canada, through over 100 interviews done with people living with mental health issues and practitioners who participated in the different GAM implementation projects. Findings – Issues, challenges and obstacles facing t...