Patterns and predictors of health service use among people with mental disorders in São Paulo metropolitan area, Brazil

Wang, Yuan‐Pang; Filho, Alexandre Dias Porto Chiavegatto; Campanha, Angela Maria; Malik, Ana María; Mogadouro, Monica; Cambraia, M.; Viana, María Carmen; Andrade, Laura Helena

doi:10.1017/s2045796016000202

Cited by 28 publications

(34 citation statements)

References 59 publications

(60 reference statements)

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“…From the segment seen in the professional health sector, 70% attended specialized services and 40% generalist services (treatment at both services was possible). Those proportions were similar among each diagnosis within the anxiety and mood disorders group, but not for substance use, which showed an ever higher proportion of specialized service usage (90% vs. 15% of general health services) [ 47 ]. Another study from the same research [ 39 ] identified that around 40% of cases of MH issues treated in general health services received only medication, while a minority (9%) received a combination of medication and psychotherapy.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies

Amaral

Campos

Oliveira

et al. 2018

Int J Ment Health Syst

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BackgroundPathways to care are actions and strategies employed by individuals in order to get help for health-related distress and the related processes of care providers. On several systematic reviews regarding pathways to mental health care (PMHC), studies regarding South American countries were not present. This review synthesizes qualitative and quantitative research about PMHC in Brazil.MethodsLILACS, MEDLINE and SCIELO databases were searched for papers regarding PMHC in Brazil. The results were organized in pathway stages, based on Goldberg and Huxley’s ‘model of Levels and Filters’ and on Kleinman’s framework of ‘Popular, Folk and Professional health sectors’. Analysis also considered the changes in national mental health policy over time.Results25 papers were found, with data ranging from 1989 to 2013. Complex social networks were involved in the initial recognition of MH issues. The preferred points of first contact also varied with the nature and severity of problems. A high proportion of patients is treated in specialized services, including mild cases. There is limited capacity of primary care professionals to identify and treat MH problems, with some improvement from collaborative care in the more recent years. The model for crisis management and acute care remains unclear: scarce evidence was found over the different arrangements used, mostly stressing lack of integration between emergency, hospital and community services and fragile continuity of care.ConclusionsThe performance of primary care and the regulation of acute demands, especially crisis management, are the most critical aspects on PMHC. Although primary care performance seems to be improving, the balanced provision and integration between services for adequate acute and long-term care is yet to be achieved.Electronic supplementary materialThe online version of this article (10.1186/s13033-018-0237-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies

Amaral

Campos

Oliveira

et al. 2018

Int J Ment Health Syst

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“…Even after overcoming these initial barriers, subjects face additional obstacles on the healthcare system. Access to treatment is unequal, resources in the public health system are insufficient and misallocated, general practitioners are not adequately trained in mental health, the provision of specialized care is limited and services are not adequately integrated [ 65 – 67 ]. Stigma against personality disorders is also a common phenomenon among health care providers.…”

Section: Discussionmentioning

confidence: 99%

The epidemiology of personality disorders in the Sao Paulo Megacity general population

et al. 2018

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IntroductionMost studies on the epidemiology of personality disorders (PDs) have been conducted in high-income countries and may not represent what happens in most part of the world. In the last decades, population growth has been concentrated in low- and middle-income countries, with rapid urbanization, increasing inequalities and escalation of violence. Our aim is to estimate the prevalence of PDs in the Sao Paulo Metropolitan Area, one of the largest megacities of the world. We examined sociodemographic correlates, the influence of urban stressors, the comorbidity with other mental disorders, functional impairment and treatment.MethodsA representative household sample of 2,942 adults was interviewed using the WHO-Composite International Diagnostic Interview and the International Personality Disorder Examination-Screening Questionnaire. Diagnoses were multiply imputed, and analyses used multivariable regression.Results and discussionPrevalence estimates were 4.3% (Cluster A), 2.7% (Cluster B), 4.6% (Cluster C) and 6.8% (any PD). Cumulative exposure to violence was associated with all PDs except Cluster A, although urbanicity, migration and neighborhood social deprivation were not significant predictors. Comorbidity was the rule, and all clusters were associated with other mental disorders. Lack of treatment is a reality in Greater Sao Paulo, and this is especially true for PDs. With the exception of Cluster C, non-comorbid PDs remained largely untreated in spite of functional impairment independent of other mental disorders.ConclusionPersonality disorders are prevalent, clinically significant and undertreated, and public health strategies must address the unmet needs of these subjects. Our results may reflect what happens in other developing world megacities, and future studies are expected in other low- and middle-income countries.

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“…O Estudo São Paulo Megacity estimou que somente 23% dos indivíduos diagnosticados com algum tipo de transtornos de ansiedade obtiveram acesso a algum tipo de serviços 17 . Entre os indivíduos que buscaram por serviços em São Paulo, apenas uma reduzida parcela obteve cuidados em serviços especializados (médicos psiquiatras, psicólogos ou enfermeiras especialistas em saúde mental).…”

Section: Uso De Serviços De Saúdeunclassified

“…Além disso, a proporção de pacientes que utilizaram formas de terapia complementar ou alternativa (grupos de autoajuda, conselheiros religiosos e outros tipos de curandeiros) também foi limitada. Ainda que dados comparativos inexistem, esta taxa de uso de serviços deve ser considerada superior a outras regiões brasileiras 17 .…”

Section: Uso De Serviços De Saúdeunclassified

Epidemiologia dos transtornos de ansiedade em regiões do Brasil

Mangolini

Andrade

Wang

2019

Rev. Med. (São Paulo)

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Patterns and predictors of health service use among people with mental disorders in São Paulo metropolitan area, Brazil

Cited by 28 publications

References 59 publications

Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies

Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies

The epidemiology of personality disorders in the Sao Paulo Megacity general population

Epidemiologia dos transtornos de ansiedade em regiões do Brasil

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