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

Abstract

The social adjustment of people with severe mental illness in São Paulo, Brazil O ajustamento social de pessoas com transtornos mentais graves em São Paulo, Brasil A b s t r a c t 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.Keywords: Mental disorders; Social adjustment; Cross-sectional studies; Interview, psychological; Mental health services; Brazil Resumo Objetivo: Investigar o ajustamento social em indivíduos com transtornos mentais graves vivendo na comunidade de um grande centro urbano de um país em desenvolvimento e as características associadas a um ajustamento social pobre. Método: Um estudo de corte transversal foi conduzido em São Paulo. Indivíduos elegíveis deviam residir em áreas definidas da cidade de São Paulo, ter tido contato com os serviços psiquiátricos do setor público em período de três meses, idade entre 18 e 65 anos e diagnóstico de psicose funcional. Entrevistas estruturadas foram utilizadas para obter dados sociodemográficos, diagnóstico (CID-10), sintomas psiquiátricos (PANSS) e ajustamento social (DAS). Resultados: Cento e oitenta e oito indivíduos foram incluídos e 120 (63,8%) apresentaram algum grau de desajustamento social. As áreas mais afetadas foram performance no trabalho e sexual. Vinte e quatro indivíduos (12,8%) apresentaram ajustamento social pobre ou muito pobre no mês anterior à entrevista. Número de internações anteriores, sintomas gerais e negativos de esquizofrenia mostraram-se associados ao ajustamento social global. Conclusões: A proporção de indivíduos apresentando qualquer grau de desajustamento social é comparável à encontrada em países mai...