Four reflections on the new global mental health priorities

The discussion of the achievements and limitations of the strategies prioritised in global mental health that has taken place in recent years contributed to a unified vision for action that addresses the gaps still existing on prevention, treatment, quality of care and human rights protection. This editorial presents four reflections on the impact of this vision on the definition of future priorities, particularly in the areas of policy implementation, services reconfiguration and organisation, human rights and research. It concludes that further debate is needed to redefine the balance between priorities and strategies that can better promote an effective response to the needs of low and middle income countries, and to ensure an efficient coordination of efforts in the future.publishersversionpublishe

Implementação de um modelo de gestão de cuidados nos Serviços de Saúde Mental Portugueses: base conceptual

ABSTRACT - Case management implementation processes are one of the best examples on how an evidence-based practice can influence health services organisation. This practice helped shaping mental health teams, increasing their multidisciplinarity and interdisciplinary work in the last decades. Examples from several countries show how effectiveness research blends into health policy development to meet different needs in each health system, thus influencing case management inception and improvement of care. Portugal followed its own path in case management implementation, determined mostly by mental health services organisation and closely linked with the capacity to implement a national mental health policy in the last years.RESUMO - Os processos de implementação de um Modelo de Gestão de Cuidados são um dos melhores exemplos de como uma prática baseada na evidência pode influenciar a organização dos serviços de saúde. Esta prática ajudou a moldar as equipas de saúde mental nas últimas décadas, aumentando a sua multidisciplinaridade e o trabalho interdisciplinar. Os exemplos de vários países mostram como a investigação sobre a efectividade se harmoniza com o desenvolvimento de políticas de saúde para fazer face às diferentes necessidades de cada sistema de saúde, influenciando a implementação da gestão de cuidados e a melhoria de cuidados. Portugal seguiu o seu próprio caminho na implementação da gestão de cuidados, determinado maioritariamente pela organização de serviços associada à capacidade de implementar uma política nacional de saúde mental, nos últimos anos.info:eu-repo/semantics/publishedVersio

Implementing the World Mental Health Survey Initiative in Portugal – rationale, design and fieldwork procedures

Background: The World Mental Health Survey Initiative was designed to evaluate the prevalence, the correlates, the impact and the treatment patterns of mental disorders. This paper describes the rationale and the methodological details regarding the implementation of the survey in Portugal, a country that still lacks representative epidemiological data about psychiatric disorders. Methods: The World Mental Health Survey is a cross-sectional study with a representative sample of the Portuguese population, aged 18 or older, based on official census information. The WMH-Composite International Diagnostic Interview, adapted to the Portuguese language by a group of bilingual experts, was used to evaluate the mental health status, disorder severity, impairment, use of services and treatment. Interviews were administered face-to-face at respondent’s dwellings, which were selected from a nationally representative multi-stage clustered area probability sample of households. The survey was administered using computer-assisted personal interview methods by trained lay interviewers. Data quality was strictly controlled in order to ensure the reliability and validity of the collected information. Results: A total of 3,849 people completed the main survey, with 2,060 completing the long interview, with a response rate of 57.3%. Data cleaning was conducted in collaboration with the WMHSI Data Analysis Coordination Centre at the Department of Health Care Policy, Harvard Medical School. Collected information will provide lifetime and 12-month mental disorders diagnoses, according to the International Classification of Diseases and to the Diagnostic and Statistical Manual of Mental Disorders. Conclusions: The findings of this study could have a major influence in mental health care policy planning efforts over the next years, specially in a country that still has a significant level of unmet needs regarding mental health services organization, delivery of care and epidemiological research

the PromQual trial

Funding This study was funded by the Directorate-General of Health of the Ministry of Health, and the funding agency had no role in the design or execution of the study.Purpose: This study aimed to assess the efficacy of a staff-training intervention to improve service users’ engagement in activities and quality of care, by means of a cluster randomised controlled trial. Method: All residential units with at least 12-h a day staff support (n = 23) were invited to participate. Quality of care was assessed with the Quality Indicator for Rehabilitative Care (QuIRC) filled online by the unit’s manager. Half the units (n = 12) were randomly assigned to continue providing treatment as usual, and half (n = 11) received a staff-training intervention that focused on skills for engaging service users in activities, with trainers working alongside staff to embed this learning in the service. The primary outcome was service users’ level of activity (measured with the Time Use Diary), reassessed at 4 and 8 months. Secondary outcomes were the quality of care provided (QuIRC), and service users’ quality of life (Manchester Short Assessment of Quality of Life) reassessed at 8 months. Generalized linear mixed effect models were used to assess the difference in outcomes between units in the two trial arms. The trial was registered with Current Controlled Trials (Ref NCT02366117). Results: Knowledge acquired by the staff during the initial workshops increased significantly (p ≤ 0.01). However, the intervention and comparison units did not differ significantly in primary and secondary outcomes at either follow-up. Conclusions: The intervention increased the level of knowledge of staff without leading to an improvement in service users’ engagement in activities, quality of life, or quality of care in the units.publishersversionpublishe

Unemployment, parental distress and youth emotional well-being : the moderation roles of parent-youth relationship and financial deprivation

We investigated, in a sample of 112 unemployed parents of adolescents aged 10-19 years, the links between parental distress and change in youth emotional problems related to parental unemployment, and the moderation roles of parent-youth relationship and financial deprivation. Data were analyzed using descriptive statistics and correlations. Further, simple moderation, additive moderation, and moderated moderation models of regression were performed to analyze the effects of parental distress, parent-youth relationship and financial deprivation in predicting change in youth emotional problems related to parental unemployment. Results show that parental distress moderated by parent-youth relationship predicted levels of change in youth emotional problems related to parental unemployment. This study provides evidence that during job loss, parental distress is linked to youth emotional well-being and that parent-youth relationships play an important moderation role. This raises the importance of further researching parental distress impacts on youth well-being, especially during periods of high unemployment rates.PostprintPeer reviewe

Intimidade e saúde

L'intimité est précédée par des processus actifs, à travers le cycle de vie. Le lien affectif est établi principalement sur la relation entre attachement mère-enfant, et les comportements et styles de liens ont tendance à avoir un impact sur les relations entre adultes. Le but de cette recherche exploratoire vise à déterminer la transcription physique (conséquences sur la santé) des expériences insatisfaisantes de l'intimité. 60 étudiants (30 femmes, 30 hommes) âgés entre 22 et 27 ans, impliqué dans un jeu de relation amoureuse (durée minimale: 6 mois) ont été contactés pour répondre à une batterie d'instruments (variables d'intérêt: l'intimité, l'identité, concept de soi et des liens). Une bonne santé semble être associée à des valeurs élevées de l'interdépendance et de faibles niveaux de dépendance dans la relation. Dans ces jeunes l'intimité fondée sur la dépendance commis 14% de la santé mentale. L'impact d'une intimité malsaine limitées de près de 9% la santé physique des jeunes adultes en bonne santé.Intimacy is preceded by active processes across the life cycle. The emotional bond is established primarily on the attachment relationship of mother-infant, whose behavioral patterns and linking styles tend to be reflected on adult relationships. The purpose of this exploratory research aims to determine the physical transcription (health consequences) of unsatisfactory experiences of intimacy. 60 university students (30 female, 30 male) aged between 22 and 27 years, involved in a love relationship set (minimum duration: 6 months) were contacted to answer a battery of instruments (variables of interest: intimacy, identity, self-concept and linking). A good health seems to be associated with high values of interdependence and low levels of dependency in the relationship. In these young students intimacy based on dependence commits 14% of mental health. The impact of an unhealthy intimacy limits by nearly 9% physical health of young healthy adults.La intimidad es precedida por los procesos activos, a través del ciclo de vida. El vínculo afectivo se establece principalmente en la relación de apego madre-hijo, y patrones de comportamiento y estilos de los vínculos tienden a repercutir en las relaciones adultas. El propósito de esta investigación exploratoria es determinar la transcripción física (consecuencias para la salud) de la intimidad de experiencias insatisfactorias. Sesenta universitarios (30 mujeres, 30 varones) de edades comprendidas entre 22 y 27 años, que participan en una relación de amor (duración mínima: 6 meses) fueron contactados para responder a una batería de instrumentos (variables de interés: la intimidad, la identidad, el autoconcepto y la vinculación). Un buen estado de salud parece estar asociado con altos valores de interdependencia y bajos niveles de dependencia en la relación. En estos jóvenes la intimidad basada en la dependencia compromete 14% de la salud mental. El impacto de una intimidad insalubre limita casi 9% de la salud física de los adultos jóvenes sanos.A intimidade é antecedida de processos ativos, transversais ao ciclo de vida. O vínculo afetivo estabelece-se primariamente na relação de vinculação mãe-bebê, e os padrões comportamentais e estilos de vinculação tendem a repercutir-se nas relações adultas. O objetivo exploratório desta investigação pretende apurar a transcrição física (consequências na saúde) de vivências insatisfatórias de intimidade. Sessenta universitários (30 do sexo feminino; 30 do sexo masculino), com idades entre 22 e 27 anos, envolvidos numa relação amorosa fixa (duração mínima: 6 meses) foram contactados para responder a uma bateria de instrumentos (variáveis de interesse: intimidade, identidade, autoconceito e vinculação). Um bom estado de saúde parece associar-se a valores elevados de interdependência e baixos valores de dependência na relação amorosa. Nestes jovens a intimidade baseada na dependência compromete 14% da saúde mental. O impacto de uma intimidade pouco saudável limita em quase 9% a saúde física de jovens adultos saudáveis

Social vulnerability on maternal health in immigrants. A problem of interculturality

The scientific literature indicates how often migrants tend to be the most vulnerable population groups, especially women of childbearing age, that regularly show greater foetal and neonatal mortality, and more complications during pregnancy and postpartum.The study followed a qualitative methodology for collecting and analysing data and was conducted in Porto. Participants were 25 recent immigrant mothers from Eastern European countries, Brazil, Portuguese-speaking African countries and six native Portuguese recent mothers (for comparison), contacted through social associations and institutions. Data suggests that healthcare depends not only on accessibility but especially on social opportunities and intercultural integration in the host countr

Factors associated with involuntary psychiatric hospitalization in Portugal

Funding This study integrated the research project “Mental Health, Impact Assessment of Local and Economic Constraints—SMAILE”, funded by the Foundation for Science and Technology (PTDC/ATP-GEO/4101/2012). The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020).Background: Identifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012. Methods: Data from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors. Results: An increment of involuntary hospitalizations was associated with male gender [exp(β ^) = 1.31; 95%CI 1.06–1.62, p < 0.05], having secondary and higher education [exp(β ^) = 1.45; 95%CI 1.05–2.01, p < 0.05, and exp(β ^) = 1.89; 95%CI 1.38–2.60, p < 0.001, respectively], a psychiatric diagnosis of psychosis [exp(β ^) = 2.02; 95%CI 1.59–2.59, p < 0.001], and being admitted in 2007 and in 2012 [exp(β ^) = 1.61; 95%CI 1.21–2.16, p < 0.01, and exp(β ^) = 1.73; 95%CI 1.31–2.32, p < 0.001, respectively]. A decrease in involuntary hospitalizations was associated with being married/cohabitating [exp(β ^) = 0.74; 95%CI 0.56–0.99, p < 0.05], having experienced a suicide attempt [exp(β ^) = 0.26; 95%CI 0.15–0.42, p < 0.001], and belonging to the catchment area of three of the psychiatric services evaluated [exp(β ^) = 0.65; 95%CI 0.49–0.86, p < 0.01, exp(β ^) = 0.67; 95%CI 0.49–0.90, p < 0.01, and exp(β ^) = 0.67; 95%CI 0.46–0.96, p < 0.05 for Hospital de Magalhães Lemos, Centro Hospitalar Psiquiátrico de Lisboa and Unidade Local de Saúde do Baixo Alentejo, respectively]. Conclusions: The findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with several sociodemographic, clinical, and contextual factors. This information may help identify high-risk patients and inform the development of better-targeted preventive interventions to reduce these hospitalizations.publishersversionpublishe

How did the use of psychotropic drugs change during the Great Recession in Portugal? A follow-up to the National Mental Health Survey

The Portuguese Mental Health Study was funded by the Champalimaud Foundation, the Gulbenkian Foundation, the Foundation for Science and Technology (FCT), and the Ministry of Health. The Portuguese Mental Health Study was carried out by the Department of Mental Health, Nova Medical School, Nova University of Lisbon, with collaboration of the CESOP– Silva et al. BMC Psychiatry (2020) 20:215 Page 7 of 9 Portuguese Catholic University, and in conjunction with the World Health Organization WMH Survey Initiative. The World Health Organization WMH Survey Initiative is supported by the National Institute of Mental Health (NIMH; R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the U.S. Public Health Service (R13-MH066849, R01-MH069864 and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline and Bristol-Myers Squibb. A complete list of funding support and publications can be found at: http://www.hcp.med.harvard.edu/wmh. The National Mental Health Survey Follow-Up was funded by the Public Health Initiatives Programme (PT06), financed by EEA Grants Financial Mechanism 2009–2014. For further information, please visit http//www.eeagrants.gov.pt/. The funding bodies of both surveys were not involved in any aspect of the design of the study and collection, analysis, or interpretation of data and in writing the manuscript.BACKGROUND: Research suggests that economic recessions might be associated with a higher use of psychotropic drugs, but literature is scarce and contradictory in identifying the most vulnerable groups. This study aims to assess possible changes in the use of psychotropic drugs due to the economic recession in Portugal, by comparing self-reported consumption in 2008/09 and 2015/16. METHODS: Data from the World Mental Health Survey Initiative Portugal (2008/09) and the National Mental Health Survey Follow-Up (2015/16) were used (n = 911). McNemar's tests were performed to estimate changes in consumption of any psychotropic drug and of antidepressants, anxiolytics, and hypnotics/sedatives. Multiple Generalised Estimating Equations models with interaction effects were used to estimate the population odds of consuming psychotropic drugs according to year, gender and age. RESULTS: An increase of 6.74% was estimated in the consumption of psychotropic drugs from 2008/09 to 2015/16. Population odds of consuming any psychotropic drugs in 2015/16 were estimated to be 1.5 times higher than in 2008/09 (OR = 1.50;95%CI:1.13-2.01), particularly for hypnotics/sedatives (OR = 1.60;95%CI:1.14-2.25). Women and older individuals presented higher odds of consuming any psychotropic drugs (OR = 2.79;95%CI:2.03-3.84, and OR = 1.80;95%CI:1.28-2.54), after adjusting for year of assessment and education. However, when evaluating the interaction effect of the year with gender and age, men and younger individuals reported higher odds of consuming any psychotropic drugs in 2015/16, when compared to 2008/09 (OR = 1.85;95%CI:1.08-3.17, and OR = 1.95;95%CI:1.32-2.90, respectively). CONCLUSIONS: The findings indicate that the period of economic recession was associated with an increased risk of psychotropic drugs use in Portugal. Consumption of psychotropic drugs remained higher among women and older individuals, but the results suggest that the economic crisis had a disproportionate impact on men and younger individuals. This identification of the most vulnerable population groups is useful to design effective and targeted public health interventions aimed at alleviating the effects of economic recessions.publishersversionpublishe

An exploratory study of stakeholders' perceptions of how epidemiologic data can be utilized for policy in the field of mental health

The World Mental Health Survey Consortium, a World Health Organization and Harvard University collaboration, totaling 28 countries participated in a uniform randomized general population survey, making use of translated versions of the WHO Composite International Diagnostic Interview. One of the major purposes of the survey was to help inform policy decision makers regarding mental health. However many obstacles prevent the direct translation of survey data to policies. We report on an investigation of the mechanisms involved in the transformation of survey data into mental health policies. After conducting 11 interviews of individuals representing 12 countries that participated in the survey, we found that although governments did take an active role in the conduct of the survey, this did not necessarily translate into direct policy changes. A number of factors were noted to influence the adoption and implement ation of mental health policy changes from the survey data: the establishment of links between the research group and policymakers; the identification of costs of mental disorder; definition of clear solutions; and lastly the generation of political will. The range of countries included in this investigation has enabled comparisons in the use of evidence to influence policies in different contexts. Gaining an understanding of why some countries were successful and why others struggled in transforming survey results to policies may help to inform researchers of translational issues of research to mental health policies in the future.publishersversionpublishe