The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

Abstract

OBJECTIVE:Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil.METHODS:A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively.RESULTS:Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence.CONCLUSIONS:Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth.

Service Engagement in Interventions for Street-Connected Children and Young People: A Summary of Evidence Supplementing a Recent Cochrane–Campbell Review

“…Five of these represent US-based work conducted by Professor Natasha Slesnick's research team (Slesnick 2001;Slesnick et al 2006;Slesnick et al 2011;Slesnick et al 2008b; For further data on treatment attendance, we included a Brazilian study involving a multicomponent drop-in centre described as a service innovation (Scivoletto et al 2012) and a study comparing community reinsertion rates among three residential shelters in Brazil and Peru …”

“…In a Brazilian study on shelter treatment attendance among street-connected children and young people, age and residential status were identified as significant predictors of treatment attendance (Scivoletto et al 2012). A comparison of psychiatric diagnosis status revealed that participants with mood disorders, 'other' disorders or no disorders were significantly more likely to adhere to treatment than participants with substance use disorders, or mood and substance use disorders.…”

“…Research on homeless adults has suggested that engagement among homeless individuals may not be shaped by demographic factors, as documented in other service contexts (Mowbray et al 1993). Compared to studies on adult populations, there has been relatively little empirical research on the role of engagement factors in psychological interventions with children and young people, let alone those with street connections (Scivoletto et al 2012).…”

“…The following empirical variables were adopted in the included studies to measure intervention engagement among participating street-connected youth (see also Scivoletto et al 2012;Slesnick et al 2006;Slesnick et al 2013a;Slesnick et al 2011;Slesnick et al 2008b;Slesnick and Prestopnik 2004;Slesnick and Prestopnik 2009;Slesnick et al 2007). …”

Identificação de fatores associados à aderência ao tratamento, reinternação hospitalar e necessidades de cuidados de pacientes inseridos na rede pública de assistência em saúde mental

“…Esse suporte familiar pode ter papel decisivo no tratamento extra--hospitalar, melhorando a aderência ao tratamento (Scivoletto et al, 2012). Em um estudo brasileiro de base populacional sobre primeiro episódio psicótico, a duração da psicose não tratada foi menor do que a esperada, e os autores atribuíram o inesperado resultado aos arranjos familiares de moradia no Brasil, acreditando que eles desempenham papel importante nos países de baixa e média renda (Oliveira et al, 2010).…”