Therapeutic Adherence of People with Mental Disorders: An Evolutionary Concept Analysis.

Patient therapeutic adherence lies at the core of mental health care. Health Care professionals and organizations play a major role in promoting adherence among people with mental disorders. However, defining therapeutic adherence remains complex. We used Rodgers' evolutionary concept analysis to explore the concept of therapeutic adherence in the context of mental health. We conducted a systematic literature search on Medline/PubMed and CINAHL for works published between January 2012 and December 2022. The concept analysis showed that major attributes of therapeutic adherence include patient, microsystem and meso/exosystem-level factors. Antecedents are those related to patients, such as their background, beliefs and attitudes, and acceptance of mental illness-and those related to patient-HCP therapeutic engagement. Lastly, three different consequences of the concept emerged: an improvement in clinical and social outcomes, commitment to treatment, and the quality of healthcare delivery. We discuss an operational definition that emerged from the concept analysis approach. However, considering the concept has undergone evolutionary changes, further research related to patient adherence experiences in an ecological stance is needed.

"Looking beyond Mental Health Stigma": An Online Focus Group Study among Senior Undergraduate Nursing Students.

Evidence highlights the need for professionals to be aware of their stigmatizing attitudes and discriminatory practices in order to minimize the negative impact on the people they take care of. However, nursing students' perceptions of these issues have been poorly studied. This study explores the perspective of senior undergraduate nursing students on mental health and the stigma around it, by considering a simulated case vignette of a person with a mental health problem. A descriptive qualitative approach was chosen and involved three online focus group discussions. The findings show various manifestations of stigma, both at an individual and collective level, which indicates that it is an obstacle to the wellbeing of people with mental illness. Individual manifestations of stigma concern its effect on the person with mental illness, while at the collective level they concern the family or society in general. Stigma is a multifactorial, multidimensional, and complex concept, in terms of identifying and fighting it. Thus, the strategies identified involve multiple approaches at the individual level, aimed at the patient and family, namely through education/training, communication, and relationship strategies. At the collective level, to intervene with the general population and specific groups, such as groups of young people, strategies suggested include education/training, use of the media, and contact with people with mental disorders as ways to fight stigma.

Measuring discrimination experienced by people with a mental illness: replication of the short-form DISCUS in six world regions.

BACKGROUND: The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally. METHODS: This study evaluated whether the psychometric properties of a short-form version, DISC-Ultra Short (DISCUS) (11-item), could be replicated in a sample of people with a wide range of mental disorders from 21 sites in 15 countries/territories, across six global regions. The frequency of experienced discrimination was reported. Scaling assumptions (confirmatory factor analysis, inter-item and item-total correlations), reliability (internal consistency) and validity (convergent validity, known groups method) were investigated in each region, and by diagnosis group. RESULTS: 1195 people participated. The most frequently reported experiences of discrimination were being shunned or avoided at work (48.7%) and discrimination in making or keeping friends (47.2%). Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnosis groups. Convergent validity was confirmed in the total sample and within all regions [ Internalised Stigma of Mental Illness (ISMI-10): 0.28-0.67, stopping self: 0.54-0.72, stigma consciousness: -0.32-0.57], as was internal consistency reliability (α = 0.74-0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001]. CONCLUSIONS: The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings.

The relation between lifestyles and positive mental health in Portuguese higher education students.

Healthy lifestyles are commonly associated with improved physical and mental health. Sleep patterns, nutrition, physical exercise, consumption of psychoactive substances, among others, can strongly influence positive mental health. The aims are: characterize lifestyles based on positive mental health clusters, considering the cross-sectional cohort sample of higher education students, and analyse the lifestyles associated with positive mental health. A cross-sectional, descriptive, correlational and multicentric study of quantitative approach was conducted. The Positive Mental Health Questionnaire was applied. Through the k-means method, four clusters were obtained based on positive mental health levels. The sample of 3647 higher education students was mostly female (78.8%), single (89.5%), with an average age of 23 years (SD = 6.68). Differences were found between clusters based on the sociodemographic characteristics and lifestyles. Findings in Cluster 1 were highlighted because they included students with a higher level of positive mental health, which was associated with greater satisfaction in affective relationships, higher recreational and sports activities, better sleep quality, a healthy diet, and lower medication and illicit drugs consumption. These key findings emphasize the promotion of healthy lifestyles and highlight the importance of positive mental health in promoting the health of higher education students.

Positive Mental Health and Mental Health Literacy of Informal Caregivers: A Scoping Review.

Positive mental health and mental health literacy are two main concepts to ensure an individual and social state of mental health and well-being. A scoping review of the scientific literature published in the field of health sciences was conducted to identify the relationship between mental health literacy and the positive mental health of family caregivers. A research expression was used to search for articles in health databases, respecting the main topics of the Participants/Concept/Context (PCC) framework. A total of eight articles were included from the 2830 initially identified using the PRISMA Extension for Scoping Reviews (PRISMA-ScR) process. It was noticeable that none of the studies related positive mental health and mental health literacy of caregivers. Nevertheless, it was possible to identify predictors of mental health and self-efficacy, such as burden and a lack of information about and support in the process of care. Caregivers' quality of life, self-esteem and confidence are also important positive mental health predictors that are closely related to health literacy. The knowledge of these factors can contribute to the reduction in negative determinants of mental health of caregivers and the resolution of strategies to meet caregivers' needs.

Positive Mental Health Literacy: A Concept Analysis.

Background: The positive component of Mental Health Literacy (PMeHL) refers to a person's awareness of how to achieve and maintain good mental health. Although explored recently, the term still lacks a clear definition among healthcare practitioners. Aim: To identify the attributes and characteristics of PMeHL, as well as its theoretical and practical applications. Methods: Literature search (using the Medline and CINAHL databases) and review, covering the last 21 years, followed by concept analysis according to the steps described by Walker and Avant approach. Results: Positive component of Mental Health Literacy is considered one component of MHL, integrating positive mental health. The concept's attributes include: (a) competence in problem-solving and self-actualization; (b) personal satisfaction; (c) autonomy; (d) relatedness and interpersonal relationship skills; (e) self-control; and (f) prosocial attitude. Four case scenarios (model, borderline, related and contrary cases) were used to clarify the antecedents (individual factors and social/contextual factors) and consequences (individual sphere; relational/social sphere; contextual/organizational sphere) of PMeHL. Conclusion: Positive component of Mental Health Literacy is considered a component of MHL, which deserves attention throughout the lifespan, in different contexts and intervention levels. Considering PMeHL as a multi-faceted and dynamic construct will help understand the mechanisms that improve mental health and promote healthy behaviors. Priority should be given to robust primary research focused on nursing interventions that enhance and sustain PMeHL in people and families.

Consumo de álcool e vulnerabilidade em saúde das pessoas em situação de sem-abrigo / Alcohol consumption and health vulnerability of homeless people / El consumo de alcohol y la vulnerabilidad a la salud de las personas sin hogar

Resumo Contexto: Em Portugal, 45% das Pessoas em Situação de Sem-Abrigo (PSSA) estão a viver na rua, na área metropolitana de Lisboa. Esta população apresenta vulnerabilidades de ordem económica, social e física. No que se refere ao seu estado de saúde, salienta-se o consumo de substâncias, problemas músculo-esqueléticos, respiratórios, cardiovasculares e psiquiátricos. As consequências da Perturbação de Uso de Álcool (PUA) refletem-se a nível socioeconómico e da saúde, pelo que se torna relevante conhecer essa problemática nas PSSA. Objetivo: Caracterizar o perfil sociodemográfico, a perceção de saúde e o consumo de álcool entre a população em situação de sem-abrigo na área metropolitana de Lisboa. Métodos: Estudo transversal, descritivo e correlacional. Os instrumentos utilizados foram um questionário com a caracterização sociodemográfica e de saúde construído pelos autores e o CAGE. A recolha de dados foi realizada na cidade de Lisboa em março de 2018. A análise de dados foi realizada com o SPSS 25. Resultados: A amostra é constituída por 199 participantes de ambos os sexos. 49,2% apresenta PUA, 56,8% fuma diariamente tabaco e o consumo de drogas foi referido ao longo da vida por 52,8% dos participantes. Foram encontradas correlações estatisticamente significativas entre o consumo de tabaco, de bebidas alcoólicas e de drogas ilícitas. Conclusões: A intervenção com PSSA, deve basear-se numa visão holística da pessoa e do meio em que se insere, na Redução de Riscos e Minimização de Danos e/ou interrupção dos consumos de álcool. As necessidades em cuidados de saúde mostram a importância da inclusão do enfermeiro nas equipas multidisciplinares que apoiam esta população.

Abstract Background: In Portugal, 45% of Homeless People (PSSA) are living on the street in the Lisbon metropolitan area. This population has economic, social and physical vulnerabilities. Regarding their health status, substance use, musculoskeletal, respiratory, cardiovascular and psychiatric problems are highlighted. The consequences of Alcohol Use Disorder (PUA) are reflected at the socioeconomic and health level, so it is relevant to know this problem in PSSA. Aim: To characterize the sociodemographic profile, health perception and alcohol consumption among the homeless population in the Lisbon metropolitan area. Methods: Cross-sectional, descriptive and correlational study. The instruments used were a sociodemographic questionnaire with health characterization built by the authors and the CAGE. Data collection was performed in the city of Lisbon during March 2018. Data analysis was performed with SPSS 25. Results: The sample consisted of 199 participants of both sexes. 49.2% had PUA, 56.8% smoked tobacco on a daily basis, and drug use was reported throughout life by 52.8% of participants. Statistically significant correlations were found between tobacco use, alcohol and illicit drugs consumption. Conclusions: Intervention with PSSA should be based on a holistic view of the person and the environment, risk reduction and harm minimization, and / or interruption of alcohol consumption. Health care needs highlights the importance of including nurses in multidisciplinary teams to support this population.

Resumen Contexto: en Portugal, el 45% de las personas sin hogar (PSSA) viven en la calle en el área metropolitana de Lisboa. Esta población tiene vulnerabilidades económicas, sociales y físicas. En cuanto a su estado de salud, se destacan el uso de sustancias, problemas musculoesqueléticos, respiratorios, cardiovasculares y psiquiátricos. Las consecuencias del trastorno por consumo de alcohol (PUA) se reflejan a nivel socioeconómico y de salud, por lo que es relevante conocer este problema en PSSA. Objetivo(s): caracterizar el perfil sociodemográfico, la percepción de salud y el consumo de alcohol entre la población sin hogar en el área metropolitana de Lisboa. Metodología: Estudio transversal, descriptivo y correlacional. Los instrumentos utilizados fueron un cuestionario con caracterización sociodemográfica y de salud construido por los autores y CAGE. La recolección de datos se realizó en la ciudad de Lisboa. El análisis de los datos se realizó con SPSS 25. Resultados: La muestra consistió en 199 participantes de ambos sexos. El 49.2% tenía PUA, el 56.8% fumaba tabaco diariamente y el 52.8% de los participantes informó el uso de drogas durante toda la vida. Se encontraron correlaciones estadísticamente significativas entre el consumo de tabaco, el alcohol y las drogas ilícitas. Conclusiones: La intervención con PSSA debe basarse en una visión holística de la persona y el medio ambiente, la reducción de riesgos y la minimización de daños, y / o la interrupción del consumo de alcohol. Las necesidades de atención médica muestran la importancia de incluir enfermeras en equipos multidisciplinarios que apoyan a esta población.

O que sabem e pensam os enfermeiros sobre a doença mental: Estudo do conhecimento e atitudes estigmatizantes em saúde mental / What nurses know and think about a mental illness: Study of knowledge and stigmatizing attitudes in mental health / Lo que saben y piensan los enfermeros sobre una enfermedad mental: Estudio del conocimiento y actitudes estigmatizantes en salud mental

CONTEXTO: O estigma em saúde mental continua a ser uma realidade.Devido ao papel que desempenham, as atitudes estigmatizantes dos enfermeiros são muitas vezes mais prejudiciais. Fatores formativos e o conhecimento são responsáveis por alterações nos níveis de estigma. OBJETIVO(S): Descrever o conhecimento sobre saúde mental e os níveis de atitudes estigmatizantes dos enfermeiros de um Centro Hospitalar da região centro de Portugal; Analisar em que medida as atitudes estigmatizantes se relacionam com os conhecimentos sobre saúde mental. MÉTODOS: Realizou-se um estudo quantitativo, descritivo-correlacional, transversal. A amostra, do tipo não probabilístico por conveniência, foi constituída por 83 enfermeiros. O questionário, para além da caraterização sociodemográfica dos participantes, integrava uma questão sobre a perceção do conhecimento e outra sobre a perceção do estigma em saúde mental; a versão portuguesa da Mental Health Knowledge Schedule; e a versão portuguesa da Mental Illness Clinician's Attitudes Scale. RESULTADOS: Os enfermeiros consideram o seu estigma em saúde mental muito baixo e o nível de conhecimento mediano. Os níveis de atitudes estigmatizantes da amostra são baixos e o nível de conhecimento é elevado. Existe uma correlação negativa entre os níveis de atitudes estigmatizantes e a perceção do conhecimento, e positiva com o nível de estigma percebido. Os enfermeiros que exercem funções em serviços não psiquiátricos apresentam mais atitudes estigmatizantes. CONCLUSÕES: Os enfermeiros revelaram conhecimento razoável em saúde mental e níveis de atitudes estigmatizantes baixos, contudo estes valores pioram nos enfermeiros que não exercem funções em serviços de psiquiatria.

BACKGROUND:Stigma in mental health continues to be a reality. Because of their role, nurses' stigmatizing attitudes are often more harmful. Learning factors and knowledge are responsible for changes in stigma levels. AIM:To describe the knowledge about mental health and the levels of stigmatizing attitudes of nurses working in a Hospital in the central region of Portugal; To analyze the extent to which stigmatizing attitudes correlate to mental health knowledge. METHODS:The sample is non-probabilistic for convenience, being constituted by 83 nurses. The questionnaire, besides the sociodemographic characterization of the participants, integrates a question about the perception of knowledge and another about the perception of stigma in mental health; the Portuguese version of the Mental Health Knowledge Schedule; and the Portuguese version of the Mental Illness Clinician's Attitudes Scale. RESULTS: Nurses consider their stigma in mental health too low and their level of knowledge medium.The levels of stigmatizing attitudes of the sample are low and the level of knowledge is high. There is a negative relationship between the levels of stigmatizing attitudes and the perception of knowledge and a positive relationship with the level of perceived stigma. Nurses who work in non-psychiatric wards have more stigmatizing attitudes. CONCLUSIONS:Nurses showed reasonable knowledge of mental health and low levels of stigma, but these values ??worsen in nurses who do not work in psychiatry wards.

CONTEXTO: El estigma en salud mental sigue siendo una realidad. Debido al papel que desempeñan, las actitudes estigmatizantes de los enfermeros son a menudo más perjudiciales. Los factores formativos y el conocimiento son responsables de cambios en los niveles de estigma. OBJETIVO(S): Describir el conocimiento acerca de la salud mental y los niveles de actitudes estigmatizantes de los profesionales de enfermería en un centro hospitalario de la región central de Portugal; Analizar en qué medida las actitudes estigmatizantes se relacionan con los conocimientos sobre salud mental. METODOLOGÍA:studio cuantitativo, descriptivo correlacional, transversal. La muestra, del tipo no probabilístico por conveniencia, fue constituida por 83 enfermeros. El cuestionario, además de la caracterización sociodemográfica de los participantes, integra una cuestión sobre la percepción del conocimiento y otra sobre la percepción del estigma en salud mental sentido; la versión portuguesa de la Mental Health Knowledge Schedule y la versión en portugués de la Mental Illness Clinician's Attitudes Scale. RESULTADOS:Los enfermeros consideran su estigma en salud mental muy bajo y el nivel de conocimiento mediano. Los niveles de actitudes estigmatizantes de la muestra son bajos y el nivel de conocimiento es elevado. Hay relación negativa entre los niveles de actitudes estigmatizantes con la percepción del conocimiento y relación positiva con el nivel de estigma percibido. Los enfermeros que ejercen funciones en servicios no psiquiátricos presentan más actitudes estigmatizantes. CONCLUSIONES:Los enfermeros revelaron conocimiento razonable en salud mental y niveles de actitudes estigmatizantes bajos, sin embargo, estos valores empeoran en los enfermeros que no ejercen funciones en servicios de psiquiatría.

Violence in intimate relationships in adolescents: effectiveness of an intervention by peers through forum theater.

OBJECTIVE: The main goal was the peer evaluation of the effectiveness of a health education intervention, also seeking the characterization of violent behaviors experienced by teens in intimate relationships. METHOD: A pretest-posttest quasi-experimental study was performed with a non-probabilistic sample of 197 teens of both genders without control group. The intervention performed consisted of one peer-run forum theater session about intimate violence in dating relationships of teens. RESULTS: Boys reported being both victims and perpetrators of violent behaviors more frequently than girls. The sample reported more behaviors associated with victimization than perpetration. Girls showed a higher level of knowledge on the topic and this knowledge increased after the intervention. CONCLUSION: Psychological violence is highly prevalent in dating relationships, particularly in cases of victimization. It seems essential to understand and act upon adolescents' perceptions about what violent behavior is. This study confirmed the effectiveness of health education in acquiring knowledge on this topic.

Violence in intimate relationships in adolescents: effectiveness of an intervention by peers through forum theater / Violência nas relações íntimas entre adolescentes: eficácia de uma intervenção mediada por pares por meio do teatro-fórum / Violencia en las relaciones íntimas entre adolescentes: efectividad de una intervención mediada por pares mediante el teatro fórum

Abstract Objective: The main goal was the peer evaluation of the effectiveness of a health education intervention, also seeking the characterization of violent behaviors experienced by teens in intimate relationships. Method: A pretest-posttest quasi-experimental study was performed with a non-probabilistic sample of 197 teens of both genders without control group. The intervention performed consisted of one peer-run forum theater session about intimate violence in dating relationships of teens. Results: Boys reported being both victims and perpetrators of violent behaviors more frequently than girls. The sample reported more behaviors associated with victimization than perpetration. Girls showed a higher level of knowledge on the topic and this knowledge increased after the intervention. Conclusion: Psychological violence is highly prevalent in dating relationships, particularly in cases of victimization. It seems essential to understand and act upon adolescents' perceptions about what violent behavior is. This study confirmed the effectiveness of health education in acquiring knowledge on this topic.

Resumo Objetivo: O principal objetivo foi a avaliação por pares da eficácia de uma intervenção educacional em saúde, também buscando a caracterização de comportamentos violentos vivenciados por adolescentes nas relações íntimas. Método: Um estudo quase-experimental pré e pós teste foi realizado com uma mostra não probabilística de 197 adolescentes de ambos os gêneros sem grupo controle. A intervenção realizada consistiu de uma sessão de teatro-fórum entre pares sobre violência íntima nos relacionamentos amorosos entre adolescentes. Resultados: Os meninos relataram ser tanto vítimas quanto perpetradores dos comportamentos violentos mais frequentemente do que as meninas. A amostra relatou mais comportamentos associados à vitimização do que perpetração. As meninas mostraram um nível mais alto de conhecimento sobre o assunto e esse conhecimento aumentou após a intervenção. Conclusão: A violência psicológica é altamente prevalente nos relacionamentos amorosos, particularmente nos casos de vitimização. Parece essencial compreender as percepções dos adolescentes sobre o que é um comportamento violento e agir nesse sentido. Este estudo confirmou a eficácia da educação em saúde na aquisição de conhecimento sobre esse tópico.

Resumen El principal objetivo: fue la evaluación por pares de la efectividad de una intervención educativa en salud, también buscando la caracterización de comportamientos violentos vividos por adolescentes en las relaciones íntimas. Método: Un estudio cuasi-experimental pre y post prueba fue llevado a cabo con una muestra no probabilística de 197 adolescentes de ambos géneros sin grupo control. La intervención realizada se constituyó en una sesión de teatro fórum entre pares acerca de la violencia íntima en las relaciones amorosas entre adolescentes. Resultados: Los chicos relataron ser tanto víctimas como perpetradores de los comportamientos violentos con más frecuencia que las chicas. La muestra relató más comportamientos asociados con la victimización que la perpetración. Las chicas mostraron un nivel más alto de conocimiento acerca del tema y dicho conocimiento se incrementó después de la intervención. Conclusión: La violencia psicológica es altamente prevaleciente en las relaciones amorosas particularmente en los casos de victimización. Parece esencial comprender las percepciones de los adolescentes acerca de qué es un comportamiento violento y actuar en ese sentido. Este estudio confirmó la efectividad de la educación sanitaria en la adquisición de conocimiento sobre ese tópico.

Impacto de uma intervenção no estigma em saúde mental e ansiedade intergrupal / Impacto de una intervención sobre el estigma en salud mental y ansiedad intergrupal / Impact of an intervention on stigma in mental health and intergroup anxiety

Resumo Objetivo Avaliar a eficácia de uma intervenção na redução das atitudes estigmatizantes e ansiedade perante o doente mental em estudantes de enfermagem. Métodos Estudo quase experimental, realizado com uma amostra intencional de 99 estudantes de enfermagem de um instituto universitário da região centro de Portugal. No grupo de controlo, os estudantes desenvolveram o plano de ensino clínico em Enfermagem de saúde mental e psiquiátrica em serviços de psiquiatria, conforme o plano de estudos (n=50). No grupo de teste, além de cumprirem o plano de estudos, os estudantes participaram de um programa psicoeducativo dirigido ao estigma (n=49). Utilizaram-se as versões portuguesas da Mental Illness: Clinicians' Attitudes Scale (MICA-4) e AQ27 para avaliação do estigma e a Intergroup Anxiety Scale (EAI) para medir a ansiedade intergrupal. Resultados A amostra apresenta homogeneidade de variáveis no momento inicial (p>0,05), com melhorias estatisticamente significativas das atitudes estigmatizantes e redução da ansiedade perante o doente mental em ambos os grupos (p<0,005). O impacto da intervenção não foi significativo, tendo o grupo de teste melhorado as atitudes estigmatizantes de medo (p=0,03) e piorado relativamente à ajuda (p= 0,04). Conclusão Verificou-se um impacto positivo do ensino clínico na redução da ansiedade perante o doente mental, conduzindo a uma redução do estigma em saúde mental. A intervenção dirigida ao estigma não revelou efeitos significativos no estigma global nem na ansiedade intergrupal o que aponta para a necessidade futura da sua reformulação e comparação com amostras de estudantes de outras instituições de ensino de enfermagem.

Resumen Objetivo Evaluar la eficacia de una intervención en la reducción de actitudes estigmatizantes y ansiedad ante la persona con enfernedad mental en estudiantes de Enfermería. Métodos Se trata de un estudio cuasi experimental, realizado con un muestreo intencional de 99 estudiantes de Enfermería de un instituto universitario de la región centro de Portugal. En el grupo de control, los estudiantes realizaron el plan de enseñanza clínica en enfermería de salud mental y psiquiátrica en servicios de psiquiatría, de acuerdo con el plan de estudios (n=50). En el grupo experimental, además de cumplir con el plan de estudios, los estudiantes participaron en un programa psicoeducativo orientado al estigma (n=49). Se utilizaron las versiones portuguesas de la Mental Illness: Clinicians' Attitudes Scale (MICA-4) y AQ27 para evaluar el estigma y la Intergroup Anxiety Scale (EAI) para medir la ansiedad intergrupal. Resultados La muestra presentó homogeneidad de variables en el momento inicial (p>0,05), con mejoras estadísticamente significativas de las actitudes estigmatizantes y reducción de la ansiedad ante la persona con enfermedad mental en ambos grupos (p>0,005). El impacto de la intervención no fue significativo: el grupo experimental mejoró las actitudes estigmatizantes de miedo (p=0,03) y empeoró relativamente la ayuda (p=0,04). Conclusión Se verificó un impacto positivo de la enseñanza clínica en la reducción de la ansiedad ante la persona con enfermedad mental, lo que lleva a una reducción del estigma en salud mental. La intervención orientada al estigma no reveló efectos significativos en el estigma global ni en la ansiedad intergrupal, lo que advierte la necesidad futura de su reformulación y comparación con muestras de estudiantes de otras instituciones educativas de Enfermería.

Abstract Objective To assess the effectiveness of an intervention to reduce stigmatizing attitudes and anxiety towards people with mental illness among nursing students. Methods This was a quasi-experimental study including an intentional sample of 99 nursing students from university of Central Portugal. In the control group, students developed the clinical teaching plan in mental health and psychiatric nursing in psychiatric health services, according to the syllabus (n=50). In the experimental group, in addition to complying with the syllabus, the students participated in a psychoeducational program oriented towards stigma (n=49). To assess stigma, the Portuguese versions of Mental Illness: Clinicians' Attitudes Scale (MICA-4) and AQ27 were used; and to measure intergroup anxiety, the Intergroup Anxiety Scale (IAS). Results The sample presents homogeneous variables in the initial time (p>0.05), with statistically significant improvement of stigmatizing attitudes and reduction of anxiety towards people with mental illness in both studied groups (p<0.005). The impact of the intervention was not significant, the experimental group improved stigmatizing attitudes regarding fear (p=0.03) and the ones regarding help had worsened (p= 0.04). Conclusion We verified a positive impact of clinical teaching in the reduction of anxiety towards people with mental illness, which led to a reduction of stigma associated to mental health. The intervention oriented towards stigma did not reveal significant effects concerning global stigma, nor intergroup anxiety, which showed the future necessity of its reformulation and comparison with samples of students from other nursing universities.

A saúde mental dos enfermeiros: Um estudo preliminar / Mental health of nurses: A preliminary study / La salud mental de los enfermeros: Estudio preliminar

CONTEXTO: Os enfermeiros estão sujeitos a que o seu bem-estar e saúde mental possam ficar comprometidos. Dois terços dos enfermeiros apresenta uma perceção negativa da sua saúde mental. A manutenção e prevenção da saúde mental dos enfermeiros é fundamental para que se prestem cuidados eficazes e de qualidade. OBJETIVO(S): Conhecer a saúde mental de um grupo de enfermeiros de um Centro Hospitalar da região centro de Portugal e correlacionar com as variáveis sociodemográficas MÉTODOS: Estudo quantitativo, descritivo-correlacional, transversal. A amostra, não probabilística de conveniência, foi composta por 83 enfermeiros. O questionário foi constituído por dados sociodemográficos e a versão portuguesa reduzida do Mental Health Inventory. Foram assegurados todos os princípios éticos e formais, recorrendo-se a software estatístico para análise estatística com testes não paramétricos. RESULTADOS: A saúde mental da amostra é considerada razoável, com valores acima do ponto de corte para a possível existência de sintomas moderados de sofrimento psicológico. A dimensão depressão é a mais bem cotada e a dimensão ansiedade aquela com menor cotação média. Ocorre a prevalência de sintomas graves de depressão em 20,5% da amostra. As mulheres apresentam níveis mais baixos de saúde mental do que os homens. Os enfermeiros que trabalham em serviços psiquiátricos evidenciam maiores níveis de saúde mental comparativamente aos que não trabalham em serviços de psiquiatria. CONCLUSÕES: Os enfermeiros que constituíram a amostra apresentam níveis razoáveis de saúde mental, parecendo contudo ser importante o desenvolvimento de programas para a sua promoção no contexto ocupacional.

BACKGROUND: Nurses are subject to having their well-being and mental health compromised. Two-thirds of the nurses present a negative perception of their mental health. Maintenance and prevention of nurses mental health is fundamental to provide an effective and quality nursing care. AIM: To know the mental health of a group of nurses from a Hospital Center in the central region of Portugal and to correlate with sociodemographic variables. METHODS: A quantitative, descriptive, correlational, cross - sectional study. The sample, non-probabilistic of convenience, consist of 83 nurses. The questionnaire consists of sociodemographic questions and reduced Portuguese version of the Mental Health Inventory. All ethical and formal principles were assured, and the statistical software was used for statistical analysis using non-parametric tests. RESULTS: The mental health of the sample is considered reasonable, and the value is above the cutoff point for the possible existence of moderate symptoms of psychological distress. The dimension depression is the most well-quoted and the dimension anxiety is the one with the lowest average quotation. Prevalence of severe symptoms of depression in 20.5% of the sample. Female nurses demonstrated lower levels of mental health than male nurses.Nurses working in psychiatric services show higher levels of mental health compared to those who do not work in psychiatric services. CONCLUSIONS: The nurses in the sample had reasonable levels of mental health. However, it seems important to develop programs for mental health promotion in occupational context.

CONTEXTO: Los enfermeros están sujetos a que su bienestar y salud mental puedan quedar comprometidos. Dos tercios de los enfermeros presentan una percepción negativa de salud mental. El mantenimiento y prevención de salud mental es fundamental para prestar cuidados de forma eficaz y de calidad. OBJETIVO(S): Conocer la salud mental de un grupo de enfermeras en un centro hospitalario de la región central de Portugal y correlacionarse con las variables socio-demográficas. METODOLOGÍA: Estudio cuantitativo, descriptivo correlacional, transversal. La muestra, no probabilística de conveniencia, es constituida por 83 enfermeros. Lo cuestionario con questiones demográficas y versión portuguesa del Inventario de Salud Mental. Asegurados todos los principios éticos y formales, habiéndose recurrido al software estadístico para análisis estadístico con pruebas no paramétricas. RESULTADOS: La salud mental de la muestra es considerada razonable, siendo por encima del punto de corte para la posible existencia de síntomas moderados de sufrimiento psicológico. La dimensión depresión es la más bien cotizada y la dimensión ansiedad aquella con menor cotización media. Prevalencia de síntomas graves de depresión en el 20,5% de la muestra. Las enfermeras presentan niveles más bajos de salud mental que los hombres. Los enfermeros que trabajan en servicios psiquiátricos evidencian mayores niveles de salud mental en comparación a los que no trabajan en servicios de psiquiatría. CONCLUSIONES: Los enfermeros que constituyen la muestra presentan niveles razonables de salud mental. Sin embargo, parece ser importante el desarrollo de programas de promoción de salud mental en el contexto ocupacional.

Relatório da prática especializada em Enfermagem de Saúde Mental e Psiquiatria / Report of the specialized practice in Mental Health Nursing and Psychiatry

A prática especializada em Enfermagem de Saúde Mental, sobre a qual versa esta Relatório, foi realizada em dois contextos da prática clínica, permitindo aprofundar conhecimentos e desenvolver atividades e intervenções em contexto comunitário e em contexto de internamento. Em contexto comunitária as atividades foram desenvolvidas na Escola Básica 2+3 D. Dinis e em contexto de internamento no Serviço de Psiquiatria do Centro Hospitalar do Médio Tejo, tendo sido possível, em ambos os contextos, desenvolver as competências de Enfermeiro Especialista e Enfermeiro especialista de Saúde Mental.

Health-promoting behaviors: psychometric properties of an assessment tool / Comportamientos promotores de la salud: propiedades psicométricas de un instrumento de evaluación / Comportamentos promotores de saúde: propriedades psicométricas de um instrumento de avaliação

Aiming to evaluate the psychometric properties of an instrument to assess the levels of health promoting behaviors, as well as to encounter those same levels related to their age, sex and graduation in a sample of 1213 Portuguese adolescents, the study was conducted of a quantitative, descriptive, correlational, retrospective and cross-sectional. The instrument has good internal consistency (Cronbach's Alpha de 0,889) and reasonable correlations between items (entre -0,009 e 0,788), confirming the six factors defined by the authors of the scale. Levels of health-promoting behaviors in the sample are good (x=3,70), being higher in girls than boys, and youth to the detriment of younger older. Thus demonstrates the reliability of the instrument in the assessment of healthy behavior in portuguese adolescents, as well as the need for an health intervention in this population.

Con el objetivo de evaluar las propiedades psicométricas de un instrumento para evaluar los niveles de comportamientos promotores de la salud, así como para conocerlos en una muestra de 1213 adolescentes portugueses en relación a su edad, sexo y años de escolaridad, se realizó este estudio de tipo cuantitativo, descriptivo, correlacional, retrospetivo y transversal. El instrumento tiene buena consistencia interna (Cronbach's Alpha de 0,889) y correlación razonable entre los elementos (entre -0,009 e 0,788), confirmado por los seis factores definidos por los autores de la escala. Los niveles de comportamientos promotores de la salud en la muestra son buenos (x=3,70), siendo mayor en las niñas que en los niños, y la juventud en detrimento de los jóvenes mayores. Por lo tanto se demuestra la confiabilidad del instrumento en la evaluación de los comportamientos saludables en los adolescentes portugueses y la necesidad de una intervención de salud en esta población.

Com o objetivo de avaliar as propriedades psicométricas de um instrumento de avaliação dos níveis de comportamentos promotores de saúde, bem como de conhecer esses mesmos níveis numa amostra de 1213 adolescentes portugueses, em relação à sua idade, sexo e ano de escolaridade, foi realizado este estudo, de caráter quantitativo, descritivo-correlacional, retrospetivo e transversal. O instrumento apresenta bons valores de consistência interna (Cronbach's Alpha de 0,889) e razoáveis correlações entre itens (entre -0,009 e 0,788), confirmando-se os seis fatores definidos pelos autores da escala. Os níveis de comportamentos promotores de saúde na amostra são bons (x=3,70), sendo mais elevados nas raparigas do que nos rapazes, e nos jovens mais novos em detrimento dos mais velhos. Demonstra-se assim a fiabilidade do instrumento na avaliação dos comportamentos promotores de saúde nos adolescentes portugueses, e a necessidade de uma intervenção em saúde, nesta população.

Crianças em perigo: o papel das Comissões de Proteção de Menores em Portugal / Children at risk: the role of Commissions for the Protection of Minors in Portugal

Since children have been acknowledged as an autonomous social group, it has become necessary to create adequate laws to protect their fundamental rights, including the right to education, health, and affection. However, despite significant progress for childhood worldwide, children's fundamental rights are still not ensured. It is thus important to reflect on the way laws for the protection of children have developed, analyzing their original objectives and principles and the means used in their enforcement. This article discusses the role of the Commissions for the Protection of Minors at Social Risk in Portugal.