Global proofing a collaborative care telemental health intervention in Brazil.

Rural proofing ensures that policies, practice guidelines, strategies, and techniques can be applied to rural populations with approximately equal benefit as what would be obtained in urban areas. Extending this concept internationally, the authors argue the importance of global proofing mental health strategies developed in well-resourced, high-income areas in order to determine their appropriateness in areas that have resource poverty such as middle- and low-income countries. An example is used to illustrate both rural and global proofing. Through this example, the authors demonstrate how they proofed urban-inspired models of mental health care in rural areas of the United States. The result is a model of rural mental health care that emphasizes collaborative care and telemental health. This model is now being global proofed in Brazil. The authors describe the application of this model in a remote rural town in Brazil. Consistent with World Health Organization recommendations, the integration of mental health care into primary care medical settings is being discovered as essential to addressing mental health disparities worldwide. (PsycINFO Database Record

Portuguese translation and validation of the Revised Dyadic Adjustment Scale.

The absence of a translated and validated instrument for measuring marital satisfaction in Brazil, the largest country in South America and fifth most populous country in the world, is a significant barrier for research and mental health service delivery. The purpose of this study was to translate and validate a marital satisfaction scale into Portuguese that would have both empirical credibility and cultural relevance in Brazil. A six-step serial approach was used to simultaneously translate and culturally validate the Revised Dyadic Adjustment Scale (RDAS). The translated instrument (RDAS-P) demonstrated good psychometric properties during field testing.

Fatores associados ao envolvimento do pai nos cuidados do lactente / Factores asociados al envolvimiento del papá en los cuidados del lactante / Factors associated with father involvement in infant care

OBJETIVO: Identificar fatores associados à falta de envolvimento ativo do pai nos cuidados de crianças aos quatro meses. MÉTODOS: Estudo transversal envolvendo famílias de 153 crianças aos quatro meses de vida, entrevistadas em suas casas por dois terapeutas de famílias. Além do envolvimento do pai nos cuidados do lactente foram examinadas características sociodemográficas, saúde mental dos pais (utilizando a escala Self Report Questionnaire-20 e avaliação com os critérios do Diagnostic and Statistical Manual of Mental Disorders-IV) e qualidade do relacionamento conjugal (usando a escala Global Assessment of Relational Functioning do Diagnostic and Statistical Manual of Mental Disorders-IV). Utilizou-se regressão de Poisson para avaliar a associação entre falta de envolvimento do pai nos cuidados do filho e variáveis selecionadas. A magnitude das associações foi estimada pela razão de prevalências. RESULTADOS: Os pais de 13 por cento dos lactentes não tinham qualquer contato com seus filhos. Entre as famílias em que os pais coabitavam (78 por cento do total), 33 por cento dos pais relataram não participar ativamente nos cuidados de seus filhos. Relação conjugal problemática e mãe ser "do lar" mostraram-se associadas à falta de envolvimento dos pais nos cuidados do filho. CONCLUSÕES: É alta a prevalência de famílias nas quais o pai não tem envolvimento ativo no cuidado de seu filho, ocorrendo em especial quando a relação conjugal é problemática e a mãe não tem trabalho remunerado.

Factors associated with father involvement in infant care.

OBJECTIVE: To identify factors associated with the lack of active father involvement in infant care at four months of age. METHODS: Cross-sectional study involving families of 153 infants at four months of age, interviewed in their homes by two family therapists. In addition to father involvement in infant care, sociodemographic, parental mental health (using the Self Report Questionnaire-20 scale and Diagnostic and Statistical Manual of Mental Disorders-IV criteria assessment) and quality of couple relationship characteristics (using the Assessment of Relational Functioning from Diagnostic and Statistical Manual of Mental Disorders-IV) were analyzed. Poisson regression was employed to assess the association between lack of father involvement in child care and the variables selected. Prevalence ratio was used to estimate the magnitude of associations. RESULTS: Fathers of 13% of infants had no contact with their children. Among families whose parents lived together (78% of all), 33% of the fathers reported not actively participating in their children's care. Problematic couple relationship and mother as a housewife were associated with lack of father involvement in infant care. CONCLUSIONS: High prevalence of families whose father is not actively involved with infant care, especially when couple relationship is problematic and the mother does not have a paid job.

Marital satisfaction and depression: a replication of the Marital Discord Model in a Latino sample.

The Marital Discord Model of Depression maintains that marital discord is an important antecedent in the development of depression. Although empirical evidence supports this premise, none of this research has been done with Latinos. The purpose of this study was to test the longitudinal relationship between marital satisfaction and depression among 99 Brazilian women. Using structural equation modeling, results indicated that marital satisfaction was a strong predictor of depression 2 years later. Marital satisfaction was also related to cooccurring depression. These results provide evidence that the Marital Discord Model of Depression is an appropriate theoretical model for the conceptualization of marital discord and depression with Latina women and suggest the potential utility of using couples therapy for treating depression among this population.

Validação de escalas diagnosticas do funcionamento familiar para utilização em serviços de atenção primaria a saude / Validation of diagnostic scales of family functioning for use in primary health care services

O atendimento a pacientes em servicos primarios de saude deveria compreender uma avaliacao tanto fisica como psicologica; em muitos casos, o sucesso do tratamento depende da compreensao do individuo e de suas interacoes, em especial de sua interacao na familia. Portanto, e importante instrumentalizar os profissionais de saude para que sejam capazes de trabalhar com os individuos nesse contexto social. Estudamos tres escalas diagnosticas do funcionamento familiar consagradas na literatura internacional (FACES III, Beavers-Timberlawn e GARF), procurando valida-las para uso em nosso meio (Porto Alegre, Brasil). Comparamos os resultados do preenchimento das escalas com a avaliacao clinica, feita atraves de entrevista familiar semi-estruturada, em 31 familias clinicas. A escala auto-respondida FACES III tambem foi testada em 102 familias na comunidade. A escala FACES III mostrou uma correlacao linear positiva, porem fraca, entre coesao familiar e risco para doenca mental, mas nao em relacao a adaptabilidade. As escalas BT e GARF demonstraram forte correlacao positiva com a avaliacao clinica. A escala FACES III nao demonstrou ser adequada para uso em triagem de cuidados primarios; entretanto, as escalas BT e GARF mostratam-se muito uteis na formulacao e classificacao do diagnostico familiar

Care provided to patients in primary health services should include both a physical and a psychological assessment. In many cases treatment success depends on understanding individuals and their interactions, especially within the family; it is important for health professionals to be trained in this area. We investigated the validity of three well-known diagnostic scales of family functioning from the United States of America (FACES III, Beavers-Timberlawn, and GARF) for use in our setting in Porto Alegre, Brazil. The three scales were used with 31 families and compared to the results from clinical evaluations (semistructured family interviews), which were considered the gold standard. FACES III was also used with a sample of 102 families in the community. The Beavers-Timberlawn and GARF scales were strongly and positively correlated with the clinical evaluations. In contrast, our results suggest that FACES III is not a useful screening tool in primary care to detect the risk of psychiatric disorders. The Beavers-Timberlawn and GARF instruments showed great usefulness for formulating and classifying diagnoses of family functioning.