Associations between primary health care strategies and outcomes of mental disorders

Mental disorders in adults from Ribeirão Preto, Brazil: a cross-sectional analysis of two birth cohorts

BACKGROUND

In Brazil, the prevalence of mental disorders is heterogeneous, with most studies conducted in large cities with high population density. This study aimed to assess the prevalence of mental disorders and psychiatric comorbidities among young adults (22-23 years old) and adults (37-38 years old) from Ribeirão Preto, a city located in the Northeast of the São Paulo state, with approximately 700,000 inhabitants, and to explore associations with sociodemographic variables, suicide risk, and health service usage. Second, we aimed to evaluate the performance of the Self-Report Questionnaire (SRQ-20) as a screening tool for mental disorders to be applied to the local population.

METHODS

Participants from the 1978/1979 and 1994 Ribeirão Preto birth cohorts were evaluated using the Mini International Neuropsychiatric Interview (MINI) and the SRQ-20 at mean ages of 22-23, and 37-38 years, respectively.

RESULTS

Our sample comprised 1,769 individuals from the 1978/1979 cohort and 1,037 from the 1994 cohort. The prevalence of mental disorders ranged from 28.6% (1978/79) to 31% (1994), with frequent comorbid diagnoses (42.7% and 43.3%, respectively). Men and women had a similar prevalence of mental disorders in the younger cohort, while women had a higher prevalence in the older cohort. Low educational attainment was associated with higher rates of diagnosis. In both cohorts, alcohol and other psychoactive substance use was higher among those with a psychiatric diagnosis. Although those with a psychiatric diagnosis were less satisfied with their own health, only one-fifth had seen a mental health professional in the previous year. A psychiatric diagnosis increased the suicide risk by 5.6 to 9.1 times. Regarding the SRQ-20, the best cutoff points were 5/6 for men and 7/8 for women, with satisfactory performance.

CONCLUSIONS

The prevalence and comorbidity of mental disorders were high in both cohorts and comparable to those in larger Brazilian cities. However, few individuals with a diagnosis had sought specialized care. These data suggest that the mental health gap is still significant in Brazil.

Flower therapy and perceived stress in primary health care nursing professionals: randomized clinical trial

OBJECTIVE

To analyze the effectiveness of Bach flower therapy compared to placebo in reducing perceived stress levels in primary health care nursing professionals.

METHOD

Pragmatic, parallel randomized clinical trial conducted with 87 primary care nursing professionals with self-identified stress, from October 2021 to June 2022, in the cities of Osasco and São Paulo, Brazil. The intervention group (n=43) received the collective flower formula, and the placebo group (n=44) received only the diluent. Data analysis was performed using the linear mixed model, and effect size was measured by partial Eta squared, significance level 5%.

RESULTS

Data analysis showed a significant reduction in perceived stress levels within groups (p=0.038). However, there was no significant difference between the study groups (p=0.750). Participants in the intervention group reported a greater perception of changes than participants in the placebo group, but without statistical significance (p=0,089).

CONCLUSION

The floral formula was not more effective than the placebo formula in reducing perceived stress. There was a significant stress reduction among nursing professionals in both study groups, although with a small effect size.

Mental-physical multimorbidity treatment adherence challenges in Brazilian primary care: A qualitative study with patients and their healthcare providers

Improved understanding of multimorbidity (MM) treatment adherence in primary health care (PHC) in Brazil is needed to achieve better healthcare and service outcomes. This study explored experiences of healthcare providers (HCP) and primary care patients (PCP) with mental-physical MM treatment adherence. Adults PCP with mental-physical MM and their primary care and community mental health care providers were recruited through maximum variation sampling from nine cities in São Paulo State, Southeast of Brazil. Experiences across quality domains of the Primary Care Assessment Tool-Brazil were explored through semi-structured in-depth interviews with 19 PCP and 62 HCP, conducted between April 2016 and April 2017. Through thematic conent analysis ten meta-themes concerning treatment adherence were developed: 1) variability and accessibility of treatment options available through PHC; 2) importance of coming to terms with a disease for treatment initation; 3) importance of person-centred communication for treatment initiation and maintenance; 4) information sources about received medication; 5) monitoring medication adherence; 6) taking medication unsafely; 7) perceived reasons for medication non-adherence; 8) most challenging health behavior change goals; 9) main motives for initiation or maintenance of treatment; 10) methods deployed to improve treatment adherence. Our analysis has advanced the understanding of complexity inherent to treatment adherence in mental-physical MM and revealed opportunities for improvement and specific solutions to effect adherence in Brazil. Our findings can inform research efforts to transform MM care through optimization.

Development and validation of gaming disorder and hazardous gaming scale (GDHGS) based on the WHO framework (ICD-11 criteria) of disordered gaming

This study aimed to develop and validate a brief psychometric scale for gaming disorder and hazardous gaming based on the WHO framework as defined in the ICD-11. The study was carried out among college students using face to face interview. A panel of mental health experts examined the face validity of the new Gaming Disorder and Hazardous Gaming Scale (GDHGS). An Exploratory Factor Analysis (EFA) using the principle component analysis (PCA) method with direct oblimin rotation on the five items of GDHGS was used for assessment of construct validity. The results of Kaiser Meyer Olkin (KMO) measure used for sampling adequacy and Bartlett's test (BT) of sphericity used to show the appropriateness of using factor analysis, confirmed the appropriateness of EFA for the present study sample. The factor analysis extracted single component with an eigenvalue of greater than one, which was further supported by the examination of scree plot. To examine the criterion related validity of the GDHGS, correlation between GDHGS and IGDS-SF scores was assessed. Spearman correlational analysis showed strong positive correlation of GDGHS score with IGDS-SF score (rs = 0.878, p < 0.01). Further, the sum of first four item score of GDHGS among participants diagnosed with GD (median: 15.00; IQR: 15.00-15.75) was significantly greater than those without GD (median: 4.00; IQR: 3.00-6.50) according to the diagnostic interview based on the ICD-11 criteria (U = 0.000, p < 0.001). The internal consistency of GDHGS as measured by the Cronbach's alpha was 0.914. Further, the GDHGS did not have its reliability increased by removal of any of the five items included in the scale. Also, the threshold for significant floor and ceiling effect was not reached. In conclusion, GDHGS is a valid measurement scale for disorders involving gaming behaviour based on the ICD- 11 construct.