Adverse sequelae of the COVID -19 pandemic on mental health services in Chile.

Objective: This study seeks to describe the adverse effects of the COVID-19 pandemic on mental health services in Chile. Methods: This study is part of ongoing multicountry research known as the Mental Health Care - Adverse Sequelae of COVID-19 study (or the MASC study) that includes seven countries. Chile is the only one in Latin America. This study used a convergent mixed methods design. The quantitative component analyzed data about public mental health care collected between January 2019 and December 2021 from the open-access database at the Ministry of Health. The qualitative component analyzed data collected from focus groups of experts that included professionals in charge of mental health services, policy-makers, service users and caregivers. Finally, the data synthesis was performed by triangulation of both components. Results: By April 2020, mental health service provision had been reduced by 88% in primary care; moreover, secondary and tertiary levels had also reduced their mental health activities by, respectively, 66.3% and 71.3% of pre-COVID levels. Negative sequelae were described at the health systems level, and full recovery had not been achieved by the end of 2021. The pandemic affected the essential characteristics of community-based mental health services, with adverse impacts on the continuity and quality of care, reduced psychosocial and community support, and negative effects on health workers' mental health. Digital solutions were widely implemented to enable remote care, but challenges included the availability of equipment, its quality and the digital divide. Conclusions: The COVID-19 pandemic has had significant and enduring adverse effects on mental health care. Lessons learned can inform recommendations for good practices for the ongoing and future pandemics and health crises, and highlight the importance of prioritizing the strengthening of mental health services in response to emergencies.

[Mental Health Global Action Programme (mhGAP) in Chile: Lessons Learned and Challenges for Latin America and the CaribbeanPrograma de ação mundial para reduzir as lacunas em saúde mental (mhGAP) no Chile: aprendizados e desafios para América Latina e Caribe]. / Programa de Acción Mundial para Superar las Brechas en Salud Mental (mhGAP) en Chile: aprendizajes y desafíos para América Latina y el Caribe.

OBJECTIVES: Present the methodology for comprehensive evaluation of the implementation of the Mental Health Global Action Programme (mhGAP) in Chile and describe the program's results. METHODS: Cross-sectional evaluative study based on a survey of key program informants deployed in 29 public health services in the country, as well as individual interviews and focus groups with key actors and experts. The evaluation was focused on the relevance and impact of mhGAP on the provision of mental health services and on the implementation of the program. RESULTS: The participants gave a positive evaluation of the progressive implementation of mhGAP in Chile. In particular: 1) They reported having better tools for detecting, diagnosing, and treating common disorders, and efficient referral strategies; (2) They rated all modules as important, the most relevant being self-harm/suicide (x¯ = 4.77) and mental and behavioral disorders in children and adolescents (x¯ = 4.58); (3) They favorably assessed the National Mental Health Day training courses and the subsequent courses repeated at the local level, indicating that these courses contributed to successful implementation of mhGAP; (4) They agreed on the need to incorporate new actors, strengthen certain aspects, and expand information on the program. CONCLUSIONS: The implementation of mhGAP in Chile is an emblematic example of learning supported by the development of community mental health and family health, among other factors. These accomplishments offer a unique opportunity to continue advancing the implementation of this program in the country and to implement this experience in other contexts in Latin America and the Caribbean.

OBJETIVOS: Apresentar a metodologia de avaliação completa da implementação do Programa de ação mundial para reduzir as lacunas em saúde mental (Mental Health GAP, mhGAP) no Chile e descrever seus resultados. MÉTODOS: Estudo avaliativo transversal baseado em levantamento realizado com profissionais de referência do programa, distribuídos em 29 serviços de saúde da rede pública do país, e entrevistas individuais e grupos focais com as principais partes interessadas e especialistas. O enfoque da avaliação foi a relevância e o impacto do mhGAP na prestação de serviços de saúde mental e a implementação do programa. RESULTADOS: Os participantes do estudo avaliaram positivamente a implementação progressiva do mhGAP no Chile. Em particular, 1) eles afirmaram possuir recursos melhores para detecção, diagnóstico e tratamento de transtornos frequentes e estratégias de encaminhamento eficientes; 2) classificaram todos os módulos como importantes, com destaque a autoagressão/suicídio (x¯ = 4,77) e transtornos mentais e de comportamento em crianças e adolescentes (x¯ = 4,58); 3) avaliaram de forma favorável a realização das Jornadas Nacionais de Saúde Mental e suas iterações em nível local contribuindo ao sucesso da implementação do mhGAP e 4) concordaram com a necessidade de atrair mais interessados, reforçar alguns aspectos e ampliar a divulgação do programa. CONCLUSÕES: A implementação do mhGAP no Chile é um caso emblemático de aprendizado apoiado no avanço da saúde mental comunitária e saúde da família, entre outros fatores. Esta conquista cria uma oportunidade única para continuar a expandir a implementação do programa no país e disseminar esta experiência a outros contextos na América Latina e Caribe.

[Validation of patient health Questionnaire-2 to detect depressive symptoms in diabetic or hypertensive patients]. / Validación inicial de Patient Health Questionnaire 2-Item para detectar síntomas depresivos en diabéticos y/o hipertensos en la atención primaria de salud.

BACKGROUND: Patient Health Questionnaire (PHQ-9) has nine questions and is used in diabetic or hypertensive patients to detect depressive symptoms. The PHQ-2 uses the first two questions of the PHQ-9 to rapidly detect those patients that should answer the whole questionnaire. AIM: To validate the PHQ-2 to detect depressive symptoms in diabetic or hypertensive patients consulting at Primary Health Care (PHC). MATERIAL AND METHODS: Secondary analysis of data obtained during the baseline assessment of a clinical trial. Diabetic and hypertensive patients aged 18 years or more, attending a public health care clinic of Metropolitan Santiago, were invited to participate. Those accepting, answered the Patient Health Questionnaire (PHQ-9), consisting in nine questions about depressive symptoms. Demographics and health data were also collected. The PHQ-2 capacity to discriminate PHQ-9 scores equal or higher than 10 and 15 and the correlation between both versions, were assessed. RESULTS: Ninety-four participants aged 64 ± years (73% women) answered the questionnaire. A cut-off score of 3 or more points in the PHQ-2 achieved the best tradeoff between sensitivity and specificity for discriminating PHQ-9 scores equal or higher than 10 (area under the receiver operating characteristic curve (ROC) = 0.92, 95% confidence interval [95% CI] = 0.87 to 0.97) and 15 points (area under the ROC curve = 0.95, 95% CI = 0.92 to 0.99). Both versions had a high positive correlation (r = 0.87). CONCLUSIONS: The PHQ-2 allows a stepped, simple and accurate screening for depressive symptoms. Diabetic or hypertensive patients with 3 or more points should be immediately assessed with the remaining questions of the PHQ-9.

Evolving child and adolescent mental health and development programs in Chile.

This analysis reviews the situation of child and adolescent mental health in Chile, organizational determinants, and the initiatives and interventions implemented to enhance child development despite the country's inequities. Progressive development of national mental health plans is covered, from the country's first plan in 2000, to growing the number of mental health professionals and the training they receive, such as MhGAP, to the implementation of "Chile Crece Contigo," whose preliminary evaluations are starting to show some effectiveness. However, the World Health Organization reports that progress in complying with the United Nations Convention of Children's Rights is insufficient. A set off legislative initiatives on behalf of children and adolescents have been passed, while others are being discussed in Parliament. There is much to be done in the nation as a whole and within its health system to ensure improved child and adolescent mental health and wellbeing. More research into child and adolescent mental health should be undertaken. Adequate funding and policymaking are also crucial to giving priority to child and adolescent mental health in Chile.

En este análisis se examina la situación de la salud mental de niños y adolescentes en Chile, los determinantes institucionales y las iniciativas e intervenciones ejecutadas para mejorar el desarrollo infantil a pesar de las inequidades del país. Se ha abarcado el desarrollo progresivo de los planes nacionales de salud mental, desde el primer plan nacional en el año 2000, pasando por el aumento del número de profesionales de salud mental y la capacitación que reciben, como el programa MhGAP, hasta la ejecución de "Chile Crece Contigo", cuyas evaluaciones preliminares están comenzando a mostrar cierta eficacia. Sin embargo, la Organización Mundial de la Salud informa que el progreso en el cumplimiento de la Convención de las Naciones Unidas sobre los Derechos del Niño es insuficiente. Se ha aprobado un conjunto de iniciativas legislativas a favor de los niños y adolescentes, mientras que otras están tratándose en el parlamento. Es mucho lo que hay por hacer en el país en general y en su sistema de salud para garantizar el mejoramiento de la salud mental y el bienestar de niños y adolescentes. Es necesario aumentar la investigación sobre la salud mental de niños y adolescentes. La disponibilidad de fondos suficientes y la formulación de políticas son también cruciales para dar prioridad a la salud mental de niños y adolescentes en Chile.

Uma análise foi realizada para examinar a situação da saúde mental de crianças e adolescentes no Chile, determinantes organizacionais e iniciativas e intervenções implementadas para melhorar o desenvolvimento infantil diante das iniquidades no país. É descrita a evolução dos planos nacionais de saúde mental, a partir do primeiro plano elaborado em 2000, o crescimento do número de profissionais de saúde mental e a capacitação recebida, como parte do programa mundial de ação para reduzir as lacunas em saúde mental da OMS (MhGAP), e a implementação do programa Chile Crece Contigo cujas avaliações preliminares indicam certo grau de efetividade. Porém, segundo informou a Organização Mundial da Saúde (OMS), houve pouco progresso no cumprimento da Convenção das Nações Unidas sobre os Direitos da Criança. Um conjunto de iniciativas legislativas em prol das crianças e adolescentes foi aprovado e outras propostas estão em debate no congresso. Há ainda muito a ser feito no país como um todo e dentro do sistema de saúde para garantir melhor saúde mental e bem-estar para crianças e adolescentes. Devem ser realizadas outras pesquisas sobre saúde mental da criança e do adolescente. É indispensável dispor de financiamento e políticas adequados que priorizem a saúde mental da criança e do adolescente no Chile.

[Mental health response capacity in primary care in Chile: a contribution to Alma-AtaCapacidade de resposta da atenção primária em saúde mental no Chile: uma contribuição de Alma-Ata]. / Capacidad de respuesta de la atención primaria en salud mental en Chile: una contribución a Alma-Ata.

This article identifies strategies that have contributed to the development of mental health response capacity in primary care in Chile and analyzes some lessons learned from this process. It highlights the formulation of national mental health plans, the gradual development of an information system, the investment of additional resources, the creation of programs and guidelines, human resources development, the positioning of mental health in integrated health service delivery networks, support for biopsychosocial child development, the family and community care model, and the strengthening of leadership and partnerships between health and human services.Its indicators of response capacity are the increase in resources for mental health in primary care, both financial and staffing (that is, the number of professionals and the training provided to them), and the expansion of mental health treatment in primary care settings, notably the rate of people in treatment for mental illness and the support provided for child development.The article analyzes different factors that have contributed to advances in primary care delivery of mental health services, together with some weaknesses in this process. It concludes by demonstrating the feasibility of progress toward the goals of Alma-Ata to other countries in the Region, gradually implementing substantial changes in mental health response capacity in primary care. To this end, it recommends an improvement in the quality and quantity of research in this area through methodologies that permit comparisons between countries in the Region.

O presente artigo identifica as estratégias que contribuíram para o desenvolvimento da capacidade de resposta da atenção primária em saúde mental no Chile e analisa alguns ensinamentos tirados neste processo. Nele se destacam a elaboração de planos nacionais de saúde mental, o desenvolvimento gradual do sistema de informação, o investimento de mais verbas, a criação de programas e diretrizes, o aperfeiçoamento dos recursos humanos, o posicionamento da saúde mental nas redes integradas de serviços de saúde, a ênfase ao desenvolvimento biopsicossocial infantil, o modelo de atenção familiar e comunitária e o fortalecimento de lideranças e parcerias entre saúde e serviços sociais.Entre os indicadores da capacidade de resposta apresentados estão o aumento de subsídios à saúde mental na atenção primária, com mais recursos financeiros e um maior número de profissionais capacitados, e o investimento nos processos de saúde mental na atenção primária, com o aumento da taxa de pessoas em tratamento por transtornos mentais e serviços de puericultura.No artigo são examinados os fatores contribuintes para o avanço da atenção primária em saúde mental, bem como as deficiências deste processo. Em conclusão, demonstra-se aos outros países da Região a viabilidade do progresso rumo aos princípios de Alma-Ata, com a implementação gradual de reformas importantes na capacidade de resposta da atenção primária em saúde mental. Recomenda-se realizar mais estudos e pesquisas de qualidade nesta área com o uso de metodologias que possibilitem uma análise comparativa entre os países da Região.

[Alcohol use and self-reported violent events in Chile]. / Consumo de alcohol y autoinforme de eventos violentos en Chile.

The objective is to examine the association between binge drinking and frequency of alcohol consumption during the last month with self-reported episodes of violence committed by people under the influence of alcohol or other drugs. We carried out a cross-sectional study that uses data from the National Survey on Drug Use on the General Population of Chile of 2010. A sample of 16,000 subjects, from 12 to 64 years of age (mean 35.8 years), representing a population of 9,536,602 individuals (49.5% men and 50.5% women) was used. The dependent variables were: being a victim of assault, aggression or sexual violence. The independent variables were: binge drinking (six or more drinks on one occasion at least once in the month) and the monthly frequency of alcohol consumption. The adjusted prevalence ratio (PR) for men reporting binge drinking (vs. negative reporting) was of 1.85 (95% CI: 1.28 to 2.66) for assault, 2.0 for aggression (1.40 to 2.66), and 1.35 for sexual violence (0.43 to 4.23). Among women, the PR was 2.08 (0.97 to 4.50), 1.61 (0.78 to 3.35) and 1.37 times (0.48 to 3.91), respectively. Regarding the frequency of alcohol use, for each day a month of alcohol consumption the PR increases significantly for aggression among men and for the three victimization variables among women. Men and women who reported frequent alcohol consumption and/or binge drinking had significantly a higher prevalence of episodes of aggression, assault or sexual violence; compared to those who did not report these consumption patterns.

[Validity evidence of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in Chile]. / Evidencia de validez en Chile del Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).

This study aims to psychometrically validate the Chilean version of the Alcohol, Smoking and Substance Involvement Screening Test ASSIST. Specifically, this study is interested in evaluating the reliability, consistency and concurrent and discriminant validity of this instrument. The sample was composed for a total of 400 people from four different settings: treatment centers (residential and ambulatories), primary health care, police stations and companies. The reliability of the ASSIST was high (α = .86 for Alcohol, α = .84 for marijuana and α = .90 for cocaine). The intra class correlation coefficient (ICC) with test-retest comparison was statistically significant for Alcohol (ICC = .66), marijuana (ICC = .74) and cocaine (ICC = .80). There were statistically significant correlations between the ASSIST and the AUDIT score (Pearson’s r = .85), the ASSIST and the ASI-Lite score (r between .66 and .83 for tobacco, alcohol, marijuana and cocaine), and the ASSIST and the SDS score (r = .65). The original cutoff point for high risk detection was 27 points, however, in order to have a better balance between sensitivity and specificity the cut was changed to 21 points. The ASSIST presents good psychometric properties and therefore is a reliable and valid instrument to be used as a mechanism to detect risk levels of substance use in the Chilean population.

OnTrack Chile for people with early psychosis: a study protocol for a Hybrid Type 1 trial.

BACKGROUND: Substantial data from high-income countries support early interventions in the form of evidence-based Coordinated Specialty Care (CSC) for people experiencing First Episode Psychosis (FEP) to ameliorate symptoms and minimize disability. Chile is unique among Latin American countries in providing universal access to FEP services through a national FEP policy that mandates the identification of FEP individuals in primary care and guarantees delivery of community-based FEP treatments within a public health care system. Nonetheless, previous research has documented that FEP services currently provided at mental health clinics do not provide evidence-based approaches. This proposal aims to address this shortfall by first adapting OnTrackNY (OTNY), a CSC program currently being implemented across the USA, into OnTrackChile (OTCH), and then examine its effectiveness and implementation in Chile. METHODS: The Dynamic Adaptation Process will be used first to inform the adaptation and implementation of OTCH to the Chilean context. Then, a Hybrid Type 1 trial design will test its effectiveness and cost and evaluate its implementation using a cluster-randomized controlled trial (RCT) (N = 300 from 21 outpatient clinics). The OTCH program will be offered in half of these outpatient clinics to individuals ages 15-35. Usual care services will continue to be offered at the other clinics. Given the current COVID-19 pandemic, most research and intervention procedures will be conducted remotely. The study will engage participants over the course of 2 years, with assessments administered at enrollment, 12 months, and 24 months. Primary outcomes include implementation (fidelity, acceptability, and uptake) and service outcomes (person-centeredness, adherence, and retention). Secondary outcomes comprise participant-level outcomes such as symptoms, functioning, and recovery orientation. Over the course of the study, interviews and focus groups with stakeholders will be conducted to better understand the implementation of OTCH. DISCUSSION: Findings from this study will help determine the feasibility, effectiveness, and cost for delivering CSC services in Chile. Lessons learned about facilitators and barriers related to the implementation of the model could help inform the approach needed for these services to be further expanded throughout Latin America. TRIAL REGISTRATION: www. CLINICALTRIALS: gov NCT04247711 . Registered 30 January 2020. TRIAL STATUS: The OTCH trial is currently recruiting participants. Recruitment started on March 1, 2021, and is expected to be completed by December 1, 2022. This is the first version of this protocol (5/12/2021).

Schizophrenia Treatment Coverage Provided by the Public and Private Health Systems of Chile.

Since health care delivery in Chile was comprehensively reformed in 2005, treating schizophrenia for its populace has been guaranteed, regardless of individuals' type of health insurance coverage. The implementation of this national schizophrenia treatment program has facilitated timely access to care for Chileans with a first episode of schizophrenia, particularly for publicly insured individuals. Although this reform has benefited 98% of the population, significant challenges remain. These include the transition to new evidence-based interventions, such as coordinated specialty care with multielement interventions, and the development of an information system that permits monitoring and improvement of quality of care and treatment outcomes.

Technology-Assisted Collaborative Care Program for People with Diabetes and/or High Blood Pressure Attending Primary Health Care: A Feasibility Study.

The comorbidity of depression with physical chronic diseases is usually not considered in clinical guidelines. This study evaluated the feasibility of a technology-assisted collaborative care (TCC) program for depression in people with diabetes and/or high blood pressure (DM/HBP) attending a primary health care (PHC) facility in Santiago, Chile. Twenty people diagnosed with DM/HBP having a Patient Health Questionnaire-9 score ≥ 15 points were recruited. The TCC program consisted of a face-to-face, computer-assisted psychosocial intervention (CPI, five biweekly sessions), telephone monitoring (TM), and a mobile phone application for behavioral activation (CONEMO). Assessments of depressive symptoms and other health-related outcomes were made. Thirteen patients completed the CAPI, 12 received TM, and none tried CONEMO. The TCC program was potentially efficacious in treating depression, with two-thirds of participants achieving response to depression treatment 12 weeks after baseline. Decreases were observed in depressive symptoms and healthcare visits and increases in mental health-related quality of life and adherence to treatment. Patients perceived the CPI as acceptable. The TCC program was partially feasible and potentially efficacious for managing depression in people with DM/HBP. These data are valuable inputs for a future randomized clinical trial.

Adverse sequelae of the COVID -19 pandemic on mental health services in Chile / Secuelas adversas de la pandemia de COVID-19 en los servicios de salud mental en Chile / Sequelas adversas da pandemia de COVID-19 nos serviços de saúde mental do Chile

ABSTRACT Objective. This study seeks to describe the adverse effects of the COVID-19 pandemic on mental health services in Chile. Methods. This study is part of ongoing multicountry research known as the Mental Health Care - Adverse Sequelae of COVID-19 study (or the MASC study) that includes seven countries. Chile is the only one in Latin America. This study used a convergent mixed methods design. The quantitative component analyzed data about public mental health care collected between January 2019 and December 2021 from the open-access database at the Ministry of Health. The qualitative component analyzed data collected from focus groups of experts that included professionals in charge of mental health services, policy-makers, service users and caregivers. Finally, the data synthesis was performed by triangulation of both components. Results. By April 2020, mental health service provision had been reduced by 88% in primary care; moreover, secondary and tertiary levels had also reduced their mental health activities by, respectively, 66.3% and 71.3% of pre-COVID levels. Negative sequelae were described at the health systems level, and full recovery had not been achieved by the end of 2021. The pandemic affected the essential characteristics of community-based mental health services, with adverse impacts on the continuity and quality of care, reduced psychosocial and community support, and negative effects on health workers' mental health. Digital solutions were widely implemented to enable remote care, but challenges included the availability of equipment, its quality and the digital divide. Conclusions. The COVID-19 pandemic has had significant and enduring adverse effects on mental health care. Lessons learned can inform recommendations for good practices for the ongoing and future pandemics and health crises, and highlight the importance of prioritizing the strengthening of mental health services in response to emergencies.

RESUMEN Objetivo. Este estudio pretende describir los efectos adversos de la pandemia de COVID-19 en los servicios de salud mental en Chile. Métodos. El estudio forma parte de una investigación multinacional en curso denominada estudio Mental Health Care - Adverse Sequelae of COVID-19 (atención de salud mental: secuelas adversas de la COVID-19), o estudio MASC, en el que participan siete países. Chile es el único de América Latina. En este estudio se utilizó un diseño de métodos mixtos convergentes. En el componente cuantitativo se analizaron los datos de atención en salud mental del sector público obtenidos entre enero del 2019 y diciembre del 2021, provenientes de la base de datos de acceso libre del Ministerio de Salud. En el componente cualitativo se analizaron los datos obtenidos a partir de grupos focales de expertos entre los que había profesionales a cargo de servicios de salud mental, responsables de la formulación de políticas, personas usuarias de los servicios y personas prestadoras de cuidados. Por último, la síntesis de los datos se realizó mediante la triangulación de ambos componentes. Resultados. En abril del 2020, la prestación de servicios de salud mental en atención primaria había disminuido en un 88%; además, los niveles secundario y terciario también habían reducido sus intervenciones en salud mental en un 66,3% y un 71,3%, respectivamente, respecto a los niveles previos a la COVID-19. Se describieron secuelas negativas a nivel de los sistemas de salud, que a fines del 2021 aún no habían logrado su plena recuperación. La pandemia afectó las características esenciales de los servicios de salud mental prestados en la comunidad, con consecuencias adversas en la continuidad y la calidad de la atención, una reducción del apoyo psicosocial y comunitario, y efectos negativos en la salud mental del personal de salud. Se generalizó la adopción de soluciones digitales para posibilitar la atención a distancia, pero algunos de los principales problemas fueron la disponibilidad de equipos, su calidad y la brecha digital. Conclusiones. La pandemia de COVID-19 ha tenido efectos adversos importantes y duraderos en la atención de salud mental. Las enseñanzas extraídas pueden servir de base para formular recomendaciones de buenas prácticas para las pandemias y crisis sanitarias presentes y futuras, a la vez que resaltan la importancia de dar prioridad al fortalecimiento de los servicios de salud mental en las situaciones de respuesta a emergencias.

RESUMO Objetivo. Descrever os efeitos adversos da pandemia de COVID-19 nos serviços de saúde mental do Chile. Métodos. Este estudo é parte de uma pesquisa em andamento em vários países, denominada Mental Health Care - Adverse Sequelae of COVID-19 (Atenção à saúde mental: sequelas adversas da COVID-19, também conhecido como estudo MASC), que inclui sete países. O Chile é o único país da América Latina incluído. O estudo utilizou um delineamento convergente de métodos mistos. O componente quantitativo analisou dados da atenção pública à saúde mental coletados entre janeiro de 2019 e dezembro de 2021 do banco de dados de acesso livre do Ministério da Saúde. O componente qualitativo analisou dados coletados de grupos focais de especialistas que incluíam profissionais responsáveis por serviços de saúde mental, formuladores de políticas, usuários de serviços e cuidadores. Por último, os dados foram sintetizados por triangulação dos dois componentes. Resultados. Até abril de 2020, havia ocorrido uma redução de 88% na prestação de serviços de saúde mental na atenção primária; além disso, os níveis secundários e terciários também haviam reduzido suas atividades de saúde mental em 66,3% e 71,3% dos níveis pré-COVID, respectivamente. Sequelas negativas foram descritas no nível dos sistemas de saúde, e a recuperação total não havia sido alcançada até o final de 2021. A pandemia afetou as características essenciais dos serviços de saúde mental de base comunitária, com impactos adversos na continuidade e na qualidade do atendimento, redução do apoio psicossocial e comunitário e efeitos negativos na saúde mental dos profissionais de saúde. Soluções digitais foram amplamente implementadas para permitir o atendimento remoto, mas os desafios incluíam a disponibilidade de equipamentos, sua qualidade e a exclusão digital. Conclusões. A pandemia de COVID-19 tem tido efeitos adversos significativos e duradouros na atenção à saúde mental. As lições aprendidas podem contribuir para recomendações de boas práticas em pandemias e crises de saúde atuais e futuras. Além disso, destacam a importância de priorizar o fortalecimento dos serviços de saúde mental em resposta a emergências.

Programa de Acción Mundial para Superar las Brechas en Salud Mental (mhGAP) en Chile: aprendizajes y desafíos para América Latina y el Caribe / Mental Health Global Action Programme (mhGAP) in Chile: Lessons Learned and Challenges for Latin America and the Caribbean / Programa de ação mundial para reduzir as lacunas em saúde mental (mhGAP) no Chile: aprendizados e desafios para América Latina e Caribe

RESUMEN Objetivos. Presentar la metodología de evaluación integral de la implementación del Programa de Acción Mundial para Superar las Brechas en Salud Mental (mhGAP) en Chile y exponer sus resultados. Métodos. Estudio evaluativo de corte transversal basado en una encuesta a referentes clave del programa, desplegados en los 29 servicios públicos de salud del país, y entrevistas individuales y grupos focales con actores clave y expertos. El foco de la evaluación estuvo en la relevancia e impacto del mhGAP en la prestación de servicios de salud mental y en la implementación del programa. Resultados. Los participantes evaluaron positivamente la implementación progresiva del mhGAP en Chile, en particular: 1) manifestaron contar con mejores herramientas de detección, diagnóstico y tratamiento de trastornos frecuentes, y estrategias eficientes de derivación; 2) calificaron todos los módulos como importantes; los más relevantes fueron autolesión/suicidio (x¯ = 4,77) y trastornos mentales y conductuales del niño y el adolescente (x¯ = 4,58); 3) evaluaron favorablemente las Jornadas Nacionales y sus réplicas y su contribución al éxito de la implementación del mhGAP; 4) coincidieron en la necesidad de incorporar nuevos actores, fortalecer algunos aspectos y ampliar la información sobre el programa. Conclusiones. La implementación del mhGAP en Chile constituye un caso emblemático de aprendizaje, apoyado por el desarrollo de la salud mental comunitaria y la salud familiar, entre otros factores. Lo logrado abre una oportunidad única para continuar avanzando en la implementación de este programa en el país y transmitir esta experiencia a otros contextos de América Latina y el Caribe.

ABSTRACT Objectives. Present the methodology for comprehensive evaluation of the implementation of the Mental Health Global Action Programme (mhGAP) in Chile and describe the program's results. Methods. Cross-sectional evaluative study based on a survey of key program informants deployed in 29 public health services in the country, as well as individual interviews and focus groups with key actors and experts. The evaluation was focused on the relevance and impact of mhGAP on the provision of mental health services and on the implementation of the program. Results. The participants gave a positive evaluation of the progressive implementation of mhGAP in Chile. In particular: 1) They reported having better tools for detecting, diagnosing, and treating common disorders, and efficient referral strategies; (2) They rated all modules as important, the most relevant being self-harm/suicide (x¯ = 4.77) and mental and behavioral disorders in children and adolescents (x¯ = 4.58); (3) They favorably assessed the National Mental Health Day training courses and the subsequent courses repeated at the local level, indicating that these courses contributed to successful implementation of mhGAP; (4) They agreed on the need to incorporate new actors, strengthen certain aspects, and expand information on the program. Conclusions. The implementation of mhGAP in Chile is an emblematic example of learning supported by the development of community mental health and family health, among other factors. These accomplishments offer a unique opportunity to continue advancing the implementation of this program in the country and to implement this experience in other contexts in Latin America and the Caribbean.

RESUMO Objetivos. Apresentar a metodologia de avaliação completa da implementação do Programa de ação mundial para reduzir as lacunas em saúde mental (Mental Health GAP, mhGAP) no Chile e descrever seus resultados. Métodos. Estudo avaliativo transversal baseado em levantamento realizado com profissionais de referência do programa, distribuídos em 29 serviços de saúde da rede pública do país, e entrevistas individuais e grupos focais com as principais partes interessadas e especialistas. O enfoque da avaliação foi a relevância e o impacto do mhGAP na prestação de serviços de saúde mental e a implementação do programa. Resultados. Os participantes do estudo avaliaram positivamente a implementação progressiva do mhGAP no Chile. Em particular, 1) eles afirmaram possuir recursos melhores para detecção, diagnóstico e tratamento de transtornos frequentes e estratégias de encaminhamento eficientes; 2) classificaram todos os módulos como importantes, com destaque a autoagressão/suicídio (x¯ = 4,77) e transtornos mentais e de comportamento em crianças e adolescentes (x¯ = 4,58); 3) avaliaram de forma favorável a realização das Jornadas Nacionais de Saúde Mental e suas iterações em nível local contribuindo ao sucesso da implementação do mhGAP e 4) concordaram com a necessidade de atrair mais interessados, reforçar alguns aspectos e ampliar a divulgação do programa. Conclusões. A implementação do mhGAP no Chile é um caso emblemático de aprendizado apoiado no avanço da saúde mental comunitária e saúde da família, entre outros fatores. Esta conquista cria uma oportunidade única para continuar a expandir a implementação do programa no país e disseminar esta experiência a outros contextos na América Latina e Caribe.

Validación inicial de Patient Health Questionnaire 2-Item para detectar síntomas depresivos en diabéticos y/o hipertensos en la atención primaria de salud

Background: Patient Health Questionnaire (PHQ-9) has nine questions and is used in diabetic or hypertensive patients to detect depressive symptoms. The PHQ-2 uses the first two questions of the PHQ-9 to rapidly detect those patients that should answer the whole questionnaire. Aim: To validate the PHQ-2 to detect depressive symptoms in diabetic or hypertensive patients consulting at Primary Health Care (PHC). Material and Methods: Secondary analysis of data obtained during the baseline assessment of a clinical trial. Diabetic and hypertensive patients aged 18 years or more, attending a public health care clinic of Metropolitan Santiago, were invited to participate. Those accepting, answered the Patient Health Questionnaire (PHQ-9), consisting in nine questions about depressive symptoms. Demographics and health data were also collected. The PHQ-2 capacity to discriminate PHQ-9 scores equal or higher than 10 and 15 and the correlation between both versions, were assessed. Results: Ninety-four participants aged 64 ± years (73% women) answered the questionnaire. A cut-off score of 3 or more points in the PHQ-2 achieved the best tradeoff between sensitivity and specificity for discriminating PHQ-9 scores equal or higher than 10 (area under the receiver operating characteristic curve (ROC) = 0.92, 95% confidence interval [95% CI] = 0.87 to 0.97) and 15 points (area under the ROC curve = 0.95, 95% CI = 0.92 to 0.99). Both versions had a high positive correlation (r = 0.87). Conclusions: The PHQ-2 allows a stepped, simple and accurate screening for depressive symptoms. Diabetic or hypertensive patients with 3 or more points should be immediately assessed with the remaining questions of the PHQ-9.

Adaptation and Validation of the Instrument Treatment Outcomes Profile to the Chilean Population.

This study aims to psychometrically validate the Chilean version of the treatment outcomes profile (TOP), an instrument that can be used by treatment centers to monitor the results of drug and alcohol treatments. Specifically, this study is interested in evaluating the inter-rater reliability, concurrent validity, change sensitivity and discriminant and construct validity of this instrument. The TOP was modified to reflect the Chilean context and then applied in three successive stages: an initial application at the beginning of treatment, a retest after 1week, and a follow up after a month. The sample was composed of 411 users of different types of drugs who were in treatment centers in the three largest regions of the country. The TOP reliability was greater than .75 for most items. Regarding concurrent validity, all the coefficients were in the expected direction and statistically significant. Change over time, as measured by Cohen's d statistic and the Reliable Change Index, was significant for most items. Users in treatment for less than 3months showed higher alcohol consumption (odds ratio [OR]=1.07; 95% confidence interval [95% CI]: 1.01-1.13), poorer psychological health (OR=0.94; 95% CI: 0.87-1.00), fewer days worked (0.56; 0.95-0.99) and poorer housing conditions (OR=2.76; 95% CI: 1.22-6.23) than did their counterparts who had more than 3months of treatment. Researchers extracted six components with eigenvalues greater than one, accounting for 69.0% of the total variance. In general, the Chilean TOP is a reliable and valid mechanism to monitor outcomes of people treated for problems with drug and alcohol abuse in Chile, but further validation work is required in some dimensions.

Capacidad de respuesta de la atención primaria en salud mental en Chile: una contribución a Alma-Ata / Mental health response capacity in primary care in Chile: a contribution to Alma-Ata / Capacidade de resposta da atenção primária em saúde mental no Chile: uma contribuição de Alma-Ata

RESUMEN El presente artículo identifica estrategias que han contribuido al desarrollo de la capacidad de respuesta de la atención primaria en salud mental en Chile y analiza algunos aprendizajes de este proceso. Se destacan la formulación de planes nacionales de salud mental, el desarrollo gradual de un sistema de información, la inversión de fondos adicionales, la creación de programas y orientaciones; el desarrollo de recursos humanos, el posicionamiento de la salud mental en las redes integradas de servicios de salud, el apoyo al desarrollo biopsicosocial de la infancia, el modelo de atención familiar y comunitario, el reforzamiento de liderazgos y alianzas entre salud y servicios sociales. Como indicadores de la capacidad de respuesta se muestran el aumento de recursos para salud mental en atención primaria, tanto financieros como en la cantidad y capacitación de profesionales, y el aumento de procesos de salud mental en atención primaria, destacándose la tasa de personas en tratamiento por trastornos mentales y las prestaciones de apoyo al desarrollo de la infancia. Se analizan diversos factores que han contribuido a los avances de la atención primaria en salud mental, así como algunas debilidades de este proceso. Como conclusión, se muestra a otros países de la Región la factibilidad de avanzar hacia los postulados de Alma-Ata, implementando gradualmente cambios sustanciales en la capacidad de respuesta de la atención primaria en salud mental. Para este efecto, se recomienda aumentar la calidad y cantidad de la investigación en el tema, con metodologías que permitan comparaciones entre distintos países de la Región.

ABSTRACT This article identifies strategies that have contributed to the development of mental health response capacity in primary care in Chile and analyzes some lessons learned from this process. It highlights the formulation of national mental health plans, the gradual development of an information system, the investment of additional resources, the creation of programs and guidelines, human resources development, the positioning of mental health in integrated health service delivery networks, support for biopsychosocial child development, the family and community care model, and the strengthening of leadership and partnerships between health and human services. Its indicators of response capacity are the increase in resources for mental health in primary care, both financial and staffing (that is, the number of professionals and the training provided to them), and the expansion of mental health treatment in primary care settings, notably the rate of people in treatment for mental illness and the support provided for child development. The article analyzes different factors that have contributed to advances in primary care delivery of mental health services, together with some weaknesses in this process. It concludes by demonstrating the feasibility of progress toward the goals of Alma-Ata to other countries in the Region, gradually implementing substantial changes in mental health response capacity in primary care. To this end, it recommends an improvement in the quality and quantity of research in this area through methodologies that permit comparisons between countries in the Region.

RESUMO O presente artigo identifica as estratégias que contribuíram para o desenvolvimento da capacidade de resposta da atenção primária em saúde mental no Chile e analisa alguns ensinamentos tirados neste processo. Nele se destacam a elaboração de planos nacionais de saúde mental, o desenvolvimento gradual do sistema de informação, o investimento de mais verbas, a criação de programas e diretrizes, o aperfeiçoamento dos recursos humanos, o posicionamento da saúde mental nas redes integradas de serviços de saúde, a ênfase ao desenvolvimento biopsicossocial infantil, o modelo de atenção familiar e comunitária e o fortalecimento de lideranças e parcerias entre saúde e serviços sociais. Entre os indicadores da capacidade de resposta apresentados estão o aumento de subsídios à saúde mental na atenção primária, com mais recursos financeiros e um maior número de profissionais capacitados, e o investimento nos processos de saúde mental na atenção primária, com o aumento da taxa de pessoas em tratamento por transtornos mentais e serviços de puericultura. No artigo são examinados os fatores contribuintes para o avanço da atenção primária em saúde mental, bem como as deficiências deste processo. Em conclusão, demonstra-se aos outros países da Região a viabilidade do progresso rumo aos princípios de Alma-Ata, com a implementação gradual de reformas importantes na capacidade de resposta da atenção primária em saúde mental. Recomenda-se realizar mais estudos e pesquisas de qualidade nesta área com o uso de metodologias que possibilitem uma análise comparativa entre os países da Região.