Understanding Users' Perspectives of Psychosocial Mechanisms Underpinning Peer Support Work in Chile.

This study explores the beliefs and attitudes about the psychosocial mechanisms of peer support work among users who participated in Critical Time Intervention-Task Shifting (CTI-TS), which tested the acceptability and feasibility of a peer support work model to improve community-based mental health care for individuals with psychosis in Latin America. We conducted a secondary analysis of 15 in-depth interviews with CTI-TS participants in Chile, using the framework method and defined the framework domains based on five major mechanisms of peer support work identified by a recent literature review. The analysis revealed that users' perceptions of peer support work mechanisms were strongly shaped by personal motivations, beliefs about professional hierarchies, familial support, and the Chilean mental health system's incipient recovery orientation. The findings underscore the importance of adopting culturally tailored strategies to promote peer support work, such as involving mental health professionals and fostering equal-powered relationships between PSWs and users.

A Recovery-Oriented Intervention for People With Psychosis: A Pilot Randomized Controlled Trial.

OBJECTIVE: This pilot randomized controlled trial evaluated the effectiveness of critical time intervention-task shifting (CTI-TS) for people with psychosis in Santiago, Chile, and Rio de Janeiro. CTI-TS is a 9-month intervention involving peer support workers and is designed to maintain treatment effects up to 18 months. METHODS: A total of 110 people with psychosis were recruited when they enrolled in community mental health clinics (Santiago, N=60; Rio de Janeiro, N=50). Participants within each city were randomly assigned to either CTI-TS or usual care for 9 months. Primary outcomes were quality of life, measured with the World Health Organization Quality of Life Assessment-Brief Version (WHOQOL-BREF), and unmet needs, measured with the Camberwell Assessment of Need (CAN), at 18-month follow-up. Results were analyzed according to intention-to-treat guidelines. Generalized estimating equations, with observations clustered within cities, and multiple imputation for missing data were used. RESULTS: At 18 months, both groups showed improved primary outcomes. In both unadjusted and fully adjusted analyses, no significant differences between CTI-TS and usual care (WHOQOL-BREF question on quality of life and CAN mean number of unmet needs) were found. CONCLUSIONS: Three factors might explain the lack of difference between CTI-TS and usual care: first-contact enrollment precluded rapport prior to randomization, a minority of patients were uncomfortable with peers being on the treatment team, and primary outcome measures may not have been sensitive enough to capture the effects of a recovery-oriented intervention. The results have implications for the design of transitional services for people with psychosis, especially in Latin America.

Prevalence of Mood and Anxiety Disorders Among Adults Seeking Care in Primary Healthcare Centers in Cordoba, Argentina.

OBJECTIVE: To estimate the prevalence of mood and anxiety disorders among adults seeking care in primary healthcare centers in Cordoba city, Argentina. METHODS: Cross-sectional analysis of a random sample of adults 18-69 years of age seeking care for general health problems in public (i.e., government-funded) primary healthcare centers in Cordoba city, Argentina in 2010-2011. Mood and anxiety disorders were assessed in the participants' lifetime, and in the last 12 months and 30 days using the World Mental Health Composite International Diagnostic Interview 3.0, and defined following the International Classification of Diseases, tenth revision. RESULTS: Overall, 1,067 participants were included in the current analysis [mean age 35.6 (SD 13.2) years, 83.7% female]. The lifetime, 12-month and 30-day prevalence of any mood or anxiety disorder was 40.4% [95% confidence interval (95%CI) 37.4-43.4%], 20.1% (17.8-22.7%) and 7.8% (6.2-9.6%), respectively. The prevalence of anxiety disorders was higher compared to mood disorders when assessed in the participants' lifetime [29.7% (95%CI 27.0-32.5%) versus 19.3% (17.0-21.8%)], and in the last 12 months [14.9% (12.8-17.2%) versus 8.7% (7.1-10.6%)] and 30 days [5.8% (4.5-7.4%) versus 2.3% (1.5-3.4%)]. Age and marital status-adjusted odds ratios for any mood or anxiety disorder in the participants' lifetime and in the last 12 months and 30 days comparing women versus men were 1.19 (95%CI 0.85-1.67), 1.70 (1.07-2.69), and 2.26 (1.02-5.00), respectively. CONCLUSION: The prevalence of mood and anxiety disorders is high among adults seeking care in primary healthcare centers in Cordoba city, particularly among women. Integration of primary and mental health services is warranted.

Implementing a community-based task-shifting psychosocial intervention for individuals with psychosis in Chile: Perspectives from users.

BACKGROUND: Latin America, and Chile in particular, has a rich tradition of community mental health services and programs. However, in vivo community-based psychosocial interventions, especially those with a recovery-oriented approach, remain scarce in the region. Between 2014 and 2015, a Critical Time Intervention-Task Shifting project (CTI-TS) was implemented in Santiago, Chile, as part of a larger pilot randomized control trial. CTI is a time-limited intervention delivered at a critical-time to users, is organized by phases, focuses on specific objectives and decreases in intensity over time. CTI-TS, which combines both the task-shifting strategy and the use of peers, introduces a novel approach to community mental health care that has not yet been tried in Chile. AIMS: We aim to evaluate the feasibility, acceptability and applicability of such a community-based psychosocial intervention in urban settings in Latin America - specifically, in Santiago (Chile) from a user perspective. METHOD: We analyzed 15 in-depth interviews ( n = 15) with service users who participated in the intervention about their perceptions and experiences with CTI-TS through thematic analysis. RESULTS: Three themes were revealed. The first was related to the structural characteristics of CTI-TS, especially regarding the timing, duration and phasic nature of the intervention. The second pertained to the acceptability of the in vivo community-based approach. The third theme dealt with the task-shifting aspect, that is, users' perceptions of the peer support workers and the community mental health workers. CONCLUSIONS: CTI-TS was generally acceptable in this Latin American context. Users' perspectives pointed to the need to make adjustments to some of the structural characteristics of the CTI model and to combine this type of intervention with others that can address stigma. Thus, future adaptations of CTI-TS or similar psychosocial interventions in Latin American contexts are feasible and can enhance community mental health in the region.

Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities.

Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.

[Pathway to care of people with first episode of schizophrenia, in Chile].

BACKGROUND: It has been considered that the duration of first episode of psychosis is a critical period influencing the clini-cal and psychosocial evolution in people with diagnosis of schizophrenia. However, there is little knowledge about this issue in Low and Middle Income Countries. OBJECTIVE: To describe the clinical characteristics and contacts with health services of people with first episode of schizophrenia, prior to their diagnoses and initiation of treatment. Sources and methods. The sample included all persons with diagnosis of first episode of schizo-phrenia, in five psychiatric care centers, located in the North, Center and South of Chile. Diagnosis was confirmed with ICD-10 criteria and psychopathology symptoms were explored using PANSS. RESULTS: The sample was constituted by 48 patients (79.2% men, average age in 23.4 years). The symptom of depression was the first to appear (me-dian of 15 months, before diagnosis). Positive symptoms started in the previous year before diagnosis (delusions, median of 6 months). Positive symptoms triggered the first contact in 77.1% of the patients. Of these cases, 91.7% had medical care in this period (in Primary Health Care Centers and Mental Health Centers). The me-dian for previous contacts was 3.5, but the correct diagnosis was not done at that time. CONCLUSION: Most of the patients had medical contacts for their psychotic symptoms, but their diagnosis were not made within that period, delaying the start of treatment. There is a need to develop strategies to improve diagnosis capabilities in these centers.

Analysis of psychometric properties of the brazilian portuguese version of the community attitudes towards the mentally ill (CAMI-BR).

OBJECTIVES: To perform an analysis of the psychometric properties of the Brazilian Portuguese version of the COMMUNITY ATTITUDES TOWARDS THE MENTALLY ILL (CAMI-BR), a 40-item scale divided into four sub-scales. METHODS: The study was conducted in a non-probability sample of 230 households located close to therapeutic residences in the west area of Rio de Janeiro. Reliability was assessed by test-retest and the Principal Component Analysis (PCA) was used to test the internal structure of the questionnaire. RESULTS: Most participants were women, married, with children aged 18 years or over. The overall score was 27.72 (SD = 3.31), showing attitudes ranging from neutral to positive stereotypes. The scale showed a high internal consistency (? = 0.842), consistent with other international studies. In the factor analysis, the sample was adequate (KMO = 0.800). The strength of the correlations among subscales and the factors of factor analysis were highly satisfactory. The version in Brazilian Portuguese suggests a better distinction among sub-scales through the lower correlation among them (between 0.336 and 0.441) as compared to higher values (between 0.630 and 0.770) found in the original scale. The community mental health ideology sub-scale showed a strong relation to factor 1 (? = 0.910). Benevolence had a strong relationship with factor 2 (? = 0.847); Authoritarianism and Social Restrictiveness had the highest correlation with factor 3 (? = 0.631 and 0.577 respectively). CONCLUSIONS: The scale psychometric properties were maintained after adjustment. Having registered a lower correlation between the scales the factor analysis further suggests that the Brazilian Portuguese version conveys more clearly the differences between the sub-scales.

[The coverage gap for mental health disosrders in the primary healthcare level of the city of Cordoba, Argentina].

UNLABELLED: Many individuals with behavioral and mental health disorders do not receive care in specialized mental health services. These individuals could potentially be identified and managed in the primary healthcare level. OBJECTIVE: To analyze the coverage gap on mental health disorders in the primary healthcare level of Córdoba city, Argentina. METHODOLOGY: Stratified multistage random sample of individuals 19 to 69 years of age seeking care in primary healthcare centers of the public health system in Córdoba city. Presence of behavioral and mental health disorder and receiving healthcare through mental health services were assesed using CIDI 3.0. Data were analyzed using descriptive statistics. RESULTS: A total of 1,067 individuals were included in the present analysis. Overall, 20.15% of individuals included in the analysis had behavioral and mental health disorders during the last year, of whom 77.33% did not receive care through mental health services. DISCUSSION AND CONCLUSION: The proportion of individuals with behavioral and mental health disorders and of those who did not receive care through mental health services are similar to those observed in other Latin American countries, but higher than those reported in Europe. This communication gives preliminary results about the coverage gap on mental health disorders present in the primary healthcare level in Cordoba city. These individuals may benefit from interventions aimed to identify and manage those with mental health disorders in the primary healthcare level.

[Psychometric properties and reliability of the general health questionnaire(GHQ-12) for adult patients in primary care centers in Cordoba, Argentina].

INTRODUCTION: The General Health Questionnaire (GHQ-12) is a commonly used instrument to screen for psychiatric distress. However, the psychometric properties and reliability of the GHQ-12 in Argentina and, more specifically, in the city of Cordoba, have not previously been studied. OBJECTIVE: To assess the psychometric properties and reliability of GHQ-12 in adult consultants of primary care in Cordoba, Argentina. METHODS: Using probabilistic sampling in primary care centers in the city of Cordoba, a cross-sectional study was conducted. The Spanish version of the GHQ-12 was administered. The psychometric properties, including internal consistency and factor structure, for the Spanish version of the GHQ-12 were measured. RESULTS: 854 primary care consultants were included in the study. The questionnaire had high internal consistency, with a Cronbach's alpha of 0.80. An exploratory factor analysis suggested a two-factor model, similar to what has been reported for the original questionnaire. CONCLUSIONS: The GHQ-12 showed good psychometric properties and reliability in the studied population.

Mental illness stigma research in Argentina.

Studies regarding stigma towards mental illness in Argentina blossomed after the first National Mental Health Law was passed in 2010. Methodological limitations and contradictory results regarding community perceptions of stigma hinder comparisons across domestic and international contexts but some lessons may still be gleaned. We examine this research and derive recommendations for future research and actions to reduce stigma. These include tackling culture-specific aspects of stigma, increasing education of the general population, making more community-based services available and exposing mental health professionals to people with mental illness who are on community paths to recovery.

Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities / Implementação de um protocolo para um estudo piloto randomizado e controlado sobre uma intervenção voltada para a recuperação em pessoas com psicoses em duas cidades latino-americanas / Implementando un protocolo para una prueba piloto controlada aleatorizada en una intervención orientada a la recuperación de personas con psicosis en dos ciudades latinoamericanas

Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.

Diversos países latino-americanos já alcançaram avanços notáveis na oferta de assistência em saúde mental para pessoas com psicoses. No entanto, as clínicas de saúde mental geralmente realizam atividades de extensão muito limitadas dentro das comunidades, tendem a ter vínculos fracos com a assistência primária, raramente envolvem os próprios pacientes nos cuidados e poucas vezes prestam serviços orientados para a recuperação. O artigo descreve um estudo piloto randomizado e controlado sobre a Critical Time Intervention-Task Shifting (CTI-TS), que teve como objetivo analisar essas limitações. O estudo piloto foi realizado em Santiago (Chile) e no Rio de Janeiro (Brasil). Teve como meta a inclusão de 110 pessoas com psicose, recrutadas no momento da entrada em clínicas comunitárias de saúde mental. Os participantes foram randomizados para o CTI-TS ou para os cuidados usuais. Aqueles alocados ao grupo da intervenção receberam os cuidados usuais e os serviços de CTI-TS ao longo de 9 meses. Os desfechos primários incluíram a qualidade de vida (WHO Quality of Life Scale - Brief Version) e as necessidades não atendidas (Camberwell Assessment of Needs) no acompanhamento aos 18 meses. Os desfechos primários aos 18 meses serão analisados com a técnica de Equações de Estimação Generalizadas (GEE), com as observações agrupadas dentro dos locais do estudo. Serão utilizados modelos em três níveis para examinar as tendências temporais nos desfechos primários. Procedimentos semelhantes serão utilizados para analisar os resultados secundários. Espera-se que o estudo forneça uma base para planejar um estudo randomizado e controlado em grande escala e em múltiplos locais para estabelecer a eficácia da intervenção orientada para a recuperação, a exemplo da CTI-TS, na América Latina.

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Measuring social integration in a pilot randomized controlled trial of critical time: intervention-task shifting in Latin America.

Global mental health movements increasingly highlight the importance of social integration for individuals living with severe mental illnesses. However, this important individual-level outcome is rarely measured in programs. As part of RedeAmericas, a pilot regional randomized controlled trial of critical time intervention - task shifting - will be conducted, which includes social integration as an outcome measure. It is a time-limited care coordination model to enhance continuity of support for people with severe mental illness during critical periods of transition. Given the challenges of measuring social integration, particularly for a multi-country study with unique cultural contexts, this paper has described the measurement approach used to create a composite measure that uses items from disability and quality of life instruments in addition to other key items.

Transmisión transgeneracional del trauma psicosocial en comunidades indígenas de Argentina: percepción del daño en el pasado y presente y acciones autoreparatorias / Transmissão transgeracional do trauma psicossocial em comunidades indígenas na Argentina: a percepção de dano no passado, presente e ações autorreparatórias

El presente artículo indagó desde la perspectiva de los sujetos, con respecto a la transmisión transgeneracional del trauma psicosocial sufrido por comunidades Wichí del Norte Argentino. Se propuso identificar las experiencias percibidas como traumáticas por las comunidades Wichí, tanto pasadas como presentes, describiendo los relatos respecto a la vivencia del trauma y a las formas de socialización generadas en dicha comunidad. Esto tuvo presente las situaciones o acciones llevadas adelante en los últimos años, que pudieran ser consideradas como autoreparatorias. Se trata de un trabajo exploratorio de tipo cualitativo, realizado en comunidades Wichí de la Provincia de Salta, durante los años 2009, 2010, y 2011. Fueron realizadas 30 entrevistas a caciques, mujeres, dirigentes y personas de las comunidades Wichí. Entre los resultados se reconoce la permanencia del daño en los grupos originarios y los mecanismos utilizados tanto por el Estado como por la sociedad para mantener esta situación, también se advierte un comportamiento de aislamiento y evasión ante el trauma, además se identifican secuelas y la manera en que éstas reproducen la situación de trauma. Fue también observado en la comunidad Wichí mecanismos de autoreparación en torno a la situación de trauma. La experiencia específica en relación con el pueblo Wichí reafirma los mecanismos de la transmisión transgeneracional del trauma psicosocial, surgiendo nuevas formas de organización de manera espontánea que develan el camino hacia la superación del trauma.

O presente artigo investigou, a partir da perspectiva do sujeito, a transmissão transgeracional do trauma psicossocial sofrido pelas comunidades Wichí no Norte Argentino. Pretendeu-se identificar as experiências percebidas como traumáticas pelas comunidades Wichí, tanto no passado como no presente, descrevendo os relatos sobre a experiência do trauma e os modos de socialização gerados em tal comunidade. Foram levadas em conta as situações ou ações realizadas nos últimos anos, que poderiam ser consideradas como autorreparatórias. Tratou-se de um trabalho qualitativo exploratório, realizado nas comunidades Wichí da Província de Salta, durante 2009, 2010 e 2011. Foram realizadas 30 entrevistas com chefes, mulheres, líderes e pessoas das comunidades Wichí. Entre os resultados, é possível reconhecer a influência dos danos nos grupos originais e os mecanismos utilizados pelo Estado e pela sociedade para manter esta situação. Também destacam-se o comportamento de isolamento e a fuga perante o trauma. Foram identificadas as sequelas e a maneira que tais pessoas reproduzem a situação de trauma. Também mostraram-se, na comunidade Wichí, os mecanismos de autorreparação sobre a situação de trauma. A experiência específica com relação ao povo Wichí reafirma os mecanismos da transmissão transgeracional do trauma psicossocial, surgindo novas formas de organização emergente espontaneamente que revelam o caminho para superar o trauma.

Measuring social integration in a pilot randomized controlled trial of critical time: intervention-task shifting in Latin America / Medindo a integração social em um estudo clínico randomizado piloto de intervenção no tempo crítico: transferência de cuidados na América Latina

Global mental health movements increasingly highlight the importance of social integration for individuals living with severe mental illnesses. However, this important individual-level outcome is rarely measured in programs. As part of RedeAmericas, a pilot regional randomized controlled trial of critical time intervention - task shifting - will be conducted, which includes social integration as an outcome measure. It is a time-limited care coordination model to enhance continuity of support for people with severe mental illness during critical periods of transition. Given the challenges of measuring social integration, particularly for a multi-country study with unique cultural contexts, this paper has described the measurement approach used to create a composite measure that uses items from disability and quality of life instruments in addition to other key items.

Ações globais de saúde mental destacam cada vez mais a importância da integração social de indivíduos portadores de transtornos mentais graves. No entanto, este resultado raramente é mensurado individualmente nos programas existentes na atualidade. Como parte do RedeAmericas, um estudo clínico piloto randomizado controlado regional de intervenção no tempo crítico - transferência de cuidados - será conduzido, o qual inclui a integração social como um resultado de mensuração. A intervenção no tempo crítico - transferência de cuidados é um modelo de tratamento comunitário com tempo limitado que tem como objetivo melhorar a continuidade do apoio às pessoas com doença mental grave, durante períodos críticos de transição. Sob os desafios de mensurar a integração social, especialmente em um estudo multicêntrico que inclui países com contextos culturais únicos, este trabalho descreveu a abordagem de mensuração utilizada na criação de uma medida composta, que utiliza itens de instrumentos de avaliação de incapacidade e qualidade vida, além de outros elementos-chave.

A violência urbana e suas consequências em um centro de atenção psicossocial na Zona Norte do Município do Rio de Janeiro / Urban violence and its consequences in a psychosocial care centre in the North Zone of the City of Rio de Janeiro

OBJETIVO: Descrever a interferência da violência urbana e do tráfico de drogas sobre um Centro de Atenção Psicossocial (CAPS) localizado na zona norte do Rio de Janeiro. METODOLOGIA: Pesquisa qualitativa com abordagem teórico-metodológica baseada nos princípios da observação participante e no trabalho de campo. Grande parte dos CAPS da zona norte está inserida em regiões de maior risco social, onde há intensificação da violência. A presença dessa problemática social se reflete na rotina do serviço, que precisa criar estratégias protetivas, realizar visitas domiciliares, atender à demanda de usuários de drogas com precária situação de vida e ainda enfrentar continuamente novos desafios. RESULTADOS: A elevada frequência da percepção de problemas sociais, como as altas taxas de violência e criminalidade, a questão do tráfico de drogas, o aumento da desigualdade social e a consequente sobreposição de exclusões a que estão submetidas essa parcela da população, requer novos estudos que permitam compreender as consequências do impacto da violência na saúde mental dos usuários de serviços em tratamento na comunidade.