Barriers to care and psychopathology among Bolivian migrants living in São Paulo, Brazil

2019 ◽  
Vol 57 (1) ◽  
pp. 71-80
Author(s):  
Lineth Hiordana Ugarte Bustamante ◽  
Raphael Oliveira Cerqueira ◽  
Fernanda De Marzio ◽  
Keila Pereira Leite ◽  
Thatiane Dal Picolo Cadurin ◽  
...  

The objective of this study was to investigate barriers to appropriate mental health care in a sample of Bolivian migrants living in São Paulo and to examine the association between barriers of care and the presence of symptoms of non-psychotic psychiatric disorders in this population. Considering that treatment usually reduces symptoms, it could be hypothesized that individuals reporting more barriers to care also will report more symptoms. The sample comprised 104 individuals born in Bolivia, with Bolivian nationality and living in São Paulo for at least 30 days prior to enrolling in the study, between 18 and 80 years of age and able to read and write in Spanish or Portuguese. The symptoms of mental disorders were assessed using the Self-Reporting Questionnaire (SRQ-20) and barriers to appropriate mental health care were evaluated using the Barriers to Assessing Care Evaluation (BACE). A multiple linear regression analysis was performed to determine the predictive effect of the BACE total score (independent variable) in the SRQ-20 score (dependent variable), including in the model, and the variables that were significantly correlated with the BACE total score or SRQ-20. Our results indicate that more than a half of the sample of Bolivian migrants living in Sao Paulo, Brazil, especially females, presented significant non-psychotic psychopathology. Individuals reporting more barriers to care, especially instrumental and attitudinal barriers, also have a higher risk of psychiatric symptoms, independently of sex, age and family income. Our results suggest that actions to increase availability of mental health services, especially culturally sensitive services, could reduce barriers to care and improve mental health among migrants.

Author(s):  
Mariana Felício De Godoy ◽  
Alline Souza Beraldo ◽  
Sulamita Gonzaga Silva Amorim ◽  
Maria Luisa Gazabim Simões Ballarin

A avaliação constitui etapa essencial no processo terapêutico ocupacional, entretanto, a produção de conhecimento sobre esta temática no cenário nacional é ainda escassa. Este trabalho tem por objetivo analisar a percepção de terapeutas ocupacionais sobre os processos de avaliação que realizam nos serviços que atuam na atenção à saúde mental de um município do interior de São Paulo, Brasil. Trata-se de um estudo exploratório, descritivo e de natureza qualitativa. Para tanto, foram analisados relatos pertinentes ao material coletado em campo, resultante da realização de 14 entrevistas semiestruturadas com os terapeutas ocupacionais, assim como a aplicação de questionário contendo perguntas abertas e fechadas. Os resultados obtidos evidenciaram que os terapeutas ocupacionais eram prioritariamente do sexo feminino, com média idade de 35 anos. Atuavam em diferentes serviços da Rede de Atenção Psicossocial do município - Centros de Atenção Psicossocial tipo, III, álcool e outras drogas, Serviço de Geração de Renda e Enfermaria de Psiquiatria em Hospital Geral. Constatou-se que os profissionais utilizavam diversas estratégias avaliativas, embora não utilizassem instrumentos padronizados e validados específicos da Terapia Ocupacional. Os entrevistados referiram avaliar os usuários em diferentes momentos (triagem, acolhimento e ao longo do processo de acompanhamento) e ressaltaram a importância da avaliação em outros contextos, no caso, o domicílio. As principais demandas dos usuários identificadas nos processos avaliativos relacionavam-se às dificuldades de realização nas atividades cotidianas. A análise dos resultados obtidos evidenciou a necessidade de que outros estudos possam ser desenvolvidos contribuindo assim para o oferecimento de um cuidado cada vez mais qualificado.Abstract The evaluation is an essential step in the occupational therapeutic process, however, the production of knowledge about this subject in the national scenario is still scarce. This study aims to analyze the perception of occupational therapist about the intervention process they perform in the mental health care services of a municipality in the interior of São Paulo, Brazil. This is an exploratory and descriptive study of a qualitative nature. In orderto do so, we analyzed pertinent reports on the material collected in the field, resulting from the accomplishment of 14 semi-structured interviews with the occupational therapists, as well as the application of a questionnaire containing open and closed questions. The results showed that occupational therapists were primarily female, with a mean age of 35 years. They worked in different services of the Psychosocial Attention Network of the city - Psychosocial Attention Centers type III, alcohol and other drugs, Income Generation Service and Psychiatric Nursing in General Hospital. It was found that professionals use several evaluative strategies, although they do not use standardized and validated instruments specific to occupational therapy. They refer to evaluating the users at different times (screening, reception and during the follow-up process) and emphasize the importance of evaluation in other contexts, in this case, the home. The main demands of the users identified in the evaluation processes related to the difficulties of accomplishment in daily activities. The analysis of the obtained results evidenced the need for other studies to be developed, thus contributing to the provision of increasingly qualified care.Key words: Evaluation; Mental health; Occupational therapy. Resumen El procedimiento de evaluación es un paso esencial en el proceso de terapia ocupacional, sin embargo, la producción de conocimiento sobre este tema en la escena nacional es todavía escasa. Así, este trabajo tiene por objetivo analizar la percipción de terapeutas ocupacionales sobre los procesos de evaluación que realizan en los servicios que actuán en la atención a la salud mental de un município del interior de São Paulo, Brasil. Se trata de un estudio exploratorio y descriptivo de naturaleza cualitativa. Por lo tanto, los informes se analizaron relevante para el material recogido en el campo, como resultado de la finalización de 14 entrevistas semiestructuradas con terapeutas ocupacionales, así como la aplicación de un cuestionario con preguntas abiertas y cerradas. Los resultados mostraron que los terapeutas ocupacionales eran principalmente mujeres, edad media 35 años. Se trabajó en diferentes departamentos de la Red de Atención Psicosocial del municipio - psicosocial tipo de centros de atención, III, alcohol y otras drogas, Servicio de Generación de Ingresos y Psiquiatría Ward en el Hospital General. Se encontró que los profesionales utilizan diversas estrategias de evaluación, pero no utilizan instrumentos estandarizados y validados terapia ocupacional específica. Refere evaluar usuarios en diferentes momentos (triaje, larecepción y todo el proceso de supervisión) y hacer hincapi é en la importancia de la evaluación en otros contextos, en este caso la casa. Las principales demandas de los usuarios identificados en los procesos de evaluación fueron relacionados con las dificultades de realización en las actividades diarias. El análisis de los resultados mostró la necesidad de realizar más estudios puede ser desarrollado que contribuye a ofrecer una atención cada vez más especializada.Palabras clave: Evaluación; Salud mental; Terapia ocupacional.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P Bezerra

Abstract Background The objective of this research was to analyze the results achieved after intersectoral actions carried out by primary health care teams working in areas of high socio-environmental vulnerability in the city of São Paulo / Brazil. The establishment of intersectoral partnerships to tackle social inequalities and inequalities can be a reality in vulnerable health territories and a way to give sustainability to expanded health care (De Andrade et al, 2015). Methods Primary data were obtained from August to October 2018 in four focus groups formed by a total of 24 health professionals, selected after quantitative analysis. The data were transcribed in full and the qualitative analysis was according to Van Den Hoonaard (2018): a) open coding of the transcriptions; b) identification of recurrent themes and respective subthemes and c) connection of themes and concepts interpreted in the light of social processes. The research was approved by the Research Ethics Committee of the Centro Universitário Saúde ABC. Results The themes found were: a) Search for partnerships for mental health assistance: in a personalized way, the teams entered into partnerships with the sectors of education, social assistance, leisure and justice for assistance; b) Effectiveness of treatment by intersectoral basis: the teams helped to insert people into public policy actions, they realized the reduction in the need to use psychotropics and specialized services in mental health. Conclusions Intersectoral collaboration was established and maintained to resume mental health care for people with psychological distress who were waiting in line for specialized treatment. Key messages Primary health care teams when looking for partners to assist patients in mental health have an expanded look at the citizen who should be embraced by public policies. There is a need to add community-based care for people with mental suffering to care based on intersectoral actions in health territories.


2021 ◽  
Vol 12 ◽  
Author(s):  
Jonathan Bär ◽  
Alexander Pabst ◽  
Susanne Röhr ◽  
Melanie Luppa ◽  
Anna Renner ◽  
...  

Background: The high prevalence of mental disorders related to posttraumatic stress among Syrian refugees is often in contrast with their low utilization of mental health care in the host countries. Mental health self-stigma, i.e., internalized stigma of having a mental disorder, could prevent individuals from seeking mental health care. Therefore, we aimed to provide evidence on different aspects of mental health self-stigmatization among adult Syrian refugees with posttraumatic stress symptoms residing in Germany. Moreover, we investigated associations with sociodemographic and psychopathological variables in order to identify those at higher risk of self-stigmatization.Material and Methods: Overall, 133 participants with mild to moderate posttraumatic stress symptoms were recruited in the metropolitan areas of Leipzig, Dresden and Halle, Germany, using a multimodal approach. Mental health self-stigma was assessed using the Self-Stigma of Mental Illness Scale – Short Form (SSMIS-SF), consisting of four subscales (Stereotype awareness, Stereotype agreement, Application to self , Harm to self-esteem), each scoring from 5 (low) to 45 (high) points. Linear regression analysis was used to test associations of sociodemographic and psychopathological variables with self-stigma subscales.Results: On average, self-stigma ratings ranged from 16.5 (SD = 6.6) points on Application to self to 28.3 (SD = 7.5) points on Stereotype awareness. Results showed higher scores on Application to self for individuals who were younger (t = 2.65, p = 0.009) and single (F = 5.70, p = 0.004). Regression analyses yielded statistically significant associations between having multiple comorbidities and a higher Application to self stigma (β = 0.18, p = 0.044), controlling for sociodemographic covariates.Discussion: Mental health self-stigma was increased among Syrian refugees in Germany. Correlates of increased self-stigma could inform efforts to improve access to mental health care among Syrian refugees with mental ill-health. Longitudinal studies following an intersectional approach by concurrently examining multiple forms of public and internalized stigma could provide helpful insights for developing tailored stigma reduction efforts in this context.


2019 ◽  
Vol 29 ◽  
Author(s):  
N. Schnyder ◽  
D. Lawrence ◽  
R. Panczak ◽  
M. G. Sawyer ◽  
H. A. Whiteford ◽  
...  

Abstract Aims Mental disorders cause high burden in adolescents, but adolescents often underutilise potentially beneficial treatments. Perceived need for and barriers to care may influence whether adolescents utilise services and which treatments they receive. Adolescents and parents are stakeholders in adolescent mental health care, but their perceptions regarding need for and barriers to care might differ. Understanding patterns of adolescent-parent agreement might help identify gaps in adolescent mental health care. Methods A nationally representative sample of Australian adolescents aged 13–17 and their parents (N = 2310), recruited between 2013–2014, were asked about perceived need for four types of adolescent mental health care (counselling, medication, information and skill training) and barriers to care. Perceived need was categorised as fully met, partially met, unmet, or no need. Cohen's kappa was used to assess adolescent-parent agreement. Multinomial logistic regressions were used to model variables associated with patterns of agreement. Results Almost half (46.5% (s.e. = 1.21)) of either adolescents or parents reported a perceived need for any type of care. For both groups, perceived need was greatest for counselling and lowest for medication. Identified needs were fully met for a third of adolescents. Adolescent-parent agreement on perceived need was fair (kappa = 0.25 (s.e. = 0.01)), but poor regarding the extent to which needs were met (kappa = −0.10 (s.e. = 0.02)). The lack of parental knowledge about adolescents' feelings was positively associated with adolescent-parent agreement that needs were partially met or unmet and disagreement about perceived need, compared to agreement that needs were fully met (relative risk ratio (RRR) = 1.91 (95% CI = 1.19–3.04) to RRR = 4.69 (95% CI = 2.38–9.28)). Having a probable disorder was positively associated with adolescent-parent agreement that needs were partially met or unmet (RRR = 2.86 (95% CI = 1.46–5.61)), and negatively with adolescent-parent disagreement on perceived need (RRR = 0.50 (95% CI = 0.30–0.82)). Adolescents reported most frequently attitudinal barriers to care (e.g. self-reliance: 55.1% (s.e. = 2.39)); parents most frequently reported that their child refused help (38.7% (s.e. = 2.69)). Adolescent-parent agreement was poor for attitudinal (kappa = −0.03 (s.e. = 0.06)) and slight for structural barriers (kappa = 0.02 (s.e. = 0.09)). Conclusions There are gaps in the extent to which adolescent mental health care is meeting the needs of adolescents and their parents. It seems important to align adolescents' and parents' needs at the beginning and throughout treatment and to improve communication between adolescents and their parents. Both might provide opportunities to increase the likelihood that needs will be fully met. Campaigns directed towards adolescents and parents need to address different barriers to care. For adolescents, attitudinal barriers such as stigma and mental health literacy require attention.


2018 ◽  
Vol 28 (6) ◽  
pp. 916-926 ◽  
Author(s):  
Ora Nakash ◽  
Michal Cohen ◽  
Maayan Nagar

Although identification of main problems is the foundation for treatment planning, limited research has examined reasons for seeking mental health care. We identified reasons for seeking mental health care as reported by clients and therapists upon initial contact with mental health services. We conducted in-depth interviews with clients and their therapists immediately following the intake. We analyzed 117 therapist and 112 client interviews using thematic analysis. Overall interrater reliability among three raters who coded the interviews was high (kappa = 0.72). Our findings suggest that, overall, clients and therapists report similar main area problems that bring clients to care. Emotional distress and other psychiatric symptoms as well as interpersonal problems were most prevalent. Therapists tended to ignore some problem areas that clients highlighted, including physical problems and socioeconomic strains. Raising awareness to potential gaps in perception of main problems that bring clients to care will promote a shared understanding and improve quality of care.


2017 ◽  
Vol 247 ◽  
pp. 236-242 ◽  
Author(s):  
Ian H. Stanley ◽  
Joseph W. Boffa ◽  
Melanie A. Hom ◽  
Nathan A. Kimbrel ◽  
Thomas E. Joiner

2005 ◽  
Vol 27 (4) ◽  
pp. 309-314 ◽  
Author(s):  
André Gulinelli ◽  
Lilian R C Ratto ◽  
Paulo Rossi Menezes

OBJECTIVE: To investigate the social adjustment of individuals with severe mental illness living in the community in a large urban center of a developing country, and the characteristics associated with poor social functioning. METHOD: A cross-sectional study was performed in the city of Sao Paulo. Eligible subjects were residents of a defined geographic area, aged between 18 and 65, with a diagnosis of functional psychosis who had had contact with any public psychiatric service during a defined period. Structured assessments were used to obtain information on social-demographic characteristics, diagnosis (ICD-10), psychiatric symptoms (PANSS), and social adjustment (DAS). RESULTS: One hundred and eighty-eight subjects were included, of whom, 120 (63.8%) had some degree of impairment in social functioning. The most frequently affected areas of social functioning were work performance and sexual role. Twenty-four patients (12.8%) showed poor or very poor social adjustment in the month prior to the interview. Negative symptoms, number of previous admissions and general symptoms showed statistically significant associations with global social adjustment scores. CONCLUSIONS: The proportion of patients showing any degree of impairment in social adjustment was as high as in more developed societies. In order to successfully implement the new mental health policy in Brazil, better provision of community-based mental health services for those with severe mental illnesses is needed.


2011 ◽  
Vol 45 (01n02) ◽  
pp. 59-72 ◽  
Author(s):  
日嵐 吳 ◽  
可如 尹 ◽  
景強 羅 ◽  
翠然 葉 ◽  
學榮 劉 ◽  
...  

社區精神復康服務在西方國家發展悠久,不同的相關文獻與實証爲本研究 ( evidence-based research) 顯示,該服務形式對生活於社區的精神病康復者有顯著成效。自2005年開始,在政府和非政府機構推動下,社區精神健康照顧服務在香港不同的地方推行。然而,有關本港社區精神健康照顧服務的研究卻相當貧乏。是次研究運用單組前測後測設計 (one group pre-test and post-test design) 方式,評估一個在本港推行的社區精神健康照顧服務,對離院後重返社區生活的服務使用者的成效。是次研究邀請了120名精神病康復者參與研究,共有87名研究對象完成所有測試。當中測試範疇包括精神病徵狀、生活質素、自我效能、社區生活技巧。研究發現在開始接受服務後的6至12個月,社區精神健康照顧服務減少精神病徵狀 ( p <.001)、提高生活質素 ( p <.05)、增強自我效能 ( p <.001)和提升社區生活技巧 ( p <.001) 能夠爲康復者帶來非常正面的效果。 Community mental health care services have been developing in Western countries for decades and have been proved to be effective in facilitating the rehabilitation of people with mental illness into the community in many evidence-based research studies. In Hong Kong, with the support of the government and non-government organisations, community mental health care services have been set up in different districts since 2005. However, research on the services is limited. By using the one-group pre-test and post-test design method, this study examines the effects of one Community Mental Health Care Services on the rehabilitation of people with mental illness discharged from hospitals. A total number of 120 service users participated in the study and 87 subjects completed all the assessments in different areas, including psychiatric symptoms, quality of life, self-efficacy and community living skills, before the commencement of intervention, 6 months after the intervention and at 12 months immediately after the intervention. Results showed that the subjects had lessened psychiatric symptoms ( p <.001), better quality of life ( p <.05), enhanced self-efficacy ( p <.001) and increased community living skills ( p <.001), after the services. The study revealed significant positive effects of the community mental heath care services on people with mental illness in the community.


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