The social adjustment of people with severe mental illness in São Paulo, Brazil

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.

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

Transcultural Psychiatry ◽

10.1177/1363461519853639 ◽

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 ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Family Income ◽

Barriers To Care ◽

Psychiatric Symptoms ◽

Linear Regression Analysis ◽

Sao Paulo ◽

São Paulo ◽

Self Reporting Questionnaire

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.

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Metabolic phenotyping reveals a potential link between elevated faecal amino acids, diet and symptom severity in individuals with severe mental illness

10.1101/2021.12.01.21267133 ◽

2021 ◽

Author(s):

Jack Jansma ◽

Rogier van Essen ◽

Bartholomeus C.M. Haarman ◽

Anastasia Chrysovalantou Chatziioannou ◽

Jenny Borkent ◽

...

Keyword(s):

Amino Acids ◽

Mental Illness ◽

Severe Mental Illness ◽

Symptom Severity ◽

Psychiatric Symptoms ◽

Mental Illnesses ◽

Therapeutic Interventions ◽

Schizophrenia Spectrum Disorders ◽

Potential Link ◽

The Brain

The brain-gut axis is increasingly recognized as an important contributing factor in the onset and progression of severe mental illnesses such as schizophrenia spectrum disorders and bipolar disorder. This study investigates associations between levels of faecal metabolites identified using 1H-NMR, clinical parameters, and dietary components of forty-two individuals diagnosed in a transdiagnostic approach to have severe mental illness. Faecal levels of the amino acids; alanine, leucine, and valine showed a significant positive correlation with psychiatric symptom severity as well as with dairy intake. Overall, this study proposes a diet-induced link between the brain-gut axis and the severity of psychiatric symptoms, which could be valuable in the design of novel dietary or therapeutic interventions to improve psychiatric symptoms.

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The Social Adjustment Scale-Self-Report: Psychometric Properties for Older Adults

Psychological Reports ◽

10.2466/pr0.101.3.920-926 ◽

2007 ◽

Vol 101 (3) ◽

pp. 920-926 ◽

Cited By ~ 5

Author(s):

Richard A. Zweig ◽

Elihu Turkel

Keyword(s):

Older Adults ◽

Social Functioning ◽

Social Adjustment ◽

Psychiatric Symptoms ◽

Brief Symptom Inventory ◽

Community Dwelling ◽

Self Report ◽

The Social ◽

Mixed Age ◽

Social Adjustment Scale

To assess the reliability and validity of the Social Adjustment Scale-Self-Report for older adults, 129 community dwelling elderly ranging in age from 63 to 87 years ( M = 72.3 yr., SD = 5.0) were surveyed using a modified version of the scale. The average internal consistency of subscales was satisfactory (mean coefficient alpha = .62). Overall social functioning impairment (total score) was associated with measures of depression (Beck Depression Inventory, r = .58) and global psychiatric symptoms (Brief Symptom Inventory, r = .55). Older adults scored higher on Marital role, Family Unit role, and overall social functioning impairment compared to mixed-age adults assessed in previous research, and higher on marital role impairment but similarly on overall social functioning when compared with a mixed-age sample from primary care. The modified Social Adjustment Scale–Self-Report has acceptable psychometric characteristics for research use with older adults, and select subscales may account for findings of age-related differences.

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Cost-effectiveness of nidotherapy for comorbid personality disorder and severe mental illness: randomized controlled trial

Epidemiologia e Psichiatria Sociale ◽

10.1017/s1121189x00001019 ◽

2009 ◽

Vol 18 (2) ◽

pp. 128-136 ◽

Cited By ~ 40

Author(s):

Maja Ranger ◽

Peter Tyrer ◽

Katerina Miloseska ◽

Hannalie Fourie ◽

Ibrahim Khaleel ◽

...

Keyword(s):

Mental Illness ◽

Randomized Controlled Trial ◽

Personality Disorder ◽

Severe Mental Illness ◽

Social Functioning ◽

Psychiatric Symptoms ◽

Controlled Trial ◽

Assertive Outreach ◽

Randomized Controlled ◽

Community Team

SummaryAims – Nidotherapy is the systematic modification of the environment to create a better fit for people. This is the first randomized controlled trial of its efficacy in an assertive community team. Methods – Patients in an assertive outreach team with continued management problems together with comorbid personality disturbance and severe mental illness were randomized to nidotherapy enhanced assertive treatment (up to 12 sessions) or to continued assertive outreach care. Use of psychiatric beds over one years (primary outcome) and change from base-line in other health service resources, psychiatric symptoms, social functioning and engagement with services were measured at 6 and 12 months (secondary outcomes). Results – 52 patients were recruited over 13 months, with 49 and 37 assessed at 6 and 12 months. Patients referred to nidotherapy had a 63% reduction in hospital bed use after one year compared with control assertive care (P=0.13) and showed non-significant improvement in psychiatric symptoms, social functioning and engagement than the control group. The mean cost savings for each patient allocated to nidotherapy was £4,112 per year, mainly as a consequence of reduced psychiatric bed use. Conclusion – Nidotherapy may be a cost-effective option in the management of comorbid serious mental illness and personality disorder, but larger confirmatory trials are necessary.

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O7.2. MENTAL HEALTH AND SOMATIC STATUS OF YOUNG CHILDREN (0–6 YEARS) BORN TO PARENTS WITH SEVERE MENTAL ILLNESSES - A NATIONWIDE DANISH REGISTER STUDY

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa028.037 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S16-S17

Author(s):

Anne Amalie Thorup ◽

Kirstine Davidsen ◽

Anne Ranning ◽

Pia Jennes-Foli ◽

Susanne Harder ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Disorder ◽

Severe Mental Illness ◽

Good Health ◽

Population Based ◽

Early Years ◽

Mental Illnesses ◽

Childhood And Adolescence ◽

Somatic Health

Abstract Background Children born to parents with severe mental illness like schizophrenia, bipolar disorder or recurrent major depression have been shown to have a higher risk, not only for developing a mental illness themselves in adulthood (Rasic) but also in childhood and adolescence. Less is known about the offspring’s somatic health and very early development processes. Increasing knowledge demonstrate the importance of the very early years of life from birth to age 6 for a healthy and natural brain development and for good life outcomes in general. Thus, more knowledge is needed about this vulnerable period in life, especially for children, who are born with a familial high risk for severe mental illness in order to develop relevant interventions for these children. Methods We used Danish registries to evaluate the incidence and the frequencies of early (i.e. age 0–6 years) psychiatric diagnoses of a nationwide cohort of children born to parents with severe mental illness. Further we calculated the frequencies of somatic health problems and compared them to population-based controls. Results We found increased ORs for children in all three FHR-groups for having received any diagnosis of a mental disorder before age 7 (e.g.: mother depressed, N=1223): OR:2.82 (CI:2.65–2.99), mother bipolar (N=98): OR: 3.06 (CI 2.50–3.76), mother schizophrenia (N=574): OR 5.23 (CI: 4.80–5.69), and similar although a bit smaller ORs if it was the father, who had a diagnosis. Especially ORs for attachment disorder and anxiety were increased but also ORs for eating disorders and sleep disorders were found to be significantly higher than for controls. Odd ratios for somatic disorders were marginally increased for all disorders and also for intoxications and injuries. Discussion Our results document that children born to parents with severe mental illnesses are vulnerable from the beginning of life, mainly in terms of their mental health but to some extent also in terms of somatic health. Parents who have a severe mental disorder may need extra support in the parenting role to ensure good health for the child.

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Illness and mental health: two sides of the same coin?

European Journal of Public Health ◽

10.1093/eurpub/ckab120.098 ◽

2021 ◽

Vol 31 (Supplement_2) ◽

Author(s):

Margarida Pocinho ◽

Fatima Ney Matos ◽

Ana Amaral

Keyword(s):

Mental Health ◽

Mental Illness ◽

Recall Test ◽

Social Representations ◽

Social Representation ◽

Mental Illnesses ◽

Word Recall ◽

The Social ◽

Two Sides

Abstract Background Although we are sometimes unaware, mental illnesses are extremely common, and if they are not properly regulated they can affect all types of structures in a person's life Methods The study is qualitative, a word evocation test was used, began to be carried out in February 2019 and ended on May 27, 2019. The word recall test were: ‘If I tell you mental health, what are the first three words that come to mind?’ ‘If I tell you mental illness, what are the first three words that come to mind?’ To analyze and build the graphs for this investigation, the corpus was inserted in the IraMuteQ program. Results When analyzing the words we can see that the social representation of mental illness is very much associated with undesirable mental illnesses or conditions and seen as negative in society. Meanwhile, mental health is full of words that you would normally consider positive. Conclusions The social representations of health and mental illness are very clearly opposed, mental health is seen almost exclusively as something positive by society, not only has feelings like happiness, but also words like success and vitality, while mental illness is very much linked to the whole type of mental illness and conditions like stress, sadness, obsession.

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Subjective mental health and need for care among psychiatric outpatients during the COVID-19 pandemic: results from an outreach initiative in Sweden

10.1101/2020.11.10.20229039 ◽

2020 ◽

Author(s):

Oskar Flygare ◽

Volen Z. Ivanov ◽

Roland Säll ◽

Henrik Malaise ◽

Christian Rück ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Severe Mental Illness ◽

Respiratory Symptoms ◽

Psychiatric Symptoms ◽

Well Being ◽

Psychiatric Clinic ◽

Cross Sectional ◽

Management Plans ◽

Subjective Mental Health

AbstractImportanceThe ongoing COVID-19 pandemic restricts access to care for psychiatric patients. The physical and mental well-being of patients with severe mental illness in the current circumstances is unknown.ObjectiveTo evaluate physical and mental well-being, subjective mental health, and need for updated psychiatric management plans in a sample of patients with severe mental illness during the early stages of the COVID-19 pandemic.DesignCross-sectional study of structured telephone assessments conducted between April 23 and June 30, 2020.SettingRegional psychiatric outpatient care centre in Stockholm, Sweden.ParticipantsPatients who had not been in contact with their psychiatric clinic between April 9 and April 23, 2020. A total of 1071 patients were contacted by phone.ExposuresOccurrence of respiratory symptoms, changes in psychiatric symptoms, and the need for updated psychiatric management plans, as determined by the telephone assessors. Subjective mental health rated 0-100 by patients.Main Outcomes and MeasuresSelf-rated physical, respiratory and psychiatric symptoms according to a semi-structured interview. Subjective mental health rated on a scale from 0-100.ResultsPatients (n = 1071) were on average 45 years old (SD = 16.9), of which 570 (53%) were female. Neurodevelopmental disorders, psychotic disorders, and bipolar disorder were the most common diagnostic categories. The majority of respondents reported no respiratory symptoms (86%), and few reported light (10%) or severe (4%) respiratory symptoms. Similarly, most patients reported no worsening in psychiatric symptoms (81%). For those who reported a worsening of psychiatric symptoms (19%), the psychiatric management plans that were already in place were deemed appropriate in most cases (16.5%), whereas 22 patients (2.5%) reported a worsening of psychiatric symptoms that warranted an earlier or immediate follow-up by their psychiatric clinic. Patients rated their subjective mental health on a 0-100 scale as 70.5 [95% CI 69 - 71.9] on average (n = 841). Response rates to the questions of the structured assessment varied from 79% - 82%.Conclusions and RelevanceThe majority of patients reported no respiratory symptoms, no change in psychiatric symptoms and a rather high subjective well-being. Patients in psychiatric care with a mental health care plan experienced stability in the management of their psychiatric symptoms and general well-being, and only a minority were in need of acute support during the early pandemic phase in Stockholm, Sweden.Key PointsQuestionWhat is the physical and mental health of patients with severe mental illness during the early phase of the COVID-19 pandemic?FindingsIn this cross-sectional study that included 1071 patients at a psychiatric outpatient clinic, the proportion of patients reporting respiratory symptoms were 4%. In addition, 19% of patients reported a worsening of psychiatric symptoms, with 2.5% needing an earlier follow-up than was planned.MeaningPatients with severe mental illness experienced stability in the management of their psychiatric symptoms during the early pandemic phase in Sweden.

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The role of social support in reducing the impact of violence on adolescents’ mental health in São Paulo, Brazil

PLoS ONE ◽

10.1371/journal.pone.0258036 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0258036

Author(s):

Meaghen Quinlan-Davidson ◽

Ligia Kiss ◽

Delan Devakumar ◽

Mario Cortina-Borja ◽

Manuel Eisner ◽

...

Keyword(s):

Mental Health ◽

Social Support ◽

School Violence ◽

Community Violence ◽

Violence Exposure ◽

Sao Paulo ◽

São Paulo ◽

Adolescent Students ◽

The Social ◽

Being Bullied

Objectives We investigated whether perceived social support among adolescent students moderated the association between violence exposure and internalising symptoms in São Paulo city, Brazil. Methods We tested the stress-buffering model using data from the cross-sectional school-based, survey São Paulo Project on the Social Development of Children and Adolescents. Internalising symptoms were measured using an adapted version of the Social Behaviour Questionnaire; serious victimisation, being bullied once/week, school violence and community violence, friend and teacher support were scales adapted by the research team; the Alabama Parenting Questionnaire measured parenting style. Linear mixed-effects models were used to quantify moderation effects of (i) social support between violence exposure and internalising symptoms and (ii) gender between violence exposure and internalising symptoms across schools. Results Across schools, being bullied once/week, school violence, and community violence were associated with a significant (p<0.001) increase in internalising symptoms (e.g., bullied b = 5.76, 95% CI 2.26, 9.26; school violence b = 0.48, 95% CI 0.30, 0.67; community violence b = 0.36; 95% CI 0.22, 0.50). Males exposed to all types of violence had significantly lower (p<0.01) internalising symptoms compared to females (e.g., serious victimisation: b = -1.45; 95% CI -2.60, -0.29; school violence b = -0.27; 95% CI -0.30, -0.24; community violence b = -0.23; 95% CI -0.25, -0.20). As a main effect, social support was associated with a significant (p<0.01) decrease in internalising symptoms across schools (e.g., positive parenting b = -2.42; 95% CI -3.12, -1.72; parent involvement b = -2.75; 95% CI -3.32, -2.17; friend support b = -1.05; 95% CI -1.74, -0.34; teacher support b = -0.90; 95% CI -1.58, -0.22). Social support did not moderate the association between violence exposure and internalising symptoms. Conclusions Adolescent students in São Paulo exposed to violence have a higher likelihood of internalising symptoms, compared to those who are not. Support from parents, friends, and teachers, independent of violence, appear to be protective against internalising symptoms, pointing to potential programmes that could improve adolescent mental health.

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Community Families: Bridging the gap between mental health services and civil society – A qualitative study from users’ perspective

International Journal of Social Psychiatry ◽

10.1177/0020764016687789 ◽

2017 ◽

Vol 63 (2) ◽

pp. 132-138 ◽

Cited By ~ 4

Author(s):

Ulla Væggemose ◽

Stina Lou ◽

Michal Frumer ◽

Nanna Limskov Stærk Christiansen ◽

Jørgen Aagaard ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Severe Mental Illness ◽

Health Workers ◽

Qualitative Interviews ◽

Mental Health Workers ◽

Service Users ◽

Social Interventions ◽

The Social

Background: Social interventions to support people with severe mental illness are important to improving the quality of life. The perspectives of users are essential in this process. This article explores users’ experiences, investments and concerns of a befriending programme. Material: Focus group and individual qualitative interviews with service users. Discussion: Overall, the experiences with the programme were positive, and the social interaction was highly valued. However, that the relationships were arranged and facilitated by mental health workers remained an unresolved concern even after several years. Conclusion: People with severe mental illness benefit from relationships despite the need of professional assistant.

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Prescriptive Power: Biologism, Biopsychiatry and Drug-centred Psychopharmacology

Somatechnics ◽

10.3366/soma.2019.0285 ◽

2019 ◽

Vol 9 (2-3) ◽

pp. 291-309

Author(s):

Francis Russell

Keyword(s):

Mental Health ◽

Mental Illness ◽

Social Justice ◽

Cultural Theory ◽

Human Experience ◽

Mental Illnesses ◽

False Consciousness ◽

The Subject ◽

Biological Ontology ◽

Health Discourse

This paper looks to make a contribution to the critical project of psychiatrist Joanna Moncrieff, by elucidating her account of ‘drug-centred’ psychiatry, and its relation to critical and cultural theory. Moncrieff's ‘drug-centred’ approach to psychiatry challenges the dominant view of mental illness, and psychopharmacology, as necessitating a strictly biological ontology. Against the mainstream view that mental illnesses have biological causes, and that medications like ‘anti-depressants’ target specific biological abnormalities, Moncrieff looks to connect pharmacotherapy for mental illness to human experience, and to issues of social justice and emancipation. However, Moncrieff's project is complicated by her framing of psychopharmacological politics in classical Marxist notions of ideology and false consciousness. Accordingly, she articulates a political project that would open up psychiatry to the subjugated knowledge of mental health sufferers, whilst also characterising those sufferers as beholden to ideology, and as being effectively without knowledge. Accordingly, in order to contribute to Moncrieff's project, and to help introduce her work to a broader humanities readership, this paper elucidates her account of ‘drug-centred psychiatry’, whilst also connecting her critique of biopsychiatry to notions of biologism, biopolitics, and bio-citizenship. This is done in order to re-describe the subject of mental health discourse, so as to better reveal their capacities and agency. As a result, this paper contends that, once reframed, Moncrieff's work helps us to see value in attending to human experience when considering pharmacotherapy for mental illness.

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